safe anesthesia

What You Should Know When Your Cat Needs to Go Under Anesthesia

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Most cat guardians worry when their cats have to go under anesthesia. I’m certainly one of them. Even though I’ve assisted with all sorts of anesthetic procedures and surgeries in my years working in veterinary clinics, understanding how it all works, and what constitutes safe anesthetic practice, still doesn’t completely take the worry out of it.

Knowing what to expect when your cat has to undergo anesthesia, and knowing the right questions to ask at your veterinary clinic prior to the procedure so that you can be sure that  your cat’s anesthesia will be done in the safest possible way, can help ease the worry factor.

The recently released AAHA anesthesia guidelines for dogs and cats (AAHA is the American Animal Hospital Association) cover the entire process from pre-anesthetic evaluation to recovery. Make sure that at a minimum, your vet adheres to these guidelines.

Here’s what happens prior to, during and after anesthesia:Continue Reading

Anesthesia in veterinary dental care

Guest post by The Animal Medical Center 

When people go to a human dentist, we sit in the dentist’s chair, often time grasping the armrests tightly with white knuckles in anticipation of the procedure about to happen. When the dentist or hygienist tells us to say “ahhhhhhhh” or turn our head, or open our mouths, we may be reluctant, but we can follow their directions to facilitate their work. When they place x-ray films or digital sensors in our mouths and tell us to hold them while they walk out of the room, we do as they say.

February is Veterinary Dental Month. Our pets need the same dental care as we do; maybe more, since they don’t brush or floss twice a day. Our pets are not as cooperative when it comes to saying “ahhhhhhhh” or when it comes to following directions, yet they often experience the same anxiety as their owners when a stranger is poking and squirting things around their mouths.

There has been recent movement to perform anesthesia-free dental cleanings on veterinary patients. The rationale for performing dentistry on awake dogs and cats is that it will be cheaper for the client and safer for the patient. This movement is in direct opposition to the American Veterinary Dental College’s position statement entitled, “Companion Animal Dental Scaling without Anesthesia.”

I understand that many people are reluctant to perform proper dental procedures because of the need for general anesthesia, especially in the older patient. I am a firm believer that “age is not a disease,” and age should not be the deciding factor in determining the safety of general anesthesia for any patient. Pre-anesthesia testing can help determine the risk associated with general anesthesia and aid in the decision whether or not to perform a dental procedure. These tests help determine the function of the internal organs such as the liver, kidneys, heart and lungs, which are necessary to help the body safely handle anesthesia.

Proper anesthesia starts with the pre-op testing but also involves choosing the proper anesthetic drugs safest for each pet. The Animal Medical Center’s Dental Service always places an intravenous catheter to administer drugs, fluids and emergency drugs if needed. We also place an endotracheal, or breathing, tube to protect the airway and deliver the anesthetic gas and oxygen mixture to the lungs. Anesthetized dogs and cats at the AMC are connected to various monitoring equipment to measure the vital signs such as pulse rate, blood oxygen levels, blood pressure, electrocardiogram, and carbon dioxide levels. Finally, we monitor at regular intervals to make sure the vital signs are stable. If any painful procedures need to be performed, we also have the ability to utilize local anesthesia to minimize the amount of general anesthesia needed.

There are many advantages to performing any dental procedures under general anesthesia. First, when we scale the calculus (also known as tartar) off the teeth, there are often large or small pieces of calculus removed. If an animal is properly intubated with a breathing tube, then this calculus cannot be aspirated into the lungs or “swallowed down the wrong pipe.” The biggest advantage to working on a patient under general anesthesia is the ability to work around every side of every tooth. In the awake patient, the veterinary dentist has a very limited view of most of the teeth in the mouth. It’s easy to see the outside of the front teeth, but virtually impossible to evaluate the inside surfaces of many teeth and impossible to see many of the back teeth. A proper cleaning involves cleaning off all of the calculus from every surface of every tooth, both above and below the gum line. In the awake patient, the area below the gum line cannot be seen, yet under anesthesia it is much easier to fully visualize this area.

Once the teeth are cleaned, they need to be evaluated for periodontal disease. This involves gently probing under the gum line in several areas around each tooth in the mouth to measure periodontal pockets, or separation of the gums from the tooth root surface. Imagine trying to do this in an awake dog.

Approximately 75% of cats presenting for dental procedures have a decay of their teeth called tooth resorption. These are holes or decay in the teeth that often start at the gum line. They are quite painful and diagnosed by probing along the gum line with an instrument called an explorer. Again, this is not the type of procedure that could be tolerated by a cat without general anesthesia.

Proper dental procedures require intra-oral x-rays to make a diagnosis. A piece of film or a digital x-ray sensor is placed in the pet’s mouth. The person taking the x-ray steps out of the room and exposes the film or sensor and then walks back in the room. Not too many awake pets will tolerate this type of procedure.

Finally, with 75% of cats having tooth resorption and 80% of all dogs over the age of 5 years having periodontal disease, most veterinary dental patients need some type of surgical procedure to correct the abnormality. Finally, it is much easier to perform oral surgery when I’m not working on a moving target.

Given the complexity of the procedures necessary to clean, diagnose and treat a pet’s mouth, it is easy to understand why general anesthesia is so vital to performing proper veterinary dental care. My recommendation to anxious pet owners over the years is to use a little general anesthesia every year in order to maintain a healthy mouth, rather than wait until the mouth has severe disease and needs several hours of surgery to clean up a messy and painful mouth.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit http://www.amcny.org. To make an appointment, please call 212.838.7053.

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Safe Anesthesia for Pets

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Safe Anesthesia for Pets

For most pet parents, the thought of their pets having to undergo anesthesia instills fear and worry.  This is often caused by a lack of knowledge about what questions to ask your veterinarian, and what constitutes safe anesthesia.  This article by Dr. Louise Murray explains in great detail what you should look for to ensure that your pet’s anesthetic procedure is done safely.

Guest Post by Dr. Louise Murray

As you can tell, my mission is to give pet owners the information they need to protect their pets’ health and to wisely choose the best veterinary practice to help achieve that. I believe that knowledge is indeed power and have seen too many pets suffer because their owners did not have the tools they needed to advocate for their animal companions.

Today I suddenly realized (duh!) that just talking about ways you can protect your pet isn’t enough; I need to show you. It’s one thing to babble on and on about safe anesthesia and having your older pet’s blood pressure checked and ensuring your pet receives safe and adequate pain control. It’s another to let you see for yourself. If nothing else, pictures are a lot less boring then listening to my nagging.

So, today let’s talk about, and take a look at, what is required for safe anesthesia. Safe anesthesia requires monitoring equipment, so that when your pet’s oxygen level or heart rate or blood pressure drops, someone knows about it and can do something to fix the problem before your pet actually stops breathing or her heart stops and…well, you know. Pets can die under anesthesia, and proper monitoring vastly reduces the chance of that.

At a minimum, your pet should be hooked up to a handy gadget called a pulse oximeter. This little gem monitors the animal’s blood oxygen level and heart rate, good parameters to keep an eye on if you want to make sure someone keeps living.

Here’s a picture of a kitty having his blood oxygen level and heart rate measured with a pulse oximeter. I think you’ll agree he seems quite happy about it.

kitty with pulse oximeter

You’re right, he’s not under anesthesia. You can also use a pulse oximeter in awake animals when you are concerned about their breathing, such as animals in heart failure or those with pneumonia. If the oxygen level is too low, the vet needs to do something about it rather quickly, such as place the animal in an oxygen cage.

Another component of safe anesthesia is called intubation. This means placing a tube in the animal’s trachea (windpipe) to deliver oxygen and anesthetic gas. If an animal under anesthesia is not intubated (if the anesthesia is delivered with a mask, or just by injection), there’s not much anyone can do if that animal start to crash or stops breathing. But if the animal is intubated, the vets or technicians can ventilate the animal (breathe for her).For example, if the pulse oximeter shows the animal’s oxygen level is dropping, the folks doing the anesthesia can give the animal a few oxygen-rich breaths by sqeezing on the oxygen bag a few times. Or, as I mentioned above, if the animal stops breathing completely, they can use the tube to breath for the animal. Can’t do that with a mask and certainly not for an animal who just got an injection. Then it’s rush rush rush to try to get a tube in before the pet dies. Not good.

Here’s a kitty who is under anesthesia and intubated.

intubated kitty

See that little black bag on the lower left? If the kitty’s oxygen level drops or she stops breathing, the vets or techs can breathe for her by squeezing the bag.That way they can keep her cute little tongue nice and pink like it is in the picture.

The other thing I want you to notice about the cat above is that she has in IV catheter in her leg. This is also super important for safe anesthesia. If this little cat’s heart slows down, she can be given a drug to speed it back up through the catheter. If her heart stops, she can be given epinephrine to help re-start it. If her blood pressure drops, she can be given a bolus of IV fluids or medications to correct this.

OK, gotta run to work now. Now you know all about safe anesthesia; don’t let your pets receive anything less!

Dr. Louise Murray is an experienced and highly regarded authority in her profession. During her ten-plus years as a practitioner, she has lectured frequently on a wide range of topics, gaining her the respect of her colleagues. She has also been honored with several prestigious awards and has had her research published in the Journal of the American Veterinary Medical Association.

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Dr. Murray is also the author of Vet Confidential:  An Insider’s Guide to Protecting Your Pet’s HealthFor more information about Dr. Murray, please visit her website.