"I'm Afraid of Anesthesia for My Pet"

Sandra L. Waugh VMD, MS - Windsor Pet Dental

Ok, Annabelle, you find this talk about anesthesia a bit, well, sleep inducing. After all, Dr Sandy (your mom) puts you under anesthesia yearly in order to keep your teeth clean and healthy and you have always been just fine. So what’s the big deal?

Well, anesthesia IS a big deal. To make anesthesia as safe as possible requires an investment in equipment, both the anesthesia machine itself and all the various monitoring equipment. It also requires an investment in the necessary medications involved. But most of all it requires an investment in the training of the anesthetists, the people who are in charge of anesthesia, from the first dose of the pre-anesthetic medication all the way to removing the intravenous catheter just before the pet goes home and everything in between. The anesthetists job is to use the information from the monitors to make constant decisions about the state of the patient and what actions need to taken, if any. A good anesthetist does not react to a problem after it arises during a procedure but anticipates potential problems and proactively takes steps to head off any problems. The anesthetist must know how to interpret the readings from the monitors, must know what to do if the readings are not normal and have the medications and equipment at hand in order to intervene.

A busy moment during the day. Two patients under anesthesia having teeth extracted (yellow arrows), two veterinarians performing the dentistry (red arrows) and two people whose sole job is to run the anesthesia (green arrows). 16 4 Legs & a Tail Fall 2021

Dr. Mike assists Dr. Sandy

Anesthesia is not a passive event where the patient is hooked up to the monitors, the gas anesthesia set at a “maintenance level” and the fluids turned on until the procedure is over. It is more like a balancing act where the anesthetist tries to minimize the level of anesthetic gas needed to keep the patient still but with enough pain medications to block the pain and keep them comfortable, all the while keeping the heart rate and rhythm, blood pressure, exhaled carbon dioxide, oxygen saturation, body temperature and respiratory rate within specific limits. This means keeping attention on every aspect of the anesthesia from beginning to end.

One essential tool is a chart used to write down the readings from the monitors every 5 minutes. This allows the anesthetist to note any trends that are occurring. For instance, a slowly decreasing blood pressure is much easier to identify with the numbers written down than to rely on memory.

As the procedure comes to an end, the anesthetist will start turning the gas anesthesia down so the patient will wake up. This simple sounding job takes experience to do well. The patient should wake up shortly after the procedure is done but needs sufficient time while still asleep to be disconnected from the monitors, cleaned up if soiled and dried if needed before they wake up. We do not want the recovery to be too soon or too prolonged. Ideally the patient is awake 15 minutes after the procedure is over and can walk out the door on their own an hour later even if they were under anesthesia for several hours.

While no one can make the risk of anesthesia go away entirely, it can be reduced to a very low level though patient evaluation, medication selection, good monitors, good anesthesia equipment and skilled anesthetists who are the single most important part of the puzzle.

As the procedure comes to an end, the anesthetist will start turning the gas anesthesia down so the patient will wake up. This simple sounding job takes experience to do well. The patient should wake up shortly after the procedure is done but needs sufficient time while still asleep to be disconnected from the monitors, cleaned up if soiled and dried if needed before they wake up. We do not want the recovery to be too soon or too prolonged. Ideally the patient is awake 15 minutes after the procedure is over and can walk out the door on their own an hour later even if they were under anesthesia for several hours.

While no one can make the risk of anesthesia go away entirely, it can be reduced to a very low level though patient evaluation, medication selection, good monitors, good anesthesia equipment and skilled anesthetists who are the single most important part of the puzzle.

Dr. Waugh is a graduate of the University of Pennsylvania School of Medicine. She also holds a Masters Degree from Washington State University of Veterinary Medicine and is owner of Windsor Pet Dental, PLC.