What you need to know about anesthesia

Pet owners often become very nervous when I recommend a procedure that requires general anesthesia, be it a dental cleaning or removal of a mass. Though anesthesia can seem scary, at Friendship we make it as safe as possible. We take special care to ensure we are providing our patients the gold standard of care. I am very proud of our anesthetic protocols. If your pet needs surgery, but you're not able to come to Friendship, please use the following as a benchmark for state-of-the-art care. Before the procedure we perform a complete physical exam. We listen to the heart to make sure there is not a heart murmur or abnormal rhythm, and we listen to the lungs to make sure they are are clear. We also make sure that pre-anesthetic bloodwork has been done in the past three months. Bloodwork allows us to evaluate the liver and kidney values of the patient. It is important that these two organs are functioning well, because they are responsible for processing the anesthetic drugs. A complete blood cell count (CBC) is included to check for low platelets that could result in excessive bleeding; decreased red cells indicating anemia; and an increase white cell count which could indicate infection is present.

Once we have this information we design a customized anesthetic plan based on the overall health of the individual pet. If, for example, we discover a heart murmur during the physical exam, we will ask our in-house cardiologist to assess the patient's heart function. We then use this information to choose drugs that cause less cardiovascular depression. If we know the patient has kidney disease then we will support their kidney function with additional intravenous fluids before and after the procedure.

On the day of the procedure...

Before going into the nitty-gritty, I want to point out something that I think really shows the amazing level of care we provide at Friendship: throughout the entire operation -- from the very beginning all the way through recovery -- a highly trained technician monitors every aspect of the patient's signs. This technician literally stands next to the patient throughout the entire procedure, making sure that every parameter is exactly where it should be.

At the beginning of every surgery, the very first step is to place an intravenous catheter. This will be used later in the procedure for a number of crucial functions throughout the anesthetic process. Next we administer the “pre-meds” -- these usually include a sedative to calm the patient down and an opoid to get a jump-start on pain. Thanks to the pre-meds, we are able to drastically reduce the amount of gas anesthetic that is used. This is desirable because higher quantities of gas anesthesia may cause cardiovascular depression, in which the heart rate slows and blood pressure plummets, depriving organs of much of the blood they need.

Once the patient is fully sedated, we use the intravenous catheter we placed at the beginning of the procedure to administer powerful anesthetics called "induction drugs." These drugs completely relax the patient's throat, so that we are able to painlessly insert an endotracheal tube -- known for short as an ET tube (pictured above). We use the ET tube to administer gas anesthesia, and also to help keep the patient breathing freely.

With the ET tube in place, gas anesthesia is turned on and the patient is now officially under general anesthesia. As soon as the ET tube is placed, we begin tracking the patient's heart rate and blood oxygen levels using a device called a pluse-oximetry machine, which is placed on the patient's tongue. We also apply ECG leads to monitor the rhythm of the patient's heart. It is critical to monitor blood pressure constantly during anesthesia. This allows us to ensure that the patient's organs are receiving an adequate supply of blood. One of the many reasons IV fluids are administered during surgery is to maintain blood pressure.

Though there is always some risk when going under general anesthesia, here at Friendship we do everything we can to make it as safe as possible. Certainly, general anesthesia should be respected, but please don’t let fear keep you from moving forward with a procedure that will benefit your pet's health.

A must read

"Pets are our seat belts on the emotional roller coaster of life - they can be trusted, they keep us safe, and they sure do smooth out the ride." --Dr. Trout

I have just finished reading Tell me where it hurts by Dr. Nick Trout who is a surgeon at Angell Animal Medical Center in Boston. In this wonderful book he accurately and eloquently describes what it is to be a veterinarian. He highlights the amazing connections that people form with their pets and how we as veterinarians are dedicated to protect that bond.

Every pet owner should read this book!

Sparkle and Dr. Bush

A few years ago, when I was in the midst of my internship year at Friendship, my rat terrier Sparkle suddenly developed severe neck pain. She hid under the bed and would scream anytime I touched her. She was six years old at the time, and had previously been one hundred percent healthy. Needless to say, I was completely freaked out and immediately started imagining all the horrible diseases that could be causing her discomfort.

It was this episode that solidified my opinion of Dr. Bush -- of Bush Veterinary Neurology Services (BVNS), -- as my all-time favorite specialist in the area. I called him very upset and he instantly squeezed me into his schedule, which was already jam-packed. Prior to these events, I had frequently spoken with him on the phone because he allowed the doctors at Friendship to call his cell phone whenever we had questions on cases with neurologic issues.

The fact that Dr. Bush permits Friendship veterinarians to call him at any time of day or night shows how dedicated he is. We have amazing specialists in DC but, besides Dr. Bush, I don’t know of a single one who will answer a cell phone at one in the morning to discuss a case. Not only that, but I have never called with a patient in need of a neurologist and been told Dr. Bush and his colleagues are unable to see the referral. It is such a comforting feeling to know I can assure my client that without a doubt their pet will be seen by a neurologist within the next twenty-four hours or less.

Sparkle’s neck pain resolved with medical management and she has not had an issue since. (It is possible that, being the neurotic pet owner that I am, I may have overreacted!) Regardless, I have been a dedicated fan of Dr. Bush ever since, and refer all of my patients that need the attention of a neurologist to BVNS.

Since my visit with Sparkle over three years ago, BVNS has grown tremendously. Dr. Bush now has two board-certified neurologists and three veterinarians who are completing advanced training to become neurologists. In addition, he has an MRI located at his clinic, ensuring that his patients can have advanced imaging when they need it rather than rely on an outside service.

Taking your pet to see a neurologist is rarely a desirable event as it is usually precipitated by a scary event such as seizures or paralysis. Here in DC, we are lucky to have the doctors at BVNS to turn to when neurologic disease strikes one of our pets.