Anesthesia Team the “Unsung Heroes” for this Older Pet
Herman, a 16-1/2-year old dachshund, presented to Foster Hospital for Small Animals at Cummings Veterinary Medical Center at Tufts University by his owner Susan Buttrick when he was not able to move his hind legs. While this situation had happened before, the most recent incident did not respond to medication that had previously been effective. Herman had a history of a heart murmur and, in recent years, Susan was afraid to have him undergo the sedation required for even a teeth cleaning. “My biggest fear was that Herman wouldn’t make it through any surgery that might have been required,” recalls Susan.
Herman eventually underwent a successful surgery, but of critical importance is the care leading up to his surgery by the anesthesia team. Because of the risk of anesthesia in older dogs, Dr. Blaze reported that, first and foremost, a thorough examination and history are critical.
This thorough examination included a cardiac consult to assess whether Herman’s heart would withstand anesthesia. Cardiac testing confirmed Herman’s very significant heart murmur and mild/moderate valvular disease (mitral valve prolapse and tricuspid valve thickening). In order to determine what was causing the problem with his hind legs, imaging would be required, and anesthesia would be needed to prevent him from moving during these tests. “Once Herman had his echocardiogram, the specifics of his valvular disease were identified, and the cardiology service gave him the green light to be sedated for his MRI, I was relieved,” said Susan. The medical history also revealed Herman had cataracts in both eyes. Ultimately, the MRI and X-ray revealed that Herman had severe spinal cord compression in the lumbar area and degenerative disc disease, very common in older dogs and, in particular, dachshunds. The X-ray ruled out cancer, but arthritis was also found in his shoulder. Had Herman’s case revealed cancer, the owners would have been consulted to make sure they understood the situation.
It was determined that Herman required surgery, a hemilaminectomy, and that it would be a painful procedure. It would now be up to the anesthesiologist to figure out what kind of medications would be needed, given the cardiac complications. Dr. Blaze noted that for each and every pet a customized anesthesia plan is developed.
A few things that are important to note about anesthesia in older animals:
1) Anesthesia/Pain control: As with humans, older pets do not need as much anesthesia as younger pets. The anesthesia cocktail is created to serve multiple purposes. Premedication/sedation is used to calm and reduce anxiety before the procedure and an induction agent is used to get them to sleep. Gas is provided to maintain sleep throughout the procedure. Ongoing pain medication is introduced during the procedure. Care would be taken not to give drugs that would affect his already compromised heart condition.
2) Ventilation: Older dogs generally have weaker musculature and it’s important to be sure their chests can move adequately for breathing during anesthesia. Oxygenation is also important and, therefore, careful attention to ventilation is essential.
3) Fluid maintenance: Anesthesia is provided with cold, dry gas and patients can lose fluids and heat in their expired breath; it is important to balance this against providing too much fluid, which would increase the workload on the heart.
4) Monitoring: A single technician provides the pet with constant attention throughout the entire process. The pet is monitored every 5 minutes, including heart rate, breathing rate, blood pressure, oxygen and carbon dioxide levels, fluid intake, and how deep the anesthesia is, and would be monitored regularly to make sure he was positioned comfortably. After the surgery is done the pet is still monitored by the technician to be sure that recovery is smooth and that any indication of pain is addressed right away. Only when the pet is fully awake does the person leave the pet’s side, but even then the pet is checked on frequently for up to an hour before being transferred to the wards.
The anesthesiologist is a key member of the care team, behind the scenes, rarely speaking directly with the owner. The anesthesia team takes all the information gathered during the history and exam and employs it in the care they provide. For example, the way they handle a pet with cataracts is different. Herman saw only shadows and everything would have looked fuzzy. “You want to handle these animals gently. Talk as you approach them and touch them to let them know where you are coming from and how close you are. We also recognized that Herman had arthritis, so we are ultra-careful about his positioning during the surgery, as we don’t want him waking up in pain from that,” says Dr. Blaze.
According to Dr. Blaze, “a dog is not a dog, he’s somebody’s family member.” There is always a risk to anesthesia and we do everything possible to minimize that risk by doing a comprehensive assessment in advance and provide thorough monitoring. Herman perfectly demonstrates that an owner does not have to give up on his/her pet at this later stage of life. “His owners are truly dedicated and would do anything to make his life more comfy,” she continues.
Herman was hospitalized for 10 days post-surgery and during that time Susan had to travel out of the area. Every day while she was away, Foster Hospital’s staff called her to provide an update, not only once, but twice a day. Susan speaks highly about the exceptional teamwork demonstrated by all involved in Herman’s care, and is extremely complimentary of the anesthesia team. “Anesthesiologists are the unsung heroes of many a surgical outcome. Dr. Dominik Faissler, neurosurgeon at Foster Hospital for Small Animals , shared with us how because of the expertise of the Tufts Foster Hospital’s anesthesiology service, he had enough time to remove disc material from both the thoracic and lumbar areas of Herman’s spine. And Dr. Faissler’s associate, Kathryn Weiss, DVM, was extremely supportive and helpful throughout.” Herman has had a slower recovery because of his age, but is doing quite well. “I’m so grateful to everyone at Tufts for their medical and clinical knowledge and skills, as well as for the compassion and kindness they showed to Herman and our family, that I still get choked up when I speak about it,” says Susan.