But Doc, My Pet is Too Old for Anesthesia!

Every week I hear this at least once, usually from someone with an older (but not elderly) pet which needs to have its teeth cleaned or ears flushed or some other sort of surgery. Most of them tell me this emphatically, stating that their last vet told them so.

"Oh, I know her teeth are bad, but my last vet said she was too old for anesthesia."

Or

"I want to have her teeth cleaned but my friend/relative/drycleaner/stockboy said that they did that and their dog died."

There is some truth to this, but it's not what you think. If a vet recommends against anesthesia because the pet is too old, then I counter that in many cases (not all, so don't come after me with sticks!) the vet's anesthesia protocols are outdated.

I'm not talking about dogs or cats with legitimate health risks: pets with heart and/or respiratory disease, pets with advanced liver or kidney ailments, or animals with precarious endocrine conditions. On the contrary. The only thing these wrong with these pets (besides the easily treatable problem at hand) is advanced age. Last I checked, age isn't a disease.

Anesthesia and monitoring has come a long way in the nearly two decades since I graduated from vet school. I no longer use many of the techniques I was taught, or the drugs used by my first employers. I regularly attend continuing education to find out what the newer protocols are, and start using those in my practice.

With a thorough pre-anesthetic workup, we can address most issues with older pets and tailor their anesthesia to them. One size does not fit all. No one drug does it all.

For instance, in a pet with kidney issues, we will avoid drugs that need to be excreted by the kidneys or are known to potentially cause problems with the kidneys. We will pay close attention to blood pressure and fluid therapy to make sure the kidneys stay happy during the procedure. In a pet with cardiac issues, we will avoid medications that cause the heart to work harder, or that changest the blood pressure. We will be prudent with fluid support so as not to overload the heart. In a pet with liver issues, we avoid drugs that need to be metabolized by the liver.

So what do we do? A big part of our anesthetic protocols is pain management. First we administer medications that do double duty -- pain control AND sedation. Using pre-anesthetic medications allows us to use LESS induction agent and lowered gas anesthesia rates, and thus fewer side effects. When pain is prevented before it is inflicted, we don't need to 'turn up the gas' to keep the animal asleep during the procedure.

Another big part is monitoring. Is there a licensed technician monitoring the pet during the procedure? Checking heart rate, pulse quality, respiratory rate, oxygen level, palpebral reflexes, blood pressure, and temperature?

Bottom line: it's not the anesthesia that is the culprit here, it's the anesthetist -- the vet administering it. It's all in the drug choice, dosage, and administering to effect, not giving a calculated volume based on weight. Or rather, there is no such thing as bad anesthesia, just bad anesthetists.

Now I'm not saying that there are no inherent risks with anesthesia, because I'm not. And I'd be a liar to say that no pet ever died under anesthesia on my watch. I will say that all of the anesthetic deaths in my bone pile were young, healthy pets in for spay or neuter, and their deaths were likely due to an underlying yet undiagnosed heart condition in addition to inappropriate though commonly used anesthetics popular at the time (late 80s, early 90s). But times change and so do anesthesia protocols.

In many cases, the risks of anesthesia for your geriatric pet are less than living with the disease process at hand (usually really rotten teeth). I can't guarantee that your pet won't die. But by doing the preanesthetic workup, paying attention to each pet's current health, tailoring the anesthesia to the specific pet, and administering multi-modal pain control as part of a balanced anesthetic protocol, administering drugs to effect, we can certainly minimize that risk.