Anesthetic risk and surgical safety (what you need to know to keep your pet safe)

😱 Don't gamble with your pet's life. When it comes to your furry friend's surgery, knowing the risks is crucial for their safety!

🩺 Surgery may not be just routine - from a tiny risk of 0.01% for neutering procedures (that's 1 death for every 10,000 surgeries) through to a 16% death rate for the sickest of patients, the risk really does vary hugely by individual.

🏥 Several measures can increase safety: from pre-surgery blood tests, weight management, to advanced monitoring equipment - these are vital!

💡 The takeaway? Proactive health management & choosing a vet with the right skills & equipment is a game-changer. It not only reduces risk but ensures peace of mind.

💬 Have you ever delayed a surgery for your pet due to fear of anesthesia risks? What could have eased your worries? Share your thoughts!

Dive into everything you need to know and more over in the show notes - https://ourpetshealth.com/podcast/pet-surgery-safety

Love the show? Sharing this episode or leaving a review helps others know it's worth a listen! - https://ourpetshealth.com/review

Transcript

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Never want to be doing unnecessary procedures, procedures that either aren't going to benefit their health in the short or the long term or where the risks outweigh that benefit. So if we have a very tiny benefit, but the risk is kind of fairly significant, that's definitely something where we want to be questioning whether it is the right decision. Welcome to the Call the Vet Show. The podcast that helps pet parents understand and optimize the health of their furry family. So they can live the full and happy life you want for them. And here's your host, veterinarian doctor Alex Avery. Hello, Kiowa, and welcome back to another episode of the show. It's great to be spending some time with you again for another episode. And in this episode, I'm talking about, a really common concern that a lot of my clients have especially if they have older animals, older dogs, and older cats. And this is the topic of anesthetic and surgical risk and how we can actually make this safer. But before we get into that, I just love to remind you that if you're not already, hit that follow button on whatever app you're listening to this on, if it's on YouTube because we're now on YouTube, hit that subscribe and make sure you don't miss out on any future episodes. You can also share this with any pet owning friends or family that you have to really help me spread the word to reach more pet parents and to help impact the lives of more pet dogs and cats no matter where they are in the world. I'd love it if you could help me in that mission. But for now let's jump into this week's episode where I'm actually bringing you a bit of an audio mash up of a couple of different videos that I've produced. So I had to plan to, rerecord these episodes effectively in one podcast episode to make it an audio first experience. But, to be honest, I've been really busy in the clinic in my day job. And so I figured something's better than nothing, and I know you're gonna get heaps of value out of this episode. So if your dog is ever facing surgery, if your cat is old and you're wondering whether you should get a procedure that involves anesthetic or sedation carried out, then this episode is definitely for you. And now, on with the show. Don't gamble with your dog's life. If they're undergoing surgery, you need to know if they're a high or a low risk of dying under anesthesia. It's the worst case scenario for everyone involved and this is what you need to know. So we have some really good figures involving high numbers of dogs. One UK study which looked at a 150,000 dogs showed that there were 14 deaths per 10,000 procedures. 10 of those per 10,000 were within 48 hours of that procedure. So are definitely likely to be due to that sedation, that anesthetic or that surgical procedure. Now clearly this is going to depend on the health of your dog to begin with and also the type of surgery that they're going to have. So for neutering surgeries and dogs are desexing or spay neuter then the risk is much smaller than this 10 in 10000. It's actually down at one death per 10,000 neutering procedures and this is naught point naught 1%. Now, those that did die, there were 2 following castration and 6 following ovarian hysterectomy. So that then is related to the the degree of difficulty of that surgery. Although we think of a spay and ovarian hysterectomy as a fairly routine procedure, and I'm certainly doing them every week, sometimes every day of the week. They are a routine in inverted commas procedure. They are quite involved and certainly for our less experienced vets that is a bit of a hurdle to jump through to get comfortable in that procedure but compared to a castration much simpler procedure and this clearly reflects on the fact that the risk is much lower. Now of those dogs that did die following a nutra desexing procedure 60% of those had an ASA score of 1 or 2 and 40% had scores of 3 and I'll come on to what that means in just a little bit. It's also worth noting that there's actually no association seen in this study between the age of the puppies at the time of neuter and their risk of death. Now, we should be desexing them, spaying, neutering them at a very young age is a topic for another day. Certainly, the the old fashioned, 6 months is the routine recommendation, is is not applicable anymore. And in my mind, we shouldn't be doing them younger than 6 months for any reason apart from maybe if they're in a shelter situation and they want to be absolutely certain they're not going to be contributing to overpopulation. A story for a different day like I say. But the other thing to note is that the stud a study of another big group of dogs that happened the previous decade had a reported death of much higher of point, naught point 17% risk of death. So that compares to a point 01%. So it's fair to say that probably we're a little bit further on again from that a 150,000 dog study. So the the the risk of death is likely even less. Again, as monitoring equipment improves, as our drugs improve, as our training and overall staff involvement also improves. But it's all very well and good thinking what that risk is for our our routine procedures. But what about if your dog is going through something more involved, something less common? What happens if they aren't as healthy as a a young animal who's had no complaints. Well, we're lucky here again because we have figures from multiple different countries as well. So Spain, Argentina, France, the UK, the USA, Chile, Portugal, and Australia kind of pooled, and they looked at the health of the individual dog and their risk of dying. So this is where the ASA score comes in. So this is our way of classifying kind of the the overall health of our surgical patients and then the risks of anesthesia to them. So our ASA one individuals are completely healthy patients. There's nothing wrong with them. They are perfectly normal in tip top health, and they have a risk of dying of naught point naught 8 percent. So that's 1 in 1,250 surgical procedures. Moving on to our ASA 2 dogs. So these are suffering from mild systemic, so whole body disease that is generally very well controlled. So we're even thinking controlled diabetes here but it could be that they are very young, they're very old, or they are obese and this is actually a pretty important one because obesity is such a common problem in our pet dog population that actually 60% of dogs are going to be classified as ASA 2 just because of their weight. And here, the risk of dying did increase it went up to naught 0.24%. So that's one in 416 surgical patients. As health deteriorates, we move up the scale to ASA 3. So these are dogs with, obvious whole body systemic diseases. So that could be anemia. It could be a low grade heart disease. It could be a degree of dehydration. There could be some liver disease present and that increases the surgical risk of death to 1%. So 1 in every 100 dogs. Then as things get even worse, we move to ASA 4 where we've got severe systemic disease that is a constant threat to life. So that clearly says that these dogs are not healthy. They're actually in a pretty bad way, and you can understand here that their risk of dying is going to be a lot more. We're thinking about advanced heart disease, uncontrolled diabetes, emaciation, end stage liver or kidney disease. And here, unsurprisingly, the risk is 6.5%, so 1 in 15 dogs. These guys are not going to be having surgery unless it's for a life threatening condition where the risks of not carrying out that surgery significantly outweigh the risk of having that anesthetic surgical procedure performed. And I guess this is a good time to to actually think about that risks benefit because no matter what your dog's health, we never want to be doing unnecessary procedures, procedures that either aren't going to benefit their health in the short or the long term, or where the risks outweigh that benefit. So if we have a very tiny benefit, but the risk is kind of fairly significant, that's definitely something where we want to be questioning whether it is the right decision. There's lots of times where this comes up. It's typically with our older animals and maybe getting that dental procedure. Now, if they're otherwise healthy, they're probably only going to be in an ASA, you know, 2. Maybe there'll be 1. If we delay that procedure though and we wait for them to stop eating for example then they're going to be a higher ASA score. The risks are going to be higher and so it's much better to get that done sooner. Equally, if you've got a dog with a growth that is not expected to be life threatening and actually having an anesthetic and surgery to remove that tumor may not be in their best interest because the risk of death or significant complications through surgery is actually higher than the benefit that they're going to get. And then the last dog health category if you like, ASA 5. Now these are dogs that are not expected to survive without the operation. So here we're thinking severe trauma, sepsis, so that might be a perforated intestine. Maybe they've eaten something spiky, it's punched a hole in their intestines, and they've developed a really nasty sepsis. End stage liver kidney disease that is really impacting their life. Their risk of death is going to be 16%. So that's 1 in 6. Equally without the surgery that is being performed, they're not expected to survive anyway. So here, you know, we really need to be thinking is it in our pets best interest? Ultimately, the alternative is likely to be euthanizing them, which isn't always the wrong thing. We need to be thinking about what's best as an overall quality of life benefit for our patient rather than maybe focusing on the next kind of day or week. And then there are some other really important factors to consider when it comes to the risk of anesthetic death in our dogs. There's a higher risk if the anesthesia and surgery is performed after hours. So middle of the night, unsurprising. I work all day. I'm on call all night, and then I work the next day. If I'm called in at 2 in the morning and have to perform an emergency surgery, that risk is going to be higher than if I'm performing that same surgery in the middle of the day with my full team around me. Equally, urgent procedures are associated with a higher mortality rather than ones that are scheduled in advance. There's a 13.6 times odds of dying irrespective of the actual specific surgery if it's performed as an urgent rather than a scheduled surgery. And also pediatrics are really, kind of young puppies and our geriatric, our senior dogs also have an increased risk due to surgery, due to anesthesia. And then obesity again is a risk factor for mortality irrespective of otherwise body health. Okay. So that video clip was all about the risks of anesthetic, obviously, and hopefully, that gives you some clarity around what your dog's individual risk may be if they have, an upcoming procedure, a surgery, an anesthetic in their in their on their horizon. And hopefully, that gives you some confidence that actually the risks aren't nearly as bad as you might have thought they were, Or if your dog is very unwell and those risks are higher, then ultimately, the risks of doing nothing are potentially much worse. And this is where that risk benefit analysis needs to come in. But despite these risks, there are steps that you can take to make sure they are kept as low as possible. And this is where the next audio clip comes in. There is always a small risk regardless of why your dog needs surgery or anesthesia, but why wouldn't you take action to reduce their risk of complications and even death? Well, these 5 steps will help you to keep your dog as safe as possible if they need surgery, sedation or anaesthesia. The first step is to optimize their health prior to having the procedures performed and this can take some time so it depends on why they're having that procedure, why they're being anaesthetised as to how possible this is going to be. But with 60% of our dogs classed as overweight or obese and knowing that this increases their risks of complications weight loss is definitely going to be the first step if possible. We could also better control any other additional diseases or any other problems that we know to be present. If they're diabetic make sure that is really nicely controlled. If they've got underlying skin disease then make sure that there's no secondary infection. Really focus on just making sure they are as healthy as possible before they have that procedure. But then the other consideration is actually having a surgical procedure carried out before they get too old or before their health deteriorates. I see this a lot where people are worried about the risk of surgery so delay a procedure only for it to be needed 6 months, 12 months, 2 years later when their pet is older and when their health is less optimal. It would have been better to jump in sooner rather than leave it to this stage. The next way to reduce risk is to actually have some pre surgery medications. This is especially important for our brachycephalic dogs, our squash nose dogs, where they are at a higher risk of what we call aspiration so where they maybe regurgitate and then they breathe that into their lungs which can be catastrophic. So we want to maybe be giving them anti vomiting medication, gastro protectants, so things that will stop an esophagitis, stop any reflux. For diabetics, we want to make sure that we are giving them the appropriate dose of insulin. Obviously, your veterinary team will talk to you about that. If your dog is on any other long term medications, then should you withhold that on the morning of the surgery? Should you actually give that? It's really important to be clear and talking to your veterinary team is crucial for this. And this comes on to the next safety step, which actually is on the day of surgery that we can take some really big actions to make sure we're keeping our patients, our pets, our dogs as safe as possible. And these are again things to discuss with your veterinary team. So we want to discuss fluid therapy. It's definitely a good idea to have an IV catheter placed and have IV fluids running. It helps support blood pressure. It helps provide an open line, what we would call open access to the blood should we need to give an intravenous injection. There's nothing worse than a dog struggling under anesthesia or sedation and not actually having a catheter in place. And then your vets, your team are scrambling around trying to get a catheter placed while your dog is potentially crashing and dying before their eyes. Fluids is a really good idea. Can we do some blood tests beforehand? So a pre anesthetic blood test just to check that there's no hidden problems going on. You know every surgical patient should have a full physical examination happened before they are anesthetized. And this is a really good check of general body health. But, actually, to check organ health, we need that blood test and it can be really crucial especially for our older patients where there's definitely more value in it of having that done a few days before they have their procedure or on the morning of the procedure. We are really lucky in that as veterinary clinics, most clinics will have blood testing equipment in their building so they can get results very very

quickly within about 20: 15:38

30 minutes of taking that blood test. It doesn't need to be sent off to an external laboratory which can take several days. And then we need to be thinking about fasting our dogs. So this again helps with reducing any regurgitation, and any risk of aspiration. There are going to be some exceptions to this. So if we have got a diabetic dog, it may be that we don't want them fasted or we want them fed a little bit later than they would otherwise have been fed. If we've got any young dogs, if there's any other concerns it may well be that there is a different instruction that is given by your vets. So the next check that you can carry out is actually checking the staff involved. So what qualifications do the nurses and technicians have? And in different parts of the world, there's different regulations about who's able to be called a veterinary nurse or a veterinary technician and it doesn't actually necessarily mean that they are qualified to any degree but also to what degree are they qualified, what skill levels do they have, how many members of staff are going to be involved with monitoring the anaesthetic with looking after your dog in the post operative period which is actually where one of the biggest risks is. So definitely check that out. And then at the same time you can ask about facilities. So what facilities does your vet clinic have? Do they have these blood machines that we can can run that pre anesthetic sample the morning, of that surgery? Do they have advanced monitoring equipment? Things like a pulse oximeter, which checks how oxygenated the blood is. Capnography which checks how well a dog is breathing, an ECG which shows any arrhythmias, any possible problems with their heart. All this equipment does add extra cost likely to the bill, but actually it helps improve the safety of the anesthesia to a really huge degree. And this is actually where it's important to almost disregard cost as a decision maker or certainly disregard the lowest cost in going for that option because if a clinic is providing the same surgery in inverted commas at a much cheaper price, we've got to ask ourselves what corners are being cut? Are there qualified staff, is there any monitoring equipment, is different surgical kits being used for every individual. We really don't want to be going by price alone when it comes to deciding where it is best for your pet to have their surgery regardless of what surgery they're having. Helping your pet live the happy, healthy life they deserve. I'll leave links to the studies and some more information about, what we've discussed today over in the full show notes at call the vet dot org. I'd also love to hear what you think so you can hit me up on all of the usual social channels. It's YouTube that I'm most active on in the comment section, when I do get the chance to to dive into those and spend some time replying, but I do read every every comment and I love hearing from you. So with that out of the way, it's been great to spend some time with you again for another episode and until the next one, I'm veterinarian doctor Alex. This is the call the vet show because they're family. That's it for this episode of the call the vet show. Be sure to visit call the vet.org to join the conversation, access the show notes, and discover our fantastic bonus content. We'll see you next time.