Anesthesia, Surgery, And Your Pet

Having anesthesia and surgery performed on your pet, whether for a routine neuter or a more complex procedure, can be stressful for pet parents.  However, with good care and planning, these procedures are generally well tolerated and considered safe for most pets.  Below are some considerations and questions you can ask your veterinarian regarding the procedure, risks, and aftercare.

What is anesthesia?  What are the risks?

Anesthesia occurs when the veterinarian uses injectable medications and/or anesthetic gases to induce a state of unconsciousness to allow for the performance of otherwise painful procedures, such as surgery, without the pet being aware of it or moving.  The dose of anesthetic medication or gas should be tightly controlled and adjusted based on the pet’s vital signs and condition during the procedure.  Overdose of anesthesia could lead to serious complications, up to and including death.  In the past, the risk of death associated with anesthesia and surgery was 0.38% to 0.25% in cats and dogs, respectively.  However, advancements in monitoring technology and the development of safer anesthetic medications have reduced this risk to 0.24% in cats and 0.17% in dogs.  These statistics include sick and high-risk patients, which have a higher rate of complications than young, otherwise healthy patients.  Overall, the risk of complications related to properly performed anesthesia in dogs and cats is considered very low.  However, every patient is different, and the veterinarian should perform a risk assessment prior to anesthesia and can discuss any possible factors that may increase your pet’s anesthetic risk with you.  For most pets, the anesthetic risk is low and should not prevent the pet from receiving recommended care, whether it’s a routine dental cleaning or a more involved surgery.

Why should anesthesia and surgery be performed?

Generally, anesthesia and surgery are recommended for a good reason.  Some procedures are recommended to prevent problems.  For example, spaying and neutering are important to help with pet overpopulation and prevent reproductive-related diseases, such as uterine infections and certain cancers.  Routine dental prophies (cleanings) under anesthesia keep the mouth healthy and prevent advanced dental disease.  Other procedures are recommended to diagnose existing health problems, treat problems, or prevent them from worsening.  Examples include: advanced imaging such as CT, tumor biopsies and removals, fracture repairs, orthopedic surgeries, laceration repairs, and so on.  The procedure is meant to benefit the pet, and as long as the pet’s individual anesthetic risk is not considered high, the benefits of the procedure should generally outweigh the potential risks. 

Which pets have a higher anesthetic risk?

Generally, young adult dogs and cats without concurrent health problems are considered the lowest risk for anesthesia.  Very young puppies and kittens, elderly patients, and patients with potentially serious concurrent health conditions (e.g. diabetes, liver disease, advanced kidney disease, heart disease, respiratory disease) are considered at increased risk.  Very underweight and very obese pets may also have a higher risk.  Some of these conditions may require additional pre-anesthetic diagnostics or adjustments to the normal anesthetic protocol to help mitigate the risk as much as possible.   If possible, addressing and treating underlying health problems in preparation for anesthesia can also reduce risk.  Pets that need emergency surgery are among the highest risk, as many of these pets are unstable and require emergency life-saving surgery while also having to deal with things like dehydration, blood loss, shock, sepsis, and other problems.   Generally, patients should be stabilized as much as possible before surgery. 

What if your pet is a higher anesthetic risk?  Why is additional pre-operative testing being recommended?

The veterinarian should perform a risk assessment and can discuss the risks of the procedure versus the potential risks of not doing the procedure with you so you can make an informed decision.  Additional testing may be recommended or required before anesthesia for some pets.  Common examples include routine blood work for senior pets or pets with a history of medical issues, and chest radiographs (x-rays) for pets with histories of heart or lung problems.  Other diagnostics or specials considerations may be recommended based on the individual pet.

How should you prepare for your pet’s surgery and anesthesia?

Generally, the pet should be fasted starting the night before anesthesia.  Exceptions to this may include very young puppies/kittens, some exotic pets, or pets with a history of low blood sugar.  If the pet is diabetic, insulin and food is usually withheld the morning of surgery.  If your pet is taking other medications, be sure to ask your veterinarian if they should be given that morning.   

What does the anesthesia and surgery process look like?  How is the pet monitored?

Different veterinary practices may have different anesthesia protocols.  Medications used, doses, and fluids rates vary for pets of different species, ages, and pets with certain concurrent illnesses.  Generally, and at TLC Animal Hospital in particular, a pre-anesthetic injection is given to provide sedation, anxiety relief and pain control.  After an IV catheter has been placed, a second injection of a short acting anesthetic induces anesthesia so a breathing tube can be placed to protect the airway and deliver oxygen and anesthetic gases.  Additional IV medications and IV fluids are provided during the procedure.  Heat support is provided using safe devices, such as the HotDog warming system, to prevent the pet from getting cold.  A trained technician should be monitoring the pet during the entire anesthesia using a combination of physical checks (checking reflexes, listening to the heart and lungs) and monitoring equipment (measuring temperature, blood pressure, heart rate, respiratory rate, blood oxygenation, ECG, and carbon dioxide levels in exhaled air).  These parameters are used to guide the dose of anesthetic gas delivered and make adjustments to the oxygen rate, fluid rate, warming efforts, and any supportive medications. Once the surgery or procedure is completed, the pet should be weaned off anesthetics and oxygen and monitored closely in recovery.  Additional medication may be given in recovery if the pet seems uncomfortable or anxious.   

How will pain be addressed?

While some anesthetics have inherent pain-relieving properties, most do not and only induce a state of unconsciousness.  Therefore, if a procedure is painful (any surgery, certain orthopedic manipulations, etc), separate pain medication should be administered.  Pain medication should ideally be given by the veterinary team before, during and after the procedure.  Often, pain medication is sent home with the owner to be given over the next several days.  Please follow the administration instructions and do not neglect to give the medication just because your pet doesn’t look obviously painful.  It is common for  pets not to vocalize or show obvious signs when in pain.  Pets cannot talk and often pain signs can be subtle.  CSU has a useful pain scale to assess dogs for acute/surgical pain  https://vetmedbiosci.colostate.edu/vth/wp-content/uploads/sites/7/2020/12/canine-pain-scale.pdf .  The cat pain scale can be found at  https://vetmedbiosci.colostate.edu/vth/wp-content/uploads/sites/7/2020/12/feline-pain-scale.pdf  .  If you miss a dose of pain medication, do not double up on the next dose.  Keep the medications away from animals or children to avoid accidental ingestion or overdose.  Do not use any medication that has not been prescribed without checking with your veterinarian first.  Over the counter pain medications are discouraged, as they can have potentially serious drug interactions and side effects (some of them potentially fatal) for cats and dogs.  This includes aspirin, Tylenol (acetaminophen), Advil (ibuprofen), and other NSAID medications. 

What care will your pet need after surgery?

Medication:

In addition to pain medication, other medications may be sent home with your pet.  Please follow the directions on when and how to administer the medication.  Only a select few medications mix well in food.  Otherwise, it is not generally recommended to mix the medications in the food as many pets will eat around it or learn to avoid their food bowl.  Please ask the veterinarian or technician for advice on how to give your pet oral medication if you are unsure.  Be sure to call the veterinary office about any questions you may have later on. 

Exercise restriction:

Instructions should also be sent home about any exercise restrictions.  Exercise restriction may range from just avoiding strenuous activity to strict kennel rest with brief walks on a short leash to go potty, and may last for 2 weeks to 2 months, depending on the type of surgery performed.  For pets and situations in which exercise restriction is important but difficult, you can ask your veterinarian about any medication options for sedation and anxiety relief to facilitate the exercise restriction.  Surgeries involving just soft tissue structures, such as spays and neuters, may only require light activity restriction for 2 weeks, whereas orthopedic procedures may require kennel rest for 2 months.  Minor surgeries on areas of the body not affected by activity, such as a small growth removal on the head, may not require exercise restriction at all after the first 24 hours.  We generally recommend avoiding letting your pet use stairs or get up on furniture where they may fall and hurt themselves for the first 12 to 24 hours following anesthesia until the sedatives have worn off and the pet is no longer at risk of falling. 

Feeding:

Instructions should be sent home about feeding.  In most cases, a small meal can be offered the evening after surgery (though your pet may not yet feel like eating) and normal feeding generally resumes the following day.  In cases of oral surgery or dental procedures, canned food or softened/soaked kibble may be recommended for several days.  For pets undergoing surgery on the stomach or intestines, very small, frequent, bland meals may be recommended initially before gradually working up to the normal feeding schedule and gradually transitioning to the normal diet over several days. 

E-collars:

Elizabethan collars (e-collars, aka “cones of shame”) are often recommended or required to be worn after many surgical procedures.  These collars are meant to prevent the pet from licking or biting at their surgery site and causing infection or opening of the incision.   Bandages are not sufficient protection – pets can easily remove (and sometimes ingest) bandages.  Do not rely on your pet’s better judgement.  While some pets are more prone to traumatizing their incisions than others, it’s not worth the risk.  If a pet is able to lick the incision and cause problems, they may require antibiotics, bandaging and wound care, and/or a second surgery to close the incision.  Most pets adapt to the collars quickly and are able to walk, drink, eat and sleep with them on.  If the pet is having trouble eating with the e-collar in place, it can be temporarily removed so the pet can eat as long as you are watching them the entire time to make sure they don’t try to lick their incision.  After eating, the e-collar should be put back on.  Two to three fingers should fit under the collar where it circles your pet’s neck.  Avoid placing the collar too tight, but also avoid placing it so loosely the pet is easily able to get it off.  For pets that are good at removing the collars, you can try placing loose wraps around their front paws to cover the dewclaws, tying the collar to a harness, or trying a different style of collar.  Cloud and donut collars are generally insufficient and not recommended.  Check the pet’s neck regularly for any irritation (hair loss, redness, wetness or discharge, pain, swelling) from the collar and contact your veterinarian if any is seen.   If needed, pipe insulation or cut pool noodles can be attached to the edge of the plastic collars to create a bumper for pets that like to ram furniture or human legs with them. 

Incision monitoring and care:

Monitor the incision at least daily.  It is common and a normal part of healing to sometimes see mild bruising, redness, and swelling around the incision while it’s healing.  However, if the redness, swelling, or bruising is more than very mild, or if you see oozing/discharge from the incision, missing sutures/staples, or gaping of the skin edges, let your veterinarian know right away.  Also keep a look out for any foul odors that may indicate an infection.  Keep the incision clean and dry.  If it becomes soiled, clean it gently with warm water or a sterile saline solution, such as contact lens solution.   Bathing and grooming are generally not recommended until after the incision has healed and any sutures or staples have been removed.  Incisions generally heal within 7 to 14 days.  It is usually recommended to remove any external sutures or staples after 14 days. If all sutures were intradermal (internal, not visible on the outside of the skin), suture removal is not necessary.  Sometimes, fast absorbing sutures may be used and will fall out on their own after 2-3 weeks without removal.  Your home care instructions from the veterinarian should include any instructions related to suture removal.  After 14 days or once the sutures have been removed, the e-collar can generally be discontinued.  Continued use may be recommended in cases with incisional complications or residual inflammation until these issues are resolved.

Defecation (aka pooping):

What about the pooping schedule?  This is a common concern.  Some pets may have loose stool/mild diarrhea for 1-2 days following surgery due to stress.  If the diarrhea is severe or lasts more than 2 days, contact your veterinarian.  Many pets may not defecate on schedule for up to several days following anesthesia.  This is usually due to a combination of decreased intake from fasting, and slow down of the intestines from anesthesia and opioid pain medications.  As long as the pet has an appetite and is not straining to defecate, there is usually nothing to be concerned about. 

Bandages:

If your pet was sent home with a small wrap covering the IV catheter site, it can be removed by the time you arrive home.  If a bandage or splint was placed, directions should be provided on its care and how often it should be checked or changed by the veterinary team.  Bandages and splints should be kept dry and clean.  If the bandaged area includes the foot, a plastic bag or empty modified IV fluid bag can be temporarily placed over the foot and secured with a rubber band or tie (not too tight) when the pet is walked outside to use the bathroom to prevent grass, dirt, and moisture from contaminating the bandage.  Remove the bag once the pet is back inside.  Monitor the tissue around the bandage for sores and smell the bandage to look for foul odor (may indicate infection).  If the bandage is on a limb, monitor the foot and toes for any swelling.  Sometimes only the nails are visible.  In this case, swelling can be indicated by an increased distance between the toenails.  Neck or chest bandages should not restrict breathing – if they are, they should be loosened or replaced immediately.  If the bandage becomes soiled or wet, if its starting to slip or fall off, you think there may be wounds or sores developing, or if the foot or toes appear swollen, the bandage should be checked and likely changed right away.  The veterinary team may have shown you how to do bandage changes at home.  If not, the pet should be taken to the veterinarian ASAP for the bandage change.  Follow your veterinarian’s recommendations about follow up appointments and bandage changes.  Not changing a bandage often enough can cause serious tissue infections and other complications.

When should you worry and contact your veterinarian or bring your pet in for an exam?

• If your pet goes more than 24 hours without eating after a procedure
• If your pet goes more than 2-4 days without defecating, or is straining to defecate
• If your pet has diarrhea that lasts more then 2 days or the diarrhea is severe
• If your pet is vomiting
• If your pet is lethargic or listless 12 hours after the procedure
• If your pet’s condition is declining instead of improving
• If your pet has any breathing trouble
• If your pet seems restless or painful despite proper administration of pain medication that was sent home
• If your pet has traumatized the surgical site
• If the incision appears overly bruised, red, swollen, is oozing, or has a foul odor
• If the incision line appears to be opening and the skin is gaping
• If sutures or staples are missing from the incision (and there where external sutures or staples to begin with)
• If a bandage or splint that was placed is wet, soiled, or slipping
• If a bandage or splint was placed and the pet’s foot or toes are swollen, there is a foul odor present, or tissue sores
• If you are worried, its better to reach out and ask then to ignore a potential problem. 

If your regular veterinarian is not available, consider taking your pet to an urgent care facility or emergency center.  Be sure to bring any paperwork or medications you have with you to provide to the veterinarian who sees your pet.

Post-operative home care is important.  Lack of adherence to recommendations about wearing e-collars, activity restriction, and monitoring so problems can be caught early is a common cause of complications and subsequent delayed healing and increased cost of care.

By far, most surgical recoveries are smooth and the pets do well.  Careful adherence to home care instructions and monitoring of your pet will go a long way to prevent problems and catch any issues early.  If you have any questions or concerns related to the anesthesia, surgery, or recovery of your pet, please reach out and ask your veterinary team.