Fall 2020, Featured, Anesthesiology

Talking to Clients About the Risks from Anesthesia

The fear of the unknown ignites client concerns about their pets and anesthesia. Help alleviate their fear with these tips for clear, thoughtful communication regarding the anesthesia event.

Lynda PaulLVT, VTS (Clinical Practice, Canine/Feline), CVPP

Lynda is the lead technician in general practice at Nanuet Animal Hospital, where she has been working for 29 years. In 2013, she achieved her VTS in clinical practice through the Academy of Veterinary Technicians in Clinical Practice (AVTCP). In 2018, she became the vice president of the AVTCP and currently serves as president. In 2015, she earned her Certified Veterinary Pain Practitioner (CVPP) credential. In her spare time Lynda likes to garden. Year-round she loves to train her 3 dogs and shows 2 in Rally Obedience. She also has a rescue pit who is happy to be a homebody, where he is most comfortable!   

Talking to Clients About the Risks from Anesthesia
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Clients’ fears about anesthesia stem from the fear of the unknown. They don’t know where their pets go when taken from them, what to expect from the surgery itself, what the recovery time will be, how the pet will be affected for the long term, and—most importantly—the facts about the anesthesia itself. Clients may have concerns about all of these issues or just some of them.

As veterinary nurses, we are in a unique position to help alleviate many of our clients’ fears about anesthesia and reduce the stress of a surgical event for them and their pet.

This article, while applicable to some emergent situations, will concentrate on addressing common concerns regarding the anesthesia event in elective and non-emergent situations and how to effectively communicate with anxious owners.

Where Does My Pet Go When Taken From Me?

Positive reinforcement and positive training methods have made an impact in the veterinary community, helping to eliminate fear and stress in our patients. We now recognize and value the emotional and mental states of our patients.1 Stress can negatively impact the patient’s overall wellbeing, not only for the anesthetic event but for healing postoperatively as well.2 Many procedures such as blood draws and other treatment and care are performed in the room with the client present, thus reducing the stress of separation on the patient as well as the owner. 

However, in most cases it is neither practical nor possible for clients to be with the pet during the actual surgical procedure. It may help to alleviate the owner’s fears of separation if they are allowed to view the surgical suite and the kennel area prior to the day of surgery. Offering a tour of the surgical suite to clients who request it can be a valuable opportunity to educate them about the various pieces of equipment that will be used to ensure the pet’s safety during anesthesia.

Seeing and knowing exactly what the pet will experience can be reassuring for the owner. Explain that postoperatively the pet will be monitored in the recovery area, then moved to their own kennel with comfortable bedding. A walk or litter box will be provided as soon as the pet is ready for it and then an appropriate meal offered. The client should be called when surgery is complete to update them of the pet’s recovery status and advised of when the pet is expected to go home.

Sending a photo of the pet resting peacefully in recovery via email or text to those clients who are particularly anxious about leaving the pet will often provide them great relief.

What Should I Expect From the Surgery Itself?

We can offset client fears about what to expect from the surgery by explaining the surgical procedure itself in detail and prepare them for their pets’ postoperative appearance. Let them know that areas of the pet’s body will be shaved, there may be bruising, and an incision may be larger than what they expect. For example, a small mast cell tumor will often require a large elliptical incision that creates a much larger wound than the client anticipates. Clients should be advised that the pet may very well be subdued and sleepy the evening at home following a same-day procedure, and the pet’s appetite may be temporarily decreased. For patients requiring extensive follow-up care, let the client know about the length of the anticipated hospital stay and visiting hours.

Promote the quality of care the pet will experience during the surgical procedure and explain that the surgeon will wear a sterile gown, cap, mask, and gloves while using a sterile surgical pack for operating. Let the client know who will be in the operating room and what each person’s role in their pet’s care entails.

Sending a photo of the pet resting peacefully in recovery via email or text to those clients who are particularly anxious about leaving the pet will often provide them great relief.

What if My Pet Doesn’t Wake up?

Clients may be worried about the anesthesia itself: how the drugs will affect their pet and even if their pet will survive. However, the risk of anesthetic death is low, at an estimated 0.05% for healthy dogs and 0.11% in cats.2 We can help calm clients’ fears by advising them of the measures that will be taken to provide the safest anesthetic event possible.

One of the first steps to providing safe anesthesia is preoperative blood work. Take the time to explain to the client how the information we obtain from this will enable us to adjust our anesthetic protocol accordingly. For example, a patient with renal insufficiencies will receive intravenous fluid therapy before, during, and after surgery; a patient with hepatic disease will require adjusted dosages of medication, possibly plasma infusions, and close monitoring for unexpected bleeding and possibly glucose monitoring;3 and a patient with any cardiac abnormalities may require thoracic radiographs as well as an echocardiogram prior to anesthesia. A thorough preoperative exam will be performed and an anesthetic protocol will be created for the patient’s specific issues including breed, age, and any comorbidities.2,4

Using smaller amounts of several drugs in combination creates a safe and balanced anesthetic protocol to achieve sedation, unconsciousness, and analgesia.5 Explain to clients the importance of an initial injection of a mild sedative that will help the patient begin to relax. Once the patient is relaxed, an intravenous catheter will be placed into a vein. This catheter will safely deliver any drugs or fluids needed to help maintain blood pressure, as well as provide instant venous access in the event of an emergency.

The most common anesthetic risks include complications from hypothermia, hypotension, cardiac arrhythmias, cerebellar dysfunction, and blindness and deafness in cats.6 Educate the client about the various methods used to help identify these risks and the protocols in place to offset their deleterious effects.

Explain that once the pet is anesthetized, an endotracheal tube will be placed in their trachea.  This protects the airway and lungs from aspiration of any stomach contents and ensures the pet will be properly oxygenated. This will enable us to provide ventilatory support if needed as well. A pulse oximeter will also be used to help ensure the patient is well oxygenated.

Let the client know that there will be several pieces of equipment used to offset some of the anticipated complications.

We will monitor the pet’s temperature and provide heat support to keep the pet at a normal body temperature. Hypothermia can negatively impact the patient by prolonging recovery time, negatively affect platelet function, and slow the heart.7

Blood pressure will be monitored and fluid rates adjusted accordingly. Maintaining adequate blood pressure is critical for perfusion of tissues to prevent damage to vital organs such as the brain, heart, lungs, and kidneys. Since renal insufficiency is not apparent until about 75% of nephrons are damaged, patients may not show effects of an insult during this surgery until later in their life.8 With proper blood pressure monitoring and taking appropriate corrective measures, we can prevent this damage. 

An electrocardiogram (ECG) will be used to help monitor the rate and rhythm of the heart. The ECG will also give us information about some electrolyte abnormalities that may be present.9 Let the client know that we will have drugs readily available to mitigate any cardiac disturbances.

An end-tidal CO2 monitor will be used to monitor any changes in lung perfusion. Changes on the capnograph can give us early warnings about any possible complications. Readings above the normal ranges can alert us to possible airway obstruction, hypoventilation, or errors with intubation. Readings lower than the normal ranges can alert us to hypothermia, disconnected circuits, or possible impending cardiac arrest.10 This information allows for a preemptive response to a possible emergency situation. 

Most importantly, assure the client about the level of competency of the veterinary nurse involved in making sure all parameters remain within the required criterion for optimal success. This is a good time to take a few moments to educate the client about the value of a credentialed veterinary technician/veterinary nurse providing hands-on monitoring of their pet during anesthesia.

Comparing these monitoring parameters to those that would be encountered in a human patient undergoing anesthesia helps the client understand the level of care provided for their pet. 

Reassure the client that changes in the medications can be made at any time and that veterinary care does not end with the patient leaving the clinic.

What Will My Pet Be Like After the Surgery?

After-care for the pet will be dependent on the specific procedure performed. Breaking down the specific posttreatment care clearly for each pet and what the home-care expectations will be helps the client feel less helpless about the event and become a part of their pet’s healthcare team.

Let the client know how long the pet is to be exercise-restricted, what physical therapy modalities might need to be performed at home, and how they can administer any medications.

Will My Pet Be in Pain?

Progress has been made in recent years in animal pain management. We now understand how pain negatively affects our patients and that untreated pain can lead to prolonged healing and recovery.11

Let the client know that a multimodal therapy plan for pain management will be utilized. This will provide a combination of several analgesics that will act on various pain pathways.12

A balanced multimodal protocol includes preemptive analgesia in the form of an injection given as part of the pre-sedation process. Additionally, a local anesthetic will be utilized prior to the incision by the surgeon, providing another form of preemptive pain management.

During the procedure the patient will receive an appropriate constant rate infusion dependent on the procedure performed. The pet will be discharged with oral pain medication to be given at home to continue to provide analgesia. With this combination of treatment, we are able to manage the pet’s pain during the hospital stay and at home.

Encourage the client to monitor the patient at home for signs of pain and have them keep an eye out for a few key indicators:

  • Is the pet vocalizing?
  • Is the pet able to settle into a comfortable sleep?
  • Is the pet eating?
  • Is the pet able to move about easily?   

Let the client know they will get a follow-up call the day after discharge to check in on them and the pet. At this time, the at-home pain management can be reassessed. Reassure the client that changes in the medications can be made at any time and that veterinary care does not end with the patient leaving the clinic.

The client should be reassured that after the initial recovery period the pet should be just as it was prior to surgery.

Will My Pet Suffer Any Long-term Effects?

The client should be reassured that after the initial recovery period the pet should be just as it was prior to surgery. With all the safety measures in place to protect the physical and physiologic wellbeing of the patient—along with the respect and care taken for the patient’s emotional wellbeing—the risks for most anesthetic procedures is readily managed for a positive outcome.

References

1. Carrozza A. Fear Free Basics. americanveterinarian.com/journals/amvet/2018/january2018/fear-free-basics. Accessed March 2020.

2. Grubb T. 2020 AAHA Anesthesia Monitoring Guidelines. aaha.org/globalassets/02-guidelines/2020-anesthesia/anesthesia_and_monitoring-guidelines_final.pdf. Accessed March 2020.

3. Clark L. Nursing the patient in recovery. In: Welsh L, ed. Anaesthesia for Veterinary Nurses. 2nd ed. Oxford, UK: Wiley-Blackwell; 2009:293.

4. Dugdale A. Concepts of general anesthesia. In: Veterinary Anesthesia: Principles to Practice. West Sussex, UK: Wiley-Blackwell; 2010:01.

5. Dugdale A. Preoperative assessment. In: Veterinary Anesthesia: Principles to Practice. West Sussex, UK: Wiley-Blackwell; 2010:05.

6. Englar R. Most Common Anesthetic Risks. veterinarypracticenews.com/taking-fear-anesthesia. Accessed March 2020.

7. Clark L. Nursing the patient in recovery. In: Welsh L, ed. Anaesthesia for Veterinary Nurses. 2nd ed. Oxford, UK: Wiley-Blackwell; 2009:260.

8. Mama K, Rezende M. Anesthesia for Patients with Renal Disease. cliniciansbrief.com/article/anesthesia-patients-renal-disease. Accessed March 2020.

9. Sleeper M. An Introduction to Reading ECGs in Veterinary Patients. dvm360.com/view/reading-ecgs-in-veterinary-patients-an-introduction. Accessed March 2020.

10. Farry T. Monitoring the critical patient. In: Norkus CL, ed. Veterinary Technician’s Manual for Small Animal Emergency and Critical Care. Oxford, UK: Wiley-Blackwell; 2012:77-78.

11. Cook A. Pain: an issue of animal welfare. In: Egger CM, Love L, Doherty T, eds. Pain Management in Veterinary Practice. Oxford, UK: Wiley-Blackwell; 2014:03.

12. Gaynor J. Principles of pain management. In: Gaynor J, Muir W, eds. Handbook of Veterinary Pain Management. 2nd ed. St. Louis, MO: Mosby-Elsevier; 2009:58.

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