What You Need To Know

The decision to schedule a surgical or dental procedure for your pet is one that should be made after careful evaluation of several factors. In the State of Wisconsin, surgeries can only be legally performed by a licensed veterinarian. Beyond that, it will surprise most people that there are no regulations or detailed requirements for how the patient is monitored and cared for during the procedure! Therefore, it is important to ask questions before you make the final decision to schedule your pet's surgery.

Questions to consider prior to scheduling your pet's surgery:

1. Do you offer pre-anesthetic blood screening?
2. Is a tube (known as an endotracheal tube) placed into the airway for the surgery?
3. Will my pet be placed on oxygen during the procedure?
4. Is there a trained technician that will monitor my pet during the time my pet is under anesthesia?
5. Is the technician assigned to my pet, or are they performing duties in another area or room in the clinic?
6. Does the technician keep a record of my pet's vital statistics during the procedure?
7. Is a pulse oximeter used to monitor anesthetized patients?
8. Is an electrocardiogram (ECG) used to monitor the heart rate and rhythm?
9. Is the blood pressure measured regularly for anesthetized patients?
10. Are carbon dioxide levels monitored for anesthetized patients?
11. Will my pet have an intravenous catheter placed into a vein?
12. Will my pet receive fluid therapy during surgery?
13. Will my pet be warmed by a circulating water blanket during the procedure?
14. Will my pet be warmed after the procedure to maintain an appropriate body temperature until recovery?
15. Will my pet receive appropriate pain control medications?
16. Do you utilize a surgical laser?

Why do these things matter?

Prior to any procedure that requires general anesthesia, it is important to perform blood tests to screen for any underlying problems that could be a concern relative to the metabolism of anesthesia or other drugs in the body. We are mainly concerned with the liver, kidneys, blood "sugar" (glucose) and blood proteins, as well as the overall blood cell counts (red blood cells, white blood cells and clotting cells). If any abnormalities are detected, we may need to alter the selection of anesthetics or post-pone the procedure.

Once a patient is anesthetized, an endotracheal tube is placed into the airway, and the patient is allowed to inhale and exhale oxygen through this tube (gas anesthetics are delivered by this route, as well). The tube also protects the airway in the event that a patient would vomit or regurgitate while under the effects of the anesthesia, since it can be very serious or even life threatening if stomach contents would leak into the airway or lungs.

Monitoring the breathing and heart rate are just part of the assessment of the patient under anesthesia. A technician is assigned to monitor the patient's ECG (heart rhythm) and blood pressure, as well as the oxygenation of the blood and carbon dioxide levels. Abnormalities in any of these areas can alert the Doctor to serious problems, allowing time to make adjustments in anesthesia or to give supportive medications. This information is carefully recorded to serve as a detailed report of the patient under anesthesia.

An intravenous catheter is placed to allow easy access to a vein at all times during the procedure, especially in the event of an emergency. The patient also receives fluids through the catheter to help maintain appropriate blood pressure and hydration. In cases of a very short surgery, we will provide fluids by an alternate method to ensure adequate hydration after surgery.

General anesthesia and some surgeries will often cause a patient to experience a drop in the normal body temperature. If a patient's temperature becomes too low, it will prolong recovery from anesthesia and cause shivering. Therefore, a circulating warm water blanket is used during surgery, and the patient is allowed to recover on a warming pad after surgery.

Finally, It is important to understand that anything that can cause pain for humans will likely cause pain for animals, yet animals are less likely to display signs of pain. Pain will adversely affect recovery, healing and attitude. Therefore, pain is controlled with appropriate use of narcotics and other anti-inflammatory medications, as well as local anesthetics when appropriate.

Dental care also varies considerably from clinic to clinic, again without any standardization for the type of equipment or the training of the staff and veterinarian (again, the veterinarian must be licensed in the appropriate state).

Questions to consider prior to your pet's dental (in addition to the questions noted above):

1. Are the teeth cleaned with an ultrasonic scalar and hand instruments, cleaning above and below the gum line?
2. Are the teeth polished with a polisher?
3. Is a dental drill available for extractions? (inquire if the clinic utilizes a dremel tool or a hack-saw blade for extractions)
4. How long does it take to scale and polish the average cat's teeth? (hint: minimum of 20 minutes is typical)
5. How long does it take to scale and polish the average dog's teeth? (hint: minimum of 30 minutes is typical)
6. Does the technician apply a disclosing solution to locate the plaque on the teeth prior to the final cleaning?
7. Does a licensed veterinarian evaluate the teeth and gums, dictating the findings to a technician to record in the patient chart?
8. Does a licensed veterinarian perform all dental treatments and extractions, as needed?
9. If extractions are needed, will a recheck appointment be scheduled to evaluate healing for my pet?
10. If advanced dental care treatments are requested, will my pet be referred to a dental specialist?

Why does it matter?

It is important to have the right equipment and training in order to do the best job. Just like a human dentist, an ultrasonic scalar, hand tools and a polisher are essential tools for cleaning the teeth. The cleaning should not be rushed, specifically tailored to each pet. If extractions or advanced procedures are needed, a dental drill is essential equipment to ensure that the procedure is performed in the most efficient and comfortable manner possible. It is also important that the veterinarian is the one to make decisions and perform the treatments for any areas of concern. Following the procedure, the mouth should be re-evaluated for proper healing, when indicated. It is also important to know that you have the option for referral to a dental specialist, if needed.

You will be surprised to learn how each clinic's approach to surgery and dentistry can vary. It is important to consider each question, since you cannot assume that each clinic will hold these same standards. Different approaches to surgery or dentistry will affect the fee for the service. After you evaluate all of this information, you can compare the cost of the procedure at one clinic to the next. It is reasonable to conclude that it will cost more to provide a technician, appropriate monitoring equipment, fluid therapy, pain management, etc. You need to know the details in order to make an informed decision before your pet is placed under anesthesia.