Why do we do what we do? (Part 2)

Have you ever wondered why vets and their nurses do what they do?

Ruby, a 2 year old Dogue de Bordeaux, wakes up from anesthesia after a TPLO to address a tear of her ACL

 

Last week, we described 5 things we do around surgery time, and why we do them

This week, we share 5 more features we provide routinely to your pet during anesthesia and surgery.

 

6. Why do we place a tube down the throat?

It’s not just down the throat, it’s into the windpipe, so that oxygen and anesthetic gas can be delivered to the lungs.

Interestingly, anesthetic gas is so powerful (yet safe) these days, that with the proper pain medications on board, we can often get by with only 1 or 2% anesthesia gas and 98 or 99% oxygen.

The tube allows us to have control of the patients breathing. So for example, we can breathe for the patient or “give a breath” if the patient doesn’t take enough oxygen in, or keeps too much CO2 in.

 

7. What do we monitor during anesthesia?

Monitoring a patient allows us to make anesthesia as safe as humanly possible. Depending on the sophistication of the hospital, we monitor multiple values, including:

. Temperature

. Heart rate

. EKG

. Blood pressure

. Oxygen level

. CO2 level

 

8. Why do we monitor anesthesia?

100% of the clinics I do surgery at have a dedicated anesthesia nurse, whose only job is to monitor the patient and make sure anesthesia is as safe as possible (if you read between the lines, this means that not all clinics take that precaution…).

Why does a nurse monitor a patient under anesthesia?

To make sure that the patient is sleeping soundly, and that the numbers on the anesthesia monitor are what they should be. Besides the monitor, nurses check on the patient. They check on the color of the gums, the depth of the anesthesia, the pulse, the breathing etc.

 

9. What’s the end result of monitoring?

Monitoring patients closely allows us to catch changes and correct them before they become a bigger problem.

* If you are not monitoring a patient’s blood pressure, how would you know that it is low and needs to be corrected?

* If the temperature is too low, we add even more devices that we had to begin with, in order to keep the patient warm.

* If you are not monitoring a patient’s EKG, how would you know that the heartbeat is abnormal and needs to be corrected?

In some cases, the nurse knows exactly what to do. In other cases, the doctor and the nurse come up with a plan to correct whatever needs to be corrected.

 

10. What happens once surgery is over?

Anesthesia stops after the patient is cleaned up and ideally has been on 100% oxygen for a while. Then the patient goes to the recovery area. There, the patient must still be monitored very closely.

Here is a little secret (too) few people know about: most pet owners are scared of anesthesia. In fact, most pets who die (thankfully extremely rarely), do so AFTER anesthesia is over. So this part is still critical and must be taken very seriously.

Similar to what is done during anesthesia, certain things are monitored during recovery: pulse, heart rate, gum color, temperature, as well as comfort level. Once the patient becomes conscious and won’t tolerate the breathing tube in their throat, the tube is removed.

Still, patients must be monitored until they are fully aware of their surroundings!

And then, nurses must still keep a close eye on their patients, on and off, until they feel confident that they are “out of the woods.”

 

In the end, these 5 steps are designed to make anesthesia and surgery safer for your pet. This is our ultimate goal.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

Why do we do what we do?

Have you ever wondered why vets and their nurses do what they do?

A Bulldog under anesthesia

 

Here are 5 common things we do around surgery time, and why we do them.

1. Why do we do blood work?

We perform preop blood work to make sure that the patient’s organs are healthy and functioning properly. We mostly look at the immune system, the red blood cells, the clotting system, the liver and the kidneys.

If one of these organs doesn’t work properly, it can dramatically affect the safety of anesthesia or surgery. In some cases, we may need to treat or “stabilize” the patient before we even consider surgery.

Many drugs are processed by the liver and the kidneys, so if they are not working well, the drugs will stay in the patient’s system for much longer than normal and could lead to complications such as a delayed recovery.

 

2. Why do we place an IV catheter?

We place an IV catheter for several reasons:

* To “stabilize” a patient before surgery, for example to correct abnormal electrolytes.

* To give a tranquilizer, before or after surgery.

* To give IV pain medications.

* To give IV antibiotics.

* To give IV fluids.

* To give IV emergency drugs if needed.

 

3. Why do we give IV fluids?

We give IV fluids for several reasons:

* To correct abnormal electrolytes (to increase or decrease them).

* To dilute some IV drugs.

* To make sure the patient is well hydrated.

* To make sure the blood pressure is high enough.

* To make sure we have easy access to a vein in case we need to give emergency drugs.

 

4. Why do we give IV antibiotics?

Under anesthesia, the patient’s immune system is weakened. Since neither the skin nor the air nor the environment is completely sterile, bacteria always end up in the surgical site. To prevent an infection, we give antibiotics before, during and after surgery.

Some organs are riskier than others: there are more, and more dangerous, bacteria in the intestine (think about removing a rock or a tennis ball from the intestine), than on the skin (think about removing a skin tumor).

 

5. Why do we give IV pain medications?

We give pain meds before anesthesia because it sedates or relaxes the patient. Interactions and minor procedures (e.g. placing an IV catheter or taking X-rays) are therefore less stressful.

In addition, it is better to give pain meds before the surgery starts because a smaller amount is needed. If we waited until the patient has been “stimulated” during surgery, we would need a bigger dose.

 

Ultimately, these 5 steps are designed to make anesthesia and surgery safer for your pet. This is our primary goal.

Phil Zeltzman, DVM, DACVS, CVJ, Fear Free Certified

German Shepherd needs surgery to catch his breath

yuengling-faceYuengling, a 7-year-old German Shepherd, had swelling along the left side of his tongue. The mass was so large that Yuengling was having difficulty breathing.

This is called a ranula, or a mucocele. It’s a large pocket of saliva often formed after trauma to a salivary gland. I performed surgery at Berks Animal Emergency & Referral Center and cut the pocket open and sutured the edges together.

But before I could close the incision, the thick, ropy saliva needed to be aspirated. You can see the mass and part of the surgery in the video below.

 

Jack Russell saved after he snacks on carpet

Sam faceSam is a 12-year-old Jack Russell, who had been vomiting and was lethargic for a few days. X-rays and an ultrasound revealed that he had swallowed a foreign body. There was a suspicion that he chewed pieces of carpet.

Carpet is really made of a very long string, so the risk was that Sam had eaten what is called a “linear” foreign body. Linear foreign bodies can be deadly if they cut into the intestine.

Sam was taken to surgery at Berks Animal Emergency & Referral Center. Two foreign bodies could be felt: one in the stomach and one in the small intestine. You can watch the removal of the string from the stomach and the intestine below. The video does contain graphic footage of a surgical procedure, so you may want to skip it if you’re sensitive to that type of footage!

Although we expect puppies (and kittens) to eat things they shouldn’t, older pets should know better. Most of the time, when an adult swallows a foreign body I suspect there is an underlying medical condition. I always take biopsies of the stomach and the intestine during surgery to check. Sure enough, Sam’s biopsies revealed a common condition called Inflammatory Bowel Disease (IBD). This disease can and should be treated to make him feel better and to hopefully prevent him from swallowing another foreign body.

Happily, Sam recovered nicely after surgery! Make sure to doggy proof your house to reduce the risk your pet will eat something dangerous. And if your dog or cat is vomiting, don’t wait! Take him to the vet to get it checked out.

Stomach removal picture

Removing the string from the stomach.

Intestine removal picture

Removing the string from the intestine.

Thick and thin intestine

The thin loop is normal, but the thick loop has IBD.

Postop strings

Here’s all the string Sam managed to eat.

Leia: the Havanese that can’t be kept down

Leia faceLeia is a 4 year-old female Havanese who just so happens to be cuter than a button.

She was experiencing back pain and right hind leg weakness, in spite of pain medication and cortisone. An MRI showed a slipped disc in the middle of her back, between T13 and L1.

Leia had spinal surgery at Berks Animal and Emergency Referral Center to remove the slipped disc. This is a delicate surgery, that can paralyze a dog, if only temporarily.

Leia did great! Just a few hours after surgery, she went outside for a little walk. Nothing is going to stop Leia!

Back pain can be treated with pain medications and a slipped disc can be treated with cortisone, but studies show that in 80% of cases, these dogs actually need spinal surgery.

Leia

The arrow is pointing at the slipped disc.