We’re thrilled to welcome back one of our favorite guests, board-certified veterinary dentist Dr. Sharon Hoffman, for a deep dive into a topic pet owners frequently ask about: anesthesia safety during pet dental procedures.
For this special “Take Two” episode, Dr. Hoffman is joined by veterinary anesthesiologist Dr. Carolyn McKune, founder of Mythos Vet LLC. This dynamic duo brings their combined expertise to demystify the critical role of anesthesia in veterinary procedures, ensuring your pet receives the safest, most effective dental care possible.
In this enlightening conversation, they cover:
- The essential need for anesthesia in comprehensive pet dental care and the risks of skipping it.
- The importance of a thorough pre-operative evaluation and how pet anxiety can be managed.
- Understanding the complete anesthesia period, from pre-op to post-op recovery.
- Answers to pet owner FAQs, including the significance of IV catheters and how to best prepare your pet for surgery.
- Debunking common myths, such as the idea that small pets are at higher risk.
- The crucial role of pain management and customizing care for pets with pre-existing conditions.
- Tune in to gain peace of mind and the knowledge you need to confidently manage your pet’s oral health journey.
Dr. Hoffman is not only a board-certified veterinary dentist but also a diplomat of the American Veterinary Dental College. She earned her DVM from Louisiana State University and now runs her own veterinary dental consulting practice in Florida, while also teaching at the University of Florida College of Veterinary Medicine.
Dr. Carolyn McKune, a Michigan native and proud Spartan. Carolyn earned her veterinary degree from Michigan State University, completed an internship at Washington State University, and then did a residency in anesthesia and critical care at UC Davis. She became board-certified in 2009 and, after a stint on the faculty at the University of Florida, launched her own independent anesthesia consulting service, Mythos Vet LLC.
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All footage is owned by SLA Video Productions.
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Watch the episode here
Listen to the Podcast here
Anesthesia…It’s Important For Pets, Too!
Welcome to the show. I’m Dr. Alice Novotny Jeromin, a board-certified veterinary dermatologist and allergist.
I’m Janet Novotny King, and I am not a board-certified allergist and dermatologist. I’m the sister.
Janet, guess what? We have a dynamic duo with us. First of all, I don’t know if you all remember our favorite board-certified veterinary dentist, Dr. Sharon Hoffman. She was on the show a few segments ago. We had so many comments and questions about dental care and oral health care that we decided to have her back. We’re very happy she could join us.
To refresh your memory, Sharon is a board-certified veterinary dentist. She’s a Diplomate of the American Veterinary Dental College. She received her DVM degree from Louisiana State University and is the owner of Veterinary Dental Consulting in Florida, where she is also on the faculty at the University of Florida College of Veterinary Medicine.
The second part of our dynamic duo is Dr. Carolyn McKune, who is a Michiganer. She’s a Spartan. She received her veterinary degree from Michigan State, did a year internship at Washington State University, and then a residency in anesthesia and critical patient care at UC Davis. She became boarded in the American College of Anesthesia and Analgesia in 2009, was on the faculty of anesthesia at the University of Florida, and then launched her own independent veterinary anesthesia consulting service, Mythos Veterinary.
She also served as a Chief Anesthesiologist and Medical Director at a local specialty hospital, but found that she liked working on her own. She is the owner at Mythos Veterinary and provides veterinary anesthesia in both physical and virtual anesthesia ways, which is cool. People don’t know that most veterinary practices do not have a boarded anesthesiologist available. Dr. McKune can provide those services virtually or in person.
What’s cool about Dr. McKune and Dr. Hoffman is that they have a wonderful specialty that complements each other. We know that for perfect oral and dental care, you need general anesthesia. We can’t wait to go over so many things, from client concerns about the anesthesia to Dr. Hoffman talking more about oral and dental care. Thank you both for joining us.
You’re welcome. Glad to be here.
Thank you very much, Alice and Janice.
It’s our pleasure.
Janet, why don’t you start with some of the questions that we had from the audience?
Safety & Necessity Of Anesthesia For Dental Care
I got my teeth cleaned, and I wish they had knocked me out. They put that pink topical stuff on my gums. It was the first time this has ever happened to me. It was bizarre. She’s in there digging with the pink stuff. It was awful. Typical pet owners, and I hear this from all my friends, are like, “I got to go have my dog’s teeth scaled or cleaned, and they’re going to knock them out. Is that okay?” Can you talk in general about the safety of anesthesia and the need for it in dental care?
We can go over a few things from the anesthesia side. One, it’s very helpful to have a veterinarian who’s the primary veterinarian. Your anesthesiologist will never be your primary veterinarian. We need people like Dr. Hoffman to be able to consult with the client, talk to the patient, and, as we’ll probably go over later in the show, discuss some important history that is very pertinent for us to be able to safely provide anesthesia for the animals.
The first thing that might be helpful is defining the anesthesia period. Everybody thinks of anesthesia as we might see on a television episode where a patient is lying on the table and, all of a sudden, they’re awake. There’s a transition time during that. What we’ve found is that we get better and better at providing anesthesia for animals, and that it is equally as important in the preoperative period, which is what the animal comes into the hospital already having had. As Janet mentioned, she might have some anxiety about the next time she goes to the dentist. The animals often also have a component of anxiety before they arrive.
We are getting better and better at providing anesthesia for animals, and it is equally important to focus on the preoperative period—what the animal experiences before coming into the hospital. Share on XWhat happens during the anesthetic event, and then equally as importantly, what happens after the anesthetic event has concluded and the patient has started to recover. Unlike in the TV shows, they’re not going to go back to being 100% normal. We’ll discuss throughout the show, I’m sure, some expectations that might be realistic to have for some of these animals. The anesthesia period is wide and encompassing for all of us.
Dr. Hoffman, clearly, you can’t clean a pet’s teeth while they’re awake.
There’s a difference between what the groomer does. There are some non-anesthesia practitioners scaling the teeth with the pet awake. That can be done in some patients, but not all. What’s missing is a thorough exam. Dental X-rays can’t be taken. Exams around each tooth and under the gum can’t be performed. That can’t happen. Anesthesia is required for a complete oral exam and treatment.
Dr. McKune, do all patients need an IV catheter, then?
That’s probably a good safety point to discuss. As Janet alluded to, there are risks with anesthesia. When we look at risks of anesthesia, some of the most common anesthetic risks are either from problems with your heart or lungs. If we have an IV catheter in place, we can administer drugs to be able to help support some of those processes. We assist the patient in being amenable to having whatever procedure they need to have done. The IV catheter access is important and critical if there is an emergency, and then very helpful during the entire anesthetic period.
Anesthesia Risks, Myths, & Patient Size Concerns
What are some common myths about anesthesia for your pet?
We have several patients who present to us in a wide variety of shapes and sizes. One of the things surrounds patient size. There are thoughts that maybe a patient is too small to be anesthetized. From the workflow perspective, it is challenging when you have quite a small patient to do some of the routine things, like the IV catheter placement we were talking about. They’re very tiny. You need to have the appropriate-sized equipment to be able to support them.
It’s not an anesthetic contraindication to be small. Being a smaller pet does not put you at any increased risk as long as we’re respectful of the fact that any anesthesia carries concerns for patients. We want to appropriately provide the right dosages for medications. We want to make sure we’re providing heat support, especially for the little guys. We want to make sure that we’ve got the right equipment to be able to support their small size.
Some of my patients come in purses. They weigh less than a gallon of milk, but they need the care. There are a lot of myths. If someone’s coming with a fear or dread, they think an anesthesia event is going to bring their pet closer to death. Each time they have that anesthesia, they’re getting closer and closer to death. They want everything done for the whole pet, mouth, ears, everything, under one anesthesia because an additional anesthesia is closer to death. Dr. McKune will often talk to the clients or the pet owners, and I’ll be in the room. She has a good way of getting them over that dread hump, which I’m going to call it.
What happens to the pet when they’re put under? I’ve been put under for procedures. They’re in a sleep zone.
There are five important components for a patient to be considered anesthetized, human or animal. We need to have the right pain control. They have to have pain medications as part of this, which is something your veterinarian might ask you about providing for the animal, because there are financial costs for doing that. We want to try to make sure that the patient is unconscious.
A good way to think about this is when you’re sleeping, if you were to roll over on something sharp, you would still move away from that. Even if you weren’t conscious, you would still have movement. Although a lack of movement is important, a true unconsciousness is also important. There is going to be analgesia, the pain control that we’re talking about, for a patient who’s not conscious, a patient who does not move, and a patient who has muscle relaxation. Their muscles are very soft and easy for them to be positioned as they need to be.
We try to make sure that the patient has amnesia. That is a very hard thing to quantify in an animal that would have amnesia because they’re not verbal responders. Like nonverbal children, they can’t tell us if something has happened. We speculate on veterinary anesthesia, but having those five components is what characterizes a patient who is anesthetized in an ethical and morally acceptable state for an intervention to be done.
You mentioned pain management. Why is that so important? How do you define pain management, and why is it important for our pets?
If we look at the broad definition that’s accepted for pain, it is a real or emotionally perceived sensation either in response to or in experiencing an event. That’s considered pain. An animal, or presumably a human, can anticipate something that’s going to be unpleasant and go through pain and discomfort. What that means for us is that we should be preemptive about anticipating that there is going to be discomfort with any intervention that we make. That’s what we would call an invasive intervention, where we’re going to be providing some stimulus to those things. Since we know that’s coming and we know that there can be such a broad definition of pain, it’s a better idea for us to do as much as we can to mitigate that before the pain occurs.
I’ve had owners say to me, “I almost lost my dog. He had a bad reaction to anesthesia.” I think people use the word reaction and side effect inappropriately. As a former pharmacist turned vet, people will say, “I have a side effect to that,” but it’s not a side effect. Can you talk about that? What is “a bad reaction?” Do they take long to wake up?
PS, when you look at the side effects of any drug like at the end of the drug commercials, it’s a list like this, like that. It’s like, “I’m never going to take that if I’m going to get any of it.” When they do the testing, they must have 1 or 2 cases of it to put it on the list as a side effect.
It has to be statistically significant. As part of a drug trial, which our office was, and I would report something, you get into a little fight about it. It’s like, “Are you sure they were on ear medicine at the same time? How do you know it wasn’t that?” Do you see what I’m saying? When it gets put on the list, it happens. Let me put it that way. To me, that’s different from what someone says as a bad reaction. I always want them to define that.
I think that that’s a good point because reaction, bad reaction, adverse reaction, or unusual reaction, those are very broad terminologies. For us in Florida, we may not think of temperatures in the 90s as nice. For somebody who’s living in Upper Northern Canada and it’s 54, maybe that does seem nice to have a little break. It’s a very broad concept. It’s helpful if we can narrow down, when an owner presents to us, what they mean by bad reaction.
Some common things that we see, and Dr. Hoffman can help fill in, would be taking a while to recover. By recover, we don’t necessarily mean that they were still unconscious at the veterinarians. We mean that maybe they didn’t have the same behaviors that we would see normally. They walked in a different pattern. They were more tired than they normally would have been. They didn’t necessarily have a huge interest in normal routines like eating their food. In some cases, as we see with anesthesia, a delay in the animal wanting to defecate normally.
Owners are very in tune with that consistent schedule for them. Other times, a bad reaction can mean that the patient was too alert and too awake. They came home and seemed very stressed and anxious. If we can get some more descriptors on what that bad event might be, it may help us to be able to alter the protocol for the next time so that we can provide something that is more tailored to the animal’s specific needs.
The vocalizing during recovery or even at night, do you want to touch on that, Dr. McKune?
We can see some patients who have altered mental states. In some patients, this can present as being very tired. They might be sleepy. In other patients, it can present as them having a remarkable amount of vocalization. Even my own pets have had this after anesthesia, where they’ve been verbal afterwards. In dogs, that usually sounds like howling. It can sometimes be disruptive for the owner trying to be able to get some rest, or the rest of the family, or the rest of the pets that are in the household. Those vocalizations being uncharacteristic are side effects, as one might consider having certain drugs during anesthesia that might take a little time to clear from the system.
Dr. Hoffman, I remember you telling us the story about a seventeen-year-old dachshund. I can imagine that with so many years of that painful mouth, after the procedure, I would think that a lot of your patients feel great in spite of the pain of the extractions.
Dr. McKune was on that case. That dog had a lot of surgery on all four sides of the mouth. Pain management was given before the procedure, during the procedure, and after the procedure. There’s some healing to do, but they start feeling better right away. The pain medication is managing their pain, but it’s gone in a few days. They’re doing better. Some people say, “I have my dog back or they’re playing.” Even a cat, they haven’t picked up a toy in five years. They don’t let us know how much pain they’re in until we take the pain away.
What we’re getting at for all of these kinds of things is quality of life for animals. What we ultimately all want is not necessarily quantity of life, but quality of life. Sometimes, that’s a balance of, in the very short-term, having a patient who vocalizes in the evening or who seems a little bit more listless than they would be, so that long-term, they can achieve what Dr. Hoffman is talking about. It is an animal that feels much more comfortable and is able to interact to a higher degree because we didn’t appreciate how much the discomfort they were living with made them not want to be a happy member of the family.
What we ultimately want is not just quantity of life, but quality of life. Share on XManaging Senior Or High-Risk Patients & Procedure Length
I remember one pet owner, a husband and wife. I can’t remember their pet. I always call the next day after a surgery to see how the pet is. I always do. I remember the missus telling me the pet is sleeping with the mister, and he hadn’t done that for a long time. The results are rewarding, and they’re very soon. We have to get them over the anesthesia hump, the dread hump. We’ve been doing that. Not all of these patients come in healthy. Some of them are seniors. They’ve got pre-existing comorbidities.
That was my next question. I would imagine it’s pretty scary, Dr. McKune, if a cat or dog is in early kidney failure. Yet, they need that dental work desperately. What changes do you make to that routine for that?
The wonderful thing about anesthesia is that we have a variety of options and things that we can use. The sad part of anesthesia is that we only have a certain number of things that we can use. The drugs play a less important role than people necessarily appreciate. We have wonderful things that are options for us, but it’s not an unlimited supply of things.
What it comes down to is the management of that patient. We might choose to bring that patient in early and hydrate them with IV fluids, knowing that a big part of where dogs get part of their water from is their food. Whether people appreciate it or not, carbohydrates, so half of a dog’s food being carbohydration, are part of what hydrates them. When we withhold food before anesthesia, we know that we’re withholding a water component.
On top of that, when animals don’t take in food, sometimes, they don’t have that thirst driver. There are a lot of reasons for even an oral patient to come in dehydrated. If we have a patient who presents to us who might have changes to the kidney, which would make dehydration a lot harder for the kidney to work, then we provide them with those fluids intravenously before we ever start. We’ll often make those patients the second patient of the day. It’s not because we want to be disrespectful of the owner’s schedule, but because we want that dog to come into the anesthetic period with the best level of hydration it could be, given that it already has some underlying disease.
I bet, Dr. Hoffman, you’re pressured to work quickly in those older dogs or cats with the comorbidities.
I work pretty quickly. That’s why I get a lot of referrals. I was in general practice for twenty years. You know that, Alice. This is all I do now, so I do it quicker. Here’s the thing. When I’m working with Dr. McKune, and we’re a team, and I know that there are comorbidities. She’s managing all that, and I’m working diligently, and I will say, “How’s the pet doing?” She’ll let me know, or she’ll say, “How much more do you have to do? How long is it going to take?” If we have to stop, we can. It’s not like the chest is open or the abdomen. We can stop, and that’s very rare.
The other thing that’s important for the pet owner to know is that it is safer for the pet to have multiple short procedures than to have a marathon 2 to 3-hour procedure. The pet owner thinks it’s safer to have one anesthesia no matter how long it is, but that’s the opposite. It’s safer to have multiple short ones. There are a lot of myths. We’re debunking the myths. It’s great to be able to help some of these that nobody else wants to help. You need a team. In our room, there are four people. There’s me. I have a dental assistant. Dr. McKune is there, and she has an anesthesia assistant. It’s a team.
I have to ask what I always hear. A dog’s mouth is cleaner than anything. Is that true?
No.
They’re like, “Why do I get dead chipmunks? I don’t know what else is out in that yard.” I’m always like, “What did you have?” Everyone says it. They’re like, “Their mouth is clean.”
That’s interesting. Let’s talk about this because it’s a myth. It’s a big myth. We know that there are so many bacteria in the mouth. There are tens of thousands of bacteria in the mouth, some of which you can’t even grow in a culture. The mouth is never sterile. The mouth is never clean. Think about what they do with their mouths.
I don’t know exactly where that came from, but you’ll also hear about dogs and cats licking themselves when they have wounds. Maybe their saliva is clean. There is some homeopathic stuff in the saliva. I don’t know because I don’t study that, but it clearly is not clean. If you’re bitten by a dog or a cat, a cat’s very bad, a chimpanzee, it’s all dirty. It’s interesting to know where that comes from.
I bet you if we had to trace the origins, they might mean the difference truly between a cat and a dog. People develop infections after cat bites more commonly than they might. In reality, it’s not necessarily a difference in bacteria. It’s a difference in the fact that dogs provide a crushing type of injury when there is a bite, as opposed to a cat having a piercing type of injury. It creates an environment where no oxygen can get to you so that bacteria can grow. I wonder if that might be the origin. I don’t know if that’s the case.
Even a cat’s scratch is nasty. Cat scratch fever is a real thing.
Are some dog breeds more prone to anesthesia difficulties or oral health care difficulties? That’s a question for you both.
In small-breed dogs, we see periodontal disease more, which is also called gum disease. In large breed dogs, we see fractures and tumors. I see tumors of any size, but that’s the older population. There are a lot of myths about different breeds. Dr. McKune has a list. With greyhounds, we know they have a bleeding problem, so that’s not a myth. That doesn’t mean they can’t have anesthesia. Dr. McKune, do you want to mention some others?
We can lead with the greyhound. A lot of the work done for greyhounds was done out of Ohio State, where they looked at what’s called delayed postoperative hemorrhage that happens for these dogs afterwards. They can have a very routine anesthesia. That can do a perfect job, and afterwards, the animal ends up in the ICU needing critical support because of this. There is a genetic predisposition for that. There are genetic tests that a person can do to try to find out more about that. Greyhounds are ones we have a little more consideration for.
We also have large-scale morbidity and mortality studies that give us numbers on death that are associated with anesthesia, as morbid as that sounds. We do see that there are certain breeds that are at a higher risk for that. Rottweilers are at a high risk. The West Highland White Terrier, which I’m sure Alice has seen plenty of in her career, and the Shepherds were at increased predisposition. We need more work to figure out what it is about those dogs that might result in an increase in mortality or death. We have speculation. We just don’t necessarily have the numbers.
We know there are other animals where we have documented that there are difficulties. Collies, for example, can possess another genetic abnormality that prevents them from being able to metabolize certain anesthetic drugs appropriately. We have to be thoughtful about what we use for them. What is equally as interesting is the dogs that are not predisposed to an anesthetic risk that we sometimes hear. For example, as we were talking about with small size, sometimes, with small breeds, people will say, “I have a Yorkie, and they’re very sensitive to anesthesia or I have another name of a small breed animal, and they’re sensitive to anesthesia.”
Dogs are not inherently predisposed to anesthetic risk, as we sometimes hear, but we do need to be thoughtful about the medications we use for them. Share on XAny animal can have individualized reactions and responses, but as a breed, unless they have an underlying genetic or physical abnormality. For example, Yorkies are predisposed to having liver shunts, which is where the blood doesn’t appropriately go to the liver to be processed and to clear things. Unless they have an underlying disease like that, they’re not at an increased risk per se as compared to other things. The one fun fact is that we do see one purebred dog that is not at increased anesthetic risk but has less of an anesthetic risk as compared to mixed breeds, and that is the Cocker Spaniel. If you’re going to invest in that, Dr. Alice will have many more patients.
We have problems everywhere else.
Also, Brachycephalics. The important thing is that as a team, we look for the risk factors before we get started. Since we find out the risk factors, whether it’s a genetic test, my exam, the blood test results, or cardiac evaluation, we’re prepared. The drugs and what we use depend on what we’ve prepared for. Every anesthesia is customized to the patient. What we’re decreasing is our chance of complications because we prepared with known risk factors. The comforting thing for the pet owner is that we can still provide anesthesia. If we can’t, we say, “We can’t,” and that’s pretty rare. Even with those known risks, we can still provide safe anesthesia.
We’re all pet owners, but Janet, as a non-veterinary person. What does she need to tell you about that pet’s habits that could influence what you two are going to do? Is it vomit?
Importance Of Pre-Anesthesia History (Vomiting/Regurgitation Risk)
When you go to the doctor’s office, and they give you six pages of your family history to fill out. I have a two-page questionnaire before I see the pet. One of the questions is, does the pet do any vomiting? If they do, when do they do that? I want to know if they’re vomiting at night, and I want to know if they’re vomiting first thing in the morning before they eat.
What I’m looking for is regurgitation. Vomiting is an act of retching. With regurgitation, it comes up, and it’s usually bile. It’s a yellow bile. These dogs and some cats have reflux or regurgitation. In people, it’s called GERD or Gastroesophageal Reflux Disease. Those are frequent questions that I ask because there’s quite a high percentage of our pets that have that. The last I heard, it was 30%. I think it’s higher than that. Dr. McKune can tell you.
Once I know that, I give some medication to be given at home to help prevent that reflux during anesthesia and for a few days later. The fasting time, the time you give the last meal before anesthesia, the length of that fasting time increases the chance of that reflux. We have a very short fasting time. That’s important to know.
I heard that. That’s contrary to what we were raised with in our early years of vet school. Isn’t that interesting?
That’s right. I have a handout. Everybody who grew up with pets remembers, “We withhold the food for 24 hours and withhold the water.” I’m thinking, “No.” I have a handout because you want to go back to what you’ve been doing for decades. It’s tradition. It’s what you remember. It’s what you’re familiar with. I make sure they have the handout on how to prepare your pet’s food. I can answer any questions that can come up after the exam, but we’re trying to prevent that. It’s quite frequent, but we can manage it.
What about these little Yorkies with tracheal collapse? I would be worried about that as an anesthesiologist.
That’s another thing that you can hear often from the owners. We sometimes hear it in the room when we have patients who have bad airway abnormalities, including LarPar as well as tracheal collapse. The owners will be the ones who might say, “He does a lot of like a honking type of cough or he’s had a recent voice change.” Those kinds of things.
When we hear from owners that there’s been something in the respiratory system that could also be related to the heart in some cases, when it comes to coughing. We want to know more about that information. Anatomy is one thing that we cannot change in the scope of an oral procedure coupled with anesthesia. There are surgeons out there who can make anatomical interventions.
For example, with the tracheal collapse we’re talking about, there are methods where they can place something to help open the trachea up. That’s not something Dr. Hoffman and I can provide in our practice. Whatever abnormal anatomy that animal comes with, especially in the postoperative period. That period after they’ve recovered from anesthesia, but they’re not necessarily back to their normal level of activities. Those kinds of things that are changes to the airway can be pretty significant.
A big part of that requires us to be very vigilant and to monitor them in that post-operative period. If we know those things are present beforehand, even in some extreme cases, we might recommend that it’s a better idea for us to keep that patient hospitalized overnight at an ER that can make interventions rather than them going home with the owner. We are starting to realize that we can have a great anesthetic event, but when we can’t alter the way that an animal comes to us physically. We have to be very thoughtful about how that animal will be in the immediate postoperative period.
Owner’s Role: Pre-Anesthesia Preparation & Post-Operative Expectations
As a pet owner, I’m going to bring my pet in to have surgery or to have dental work done. What am I supposed to do at home? What do I do afterwards? What can I expect in the average pet?
Do you want to address the anesthesia part of that, Dr. McKune?
One of the advances we’ve made in veterinary medicine that I think is wonderful is that we anticipate, because we can’t verbally necessarily reassure a pet. For example, even though they might walk into the veterinary clinic and we might say, “Everything’s fine.” They pick up on all of the cues. They pick up on the owner being stressed to be there. They pick up on the other animals in the exam room that are stressed to be there on all of the scents and everything.
We have started to prescribe in advance of anesthesia medications that can take away a patient’s anxiety. As a pet owner, your veterinarian may ask you to preemptively the night before, the morning of, or both, administer one of these drugs that helps with anxiety. That way, when they present to the hospital, they come in less anxious than they could be. That sets the tone.
I had an anesthesia mentor who used to tell me that the golden rule of anesthesia is thou shalt not upset thy patient. By bringing them in already having a certain degree of calmness, the owner has done us a huge favor by making that patient more comfortable with the whole process. That allows us to reduce the amount of pre-medication that we have to use and the other support measures.
Once we’ve completed anesthesia, we do usually want to keep the pet for the first 2 to 3 hours. Sometimes, it can seem like, “My pet had a procedure that went all day.” In reality, the procedure itself may only have been an hour long, but the veterinarian wants to keep the animal so that they can make sure there are no problems.
We do see, depending on the study you look at, that mortality afterwards, in other words, an animal passing away after they’ve woken up from anesthesia, is anywhere between 47% all the way up to 83%. They make it through the anesthetic event without complication, but in the postoperative period, which can be up to the first 48 hours, they pass away. We take those things very seriously on the anesthesia side. It’s something that we want to hear about from owners. If you are an owner who does have a complication, sometimes as minor as, “He was vocalizing all night or my pet has passed away.” We want you to reach out to us and let us know.
Normal average pets, the biggest things you’ll probably see are patients who are going to have that delay back into their normal return to function. Sometimes, they feel so comfortable after anesthesia that they want to eat right away. Sometimes, because of the anesthetic agents themselves, they aren’t interested in food. That first night, we do tell people to allow the animal to make the choice. If they’re not ready for food, we’re not forcing it on them. We want to try and make sure we send you home with some pain medication to make sure it’s not pain or discomfort that they are not eating because of.
After coming out of anesthesia, we tell people to let the animal decide. If they’re not ready for food, we don’t force it. We also make sure to send them home with pain medication, so if they’re not eating, it’s not due to pain or discomfort. Share on XThe next morning, they should be moving back into the normal eating routine. We do see that it sometimes takes 2 to 3 days for them to return to those normal bowel movements that we talked about earlier. That’s because anesthesia, if we’re doing it right, slows everything down. That slowdown means that we may see a patient who normally goes to the bathroom outside every morning at 8:00. We expect them to urinate normally. If they don’t defecate, then that’s not something that we’re surprised by, but it is something that can be disturbing to the owners when they’re used to a regular schedule.
The senior or the very old, geriatric patients can take even longer than a day. It could be three days before they’re back to themselves.
Don’t pain medications slow that down the GI trends as well?
Certain ones.
I’ve always wondered when they come home and they want to eat, and I say, “Okay,” but then they throw up. Do I need to call you about that?
Sometimes, they don’t want to eat because their mouth has undergone a lot of surgery, or maybe I took a part of the jaw off. There are different things. I always say, and I think Dr. McKune will agree, that we only have them give a small portion of a meal the first night because we don’t want them drinking a whole big bowl of water and eating a big bowl of food because they’re probably hungry.
That’s where they go. They go right to the food and water bowl as soon as they get in the house.
That’s too much. We always have them give up a portion of a meal and small amounts of water. The next day, back to normal volumes of food and water, but if they had oral surgery, it’s going to be soft food for a while.
Keep them on the hungry side, so to speak. I always worry about that. Even with us, when we have procedures, we come home, and we’re like, “I wonder if I should eat.” With colonoscopies and things, you haven’t eaten for, it seems like, weeks. Janet had a family member who had a procedure and then vomited and aspirated. Does that happen a lot, or is it because they’re intubated, and we don’t see it?
That’s the reason we want to know if there’s any vomiting at home during the night and in the morning, the regurgitation. I have seen regurgitating patients vomit through their nose during anesthesia because we didn’t know it was regurgitation patients. What’s the percentage, Dr. McKune?
As Dr. Hoffman was saying, part of the history is critical. What we find is up to 50% of animals, 1 out of every 2 animals, if we have something that evaluates for a change in the pH in your esophagus, the lung tube that connects your mouth to your stomach, and look for change in pH, we’ll see a change or a drop in pH as stomach contents move forward, which are normally kept out of that tube.
Dr. Hoffman and I may see nothing, but if we have a pH meter in them, we’ll see that 1 out of 2 patients will have a change in the pH, indicating that stomach contents are moving forward. What we are worried about is if they move forward far enough up into the mouth. There is another tube there. As we like to jokingly refer to, along with my husband, who’s also a veterinarian, the eating hole and the breathing hole. In that hole that connects them to their lungs, which is where we place the endotracheal tube to keep that safe, if they get fluid far enough forward, they can move that fluid down into the lungs.
We keep a tube in animals. People will sometimes ask, “Does my animal have to have this, too?” They have to have the tube to protect the airway, but we can’t keep that in them forever. As soon as they’re awake and they’re starting to come around, no human or animal loves the idea of something placed within their space to breathe. That’s very foreign. It’s natural for us to cough when we get something down in our trachea. They don’t like that tracheostomy tube, so we have to pull that at some point.
If that animal becomes more relaxed and they’ve had this regurgitation, they can aspirate that fluid. The biggest concern about that is that the fluid has a low pH. It’s very much acid. That acid will burn the inside of their lungs and their trachea, which sets off a whole series of events that can often lead to a patient requiring major veterinary support, which usually is at what we call a tertiary level. Meaning, we’d be at a referral specialist. Most veterinarians don’t have the ability to deal with that. It is something that can also end up in a patient who dies afterwards from everything, so we want to be preemptive then.
As Dr. Hoffman said, if you tell us that this patient has these things, that after a long meal, they bring up some bile and some fluids, we’re going to preemptively have the owner start on things to neutralize the stomach pH. Anybody who has accidentally swallowed water down the wrong hole knows that it’s irritating. You cough, you get it out, and then you go back to living your normal life. If you can imagine drinking a thing of bleach down your lungs, you would probably not just cough it out and go back to a normal life. We know those things in advance. We can have things that will help to neutralize the pH.
We do give things during the anesthetic procedure regardless to neutralize stomach pH, but there are some drugs that do a way better job than others. We can give better drugs in advance, the ones that we give during the procedure. They’re the ones that are meant to act quickly to reduce pH. Not necessarily to be the best, but to act very quickly with all that. We also employ other things that might help to keep things moving forward so that we don’t have fluid that’s brought up. We can never fully prevent something that’s passive, like a regurgitation, but we can mitigate the side effects that might happen.
The Power Of Personalized Care & Pet Advocacy
Do you know what I love about what the two of you do together? Much of human medicine, and Janet, I think you would attest to this, is like factory farming. They try to act like it’s personalized, but it truly is personalized and geared toward each individual patient what you both do and what I did as a dermatologist, too. There are no too allergic dogs and allergic cats that are alike. I appreciate you taking each patient as an individual. Isn’t that what we all want for ourselves? Not to mention our pets. Dentistry and anesthesiology are still wonderful because of that. We’re so lucky to be practicing with such good individualized patient care.
I learned a lot about the safety of anesthesiology. As a general layman pet owner, you hear all this around you, like, “They knocked him out for five hours.” It’s not all true. Now, I know that there’s a recovery period. I’ve had to go under general, and it’s not so bad. You’re off, and you don’t remember a dang thing, and everything’s fine.
That’s because you had a good anesthesiologist.
That’s right.
We appreciate you two.
This has been wonderful. I’ve learned so much. Janet, we have to have them back on again.
We have a question for Dr. McKune and Dr. Hoffman. Tell us what your pet or human peeve is, please.
I’ll start because I’ve been doing some reflection on all of that. My biggest pet peeve, and it’s going to sound very cliché to say this after this episode, is when people don’t advocate for their own patient. I don’t mean that they do that out of carelessness. It’s not that they’re like, “I don’t care what happens with this animal.” It’s when they feel bullied by the staff or when they feel like they don’t get along with the veterinarian, and they accept that this is what it has to be.
As Dr. Hoffman and I work so closely together, we’re blessed to have a wonderful relationship. We are oftentimes sought out for people who are advocating for their own animal. Yet, I know many other times where animals have had a complication, and somebody says, “I wish when I said this, somebody listened.” If you feel like someone is not listening to you, there are veterinarians that you can reach out to.
If you feel like someone isn’t listening to you, there are other veterinarians you can reach out to. It’s a wonderful thing for your pet to have the same kind of strong, trusting relationship with a veterinarian that you have with a good friend. Share on XIt’s a wonderful thing for your animal to have that same good quality relationship with your veterinarian that you have with a good friend. I feel like that’s Dr. Hoffman and my relationship. We’ve been on the phone together several times. We collaborate on things. That synergism allows the best outcome. If you don’t feel synergistic with your veterinarian, it’s important for you to maybe evaluate other veterinarians in the area that you might have that same relationship with, so that the animal can succeed and do well. They need that from you.
That’s great advice. Can I cut in before Dr. Hoffman? Can I say this? It’s because you both care. That’s what it comes down to. I’m sorry, Dr. Hoffman. You go for your pet peeve. I’m so impressed by their caring and devotion. It’s wonderful.
It’s hard for me because I struggle with that. Mine is not going to be as poignant as Dr. McKune’s. I don’t like it when fast food isn’t fast.
Name names.
I don’t do that.
Being a vegetarian, I hardly ever eat fast food.
There’s some great fast food.
Where? Anyway, this has been so great. We hope you’ll join us again. I loved every minute. I was counting on every word. You remind me of me. That’s what I love about veterinary medicine. People like you.
We have some human owners who need that valium prescription.
That is true.
We talk to all owners and tell them afterwards that, as the patient is being anesthetized, they need to take a moment of it and give themselves a little bit of grace. It is hard to get your pet to that point where they’re ready. Sometimes, the hardest thing in this society is to take a few minutes for yourself, reward, and congratulate yourself for all that work and effort. Give yourself a moment to breathe.
You started with a story about you going to the dentist and getting stuff, and you wish you had had sedation. This is true. People want anesthesia or sedation for themselves, not for their pet.
That’s true. Thank you both. We appreciate it.
Janet, we’ll wind it up, but we haven’t seen the last of this dynamic duo.
You need T-shirts with the Dynamic Duo.
We love them.
I see the logo already. You knock them out with their teeth or saw their jaws.
We call Dr. Hoffman, the Tooth Fairy. I’ll be the Sweet Dreams Fairy. We’re the fairy team.
We’re going to close it out. This is Dr. Alice Novotny Jeromin.
Also, Janet Novotny King, saying thanks for joining us. We’re the Novotny Sisters from good old Cleveland, Ohio. Thanks for tuning in. Don’t forget to follow us and like us.
Bye.
Important Links
- Sharon Hoffman on LinkedIn
- Carolyn McKune on LinkedIn
- Mythos Veterinary
- Speaking of Pets on Apple Podcasts
About Dr. Sharon Hoffman
Dr. Sharon Hoffman has a BS in Animal Husbandry from Michigan State University, a DVM degree from Louisiana State University, is a Diplomate of the American Veterinary Dental College, and has completed the Sollecito One Health Fellowship in Oral Medicine from the University of Pennsylvania.
She is the owner of Veterinary Dental Consulting in Florida and adjunct faculty at the University of Florida College of Veterinary Medicine. She has been awarded the Gold Star Award for outstanding contributions to Veterinary Medicine in Florida.
When Sharon is not relieving pain in the mouths of her patients, you will find her behind her camera pursuing her passion for photography. Her photography is available for purchase at Fine Art America. She also volunteers as the photographer for The Street Dog Coalition in Jacksonville.
A portion of proceeds from her photography sales is donated to the Make Me Smile Program. This program offers free equipment and training to shelter veterinarians and technicians, so adoptable dogs and cats can receive dental care before adoption into their forever homes.
About Dr. Carolyn McKune
Carolyn, a Spartan, received her Doctor of Veterinary Medicine (DVM) from Michigan State University’s College of Veterinary Medicine. After a year of private practice, she followed her husband to Washington State University to instruct students on common soft tissue procedures. The need for structured perioperative patient advocacy incited her to learn more; she went on to complete an internship at Washington State University and a residency in anesthesia and critical patient care at UC Davis. In 2009, she became a boarded Diplomate of the American College of Anesthesia and Analgesia.
After spending nearly 3 years as anesthesia faculty at the University of Florida, she launched her own independent veterinary anesthesia consultancy, Mythos Veterinary LLC. That experience provided her the opportunity to work at universities and veterinary centers all over the globe. While she took a brief hiatus of 6 years to serve as Chief Anesthesiologist and Medical Director for a local specialty practice, she missed the best boss she ever had: herself. She has returned to work full-time at Mythos Veterinary-veterinary anesthesia that keeps climbing, providing both physical and virtual anesthesia services.