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We get asked this question all the time. Dr Barron and Ellen answered questions during one of their famous “Coffee Talks”.
You may want to catch one of these talks on Facebook Live on Wednesdays. A transcript precedes the talk.
Today we’re going to show you, using this really cute stuffed animal, how we monitor cats under anesthesia. Because we always have questions about, “Oh, what do you actually do? Why is a dental so much more than when I have a dental when I go to the dentist?” Well, because they’re under anesthesia. And anesthesia, it has a lot of risks which can be avoided or minimized if we do proper monitoring. So that’s why we do monitoring. But Ellen, quick question. This is on every anesthesia– everything I’ve ever done. What is the most important part of monitoring anesthesia?It’s always a person. All of the tools tell you what’s going on, but the person has to know if something’s wrong. So that’s part of the reason anesthesia’s so expensive. Because we need so many people staring at the cat, and the machines, and the beeps.Right? And the machines only complement what we can do. Of course, our number one tool we always use under anesthesia is a stethoscope. But the pieces of equipment we’re going to show you today actually help us determine if we’re starting to have an anesthetic-adverse event earlier–Which we need to work on.Okay. So let’s start. So first, we sedate the cat. We give it an injection. Okay. Then sometimes they throw up. Okay. That’s done [laughter]. We don’t want them to, but sometimes it happens. Then we go ahead and we put in an IV catheter. We usually use the inside of the back leg because then we don’t have to shave as much on the front, and the cats don’t go after it. And then we–It’s more aesthetically pleasing too to a lot of our clients. It’s one of the reasons why we got into the habit of that. Also, if that cat needs a long-term indwelling catheter, those front legs are your best friends. So if we’re doing this very short-term procedure, just for maybe a couple hours or so, that back leg is perfectly acceptable.Right. Plus, it also helps that we put your pet on IV fluids during their procedure which helps keeps them hydrated because they have been fasting for several hours. It also helps keep their blood pressure up because when you are under anesthesia or you are sedated, your blood pressure is going to be compromised from the pharmaceuticals that are used. So we want to make sure that the body can keep up that blood pressure and actually process those drugs properly too. So you have to flush your system out.Yes. It’s important. Okay. So IV catheter is placed. We put an E-tube down your throat. We’re not going to show that because that’s not going to fit on this guy. It’s bigger than him, or her. I don’t want to say it’s a him or her. It’s the cat. Feel like he needs a name. Do you want to name him?I just think he’s Bravecto-cat.Bravecto-cat. Bravecto is great. We won’t talk about that today, but it’s great. Let’s call him Bob. Okay. So Bob then has the E-tube put down. That’s how we breathe for them. We inflate it. We do whatever we need to do before surgery once he’s hooked into the gas machine. So let’s say it is– let’s say it’s a foreign-body procedure because those are fun for me. Not for the cat, for me. So then we’re going to prep him here. While he’s being prepped, Ellen, what’s the next step?He is hooked up to everything so he gets– he’s literally being prepped for surgery. We’re done with the IV catheter. He’s now on his back.He has a tube in.
. But what we’re going to do now is we’re going to hook him up to oxygen, and we are going to– first thing we are going to attach the anesthesia machine it’s– this is our capnographer.And this actually checks the cat’s end-tidal CO2, which helps determine their ventilation. It lets us know that they are actually moving enough oxygen and carbon dioxide in and out of their body and, plus, it also counts the respiration for us, even though we will still visually do it and listen to your cat’s lungs under anesthesia, this can give us an indication by the numbers if this cat is starting to get too deep under anesthesia, or the cat is starting to become a little too light under anesthesia. So it helps us determine what the depth of anesthesia by the end-tidal CO2. So that gets hooked up immediately to your pet. Now they’re on oxygen. They’re on gas. Next thing that starts to get hooked up to them is our ECG monitor that also has a pulse oximeter on it. And what does ECG do?ECG tells me the electric current of your heart and if it’s appropriate. There is a specific way it’s supposed to look when it’s under anesthesia because there’s a specific line through the heart, where the beats are supposed to go. So the lup dup is a certain way it’s supposed to happen. If that is abnormal, if it’s taking too long in the lup, if it’s taking too long in the dup, if it’s going dup lup, or if the current is going the opposite way, which can happen, then we can see it, and then we can do something about it. It’s very important for us to see this because even though it’s not common for there to be an issue, there is an issue, we need to know, and we need to know what to do. Also, sometimes when cats and dogs, well more dogs, start to go under anesthesia – I know we’re talking about cats, but it’s worth it just to say – they can have different, not just the way the ECG is supposed to look, but there’s also a rhythm to it, and if the rhythm is abnormal, that’s important to see as well. So that gives us a lot of information about what we can do because some of the sedatives can give you an arrhythmia, or drop your blood pressure, or do a lot of different things. So if that’s happening we need to know so that we can fix it before it becomes detrimental to the pet.Right. And it also gives us an early indication, are you getting ready to go into cardiopulmonary arrest. We can catch that earlier on these devices than we can, a lot of times, listening to the patient. Because they may sound perfectly normal 20 seconds ago, and all of a sudden, the screen on this machine starts not looking correct. We can catch everything early and start treating appropriately before we have a disastrous event starting to occur. And the nice thing about this little gizmo, it also has a pulse oximeter on it, and these little guys basically checks your heart rate and also does your oxygen saturation rate to make sure, do we have enough oxygen going to you? You better be at 100% the entire time.Or their ear. Or their tongue. Anywhere that’s pink. Black things tend to have a little bit of more of an issue. So we tend to use their tongue or their ears. This piece of equipment is the same thing. It’s just simply a pulse oximeter. That is it. Versus–That way we can see it.–the smaller gizmo. We can see the waves and everything from the electrocardiogram, etc.And on top of that, while we have that going, we’re also hooking up your cat’s blood pressure monitor. And blood pressure is just equally as important under anesthesia because, well, this is the pressure of the blood against the vessel walls. It can go too high. It can go too low. It can also be an indication that we’re starting to have a problem, as well. Especially if you already have a patient that already has compromised blood pressure before going under anesthesia.You might have a normal rhythm, but if your blood pressure is dropping– the reason we need more than one machine telling us all these different things is so we can monitor effectively. Because all of these machines give us different information that helps us decide which drugs, or if we need to turn the gas down, if we need to give you some type of drug to [ox?] out what’s going on. If you’re too light. If you’re too low. There’s a lot of different things, and these all give us different types of information to help us choose what to do next. That’s why it’s all so important. Okay. So that’s all stuck in. Cat’s ready to go have a foreign body.Wait, this is important. You have to have the temperature checked.Yeah. We do that too.It is. And then they go, and they’re under anesthesia, and everybody’s staring at them. It’s fun. It’s fun to do, and it’s important to make sure that they’re monitored correctly because they’re members of the family, and they should be treated as such.Right. And then everything is put down on a flow sheet, and we can document your pet’s trends the entire time. Where if we have started having any problems occurring, or if they have been a smooth-sailing anesthesia the entire way. So this is–Not only is that important for this anesthesia, but if they ever need to have anesthesia in the future, then we can see, “Oh, wait. This one’s a little bit sensitive to opioids. We might not want to give that drug.” Or, “Wait. This one went a little bit low. Why don’t we pre-treat with glycopyrrolate or something?” So everybody’s an individual, so we need to treat as such. And that’s why it’s important to have that in the medical records, so we know what to do in the future. It’s the same thing like I can’t have Sudafed. It knocks me out. I know it says it’s non-drowsy, but it knocks me out. But I know that, and my doctors know that. So I don’t get that. Same idea. Okay. Does anybody have any questions for us because this cat had a very successful anesthetic procedure? Oh, you know what we should say? What are the most two important– well, the whole thing’s important to monitor, but what are the two the most important times to monitor closely because that is when a pet or person is most likely to have a complication? Anybody there? Anybody know? At the beginning, at induction, and during recovery. So that’s why we stare at them all day. We’re still staring at our patients from earlier.Yup. That’s why someone needs to be dedicated monitor for the pet the entire day. It is very common to have a post-operative anesthetic death because someone’s not paying attention to the oxygen saturation of the patient. If they are not awake enough, or they’re not reversed, or they’re not metabolizing their drugs properly, that can be a big issue. Their temperature can get too low. That can be a big issue. So all of these complications can play a role into a successful post-anesthetic recovery. We want to make sure that your patient that we have that day, they wake up within 20 minutes of their procedure comfortably. There are some patients that will take a lot longer to recover because we want them to take a longer recovery due to the type of surgery we performed. Especially if we want them to recover really slowly from a gastroenterotomy, or an amputation, or whatever. Because we want them to recover slowly. Because we don’t want them to hurt themselves. So there is different sets on how you can recover your patient. But effectively waking them up at a nice, steady rate and paying attention to them the entire time is vitally important for them. So our patients don’t get to go home minimum of three hours after their procedure. When they’re here they might be up, they might be eating, but we require that you will stay with me for three hours to make sure I don’t run into any complications postoperatively that a doctor needs to address.Yes. What is the most common complication post-anaesthesia when you bring your pet home from the procedure. Is a URI common after intubation?Oh, an upper respiratory infection? It sure can be a complication, and we’ll tell you why. Your pets can have an upper respiratory post-anaesthesia. It could be from stress. A lot of times we see cats break out with a herpes flare-up. It’s pretty common. It was a stressful event. Some cats may have an underlying upper respiratory as it is, and we go and we intubate them, and we hear that their lungs don’t sound as great suddenly, or when we extubate them there’s a big glob of boogers on the end of it. Well, something’s been going on, and now that we’ve stuck a tube down there, we stressed them out, and now we’ve aggravated it. Or a worst-case scenario is that that endotracheal tube, that was used on that patient, wasn’t clean or brand-new beforehand––it can happen. Worst-case scenario they’re given a tube that hasn’t been cleaned properly, and now you’ve just passed germs back and forth through each other. But the most common effect is I get a herpes flare-up right after surgery. I’m a cat. You just brought me into the office. Now I’m going to have an upper respiratory infection.Because remember, all cats have herpes. It’s just how it is, and during times of stress their herpes comes on as walking around like this and having a gunky eye or upper respiratory seizing. So it’s a viral issue, and then it can open the gateway for a secondary infection. Also, cats are a species of prey and predation. They are the masters at hiding everything from us. So it’s not unlikely for a cat to come in that we all think is perfect. Its bloodwork looks perfect. It sounds perfect. Everything is perfect. And then the next day, after a procedure which was routine, there was no issue, they come in and something else is going on. It just happens because that’s the nature of the beast or the nature of the cat. One of the things we were saying earlier with complications, I had a dog I worked on a while ago, and when she woke up from anesthesia she was fine, but she was a Bulldog. And about an hour after she had woken up, and she had been fine under anesthesia; she was fine at extubation; everything was okay. She just had a really hard time breathing. We actually had to sedate her and re-intubate her, and she had to stay intubated and go to the ER for about two days to help her clear a pneumonia that just occurred. She didn’t have pneumonia before. Sometimes it can happen. It’s usually in Bulldogs. And luckily she was okay. But that’s why you have to stare– that’s why the patients are stared at for so long because if something bad happens, we need to act fast. You don’t act slow with the anesthesia. You don’t’ just sit there, and wait, and not act when you see something’s going on.At what point to you remove the catheter after the procedure?Now, it all depends. Now, if I have a patient that has had complications postoperatively, you bet you that IV catheter’s probably going to stay in until we’re getting ready to go home.But usually, when the patient is sitting up, they’ve been extubated, they look comfortable, remove the IV catheter at that point in time so they can finish recovering. Because you have to remember, some of our patients that we get are a little fiery and spicy. And so removing them from the cat kennel again can cause further issues. But we make sure that it’s usually within a half an hour of them recovering that that IV catheter gets to come on out. Unless they are a critical patient who’s been under surgery for quite a long time or a cardiac patient that we don’t want to take any chances with, we’re going to leave that catheter in until the very last momentYup. And you can find either a feline-friendly hospital – do your research; make sure it truly is a feline-friendly hospital – or look up ones that are feline-specific only.