Anesthetic and Surgical Considerations
Practitioners will find the 2020 AAHA Anesthesia and Monitoring Guidelines for Dogs and Cats to be a useful, comprehensive supplement to this section of the Senior Care Guidelines.16
Senior pets may require general anesthesia for surgical and nonsurgical procedures, such as dental care, to treat ailments and/or improve their QOL. Advanced age alone is not a contraindication to general anesthesia. Senior pets can safely undergo multiple anesthetic events if necessary. Medication choices and other precautions should be considered to minimize the risk for the pet. Because clients may have additional anxiety about anesthesia for their senior pet, the role of the veterinarian and technician includes reassuring the client of the indication for and safety of the procedure.
An anesthetic evaluation should include a preoperative physical examination, focusing on diseases that may increase risk. In addition to the physical examination, preoperative laboratory tests should be performed, with a specific focus on renal (creatinine) and cardiac function (N-terminal pro B-type natriuretic peptide). Imaging, including radiographs and ultrasonography, may also be indicated. Preoperative care may include preprocedural IV fluids in a patient with compromised renal function, where fasting or anxiety associated with hospitalization may decrease normal water consumption. Preoxygenation may be recommended for patients with cardiovascular or pulmonary illnesses.
Induction, maintenance, and monitoring anesthesia are also significant, and checklists and anesthetic forms may be used to minimize risk and complications. A dedicated, trained technician with a checklist can focus on monitoring anesthesia and be prepared for any potential complications associated with either the individual patient or specific risks associated with the procedure. Checklists can be comprehensive and may include handling of the pet, padding for the animal, monitoring tools, surgical needs such as blood product availability if hemorrhage is a potential complication, preoperative and postoperative analgesia and other indicated medications, a validated pain scale that is species specific, and a postoperative plan and patient discharge instructions. To lessen mobility complications, senior pets should be kept warm, handled gently, placed in a comfortable position, and kept on a well-padded surgical or treatment table. To minimize the time of anesthesia for the pet, it is recommended that the surgeon be readily available at the time of anesthesia induction. Other considerations for anesthesia with a senior pet may include titrating doses of anesthetic agents as lower doses may be needed. Postprocedural analgesics should be prescribed as indicated by the procedure; consider that the dose needed for opioids and other analgesics may be different for senior pets. Validated pain scales can be very useful for postoperative analgesia care.12
From a surgical standpoint, the benefit to quality or quantity of life should be established with the client before surgery is performed. Many surgeries, including dental procedures, can result in substantial improvement in QOL. However, perhaps the biggest predictor of postsurgical QOL is preprocedure function; for example, a healthy, robust 15 yr old terrier would be expected to recover quickly from a mass removal, whereas a 13 yr old Labrador mixed-breed dog with geriatric onset laryngeal paralysis polyneuropathy (GOLPP), severe osteoarthritis, and International Renal Interest Society (IRIS) stage 3 renal disease may require a longer recovery time.68
The surgeon should be experienced with the procedure and/or have adequate training in similar techniques. All necessary equipment should be prepared and potential surgical needs anticipated (e.g., implant, specific instrument). For senior pets, recovery times are improved with speed of the procedure and meticulous focus by the surgeon. Perioperative antibiotics and pain management should be provided if indicated. Postprocedural return to function is enhanced with appropriate analgesics, and physical therapy/rehabilitation may also lead to a more rapid return to function.