Anesthesia, sedation, and analgesia considerations
Click to access the 2011 AAHA Anesthesia Guidelines for Dogs and Cats.
Fear of anesthesia is the most common cause of clients’ decisions to forego dental procedures for their pets.60 Canine and feline patients in need of medical or surgical procedures requiring anesthesia can be managed to maintain a favorable balance between risk and derived benefit. Medically important and indicated procedures should not be absolutely discouraged based on chronologic age or most underlying comorbidities. The most recent AAHA/AAFP Pain Management Guidelines provide the entire veterinary care team an opportunity to revisit the pathophysiology of pain and intervention strategies and associated pharmacology/pharmacokinetics of treatment.
General anesthesia with endotracheal intubation, appropriate monitoring, and physiologic support is necessary for dental procedures, including dental cleaning and scaling as well as more advanced dental care. Expert opinion and published data strongly support the use of general anesthesia for dentistry. So-called “anesthesia-free” dentistry has not been shown to be safer or comparable to the capacity to supra- and subgingivally clean teeth in an anesthetized patient and is therefore unacceptable.2,61 Click here to learn more about sharing facts with pet owners about nonanesthetic dentistry.
Any dog or cat presenting for anesthesia should be considered on an individual basis. Anesthesia for older dental patients and those with comorbidities requires special attention. Each patient will have specific physiologic alterations or diseases unique to that individual. Thus, the anesthetic protocol needed for one patient typically will be quite different from that needed for another. The use of local anesthetics as dental blocks dramatically decreases the depth of general anesthesia needed, and thereby helps support blood pressure, decreases ventilatory depression, provides analgesia, and generally increases safety. Additionally, anxiolytic administration prior to veterinary visits has become routine to decrease stress in some patients. The synergistic effect between anxiolytics and other drugs necessitates consideration for decreased amount of premedication, induction agents, and maintenance anesthetics necessary to achieve the desired effect and should be considered when formulating an anesthetic plan.
As with any patient, a thorough and complete history and preanesthetic examination should be completed. Any previous anesthetic experience with the patient should be noted, and close attention should be paid to any anesthetic complications or abnormal responses. A minimum database including laboratory evaluation and imaging will be individually developed. Additional diagnostics will be indicated for some dental patients based on clinical signs, practical availability, and client consultation. Any abnormal preanesthetic findings should be thoroughly evaluated and delaying the anesthesia and surgery should be considered if necessary to address any potential problem areas identified. Veterinarians must be in tune with their clients, their patient’s psychosocial issues, and the existing human–animal bond. Often, stressed and compromised animals do not thrive at the veterinary practice, away from their families and homes.
Considerations should be made to make the dental stay brief and less stressful. Outpatient techniques with prompt return of the patient to familiar settings and routines are highly desirable for all dental patients. A gentle approach, both in pharmacology and in the application of clinical techniques, is especially important and will benefit all patients. Support of the human–animal bond is an important goal, and dedicated emphasis on the reduction of fear, stress, and pain is always warranted and primarily addressed through management and behavioral modification. Anesthetic management represents a powerful combination of additional modalities.