Senior dog anesthesia can be a controversial topic. Is your dog is too old for anesthesia? Is living with the status quo better than risking anesthesia? Integrative veterinarian Dr. Julie Buzby guides you through how to make this decision in the best interest of your dear old dog.
When is a dog too old for anesthesia?
As a veterinarian, I have a healthy respect for anesthesia and understand my clients’ fears. Anesthesia is essentially the process of taking a living being to the brink of death—obliterating many life-preserving reflexes—and then bringing that being back to life again. It is never, ever without risk. I calculate that risk for any dog undergoing anesthesia, regardless of age—weighing risk versus reward.
Senior dog anesthesia is a calculated risk
More often than not, when I tell people I’m a veterinarian, their first reaction is to tell me that they love animals, but could never have worked in veterinary medicine because dog euthanasia is too sad. While I obviously wish all dogs lived forever, euthanasia is not where the biggest gut-punch lies for me. Losing a patient under anesthesia is what I lose sleep over.
A decade ago, I lost a patient named Teddy under anesthesia. Teddy the Pug would probably have been considered over 100 in “human years,” which, of course, was a concern as we considered anesthesia for an elective procedure. By this point, he had more rotten teeth than healthy ones, so it was my professional opinion that the benefits outweighed the risks for Teddy having a complicated dental procedure involving over a dozen extractions. I can say with confidence it’s what I would have done for my own dog.
Anesthesia for oral surgery in senior dogs
Teddy’s mom agreed that he was in a lot of pain and that the anesthesia for oral surgery was a risk worth taking. He might have been in his golden years—when many would argue anesthesia is just not worth it—but the hope of eliminating his pain made the decision obvious.
I contacted board-certified anesthesiologists before the surgery to discuss my concerns and formulate a customized anesthetic protocol based on age, lab results, and physical condition.
The dental procedure took over two hours and Teddy’s vital signs were perfect. No red flags. I worked as swiftly as I could to extract the abscessed teeth and suture the flaps of gum left behind. Meanwhile, my conscientious technician monitored Teddy’s anesthetic depth, heart rate, respiratory rate, body temperature, blood pressure, and blood oxygen levels, and we made adjustments in Teddy’s anesthesia accordingly.
She carefully recorded this data every few minutes on a chart, which she held on a clipboard, so we could monitor trends. We gave Teddy intravenous fluids before and during the procedure to maintain his blood pressure and hydration.
When the unexpected happens…
Finally, I tied the last suture and stood up to stretch my aching back. Despite my fatigue, I felt proud of the work I’d done. I expected this surgery would be life-changing for this dog. I knew that Teddy would have a few rough days, during which we would be aggressive with a cocktail of pain medications. But then, as he began to move into the healing phase, I truly believed he would be a different dog—acting years younger.
Major dental work for dental disease in dogs can be a fountain of youth for senior dogs. I had witnessed this transformation dozens of times. I couldn’t wait to watch him bloom.
As I wrapped up my medical notes, my technician turned off the anesthetic gas. This allowed Teddy to breathe pure oxygen from the machine as we cleaned up his mouth, which was standard procedure.
Seconds later, Teddy veered off the normal path of recovery. Instead of slowly waking up…Teddy died.
Alarm bells sounded on our anesthetic monitoring machines. He had no heart rate. No pulse. No respiratory rate. We immediately began chest compressions and breathing for him through the anesthesia machine. We had all hands on deck as we drew up drugs and pumped them into his blood stream in an attempt to restart his heart.
Loss and love…grief and grace
As the scene unfolded, my mind jumped to Teddy’s family. Here he was, dying in my care, and his family was elsewhere, going about their day, unaware of the crisis. While we worked on Teddy, my receptionist immediately got a family member on the line so I could briefly alert them that Teddy had taken a turn for the worse.
By the time they arrived, Teddy was officially gone. The grief in our office was palpable, shrouding the soul of every one of us in the building. I will never forget the reaction of Teddy’s parents, which I was dreading. They wept with us–and they extended an incredible amount of grace. They knew we did our best and they told us so.
Once again, I reached out to the same specialists who helped me strategize the anesthetic protocol we had used for Teddy. I explained the entire story and provided the data which we had charted on the clipboard.
They all arrived at the same conclusion: Teddy had most likely suffered a pulmonary embolism—a clot which blocked blood supply between the heart and lungs. We couldn’t have foreseen this. There was nothing that we could have done differently. But that didn’t change that fact that Teddy was gone, and I had been responsible for his life that afternoon.
While this situation was incredibly tragic, what happened to Teddy is not common. Studies show that approximately 99.8% of healthy dogs that are anesthetized live to tell about it.
While it’s true that age and infirmity are risk factors that make the odds less rosy, through custom-tailored anesthetic protocols and diligent monitoring of patients under anesthesia and in recovery, I believe the rewards often outweigh the risks.
Next, let’s learn some protocols that you can discuss with your veterinarian to help reduce those risks.
5 ways to reduce the risks of anesthesia for older dogs
1. A thorough pre-anesthetic work-up
Any dog undergoing anesthesia should have a diagnostic evaluation directed by his or her veterinarian. These often include a physical exam and blood work, and can include more advanced diagnostics such as X-rays or ultrasound. The recommendations can vary based on your dog’s age, breed, overall health, and what procedure he or she is undergoing anesthesia for.
Typically, geriatric patients will have a more advanced work-up than young, healthy dogs.
Have a discussion with your vet about what tests may be recommended for your dog prior to anesthesia. Veterinarians can tailor anesthetic drugs and procedures based on the results of these tests to minimize the risks associated with anesthesia.
2. Anesthetic monitoring
All dogs should be monitored under anesthesia, but this is especially crucial for older dogs who may have sudden issues with their vitals. Anesthetic monitoring can be anything from a dedicated technician monitoring heart and respiration rate, to a pulse oximeter measuring oxygen levels, to an EKG, a capnograph measuring carbon dioxide output, blood pressure monitoring, and more.
Some of these tests require special equipment, and not all veterinary hospitals have advanced monitoring. Before your dog has an anesthetic procedure, have a conversation with your veterinarian about how your dear old dog will be monitored during the procedure.
For some dogs, it may be prudent to have the procedure done at a specialty referral hospital, where they have more advanced equipment and even board-certified veterinary anesthesiologists to monitor patients.
3. Stabilize underlying health conditions
Anesthetic risk increases with age, but underlying medical conditions can exacerbate this risk. Heart disease, diabetes, Cushing’s disease in dogs, thyroid disease, and other chronic issues can cause problems under anesthesia. Veterinarians can manage most of these conditions with medications, and try to make sure things are stable before proceeding with anesthesia whenever possible. Geriatric dogs with chronic medical conditions may also require more specialized blood tests as part of their pre-anesthetic work ups.
4. Post-op monitoring: senior dog anesthesia recovery
You may be surprised to hear that the most dangerous time for anesthesia is actually the first three hours after the procedure is completed. Statistically, this is when most animals have adverse anesthetic events. Just like what happened with Teddy, animals can do great during surgery and then have life-threatening complications during recovery.
Post-operative monitoring is critical for any patient, and this is even more important in older dogs who may have more trouble with breathing and circulation. Your vet will have a plan for pre-operative testing, intra-operative monitoring, and a post-op plan as well. For more intensive procedures, he or she may recommend your dog stay overnight, or be transferred to a 24-hour facility if needed.
5. Avoid it: Skip elective or cosmetic procedures
Every anesthetic procedure involves a risk/benefit analysis. In older dogs, the risk is higher, so we need to make sure the benefit of what we’re trying to do is higher as well. Cosmetic or elective procedures may not be worth it.
Explore whether local anesthesia may be a possibility. Of course, for lifesaving procedures, or procedures where the quality of life improvement warrants the risk (like with Teddy’s dental), anesthesia may not be avoidable and can be under the guidance of your veterinarian.
Caring for a senior dog often means making difficult choices
I’ve been transparent about a situation that haunts me to this day. But please don’t miss my take-home message:
Age is not an excuse to do nothing. I believe this is a message even Teddy’s parents would preach.
Living with pain in dogs doesn’t have to be the case. It was not good enough for Teddy, for Teddy’s family, or for me. We had the opportunity—and good odds—to dramatically change Teddy’s quality of life for his remaining days, months, and years. If I had the same odds, I would have made the same choice.
Anesthesia for dogs is not determined by age alone
I love my senior dog patients, and I want what’s best for them. I find myself frequently having conversations with pet parents convincing them that their dogs don’t need to live in the status quo because they are “too old to do anything about it.”
While certain conditions make the risk of anesthesia for dogs far greater than the reward, age alone is not the only factor that shuts the door on the possibility of anesthesia.
Speak with your vet about anesthesia for your old dog
If you’ve been nervous about anesthetizing your senior dog for a recommended procedure, I have some homework for you. Talk to your vet. Have a frank discussion with him or her about your concerns and learn about the risk-reward ratio. You may be surprised at the possibilities!
Are you considering anesthesia for your senior dog?
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