Is My Dog Too Old For Anesthesia?

Senior dog anesthesia can be a stressful subject. 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 much as I wish I could give a definite age beyond which anesthesia is unsafe for dogs, there is no universal number. While certain conditions make the risk of anesthesia for older dogs far greater than the reward, age alone is not the only factor that counts. Senior dog anesthesia is a calculated risk. For dogs of any age, we always want to make sure the benefits of the procedure outweigh the inherent risks of 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—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 of managing dental disease in dogs outweighed the risks. 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 her senior dog 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 an obvious one.

The dental procedure took over two hours and Teddy’s vital signs were perfect the entire time. 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 my patient’s anesthetic depth, heart rate, respiratory rate, body temperature, blood pressure, and oxygen levels. We made adjustments in anesthesia accordingly.

When the unexpected happens…

Despite everything looking great during surgery, after we turned off the anesthetic gas, 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 CPR. We had all hands on deck as we attempted 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, we 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. 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 we were able to see past our grief, we took another look at Teddy’s anesthetic protocol to see if there was anything we could have done differently. We discovered that 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.

Older dog sedation protocol: 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. Generally anesthetic work-ups include a physical exam and blood work (complete blood count, blood chemistry). In individual cases, more advanced diagnostics such as X-rays or ultrasound may be indicated. These 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 saturation, 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 practices 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. Some of these conditions include:

• Heart disease
• Diabetes
• Cushing’s disease in dogs
• Thyroid disease
• Kidney disease
• Liver damage
• Seizure disorders

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.

If your dog has any manageable chronic conditions, it is always a good idea to get them to a stable point in their disease management before undergoing anesthesia, unless the procedure is an emergency.

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 senior patient, animals can do great during surgery and then have life-threatening complications during recovery from anesthesia.

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 greater as well. Cosmetic or elective procedures may not be worth it.

Of course, for lifesaving procedures, or procedures where the quality of life improvement warrants the risk (like with my patient’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

Although the risks associated with anesthesia can be scary, please don’t miss my take-home message:

Age is not an excuse to do nothing. 

Living with pain in dogs doesn’t have to be the case. Even though Teddy’s case ended tragically, I do not think we made the wrong decision to move forward with his dental surgery. We had the opportunity—and good odds—to dramatically change Teddy’s quality of life for his remaining days, months, and years. If I could do it over, I would make 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 discomfort because they are “too old to do anything about it.”

While certain variables 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.

Frequently asked questions about anesthesia for senior dogs

While each patient and anesthetic procedure have their own considerations, there are some common questions that should be addressed if your older dog is undergoing anesthesia.

What are the side effects of anesthesia in older dogs?

Anesthesia does carry some expected side effects. Some of those are more pronounced or more dangerous in older dogs, especially if they have other underlying conditions. These effects may include:

• Low heart rate (bradycardia)
• Low blood pressure (hypotension)
• Low blood oxygen (hypoxemia)
• Low body temperature (hypothermia)
• Prolonged recovery

These are expected effects of anesthesia, but if left unchecked can become life-threatening. This is why careful anesthetic monitoring is so important.

How long does it take an older dog to recover from anesthesia?

It is common for older dogs to take longer to recover from anesthesia than their younger counterparts. Their metabolisms are slower, and that includes more than just processing food. Many organ systems slow down a bit as dogs age. With kidneys and livers that may not be 100%—even if we don’t see bloodwork changes—older dogs generally take longer to metabolize and clear anesthetic drugs.

Recovery time varies. It not only depends on the patient’s age and condition, but also on the types of medications used and the length of the anesthetic procedure. The longer a dog is under, the longer it will take them to wake up.

Some of the anesthetic medications we use are reversible, so if a dog is experiencing a prolonged recovery, we may be able to give them a reversal medication to counteract the effects of the anesthesia. This is one of the considerations veterinarians take into account when developing an individual anesthetic plan.

How does anesthesia affect older dogs?

Older dogs are more likely to have organ dysfunction that may decrease their ability to handle anesthetic agents. Unfortunately, bloodwork is not sensitive enough to detect very mild organ damage. So even a patient with perfect bloodwork may have some troubles with metabolizing anesthetic drugs.

Generally older dogs don’t have a lot of unique anesthetic risks based on their age, they just have an increased chance of having side effects. Higher risks of effects like hypotension and hypoxemia can be dangerous in our older patients.

Sometimes older dogs can experience more confusion as they wake up from anesthesia. This confusion usually resolves within a few hours of waking up, but sometimes can last for a day or two.

What should I expect as my senior dog recovers from anesthesia?

Each dog handles anesthesia differently. Some dogs pop right up like nothing happened, and some take hours to fully recover.

Senior dogs often take a bit to recover from anesthesia. Sometimes they are even still groggy for a day or two after surgery. Your dog may be extra tired, sleep longer and/or heavier, and may seem confused. These effects are temporary, and your pup should be back to his or herself in no time.

Some of the anesthetic drugs can cause nausea and vomiting. Your dog may throw up after surgery (even several hours later), and may have a decreased appetite for a day or so.

I sometimes get asked about dogs’ bathroom habits after surgery. A gross detail I’ll share with you is that dogs’ bodies relax during anesthesia—their whole bodies, including the colon. Most dogs poop under anesthesia. Additionally, opiate medications, which are often used for surgery in dogs, tend to slow down the GI tract a bit. Combining the effects from the medications with a pretty cleaned out colon means it is perfectly normal for dogs not to poop for a few days after surgery.

Can anesthesia have long-term effects on dogs?

In healthy dogs who have uncomplicated anesthetic procedures, there should be no long-term effects from anesthesia itself.

Because blood pressure is lowered under anesthesia, it is possible that some organs, such as the kidneys, don’t get enough oxygen delivered to them. If this happens, those organs could sustain long-term damage. This is one of the reasons pre-operative bloodwork is so important. We want to make sure all organ systems are in tip-top shape to be able to handle anesthesia.

One of the organs that can sustain long-term damage from hypoxemia is the brain. If a dog’s blood pressure or heart rate get too slow under anesthesia, the brain may be deprived of oxygen for a period of time. If that happens, long-term effects can include seizures, blindness, cognitive impairment, and even death.

Keep in mind, though, that those complications happen very rarely—and good monitoring of vitals during surgery can catch issues before they cause any permanent damage.

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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