Here is a quick summary, with details to follow.

How Long To Withhold Food Before Surgery

• Dog: 12-18 hours
• Cat: 12-18 hours
• Rabbit: NO fasting
• Guinea pig: NO fasting
• Ferret: 4 hours
• Rat: 1 hour

Guinea pigs and rabbits are not fasted to reduce the risk of gastrointestinal stasis and we even ask you to bring in their food for before and after the anaesthetic. For ferrets and rodents, we lack evidence but gut transit times are very short and metabolic rates high, so shorter fasting seems appropriate.

This article gives a good summary of the evidence for dogs, cats and rabbits.

Very young puppies and kittens need reduced fasting times to prevent low blood glucose. The amount of fasting depends on the age. By 5 months of age, food can usually be withheld for the same time as adults.

What To Feed Before Surgery

The final meal before fasting should be no more than the normal amount and contain no unusual ingredients. If your pet is normally fed only once daily in the morning, consider giving a half-sized meal in the late afternoon, as it has been shown that prolonged fasting causes increased gastric acidity. However, we also know that by 3 hours, even small amounts lead to higher rates of problems.

Therefore, be completely honest with your vet if there’s any chance that even a small morsel was eaten. We’d much prefer to put off the procedure than take a risk. And here’s something else to consider: how about never feeding dogs or cats before any vet checkup? That way, if anything needs doing, it might be possible straight away.

So what’s the big deal anyway?

Why Do Dogs & Cats Need Fasting?

The danger of food being in the stomach during anaesthesia is gastro-oesophageal reflux or GOR. This is when the lower oesophageal sphincter relaxes and stomach contents are allowed to flow back up (the oesophagus or esophagus is the tube connecting the mouth with the stomach and the sphincter is a type of valve at the end).

Obesity and pregnancy increase the risk of GOR, presumably due to extra pressure on the stomach. There’s also likely to be a higher risk for emergency procedures or animals with pre-existing health problems.

GOR is actually not uncommon, but most of the time it causes no visible health consequences. Sometimes, however, one of the following happens:

1. Food flowing up the oesophagus reaches the airway and enters the lungs, resulting in aspiration pneumonia, a serious and often fatal lung infection. Aspiration pneumonia is rare due to the widespread use of endotracheal tubes (ET tubes) with inflatable cuffs.
2. Stomach acids cause severe burns to the lining of the oesophagus. Scar tissue formed during the healing process then contracts, resulting in a narrowing of the oesophagus called an oesophageal stricture. 

Both are rare complications of pet anaesthesia, but important to know about, especially for dog and cat owners. All vets see too many animals that should have been starved, but instead turn out to have food in their stomach. If their owners truly understood the consequences, then those hungry pleading eyes would stay hungry, and safe! 

Now read: Treatment Of Oesophageal Stricture In Dogs & Cats

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

Signs Of Oesophageal Stricture

Affected dogs and cats show the characteristic sign of being interested in food, but unable to keep it down. Critically, this is due to regurgitation. 

Recognising the difference between regurgitation and vomiting is very important for a quick diagnosis:

• Regurgitation is a passive flow of food or water without obvious effort. There can be a lot of white foam and it almost never contains yellow bile.
• Vomiting involves repeated abdominal muscle contractions, and usually takes longer. Bile or a strong acid smell is often present. 

Other signs of oesophageal stricture can be:

• Excessive salivation
• Difficulty eating or swallowing
• Weight loss
• Dehydration

What Causes Oesophageal Stricture?

The table shows a summary of 111 affected dogs and cats where the cause was reported. 

Any injury to the oesophageal wall can lead to scarring and narrowing of its internal diameter. The most important of these is gastro-oesophageal reflux. Under anaesthesia, stomach acids sometimes enter the oesophagus where they may cause severe burns. This can also happen during severe vomiting episodes.

Other injuries leading to stricture can be caused by foreign bodies (especially inappropriately fed bones), severe road trauma and caustic drugs. Doxycycline and clindamycin in particular are two commonly used tablets that must never be given without food. 

After the damage occurs, regurgitation can develop anytime within 3 weeks (typically 7 days). It’s essential to stress that while anaesthesia can cause it, oesophageal stricture is an extremely rare consequence (I have only seen it once, after an emergency surgery). 

Click here to read more about the prevention of oesophageal stricture after anaesthesia.

Treatment Of Oesophageal Stricture

The goal of treatment is to allow a dog or cat to eat and drink without requiring special care. Complete cure, defined as the ability to ingest food of any consistency, is only seen in 12%‐23% of cases but is not necessary for a good quality of life.

Once a stricture is diagnosed, immediate supportive treatment may be:

• Drug therapy to reduce ongoing oesophagitis
• Nutrition and hydration via placement of a feeding tube in cases of severe narrowing

If the patient is stable, attempts are made to widen the narrowing via mechanical dilation. There are currently two established methods:

1. Bougienage is the passing of solid tubes of increasing diameter to slowly stretch the stricture
2. Balloon dilation is the same approach using inflatable tubes of gradually increasing size

Whichever is chosen (mostly balloon these days), process is slow to avoid tearing the oesophageal wall, which can be fatal. Dogs and cats require an average of three treatments, but a positive outcome is not always achieved.

Success Rates Of Dilation

The following table gives a quick summary of all the major studies in the past 25 years.

As you can see, death rates are low but success only occurs in around 2 in 3 cases. Study 6 remains an experimental approach which (in my opinion) will end up with similar success and mortality rates if and when it becomes more widely used.

Management after dilation generally includes administration of various drugs to reduce gastric acidity, increase forward movement of the gut, and reduce scarring during healing.

Failure of dilation has in the past been sometimes followed by further surgical procedures, especially stenting and resection. Neither have sufficient success to be routinely recommended.

Do All Cases Need Treatment?

If you have a dog or cat with an oesophageal stricture, I hope that this information will allow you to make an informed decision. Whether to have dilation performed will come down to four things:

1. How well your best mate is coping,
2. The potential risk of aspiration pneumonia or megaoesophagus in your case,
3. How much special care will be needed over life if you don’t,
4. Sadly, also costs

Specialist veterinary care is unquestionably expensive, and I would prepare for around $5000. Costs will vary depending on how many dilations are needed. It might help to know that several papers observed that a favourable outcome was often associated with good results from the outset.

Most referral centres are quite willing to talk about their fees, especially to us vets, so it’s your right to ask. Good luck.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

1. Adamama-Moraitou, K. K., Rallis, T. S., Prassinos, N. N., & Galatos, A. D. (2002). Benign esophageal stricture in the dog and cat: a retrospective study of 20 cases. Canadian Journal of Veterinary Research, 66(1), 55 
2. Bissett, S. A., Davis, J., Subler, K., & Degernes, L. A. (2009). Risk factors and outcome of bougienage for treatment of benign esophageal strictures in dogs and cats: 28 cases (1995–2004). Journal of the American Veterinary Medical Association, 235(7), 844-850
3. Harai, B. H., Johnson, S. E., & Sherding, R. G. (1995). Endoscopically guided balloon dilatation of benign esophageal strictures in 6 cats and 7 dogs. Journal of Veterinary Internal Medicine, 9(5), 332-335
4. Leib, M. S., Dinnel, H., Ward, D. L., Reimer, M. E., Towell, T. L., & Monroe, W. E. (2001). Endoscopic balloon dilation of benign esophageal strictures in dogs and cats. Journal of Veterinary Internal Medicine, 15(6), 547-552
5. Melendez, L. D., Twedt, D. C., Weyrauch, E. A., & Willard, M. D. (1998). Conservative therapy using balloon dilation for intramural, inflammatory esophageal strictures in dogs and cats: a retrospective study of 23 cases (1987–1997). Eur J Comp Gastroenterol, 3(1), 31-36
6. Tan, D. K., Weisse, C., Berent, A., & Lamb, K. E. (2018). Prospective evaluation of an indwelling esophageal balloon dilatation feeding tube for treatment of benign esophageal strictures in dogs and cats. Journal of veterinary internal medicine, 32(2), 693-700

Both drugs are most commonly used in the following sequence:

1. Premedication (mild sedation) with opiates, phenothiazines etc
2. Creation of unconsciousness with intravenous alfaxalone or propofol
3. Placement of an endotracheal tube into the airway
4. Maintenance of anaesthesia with oxygen and inhaled isoflurane or sevoflurane

Under this use, alfaxalone and propofol are called induction agents. Another, much rarer use is in total intravenous anaesthesia (TIVA) which I will not discuss here.

Presentation & Storage Differences

Both drugs are pictured above. Propofol is a white liquid sold under many brand names whereas Alfaxalone comes as a clear liquid branded Alfaxan® or Alfaxan® Multidose.

Due to the potential for bacterial contamination, after opening Alfaxan® and propofol should be refrigerated and used within 24 hours. Alfaxan® Multidose has a potential life after first use of 30 days if stored correctly.

Currently only propofol is used in human anaesthesia. Alfaxalone is commencing phase three clinical trials in Australia under the brand name Phaxan.

* Propofol is also available for veterinary use as Aquafol®, a clear liquid in a 100mL multidose vial. This product is know to cause an anaphylactoid type skin hypersensitivity in some dogs and cats. Such reactions primarily consist of transient swelling, urticaria and redness around the head, abdomen or other body parts.

Quality Of Induction

Both agents cause a fast, smooth and predictable loss of consciousness. In humans, propofol is sometimes associated with pain on injection. This has not been observed in animals, possibly due to the widespread use of pain relieving premedicants.

Propofol has a shorter duration of action, meaning that occasionally ‘top-up’ doses are required before the inhaled gaseous anaesthetic takes effect.

Safety Margins

Overdosage is extremely rare with either drug, as they are given ‘to effect’. This means that the drug is slowly injected until the right level of anaesthetic is achieved, and any remainder discarded.

In situations of neglect and inattention, where excessive doses are given, alfaxalone has greater safety.

Side Effects

Alfaxalone and propofol are equally safe.

Both drugs are known to cause post-induction apnoea, which is a transient suppression of respiration. This is routinely managed by manual ventilation (‘bagging’) for 30 seconds to 2 minutes after induction. Its incidence may be reduced with alfaxalone by slow intravenous injection.

There is no difference observed in any of the following:

• Oxygenation
• Blood gases
• Blood pressure

Alfaxalone leads to a short-term increase in cortisol production in healthy cats as compared with propofol but its significance is unknown. Alfaxalone results in a slightly lower body temperature, although the difference of 0.3 °C is probably insignificant.

Recovery

Both drugs give a rapid return to consciousness. Recovery from alfaxalone takes slightly longer than propofol but the difference is small (6 vs 2 minutes to sitting up). During longer anaesthetics where gaseous agents are used for maintenance, there is probably no difference as the induction agents will have been fully metabolised.

Quality of recovery is better for propofol. Animals recovering from alfaxalone are known to sometimes have tremor, vocalisation or leg paddling, and may be more noise sensitive. These events are short lived and typically last less than 2 minutes.

Use In Caesarian Section

During caesarian section, alfaxalone gives higher Apgar scores in the newborn puppies. However, no difference in neonatal survival is documented between propofol and alfaxalone.

Use in Sighthounds

Both alfaxalone and propofol are equally safe in Greyhounds and Whippets due to minimal accumulation in body tissues. This is in contrast to barbiturates such as thiopentone, which should no longer be used in developed countries.

Mode of Delivery

Propofol must be given intravenously; if given subcutaneously or intramuscularly it does not appear irritant but will be ineffective. By contrast, alfaxalone can be used as an intramuscular premed or induction agent for cats and other smaller animals. This use is limited by the large volume required.

Summary: Alfaxalone vs Propofol

Both alfaxalone and propofol are appropriate choices for a wide range of anaesthetic uses in dogs and cats. There are few or no significant differences and the use of either drug provides excellent safety.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

References

Amengual, M., Flaherty, D., Auckburally, A., Bell, A. M., Scott, E. M., & Pawson, P. (2013). An evaluation of anaesthetic induction in healthy dogs using rapid intravenous injection of propofol or alfaxalone. Veterinary anaesthesia and analgesia, 40(2), 115-123

Bigby, S. E., Beths, T., Bauquier, S., & Carter, J. E. (2017). Postinduction apnoea in dogs premedicated with acepromazine or dexmedetomidine and anaesthetized with alfaxalone or propofol. Veterinary anaesthesia and analgesia, 44(5), 1007-1015

Doebeli, A.; Michel, E.; Bettschart, R.; Hartnack, S.; Reichler, I.M. Apgar score after induction of anesthesia for canine cesarean section with alfaxalone versus propofol. Theriogenology 2013, 80, 850–854. 

Maney, J. K., Shepard, M. K., Braun, C., Cremer, J., & Hofmeister, E. H. (2013). A comparison of cardiopulmonary and anesthetic effects of an induction dose of alfaxalone or propofol in dogs. Veterinary anaesthesia and analgesia, 40(3), 237-244

Mathis, A., Pinelas, R., Brodbelt, D. C., & Alibhai, H. I. (2012). Comparison of quality of recovery from anaesthesia in cats induced with propofol or alfaxalone. Veterinary anaesthesia and analgesia, 39(3), 282-290

Metcalfe, S., Hulands‐Nave, A., Bell, M., Kidd, C., Pasloske, K., O’hagan, B., … & Whittem, T. (2014). Multicentre, randomised clinical trial evaluating the efficacy and safety of alfaxalone administered to bitches for induction of anaesthesia prior to caesarean section. Australian veterinary journal, 92(9), 333-338

Taboada, F. M., & Murison, P. J. (2010). Induction of anaesthesia with alfaxalone or propofol before isoflurane maintenance in cats. Veterinary Record, 167(3), 85-89

I’m going to use the evidence and my experience to help you decide if blood tests are a good idea for your pet. I’ll start by answering the question: when are blood tests useful? Then I’ll discuss the downsides.

How Often Are Blood Tests Abnormal?

The odds are low but definitely not zero. Three recent studies have looked at how often significant abnormalities are found in apparently healthy dogs and cats:

• 20 out of 1293 young dogs (1.5%).
• 3 in 100 middle-aged and old cats (3%)*
• 11 in 406 dogs aged 6 to 9 (2.7%)**
• 5 in 130 cats aged 6 to 9 (3.8%)**

From this, I roughly estimate that 1 in 70 young animals, and 1 in 25 in middle age, will benefit from blood testing. Tests will be even more useful for:

• The elderly
• When we can’t get a good physical exam
• When a pet’s history is unknown
• Breeds prone to certain conditions

It’s up to each owner to decide if risks like these can be accepted. Personally, I choose to test my pets from 7 years of age, but I applaud puppy owners who want testing done before desexing. This can act both as a useful check for some congenital diseases and a baseline set of values for future tests.

The most common abnormalities we find are kidney or liver disease. Just like my dog Tinker, they can be treated if found early and modified anaesthetics can still be given safely.

How Much Does Blood Work Cost?

Prices will vary between clinics but the typical fees can be found on our pricelist here.

What Are The Negatives Of Blood Work?

Now for the downside. Apart from cost, there are two important reasons why blood testing needs consideration:

Stress & Anxiety

Stress and anxiety need to be recognised with any veterinary procedure. I painfully recall a case where a very educated owner wanted her tiny puppy to have a special blood test. I should have gently explained why it wasn’t a good idea. Instead the poor thing had a terrible experience that could have been avoided. How?

Easy. If I had waited until the day of the anaesthetic I could have taken it with no extra stress. We draw the blood directly from the intravenous line we place before surgery.

Most of the time, dogs and cats tolerate blood testing well, and we encourage you to stay with your pet to offer support. Occasionally the negatives of stress outweigh the positive benefits of testing.  You can usually trust us to advise you on this.

False Positives

Every pet owner needs to know that tests are never 100% reliable. For any single test, there’s a 5% chance of it looking abnormal when it’s actually OK. Once you test 20 values, that number jumps to 64%. The reasons for this have to do with the natural variation that occurs in nature.

When I review any pet’s blood test results, there is almost always something that looks wrong. My job is to separate the wheat from the chaff. Most of the time it’s easy, but every now and again a ‘false positive’ will require extra tests to identify.

It’s not devastating to get this wrong as long as we don’t assume anything without proof. However, it’s always a time of worry for owners while we sort it out.

Is Blood Testing Necessary?

There isn’t one right answer. Each pet owner will have a different attitude to the risks of not testing, the costs and the downsides. Each pet will have a different risk profile depending on their age, breed, tolerance of handling and how much we can learn by other means. In the end, it comes down to a personal choice.

We’ll always be there to guide you and do whatever you ask. Or instead, you can always ask the magic question: “What would you do if it was your pet?”

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

*This study also found FIV in 14% and one urinary infection
**This study (in my opinion) over-diagnosed significant problems so these numbers are adjusted by me. I’m happy to discuss my reasoning.

Further Reading

For an in-depth look at everything we check please visit our page on what we test blood for in dogs & cats.

Paepe, D., Verjans, G., Duchateau, L., Piron, K., Ghys, L., & Daminet, S. (2013). Routine health screening: findings in apparently healthy middle-aged and old cats. Journal of feline medicine and surgery, 15(1), 8-19.

Alef, M., Von Praun, F., & Oechtering, G. (2008). Is routine pre‐anaesthetic haematological and biochemical screening justified in dogs?. Veterinary anaesthesia and analgesia, 35(2), 132-140.

Dell’Osa, D., & Jaensch, S. (2016). Prevalence of clinicopathological changes in healthy middle‐aged dogs and cats presenting to veterinary practices for routine procedures. Australian veterinary journal, 94(9), 317-323.

Do Pets Need To Stay Overnight?

Nearly all dogs and cats will go home the same day of their surgery. This is certainly true for desexing and dentistry, and is mostly true even for major procedures.

Don’t worry. We won’t send them home if they need any ongoing care that you can’t provide. We know how much happier a cat or dog is with their family and will plan our surgeries so this is possible most of the time.

How Sleepy Will They Be?

By the time dogs and cats leave the vet clinic, you can hardly tell they’ve had an anaesthetic. We won’t send dogs or cats home after routine procedures unless they are fully awake and able to walk. They should be wagging their tail and happy to see you.

This can give you a false sense of confidence. Just because they can jump doesn’t mean they should!

What Time Do Dogs & Cats Go Home?

At most vet clinics, you will be told what time to expect them to go home. However, it only takes one other animal needing emergency surgery to mess up our roster! Therefore, we also advise you to call by 3pm if you haven’t heard from us. Our nurses or vets will usually call you when your pet is awake.

Routine, uncomplicated procedures like desexing, dental scale & polishes or simple lump removals can be discharged in a nurse clinic. For complex surgery, the nurses will make an appointment with a vet to talk to you about the procedure and recovery.

You will receive printed postoperative notes on what to do and the nurse or vet will explain the important points. Please ask as many questions as you can!

How To Transport Pets After Surgery

Here’s Loki on the way home after his knee surgery. Placing a crate or cat box in the car means your pet won’t be in danger of falling when you turn or stop. He’s not happy and would much rather have been held, but I was on my own.

Please either use a crate or box, a car harness or get a family member to hold them for the trip home. Don’t forget that the anaesthetic will make them less coordinated and also prone to behave unpredictably. They shouldn’t try to jump in or out of the car.

Settling At Home

Being crate trained as a puppy made Loki very easy to keep safe and happy after surgery. I placed the crate on the first day in a quiet room and let him sleep it off.

Tell the family not to expect to be able to play or make a fuss. Your pet will probably want to find a quiet, safe place to rest, and excess stimulation may cause distress.

The first night is often tough for pets, especially after major orthopaedic surgery. Despite all the pain relief, they can still experience some discomfort. The best thing is the contact of someone they love.

If your dog is whimpering then please by all means give them a cuddle. It’s usually all they need to quieten and settle back to sleep.

A good idea (if you can bear it!) is to bring a mattress out and set up your bed next to theirs. Just being next to a dog after surgery can provide a lot of relief. Having a dog on your bed instead can be OK, but the danger of them jumping down overnight is too much for me to take.

When Can Pets Eat & Drink?

Unless we tell you otherwise, you can offer a half-sized meal in the evening after your dog or cat goes home. Don’t give too much, and don’t be alarmed if it gets vomited up. Anaesthetics can make this happen, and it isn’t much to worry about.

It doesn’t matter if dogs take a few days to eat after surgery, but we want cats to eat by the next day at the latest. See our guide to helping cats start eating. Don’t forget that your pet has been on a drip during the day so they won’t need to drink until the day after.

Post-operative Medications

Depending on the procedure you may have tablets or drops to give at home after surgery. Please tell us if you find it hard to give medications. The picture shows the way most dog owners get the job done, and the only time most vets will tolerate the giving of cheese!

Drugs like tramadol taste terrible and are very hard to hide in food; other pets (especially cats) can’t be tricked. It’s best to give these pets their tablets by mouth. Here’s a link to our video showing how to give pills to cats.

The Cone Of Shame

No one wants to put their dog or cat in an elizabethan collar. Sometimes you can get away with not using one. However, the odds are that if you don’t use it the wound will get damaged or infected, and the recovery will be complicated. Sometimes the wound can even be opened right up.

Read why dogs and cats just can’t leave wounds alone and the damage that licking can do.

I promise that if you leave the collar on 24 hours a day your dog and cat will get used to it and forget it’s even there. On the other hand, if you keep taking it off and putting it on they will never learn how far around furniture, doors and legs they need to steer.

Cones can make it hard to get to food and water. Here’s Loki with his water in a container that is thin and high enough for him to access while wearing the cone. The food can be put in a narrow container on top of a brick for example to get the same result.

There are also donut-shaped collars by Kong which are great for many wounds, but not all. Fergus (shown later) certainly preferred his to a regular cone.

How Much Exercise After Surgery?

Ask your vet! Most pets can have moderate exercise, as long as it’s well-supervised. However, there are some times you will need at give strict cage rest.

A good idea is to continue to use a crate for whenever you can’t supervise your pet closely. You can make it fun like Loki’s here. Alternatively, consider setting up a room for your dog or cat to be left when unsupervised. You can add lots of amusements and soft bedding but avoid furniture that can be jumped on or off.

If allowed, exercise should be on a very short leash and only out into the street in front of your house. Avoid contact with other dogs and stop if they get too excited. It’s mainly about the mental stimulation so don’t feel you have to do anything energetic.

The way I see it is this. If your dog is used to regular exercise, then by excessive confinement they are likely to get stir crazy from cabin fever. Far better to give them the stimulation in a safe and controlled way than them being silly and jumpy around the house and putting the surgery at risk.

Cats should be kept inside at least until the stitches are removed. For cats it’s not just for wound care: they can very easily get dangerously stuck wearing an elizabethan collar outside.

What To Do About Constipation

Many dogs take a few days to start defaecating after anaesthetics and surgery. Don’t get stressed; they usually start going again without any problems. The exercise of a controlled walk certainly helps them to pass their motions but even in cage rest we rarely have to intervene.

If it’s been three days without a poo, please call us for advice.

Do You Need To Clean The Wound?

No. If it doesn’t look right, please come in for a check. We don’t charge a visit fee for any postoperative checks, even if you do it every day. We’d rather you were over-concerned and came in for nothing than ignore a possible problem.

When Do The Stitches Come Out?

We ask you to come back in ten days for suture removal.

Are The Stitches Dissolving?

We prefer to use skin sutures which don’t dissolve, simply because they are stronger. We also find that the wound looks better afterwards. The only times we will use dissolving sutures are for internal stitches or when removing the sutures will be very difficult. Most of the time it’s so easy we’ll have done it before you think we’ve started.

When Does The Hair Grow Back?

It takes around two months for a clipped area to look like the rest of the coat. Sorry about that, but if we don’t clip there is a high probability of infection.

Remember the most important thing: If you are worried about anything at all please ring, email or make an appointment!

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here. The information provided here is not intended to be used as a substitute for going to the vet. If your pet is unwell, please seek veterinary attention.

Whatever the procedure, there are several things you must do:

• Schedule The Day Of Surgery
• Prepare The House And Family
• Prepare Your Pet
• Know When To Stop Food And Water

Booking Your Pet’s Surgery

Most vet clinics operate on Monday to Friday. Unlike our consultations with a vet, we won’t always be able to do the surgery on the day you request. The more you book ahead the better chance you’ll get the day you want.

Even when you’ve done everything right, we may see another pet on the same day who needs immediate surgery. This means that on occasions the theatre will be tied up unexpectedly for an emergency procedure and we won’t be able to do your pet’s operation.

This only happens a few times a year, and annoying as it is, most owners understand that we’d do the same for their pet if he or she were the one in need. Your pet’s surgery is important, and we’ll never do it if it can only be done in a rush.

Desexing dogs and cats should be done before six months of age to avoid the first season in females, or unwanted male behaviours. Rabbits and ferrets should be done before four months of age. If your female goes into season, we will advise rescheduling their spey until after the end of the heat period. This avoids us performing an elective procedure at a time of greater risk.

The day before your pet’s surgery you should receive the nifty text message shown earlier. If you don’t, please check we have your up to date contact details.

Do You Need To Take Time Off?

Ask your vet! It’s always nice to be around the next day but for most routine procedures like dentistry or desexing, it’s not really necessary.

Preparing Your Pet

You won’t be able to bath or clip your pet for at least ten days after surgery and it’s not a good idea to apply flea control products. Therefore, it’s a great idea to give them a bath or book them in at the grooming salon before their operation, and then give them their monthly flea control. DO NOT bath your dog on the same day to avoid accidental body temperature loss.

Before coming in, I like a patient to have had some moderate exercise. Not only will it be their last decent outing for a few days, but it helps them toilet before their day in hospital.

Preparing The House & Family

Most pets will need to be well-rested after surgery.

Your vet will tell you how much activity is OK. Some orthopaedic procedures need 100% strict cage rest, others can tolerate some activity. After desexing, for example, pets are OK to walk around the house. For all surgeries you will need to plan how to stop your pet from running and jumping.

Dogs: There are many ways to keep a dog quiet, but the best is to use a crate. We’ve written about using crates for resting and training dogs before.

If your dog isn’t used to being in a crate, a great idea is to purchase one (they are around $100) and train your dog to settle there in advance. It’s best to take it slowly so they don’t get stressed, and then when they come home needing rest, they will tolerate being restricted so much better.

If crating is difficult, you should at least plan to prevent your dog from any access to furniture such as beds and couches by closing doors or overturning chairs. You should also plan to stop any activity with causes excitement, jumping or running. Sometimes you have to disconnect the doorbell!

Cats will need to be kept inside the house, and possibly in just one room if there is still too much activity. You may need to restrict access to benches and other high places.

Rabbits, ferrets and rodents can be easily rested by using their usual nighttime accommodation. Make sure the litter is freshly changed and their enclosure is cleaned for when they come home.

Many people take time off for their pet’s recovery. This is great, but not essential, especially for soft tissue surgery like desexing or lump removal. I made sure I had a day off after Loki’s surgery and it was well worth it.

When To Stop Food & Water

It is essential that your dog, cat or ferret has no food or water in their stomach at the time of their anaesthetic. If they do, under anaesthetic their oesophageal sphincter can relax and allow fluids to pass into the oesophagus, causing acid burns. In some cases these fluids can even reach the lungs, causing severe aspiration pneumonia.

Dogs and cats should have had no food for 12 hours before an anaesthetic, and no water for 8 hours. In our clinic, unless you are otherwise instructed, this means your dog or cat should have their last meal at 9pm the night before, and no water after 1am.

All dogs and cats go on intravenous fluids (the cost is included in desexing) and so you do not need to worry about your pet becoming dehydrated.

You must be utterly ruthless at eliminating all chances of your dog or cat having access to food. All family members need to be instructed to behave themselves! It’s also best all the animals in the house are not fed over the same time to avoid accidents. Water sources such as toilets need to be closed away or covered. Cats must be kept inside to prevent scavenging and food removed even from benchtops.

Food restriction is critical. If there is any chance that your pet may have eaten even one biscuit, please tell us. We will usually reschedule the surgery to avoid any risk.

Water restriction is less important. Please let us know if you haven’t taken the water away, or left it out until morning. We usually can still do the surgery, but we may just do it later in the day.

Ferrets, Rabbits and Rodents should NOT be deprived of food and water. Ferrets have such a rapid gut transit time that the short wait in hospital will be enough. Rabbits and rodents are safe to have food in their stomachs, and in fact it is best if they do.

Please bring in your ferret’s, rabbit’s or rodent’s usual food so they can eat as soon as they are awake.

What To Expect On The Day

Surgery Admission

We ask our patients to be admitted between 8am and 8:45am on the morning of surgery. If this is a problem, please ask as it is possible to be flexible. If we haven’t seen your pet before, your pet will receive a free checkup with the vet as well.

The nurse on admission will ask you a series of questions. These include:

• Has your pet been unwell?
• Has there has been any access to food and water?
• Do you have any concerns or other requests such as nail clipping?
• Would you like pre-anaesthetic blood testing? (read why you might choose blood testing here)

Surgery and Anaesthetic

When the theatre and nurses are ready, we’ll start by placing an intravenous drip. Through this we will give a premedicant calming pain relief. Some patients will also have the pain relief patch shown earlier.

Next, we will administer the anaesthetic induction agent (usually propofol).

Once this takes effect, the vet will insert an endotracheal tube and the nurses will connect your pet to a anaesthetic machine delivering inhaled isoflurane gas in oxygen.

Monitoring equipment and thermal insulation wrapping will be placed, and the surgery site will be clipped of hair.

Then the patient is transferred to the theatre for sterile surgery. See our guide to vet anaesthetics to learn more about how we monitor your pet during their anaesthetic and recovery.

Recovery

Once the surgery is completed, your pet will be transferred to recovery. A nurse will monitor all animals continuously until they are able to sit up and maintain their airway. After this they will usually want to sleep off the rest of the anaesthetic. During this time we will monitor your pet’s pain levels and give extra relief as needed.

Once your pet is awake and ready to go one of our nurses will usually call you. If you have not heard from us by 3pm, please call to arrange a time for discharge from hospital.

Next week I’ll tell you how to look after your pet after surgery.

By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. These blogs are from a series regularly posted on email and Twitter. Subscribe via email here to never miss a story!
Have something to add? Comments are welcome below and will appear within 24 hours of lodging.

“He’s too old to have an anaesthetic. It’s too dangerous.”

What utter poppycock. These poor animals were living with painful and easily treated problems.

However, before I carry on ranting, please stop me to remind you that these attitudes are increasingly rare . Nearly all vets will agree with what I am about to say.

That is: Age is not a disease. What matters is your pet’s health status.

There are a few common myths we hear about anaesthetics:

• Too many anaesthetics are dangerous. Each anaesthetic is independent, and there is no cumulative effect if the effect of the last drugs have worn off. This can be within a few days.
• You can’t anaesthetise sick animals. If this was true it would be very bad news for many dogs we see.
• Anaesthetics aren’t safe in old animals. Ditto.
• Sedation is safer that anaesthesia. Not always. The airway is controlled by an ET tube under GA, and gaseous anaesthetics are easier to control and monitor.

So What Does Make Anaesthetics Risky?

No question, sometimes we will advise you avoid an anaesthetic. Here’s when:

• No recent checkup. We could be sleepwalking into a disaster. Please understand if we ask for another checkup before surgery if it’s been too long.

  

• Untreated diseases. These can include anaemia, heart disease, cushing’s syndrome etc. I have no trouble with anaesthetising these animals once they are treated.
• Very young or underweight animals who can rapidly lose body heat or suffer low blood glucose.
• Repeated unnecessary or cosmetic procedures. Don’t worry: we’ll give our honest opinion. However, if a dog needs daily anaesthetics (for example for burns dressing changes) we can do it. We just don’t want to do it needlessly.
• Or simply if we haven’t enough nurses to monitor. That’s why we won’t do routine procedures on Saturdays or after 5pm. Sometimes we’ll even reschedule procedures if nurses call in sick.

What Can Vets Do To Make Anaesthetics Safer?

• Thorough patient evaluation. We don’t perform a pet anaesthetic without a recent, full physical examination. We need to know about cardiovascular and respiratory function, plus any other health issues that may be relevant. Often we will defer an anaesthetic until we have investigated or stabilised a problem we find.
• Preanaesthetic blood testing. This simple and inexpensive test will identify a wide range of hidden diseases. We recommend testing on all animals, but if we see a specific reason for concern, our recommendation will get a little pushier.
• Planning. Each patient is different, and anaesthetics are tailored to suit each animal’s needs.
• Trained and motivated staff. Our greatest resource is our nurses. They have to be highly trained and updated, and empowered to have their concerns listened to.
• Heat conservation. Our nurses not only wrap their patients before surgery, they also bed them on a forced air patient warmer. This is really effective. By doing this we can prevent significant heat loss in almost all animals.
• Up to date monitoring equipment. We routinely monitor blood oxygen saturation (pulse oximetry), blood pressure, heart rate, respiratory rate and core body temperature.
• Fluid therapy. All our patients receive intravenous fluids during their anaesthetic, to maintain blood pressure and provide a quick route for emergency drugs.
• Post operative monitoring. In a recent UK survey*, although total deaths were small, over half of these occurred after the operation had finished. We have strict monitoring protocols to ensure a patient is never left alone after surgery.

It may help you to know that most of our anaesthetics (except desexings) are in elderly patients. Old animals do get more health problems. Rather than that being a reason to not give them anaesthetics, it actually means we need to do it more often to maintain their wellbeing.

Anaesthetics are a wonderful invention. Ever since Queen Victoria used them for childbirth, anaesthetics have saved animals and people from immense pain and suffering. Nowadays, pets get similar drugs and monitoring to human anaesthesia. Risks exist, but they can be minimised by following simple protocols. The next time your pet needs an anaesthetic, trust the vet if they tell you the risks are small. They care deeply about their patients and only want what you want: a pet with the best quality of life they can get.

*Brodbelt, D. C., Blissitt, K. J., Hammond, R. A., Neath, P. J., Young, L. E., Pfeiffer, D. U., & Wood, J. L. (2008). The risk of death: the confidential enquiry into perioperative small animal fatalities. Veterinary anaesthesia and analgesia,35(5), 365-373.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.

These days she still has a go but though she’s a puppy at heart, she’s old and has significant arthritis. However, her quality of life is good. A few weeks ago, her owner noticed Mia being a bit unsteady and wondered if it could be the arthritis treatment. We thought that was unlikely and so did a home visit to check on her.

The physical exam seemed OK but we took a blood test just to be sure. The blood result showed mild anaemia; not enough to be obvious, but possibly the cause of the symptoms. Anaemia in dogs is very unusual and immediately made us worry she had a bleeding disorder. There was no access to rodent poisons so we considered a ruptured splenic tumour to be the most likely given her breed and age. We recommended an ultrasound exam, which confirmed the presence of blood in the abdomen and a large mass growing from the spleen.

There were only two options; euthanasia or surgery. Mia’s owner was understandably reluctant to put her through such a major surgery especially with her other problems. However, our independent advice was that it was worth doing, as the tumour appeared to not have spread and Mia’s health would easily cope with the anaesthetic and surgery.

Mia had surgery shortly afterwards. Her spleen plus haemangiosarcoma was removed, and inspection of the abdomen confirmed the ultrasound findings of no visible metastasis. Her recovery was good, but she certainly had trouble getting up out of her hospital kennel the next day, and the trip home was quite stressful for her owner.

The pictures show her last week when we took her sutures out. She’s back to playing again and is brighter than she’s been for some time.

There are many stories of dogs and cats just like her who have had major surgery at an advanced age. Most of the time, their owners are glad they did it. There’s always the chance they won’t have much more time, but if we carefully assess them beforehand, we can reduce that risk. We won’t ever recommend something we don’t genuinely feel will make a valuable difference to their quality of life.

I know I shouldn’t end on a sad note but the same day as Mia’s surgery, we saw a second dog with the same condition. His ultrasound showed that the cancer had spread and there were secondary metastases in the liver and abdomen. For him, all we could do was make him comfortable until it was his time. His owners loved him dearly, and would never have wanted him to have unnecessary surgery. All of us as pet owners have to face this; we as vets deal with this a lot but it’s never easy. If you leave them a message in the comments I’ll make sure they hear it.

Follow Up: A year later, Mia is still going strong. These days we do house visits as she has trouble travelling but she’s just as happy. She even needed another tumour removed, this time on her skin.

Have something to add? Comments (if open) will appear within 24 hours.
By Andrew Spanner BVSc(Hons) MVetStud, a vet in Adelaide, Australia. Meet his team here.