Sunday, March 24, 2013

So sorry, it was an "anesthesia reaction"

Either we dog breeders are turning out a bunch of severely defective dogs or our veterinarians are lying to us.

Can't count the number of times over the past few years that I have heard these stories:

Dog died getting teeth cleaned - anesthesia reaction

Dog died during spay/neuter surgery - anesthesia reaction

We are talking YOUNG dogs here, not old dogs with failing organs. Young dogs who were perfectly healthy prior to undergoing their procedures.

And if your vet says, it was an "anesthesia reaction" what are you to say? You weren't there, so you don't know what happened. You don't know if the dog was overdosed, or the tube came out before he was awake, or if it was really an "anesthesia reaction"; if your dog had some profound reaction to the anesthesia itself that killed him.

Would we accept our doctor's statement that our spouse/child/parent died during surgery due to an "anesthesia reaction"? You can bet the answer would be NO. There would be an investigation, and the parties involved would have to testify as to exactly what happened. Medical malpractice is the scenario, and thankfully is relatively uncommon. The threat of litigation keeps your doctor on his best behavior. He utilizes clinincal monitors and exercises his best judgement at all times. Anything less would be professional suicide.

But understandably, there is not the same standard of care for animals including our dogs. When the vet blames an "anesthesia reaction" you can suspect that possibly he didn't want to have to say, "I'm sorry, I didn't monitor him closely enough" or "Gosh darn it, I nicked an artery."

I hope to hear from some veterinarians on this, because I would love to be wrong on this. Are there many dogs who are so susceptible to anesthesia that it kills them outright, even while you have them intubated and on life support?

From Ron Hines, DVM: "We veterinarians are fortunate in that older, less predictable, anethesthetics have been replaced by compounds that are very predictable and safe when properly used."


  1. my nine year old dog just this way.. healthy happy.. was having his teeth cleaned.. NEVER again NEVER EVER will I have a dogs teeth cleaned by giving them anesthesia..this is another way for vets to scare people.. dirty teeth can lead to.. you name it..
    sadly what dirty teeth has led to is the seizure of peoples animals.. when they don't seize children for "dirty teeth"
    . that phone call that said "he didn't make it' jarred me to my core and left me wondering how long Roasdy might have lived if i did not elect to clean his teeth.. no more .. no how.. no way

  2. Your blog is complaining that my comment is too long, so I'm breaking it up. Sorry for the multiple comments, but I do take this seriously, and would be just as frustrated about the words "anesthesia reaction" as you and bestuvall are.

    But "anesthesia reaction" needs some elaboration.

    Was pre-anesthetic bloodwork done (if not that day, then at least within the month) to check organ function to be sure the dog could appropriately metabolize and excrete anesthetic agents?

    There have been very few patients on whom we have delayed surgery because of bloodwork values that deem them unfit for anesthesia that day. Our next job is to help them become stable, depending on any further diagnostics recommended or treatment to be done, so that they can be appropriate surgical candidates for whatever their procedure. One was a dog with kidney disease. She's managed just fine now, and was able to have her dental done. Another was a kitten with elevated liver values. We delayed the surgery, did some more diagnostics and was able to neuter him just fine the next month.

    People think they're saving money when they decline the presurg bloodwork and IVcath/IV fluids (ALL required, no exceptions, for pets over 7 years), and that we just offer it do get more out of them. No. Really. We offer it to make the surgery safer, and prevent problems. Ever try to place a catheter into a flat vein while standing on your head (because the animal is tied to the table and the sterile field still needs to stay that way, unless you WANT to contaminate organs), knowing you have a time limit before things bottom out? I haven't. But I've seen it done, and I'd rather NOT have to do it.

    Who was monitoring the pet, and what instruments are used to monitor?

    Where I work, we use pulse ox, ECG, Doppler, NIBP, and common sense by the technician doing the monitoring. If I had two things at my disposal, I would choose the Doppler and NIBP, because more often than not, I am the technician doing the monitoring. And I have caught a heart rate that kept dropping in time to administer epinephrine before we had to reach for the crash cart. Dog did great, we finished the dental, and she now has multiple warnings in her chart about anesthesia precautions. There has also been a case where a dog coded under anesthesia--perfectly healthy young dog having a FHNO due to Legge-Calve-Perthes. Bloodwork looked great on her, and IVcath/fluids were not optional for that procedure, so the vet and technicians already had a port to the vein for emergency drugs. The only conclusion is that the dog might be sensitive to iso, and any further procedures, should they be necessary, will be done with utmost caution and a different gas anesthesia. The hospital where that happened is a sister clinic to the one where I work, and I know they have the same monitoring instruments and procedures as we do.

    The law in my state is that there MUST be some kind of record that someone was monitoring the animal under anesthesia. Most techs are trained to take TPR and other parameters every 5 minutes. What I like to see is that something happens when trends are noticed. Blood pressure is slowly dropping over a period of time--is it written on the sheet what you do about it (e.g. lower the gas anesthetic, give a fluid bolus, etc), and did it help? Heart rate drops--what did you do to CHANGE that trend? Did the technician consult the doctor? I am a VERY verbal technician, and my doctors are just fine with it: every so often, I'll tell them parameters, that things are going great or maybe I'm concerned about one thing, but here's what I can do about it. Maybe it's up to them: is the surgery particularly painful and their actions will help raise the heart rate or BP? Or are they closing up when things might start looking concerning?

  3. Continued...

    I was also present when an orthopedic surgeon at a highly respected university veterinary hospital nicked the popliteal artery during a TPLO. Everyone exploded into action, and my intern self just stayed out of the way. One tech ran to get hemoclips for the vessel, another one ran for the hetastarch and immediately got that going, the doctor and several students who were scrubbed in all but laid on the artery while another assistant kept the suction on. It was amazing to watch, and the dog recovered just fine.

    Freak accidents happen, and I hope that that's what they are: incidents caused by something completely unexpected and out of anyone's control. When something happens that MIGHT have been caught--then what? What if the dog has a liver shunt and the owner declined bloodwork, and it's written right there on the consent form they signed (indicating that they also know the risks of doing anesthesia without it)? What if a necropsy turns up something that neither the doctor nor the owner could have expected (and that's IF a necropsy is ever done!)?

    ANY death under anesthesia should be investigated if, for no other reason, to determine what can prevent it from happening to someone else. Determining a cause would be awesome, and hopefully that would be investigated too. To leave something like this as a "Sorry, it was an 'anesthesia reaction,' do you want your pet cremated or take it home to bury" isn't right. There is a lesson in everything.