Managing Anaesthesia In An Older Patient
Anna is a 14 year old Kelpie Cross who started coming to Pascoe Vale Vet Hospital for routine check-ups early last year. During one of her visits, we discussed with her owner her severe dental disease. Anna’s owner knew that her teeth were in a bad way and causing her a lot of discomfort but was concerned about her ability to cope with the general anaesthetic that would be required to perform the procedure. We discussed the many ways in which we could make the anaesthetic as safe as possible for an older dog but Anna’s dad was still very worried about the risk of her not surviving the procedure. Together we decided to put the idea of a dental procedure on hold for the moment, but to start feeding her a prescription dental diet so that we could at least slow down the progression of her dental disease.
We continued to see Anna each month for her routine check-ups and at each visit reassessed her general health. This included a look in her mouth to monitor any changes. During one of these monthly visits, we detected a heart murmur when listening to her chest with a stethoscope – a sign that Anna’s heart is losing its efficiency. Although there were no outside signs that she was being affected by the changes inside her heart, this increased her anaesthetic risk, and Anna’s owner was more reluctant than ever to let her go under general anaesthesia.
Unfortunately, one of the effects of long term dental disease is bacterial spread to the heart valves, which weakens them and interferes with their normal function. So it was becoming even more important to clean her teeth. Along with her heart murmur, Anna was also starting to show other signs common to aging pets – reduced mobility, joint stiffness, and weight gain. Anna needed more intensive management to improve her overall health as her quality of life was deteriorating.
After discussion with Anna’s owner, we began to introduce several strategies to tackle her issues. First, we started giving her a course of injections to reduce joint inflammation and improve her mobility. Signs of improvement were soon seen, but Anna was continuing to gain weight as her owner was not able to walk her often. The weight gain was putting added strain on her joints and her heart, as well as other body organs. We started her on a prescription weight loss diet with strict guidelines, so that we could safely reduce her weight while not compromising her nutrition. She began losing weight and looking much better and happier for it!
The next step was a general blood test, which showed no major problems with her blood cells, or her major abdominal organs including liver and kidneys. This was very good news as these organs are vitally important for the body to process anaesthetic medications and are among the most sensitive to the drop in blood pressure which often accompanies anaesthesia.
Given Anna’s improvement from managing her arthritis and weight, as well as her good blood test results, Anna’s owner was becoming more optimistic about her body’s ability to handle an anaesthetic. The next step was to check her heart in more detail. She came in for a day stay at the hospital to have chest x-rays taken and an ultrasound check of her heart. These confirmed that her heart did have changes consistent with heart failure, but after commencing some appropriate heart medication and repeating the chest x-rays we could clearly see less congestion in her chest, indicating improved heart function. We had done as much as we could to ensure that Anna’s body was in the best shape we could achieve to lessen her anaesthetic risk.
Anna’s owner was gradually becoming less fearful of the anaesthetic risk as he could see her improving. We booked her in for another day stay to have her dental procedure. During the procedure, we had one vet managing her general anaesthetic using carefully chosen medications that would keep her safely asleep and stable during the procedure, but would have the least effect on her heart rate and blood pressure. Her body was closely monitored throughout the anaesthetic including the use of specialised instruments and machines to check her blood pressure, heart rate and electrical activity, blood oxygen and carbon dioxide levels, and breathing rate. Meanwhile the second vet was working on her mouth, carefully extracting the teeth that were damaged beyond repair, and cleaning the teeth that remained sufficiently healthy. Her procedure went smoothly and without complication although, as expected, it took some time for all the work to be done. She recovered smoothly and gently from the anaesthetic and was able to go home later the same day.
Anna’s owner was very impressed with how quickly she recovered and she was back to eating and doing her daily activities by the next day! Since her operation, she has been back to us several times to confirm that she is healing well and has shown no ill effects from her dental procedure. We are all very happy that we were able to finally but safely get her dental disease under control. She is a perfect example of how an older pet, despite often having a few more health factors to consider and carefully manage, can still undergo a safe anaesthetic in order to have a necessary and life-changing operation.