Admission
The doctor or a nurse meets with the patient and client the morning of the procedure to discuss any changes at home, review treatment plan, make sure contact information is correct, and to complete consent forms. This helps us find any red flags that might indicate anesthesia should be avoided or modified and helps make sure we are on the same page as the family regarding exactly what procedure(s) are going to be performed. This is a final opportunity for us to make sure all of the client’s questions and concerns have been addressed.

Pre-anesthetic examination
The doctor will perform a thorough exam, from nose to tail, to look for any problems that may make anesthesia or surgery unsafe. The patient’s weight is assessed to allow very careful calculations of anesthestics.

Pre-anesthetic blood testing
Complete Blood Counts and a Chemistry Panel help us detect illnesses like anemia, low platelets, diabetes, kidney disease, or liver disease that may not be obvious on physical examination. Additional screening, such as chest x-rays for patients with suspected heart disease, may be indicated for some patients. New medical problems that necessitate altering the anesthetic protocol or forgoing surgery altogether are detected in approximately 30% of senior patients!

Team review
All veterinary team members involved with the procedure discuss the patient’s lab work, exam findings, home history, procedure, and any suspected anesthesia/surgical risks or modifications to further reduce risks of unexpected complications or errors.

Sedation injection
For most healthy patients, a combination injection of opioid (butorphanol) and sedative (Dexdomitor) is administered to help the patient relax, provide pain relief during the procedure, and to reduce general anesthetic requirements. Our clinic’s primary goals with our medication selection/protocol are safety and effectiveness; in fact, these are the same drugs you’d see used in human pediatric patients at the nearby human hospital.

Oxygen support
As the patient becomes relaxed, oxygen is supplied via mask to help support blood oxygen levels during anesthesia. Higher risk patients like dogs with shortened faces (brachycephalic breeds like bulldogs, pugs, shih tzus), obese/overweight patients, or patients with heart disease especially benefit from several minutes of pre-oxygenation prior to induction of general anesthesia.

Monitoring
Initial monitoring at this time includes physical assessments by the highly trained veterinary team along with Pulse Oximetry machine constant monitoring of heart rate and blood oxygenation.

IV catheter placement
Once our patient is relaxed, we clip a small area of fur over the cephalic vein in a front leg, surgically prep the area, then place an IV catheter. This catheter will be used to deliver anesthetic injection and IV fluids, and provide immediate access for the delivery of life-saving drugs should an anesthetic complication occur.

Induction
For most patients, an injection of Propofol is administered through the IV catheter until general anesthesia is induced. Again, this may not be the cheapest or quickest anesthesia protocol available, but we prefer patient safety and comfort at our clinic.

Endotracheal intubation
To protect the lower airways from any refluxed stomach contents and to allow direct delivery of oxygen and anesthetic gas, a tube is placed into the windpipe, and a cuff is carefully inflated to an ideal, measured pressure.

Isoflurane anesthesia
The Propofol injection only lasts a few minutes, so the remainder of the patient’s procedure is performed with isoflurane gas providing general anesthesia. This gas allows us to quickly fine-tune the patient’s anesthesia level according to his or her needs.

Surgical preparation
Area(s) surrounding the surgical site are surgically clipped, sterilized with 10 minutes of surgical scrub followed by surgical rinse, and a local numbing block is often applied.

Transfer to Operating Room: The patient is moved to the disinfected operating table and placed on a warming blanket. Additional monitoring equipment is connected. Autoclaved/sterilized surgical instrument packs are set up.

Doctor preparation

While the patient is prepped for surgery and monitoring equipment is set up, the doctor dons a surgical cap and mask, then scrubs in using Betadine hand scrub and Avagard hand rinse in our AAHA-approved surgical scrub sink. The doctor then dons a sterile surgical gown and sterile operating gloves. While many of these steps may be skipped in many clinics for the sake of saving time and costs, our highest priority is surgical safety.

Patient monitoring
Our licensed veterinary nurse (RVT) continuously monitors and records the patient’s heart rate, gum color, and respiratory rate manually along with more extensive values measured by our monitoring equipment such as blood pressure, blood oxygenation, carbon dioxide levels in the breath, EKG, and temperature. Having a highly trained, licensed team member monitoring in this way allows early intervention at the first sign of slight changes and is one of the most effective methods of prevent catastrophic anesthetic complications or insidious ones like mild kidney damage, but you might be surprised that this is not standard precaution with many clinics.

Laser surgery
In general, our surgical procedures are performed using a surgical laser instead of traditional scalpel blade to reduce or eliminate blood loss, reduce post-op pain, reduce surgical complications due to poor visualization, and to speed recovery to normal function.

Laser therapy
With the exception of eye or cancer surgeries, a post-op laser therapy session is performed to reduce post-op pain and inflammation, and speed recovery.

Post-operation pain control
In general, patients receive a Non-Steroidal Anti-Inflammatory medication injection such as Carprofen or Meloxicam along with an additional post-op opioid injection(s) such as buprenorphine. We 100% support using 21st century pain control to keep our 21st century patients as comfortable as possible before, during, and after surgery.

Post-operation monitoring
The majority of anesthesia-related complications actually occur in the few hours following the procedure, so our patients are closely monitored in hospital until discharge later in the day.

Post-operation phone call: We realize that anesthesia and surgery come with very real risks despite our best efforts to minimize them, so we make sure to call you once your pet’s procedure is over just to let you know how he’s doing.

Discharge appointment
At least several hours after the procedure, we’ll meet to go over our surgical findings, post-op medications, and any additional home care needs. We are not staffed overnight, so we prefer to discharge our patients before we close where they can be comfortable and watched at home. Orthopedic procedures are an exception to this rule, as 100% strict confinement immediately post-op is critical. We do occasionally have a critical patient/emergency surgery that would benefit from close monitoring or more intensive care that is referred to our local emergency/critical care hospital. We recognize that it’s hard to remember every detail we go over at this appointment, so a written copy of instructions is sent home as well.

Patient follow-up
We worry too—so we like to check in post-op to make sure things are going well at home! Most of our routine surgeries are completed without external sutures or staples, but occasionally these will be needed, so a patient will need to return for them to be removed after 10-14 days.

Post-operation complications
Due to the above protocol and obsessive care during surgery, we very rarely see surgical complications. The ones we do see are almost always due to licking/chewing at the incision or being overly active at home during the recovery period—so please follow our discharge instructions closely!