Anesthesia Fears

      When we recommend a surgical or dental procedure that will require general anesthesia, fear of anesthesia is frequently paramount in the owner’s mind.  Fear of anesthesia is universal.  In people, patients often fear anesthesia more than the procedure itself.  This is true even though patients often are at a greater risk of dying from the procedure than from the anesthesia.   For example, women have about the same risk of dying from an uncomplicated pregnancy as they do from having anesthesia.  The fear of anesthesia is much greater than the real risk.  Though we can’t ever take the risk of anesthesia to zero, the risks are very minimal in animals and people.

     The first anesthesia was used by a doctor at Massachusetts General Hospital in 1846.  Ether was the first agent used; later chloroform was introduced.  In the 168 years since the beginnings of anesthesia, veterinary and human medicine have worked and struggled to improve safety.  We long ago stopped using drugs that were explosive. Current agents also do a much better job of protecting vital functions.  New drugs are constantly on the horizon and we are always fine tuning monitoring parameters and techniques.

       During anesthesia in our hospital, veterinary surgical staff monitors blood pressure, oxygen content of the blood, ECG and blood carbon dioxide levels, among other parameters.  In addition to mechanical monitors, we know, and have always believed, that the best monitor is well-trained staff. At the Lien Animal Clinic, every patient is assigned a licensed veterinary technician who is with that patient from the time they are prepped for surgery until they wake up. The technician administers drugs that relax the patient and provide pain relief, induces the patient and places an endotracheal tube, enabling the patient to breathe oxygen as well as the anesthetic gas. The same technician monitors anesthesia throughout the surgical procedure and is with the patient until it is fully awake following surgery. Our belief is that the technician should act as an advocate for the patient, including requesting additional pain control or other techniques to provide patient comfort and safety.

      Most patients have a blood test before anesthesia ensuring that they are normal metabolically.  All patients have intravenous catheters that supply vital fluids throughout surgery and give us constant access to their blood stream.   All patients are intubated so they can breathe oxygen along with anesthesia gas. This provides additional safety in cases where it becomes necessary to offer respiratory support. 

       We hear quite often that certain breeds are sensitive to anesthesia or specific medications.  This is rarely true. Each patient is unique and our drug and anesthesia protocols are based on what is best for that patient, not on their breed.  A multi-drug approach is the most effective and safest approach.  We add the benefits of certain medications while decreasing the negatives by using anesthesia cocktails with lower doses of individual medications.  Typically, animals receive pain medications with sedative medications prior to anesthesia.  This relaxes them, pre-treats for pain and removes the stress from their experience.  Then, an IV catheter is placed and the patient receives anesthesia-inducing medications.  The endotracheal tube is then placed enabling them to breathe anesthesia gas and oxygen.  Following the procedure, the patient is given oxygen until they eliminate the anesthetic gas from their body.  If appropriate, pain medication is repeated on recovery.

This scenario is exceptionally safe and is our standard protocol.  Know that the care-giving team providing your pet’s anesthesia is skilled and focused on your pet for the duration of its procedure and attentive to its needs through discharge from the hospital.

      Always feel free to discuss any concerns with us about any care your animal may need, including anesthesia or other procedures.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners

Family Medicine

     The blog I re-posted last week was by Dr. Brita Kiffney.  Brita is veterinarian in Bellingham and is my cousin.  I have always been very proud that we are both veterinarians.  In all the interactions we had as kids I don't ever remember talking about both of us wanting to be veterinarians. We just looked up when we were in college and saw we were following the same path.  I graduated from vet school in 1989 and Brita in 1995. We had this happen again a few years ago when we realized we were both pursuing board certification with the American Board of Veterinary Practitioners (ABVP). We are now both Diplomates of the American Board of Veterinary Practitioners, specialty Canine and Feline Practice, and certified just a year apart.

   
Brita's dad, Paul, is my dad's little brother.  Their dad, Don, was a physician as was his brother, Austin.  Don and Austin practiced together in the Kraabel Clinic near Woodland Park Zoo.   Grandpa and his brother were in practice when penicillin was discovered.  My Uncle Paul tells stories about how magical his Dad's little black bag that he carried on house calls seemed.  He learned later that mostly he could only dispense hope.  Grandpa used to talk about the advent of penicillin ushering in the era where doctors could finally do something.  Our Uncle Al is also a physician and orthopedic surgeon, though he hasn't practiced since the early 90's.
   
Brita and I grew up with our family taking care of us.  I remember going to the Kraabel Clinic. There was a messy doctors' office with shag carpeting and dark paneling and a spot in reception where lollipops were kept.  Helen, the great nurse who seemed larger than life, would always let me have as many as I wanted. My memories are sketchy since I was young when they both stopped practicing and they were both gone by the time I was in middle school.  Our Uncle Al was a great role model.  I spent a lot of time at his office with various orthopedic/sports injuries over the years.
   
Brita and I took the medical legacy in our family into veterinary medicine.  I have always felt medicine was in my blood, even if I didn't chose to direct that towards human patients.   Early in my career, I would see the occasional client that had been a patient of my grandpa or Uncle Austin.  It always made me feel connected across decades to a set of brothers that I only really knew for a short time.  I recognize their contribution to my life in veterinary medicine.

Life has interfered many times and Brita and I have had times we haven't kept in great contact.  But between social media and ABVP that has changed.  We initially reconnected over the ABVP certification process and have stayed in better contact since.  We just got back from the annual ABVP continuing education conference.  It was great to spend time with Brita and our extended group of friends in the organization.
 
Significantly, Dr. Fritzler and I are proud that the family legacy may move into the next generation.  I wrote in a blog before that our sons both want to be veterinarians.  We just found out this week that our oldest son Geoffrey got through the initial application process to vet school and has an interview in January for a spot in the WSU College of Veterinary Medicine Class of 2019.

Timothy R Kraabel, DVM, DABVP (Canine/Feline Practice)

Outreach Chairman, American Board of VeterinaryPractitioners