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Old September 24th, 2009, 02:13 PM
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3 X sedated in 6 weeks

Sasha has had to have some broken teeth pulled today and has undergone yet another sedation, this is the 2nd one in 4 weeks, she will have to be sedated again in 2 weeks time to check out her jaw to make sure there is no infection. Unfortunately today the vets dental xray machine was down so they could not xray.

So my question is, is this OK I mean this will be 3 times sedated in a matter of 6 weeks. She has done very well with the first two no complications or anything. Her vet does not seem to be worried about this but I am.

She will also be going through another 14 days of antibiotcs, poor baby.

Thanks for any comments.
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Old September 24th, 2009, 03:33 PM
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Oh no Pbpatti! your poor girl! What the heck did she do to her teefy's! I dont know about the sedation but Winston wanted me to send his good wishes for his friend Sasha~!
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Old September 24th, 2009, 03:39 PM
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Poor Sasha . She is young enough that this should not be a problem. The anasthesia is quite hard on the liver/kidney so it probably wouldn't hurt to support the liver by adding some milk thistle to her diet as well as supplementing with acidophilus. I would also worry a bit about her immune system being a little overwhelmed so would supplement her food (I think you feed kibble) with some added quality protein like scrambled eggs and meat.

Good luck .
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Old September 24th, 2009, 04:08 PM
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Poor Sasha! It just never seems to end for the poor dear!

The good thing about the sedation they use for xraying is that it's usually pretty light. It's not usually a general anesthesia...just something to make them relax. And generally, these drugs seem to be easier on the body than the ones meant to knock them out for a lengthy surgery, for example. Do you know if he's planning on using light sedation as opposed to anesthesia?

We've had occasion where there have been a series of sedations over just a few weeks and have not had problems. Can you talk with the vet ahead of time and bring up your concerns? Getting a few questions answered might help set your mind at ease about this.

for quick healing for Sasha's mouth!
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Old September 24th, 2009, 11:03 PM
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This is a great question - how safe is multiple anesthetic procedures within a short period of time?

My answer is this - it comes down to the anesthetist.

I would rather undergo ten episodes of anesthesia with a great anesthetist than one with a bad one. Heck, lets make it twenty!

Many of the anesthetic compounds are gone and out of the system in a very short period of time despite the fact that the recovery takes longer. Human studies have shown that 30 minutes after extubation (breathing tube taken out) about 90% of isoflurane has been breathed out. Propofol's "elimination half-life is about 1.4 hours and [its] clearance is about 50 ml/kg/min." (Plumb's Veterinary Drug Handbook Fifth Edition) That is also pretty quick. So it not that anesthetics build up in the body.

So what is the negative long lasting or 'summative' effects of anesthesia?

1) There is always a potential for a catastrophic idiosyncratic reaction to the anesthesia involving cardiac arrest. These are extremely rare though.

2) There is a potential that the pet is sensitive to a type of anesthesia - this has been ruled out if the pet has been anesthetized before with the same medications.

3) The patient's blood pressure drops and is not adequately addressed. This is probably the one I worry about most in our field. All anesthetics can drop blood pressure. It can frequently drop low enough to cause very small minute damage to the kidneys and other organs or even not so small damage. There was an anesthetic lecture that talked about a dog study with dogs being under for 45min at an anesthetic depth equivalent to a spay that lead to some animals having as much as 5% kidney loss. These blood pressure drops can occur without any obvious change in the patient's vitals other than blood pressure. I believe that blood pressure monitoring and having an intravenous catheter with fluids is important.

4) Stress. Yes going to the vet and having an anesthetic procedure is stressful. Some animals handle it well and others do not. (I am a wimp and handle any minor visit to the dentist with a great deal of stress - others are braver than I). Does this lower the immune system? Possibly, to some degree. Less stress is always better but anesthesia is not done without a good reason - one that should out weight the stress (and this can be different for each patient).

5) Other problems associated with lack of attention and care: pressure sores, heating pads/bottle burns, IV drugs leaking into the subcutaneous space, too great an anesthetic level, clogged airway, ET tube too far in or not far enough in, too much or too little fluids, mild or moderate asphyxia, tracheal pressure from incorrect tube size, etc....

6) Other underlying diseases such as heart disease may be affected by the stress of the anesthesia.

So if problems (1) and (2) don't occur that day - then there is no long term effect here, period. Problems (3) and (4) are harder to quantify. Until over 50% of the kidney's have been damaged, you cannot see it on the blood work (the study unfortunately had each of the beagles euthanized and their kidneys microscopically evaluated - that was the only way to get the numbers accurately). So problem for problem (3) we really must rely on a good veterinarian, with a good blood pressure monitor and an IV catheter with fluids going. Problem (4) relies on a friendly staff as well as the personality of the patient (no matter how nice the dentist is, I always cringe). while problem (5) may show up immediately or may show up later - with a careful anesthetist and supportive team, these should not occur. Problem (6) should be handled with careful pre-anesthetic evaluation of the patient. Sometimes it is impossible to know until after the procedure - this is one problem that multiple session of anesthesia likely have a summative damage versus a single anesthesia.



So bottom line, if you pet medically needs to be sedated/anesthetized repeatedly in a short period of time, then as long as you have a good veterinarian with a good support staff (this is as important as a good veterinarian) your pet should be fine. Can there always be a horrible unexpected and unpredicable crisis? Yes, but less likely with a pet that we know can handle anesthesia and less likely with a good vet who has a good team.

Why do I mix sedation and anesthesia terms? Because they are basically the same. In fact injectable sedation is often more risky than anesthesia. With anesthesia we have an ET tube in place that we can breathe for the pet and give oxygen, we have several monitor systems in place, we have intravenous fluids in place, etc.... Furthermore with gas anesthesia, if we have a problem we can turn off the amount of anesthetic going into the patient. With an injectable sedative, the amount of anesthetic has already been given in a single dose.

Good luck and I hope this helps.
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Old September 24th, 2009, 11:30 PM
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Some clinics will also give an antagonist drug that neutralizes the initial anaesthetic if there are any concerns post anaesthia or just to help wake them up faster, and the dopyness when waking/recovering is greatly reduced.

for Sasha this is the last medical issue she has for a very long time
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Old September 25th, 2009, 09:10 AM
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Dr Lee, thank you so much for the information. Sasha has come through this procedure really well. Her Vet said that she was a litle slow to wake up but there were no complications whatsoever. Today she is sleepy but alert she is on a course of meds that would keep her out of pain and calm. I trust Dr Suzanne implicitly she is a wonderful vet/surgeon.

Thank you all for your caring responses.

Hazel the next sedation is a very light one, as you mentioned they only need to get an xray of her jaw to make sure there is no deeper infection. pbp
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Old September 28th, 2009, 04:58 PM
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I'd like to clear up a few points that may cause some misconceptions:

Except for the risk of kidney damage during each sedation, there isn't really any cumulative risk for dogs undergoing multiple anesthesias or sedations. Each procedure is separate and the risk of each must be balanced against the risk of disease. So the risk of that third sedation is less than the risk of lingering infection.

I would also caution against any conclusions that gas anesthesia is safer than injectables just because it can be turned off quickly. That is far from true. There are a wide range of types of injectables, each with their own risks and benefits. Gas, itself, has risks especially when it is the only agent used. Usually, the safest anesthesia is a balanced one involving multiple injectables plus gas anesthesia.

It is true that some drugs can be reversed but when you reverse them, ALL their effects are generally reversed. Many of the reversible drugs are also the drugs we use for pain relief so we generally do not reverse these drugs unless it is necessary or if the procedure does not cause pain. It also isn't always true that a fast recovery is the best recovery. I always prefer a slow recovery if that means a calm, gentle recovery over a stormy, fast recovery.
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