What happens when my Pet stays in as an inpatient for the day?
(Molly the Moggy, a 6mth old tortie girl, spends the day at the vets for her spay operation).
It can be an anxious time when the Vet or Vet Nurse picks up the travel box and disappears through the back door of the consulting room with our favourite pet. A recent history has been taken, no food since last night, we’ve done a pre anaesthetic health check, weighed, you’ve gone over the consent forms and are confident with your vets…. but there is still a pang of guilt as your loved one crosses that exclusive, invisible “Staff Only” line and disappears into the corridors of the building with a forlorn ‘meow‘.
“Give us a phone at 2 o’clock to see how she is getting on, home time is usually between 4 and 6 o’clock”.
So as you are sitting at home or the office with that niggling little worry at the back of your mind, what actually is going on with Molly the Moggy back behind closed doors at “Castle Greyskull Veterinary Clinic” as she undergoes her operation?
Molly the Moggy in her cat carrier comes out of the consulting room, down the corridor and into the cattery where she is quickly transferred into a kennel with a soft bed large enough to stretch out on. The front part of vet practices can be noisy places with a lot of coming and going, especially first thing in the morning. The key to a good anaesthetic is to keep the patient calm and stress free. So getting Molly quickly installed in her own space and out of her cramp cat carrier will let her relax a bit before we start the morning. Her notes are transferred to the Nurse in charge of the kennels that day, along with any extra details above what has been booked in for the day – in Molly’s case she is booked in for a general anaesthetic and spay but is also getting a microchip and her nails clipped. Molly’s owner would also like a pre-anaesthetic blood profile done before her operation to be as thorough as possible before going ahead with her procedure.
A pre-anaesthetic blood profile is a service most vets will offer to all clients as part of coarse before any sedation or anaesthetic. It is considered to be best practice and therefore should be available to everyone. There is an extra cost involved so it is offered as an option, taking into account your pets clinical history and physical condition in conjunction with the advice of your veterinary surgeon. It is a less pressing concern if funds are tight in young fit healthy animal, but is almost insisted on in old or sick animals before an anaesthetic. The blood sample gives us an indication of how well Molly’s internal organs are working, especially her liver and kidneys and whether she is carrying an underlying infection that is not yet clinically apparent. When an animal is given an anaesthetic or sedation, their blood pressure is artificially lowered for a period of time. If there is an underlying problem with the working of their liver or kidneys, this maybe exaggerated by going ahead with the anaesthetic. Therefore by doing the blood test we can make an informed decision whether we need to postpone the operation until we have dealt with the underlying condition, or if we need to go ahead with the procedure but take extra precautions (such as putting on a drip) to minimise the chance of further problems. We usually take blood from the big jugular vein in the neck as it is easier to get a good sample and less painful for the patient. We will usually clip an area of hair from the site first so as not to introduce infection when we access the vein. Molly’s bloods were all normal.
Once she has had a chance to settle down, we check Molly over again to make sure her heart and lungs are ok and that there is no reason not to go ahead with the operation. We then give her the first part of her anaesthetic, the premed and allowed to get sleepy in her kennel.
A general anaesthetic can be divided into 4 phases:
Premed – is the first part of an anaesthetic. It is usually an injection under the skin of a drug which calms the patient down and makes them sleepy. It allows a smooth easy transition into the unconscious state. This phase usually takes anything from 10min to 30min depending on the individual.
Induction – this is when we take the patient from a sleepy state of premed into a managed state of unconsciousness. We usually administer this as an injection into the vein of the front leg, which is clipped before hand to prevent the introduction of infection into the vein when injecting. A tube is placed into her throat and connected to the anaesthetic machine. From now until she is fully awake again Molly will be under constant observation with regular heart rate and blood oxygen monitoring. This phase takes just a few minutes.
Maintenance – Molly is connected to the anaesthetic machine and a mixture of oxygen and anaesthetic gas is administered through the tube in her throat to her lungs. This allows us to keep her in a state of carefully managed unconsciousness so we can perform her surgery. For a cat spay, Molly has her flank shaved and surgically scrubbed up for her operation. In a cat spay her ovaries and womb are surgically removed to prevent her from having kittens. This phase of anaesthetic takes as long as the operation to complete. On average a cat spay can take 15min to 30min depending on the degree of difficulty and the skill of the surgeon. All surgeons like to be efficient with their operations but care and precision are never sacrificed for speed during a procedure. The microchip is implanted and nails are clipped while she is still asleep.
Recovery – Time to wake up! Surgery over and all is well, the anaesthetic gas is turned off and Molly continues to have oxygen delivered to her via the tube in her throat. As she starts to come round from a state of unconsciousness to sleepiness the last of her painkiller injections are given, the tube is removed from her throat and she is returned to her kennel. As she is awake now and holding her head up we can leave Molly to recover from her anaesthetic, but the vet and nurse in charge of kennels always keep a quiet eye on all recovering patients. Recovery time is hugely variable on the individual and procedure involved sometimes taking minutes, sometimes a lot longer. We always aim for a quiet steady recovery back to normal, much like waking up from a long deep sleep. This can be helped a lot by keeping the recovering patient in a warm, quiet, dimly lit area, with as little fuss as possible. Some pets can have quite dramatic responses during their recovery from an anaesthetic. As many of the drugs we use have a similar affect as alcohol has on human behaviour, on occasion, we may see staggering about the kennels, seeing imaginary objects or vocalising (“singing”) from some patients, sometimes called “the happy drunk recovery”!
In all cases we like to keep all patients in for as long as possible post anaesthetic to make sure there are no problems with the surgery and to monitor for signs of pain or discomfort. This care has to continue for the first night at home so we always advise to make provisions for a familiar warm and quiet place to let your pet sleep off the effects of their anaesthetic. In most cases after the first 12hrs they are back to normal, but in some cases it can take a bit longer. In Molly’s case all went smoothly and she even had time for a drink of water and a bite to eat before her owner picked her up at 6pm after work!
We saw Molly back at her routine 5 day check and all was well. She was a bit of a minx and had to have a head collar on for the first few days after her operation as she was licking around the wound, but we think it was just itchy from the hair growing back in where she was shaved. 10 days later, apart from a bit of a bald patch she was back to her usual mischievous self!