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Anesthesia Phobia

Everyone worries when a pet requires anesthesia, but most pet owners worry for the wrong reasons.

There is always risk when a patient must undergo anesthesia and it’s easy to focus on the anesthetic. But does anyone really think the anesthetic is more dangerous than cutting a dog’s tummy open and removing her ovaries? Or extracting an infected premolar? Does anyone really think it’s safer for the animal to bear litter after litter, or to live with a big infection in its jawbone?

Statistics vary but I’m satisfied that the anesthetic-related death rate for healthy animals is about 5 deaths per 10,000 anesthetics. Some people round this figure up to 1 death per 1,000 anesthetics. For diseased animals, the death rates are much higher, about 14 deaths per 1,000 anesthetics.

In human medicine the anesthetic death rates are much different. Some studies claim that only 1 death occurs per 25,000 anesthetic procedures. One study suggested the figure is more like 1 death per 250,000 anesthetics. Sounds pretty scary, doesn’t it? If you believe these numbers, your pets are somewhere between 25 and 3,500 times more likely to die under anesthesia than you are!

Except that it’s not true. It’s not realistic to compare human anesthesiology, where a full-time specialist performs anesthesia using the most sophisticated, state-of-the-art equipment in a cost-is-not-a-consideration environment, to veterinary medicine, where YOU directly pay for the IV catheter placement and fluid administration, the pre-op blood testing and the myriad other things that are virtually always used in human anesthesia. Pet owners must often make certain trade-offs for the sake of economy.

What’s it worth to decrease you dog’s risk of anesthetic death from 1 in 1,000 to 1 in 25,000? Is it worth $600 per hour? That’s the best figure I could find from human medicine – for the anesthesiologist alone (drugs and equipment not included). In veterinary medicine, a more typical anesthesia cost would be something like $125 per hour – about 1/5th the cost, drugs and equipment included.

Let’s say a cancer patient is in critical condition and will certainly die without surgery. In veterinary medicine, we’re likely to take our chances. If the patient is going to die without surgery and might survive with surgery, taking the higher risk actually increases the patient’s chance of survival. I put myself in the animal’s place: I’d rather die fighting to survive than just die. In 30 years of surgical practice, I’m happy to say that I’ve saved many more patients than I’ve lost – but I’ve lost some too. Taking this kind of risk – or not - is for pet owners to decide according to what’s right for them and their pets.

Does this sort of thing happen in human medicine? Not really. Television drama notwithstanding, your surgeon is not going to take you into surgery if your lab tests and condition do not provide certainty that you will survive the procedure. But if you’re sure to die anyway, why not? Click the remote to the courtroom drama on the next station: No physician wants to appear responsible for “causing” the death of a patient, even a terminal patient, even during a heroic life-saving procedure. No matter what release you sign, when you die somebody is getting sued.

Fortunately, we don’t get much of this in veterinary medicine. This allows us to take higher risk patients in for potentially life-saving surgery and many of these patients survive – and thrive. However, when a patient does die, it’s counted as an “anesthetic-related” death.

Does this mean the patient actually died from the anesthetic? Heck no! But they alter the statistics to make anesthesia appear more dangerous than it really is. Veterinary patients rarely die from anesthesia. They die from illness, or whatever disease caused them to need anesthesia. Sure, there are rare healthy animals that don’t make it through a routine anesthetic, but most of these deaths result from hidden conditions or patient-specific drug responses that could never be detected until they are actually anesthetized. A tiny fraction of these deaths result from human error or just plain sloppiness.

What can you do to keep your pet safe in anesthesia?

-- Choose an experienced veterinarian and a facility with a good reputation. Avoid mass-production surgery – the savings usually mean decreased doctor and staff time with each patient.

-- Don’t stint. When your veterinarian recommends pre-anesthetic testing, pay for it! You’re buying knowledge that increases your pet’s safety.

-- Don’t put things off. When you delay treatment because of anesthesia phobia, your pet gets worse and anesthetic risk increases.

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