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Wednesday, December 15, 2010

Evolving Anesthesia

Currently my practice is getting ready to change our anesthesia protocols.  We've spent time reviewing the literature, consulting with specialists, and deciding what is both safe and cost-effective to use.  I'm pretty excited about the changes, and really believe that it will allow us to have better and safer anesthesia, as well as better and safer pain control.

Most clients probably don't realize that the anesthesia can be extremely different from one veterinary practice to another.  There simply is no one, single consensus among veterinarians regarding which protocol should be used.  Some vets elect to do anesthesia as cheaply as possible to make it available to more people, recognizing that the cheapest drugs usually come with greater risks than others.  Some vets use the most modern equipment and drugs, realizing that their anesthesia will be more expensive than their colleagues, but willing to do so for the increased safety.  There are numerous variables to how anesthesia is performed, including drugs used (inhaled versus strictly injectable, and then several choices in each category), supportive care given (warming aids to reduce hypothermia, fluid support), monitoring (ranges from none at all to ECGs, blood pressure, and oxygen monitors), and analgesia (ranging from none at all to both pre- and post-operative pain medications).

I have seen many changes in my 13+ years of practice and 26 years in the field.  Many of those changes have been in the last 5 years as research expands and companies develop better drugs.  The way we as a profession look at anesthesia and pain control in 2010 is a far cry from how we looked at it in 1990.  And depending on how they have kept up with their continuing education, a veterinarian who has been practicing for 30 years is likely going to see the subject differently than someone who just graduated. 

What does this mean for a client?  Ask LOTS of questions about how your pet is being treated and monitored.  When you ask about surgery costs and ask "what does that include?", don't settle for an answer of "Oh, it covers everything."  Yes, I've heard veterinary practices state it that way.  Ask details of precisely what is included, which drugs are used, and how monitoring and supportive care is done.  If you're comparing veterinary clinics, please don't go simply on price, as there are inevitably shortcuts made or corners cut in the cheaper of two quotes. 

What does this mean for a veterinarian?  We all need to keep up with current research and options, striving to do the highest quality and safest care possible.  I can guarantee that how you were/are trained in school is not going to be the standard in a decade or two.  Change in medicine is continual, usually for the better, and it's our responsibility to keep up with the new knowledge.

In essence, anesthesia is willfully bringing a pet closer to the conditions of death than we do in any other circumstance.  It's important to make it safe and reversible with no long-term consequences.  There is no way to make this perfect in 100% of the cases, but we can continue to improve.  Embracing the change is a good way to do so.

5 comments:

  1. I linked to it by email and it reproduced the whole thing on my blog,which is usually just an extract, but have credited you and added the link. Excellent article Chris.

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  2. For Veterinary Medicine price shopping will get you in trouble... to be more exact it will get your pet in trouble.

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  3. Personally I don't have a problem with people price shopping as long as they know WHY someone else is cheaper. When it comes it anesthesia it's usually because the cheaper vet is not doing as many services as the more expensive one, and that can lead to riskier procedures.

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  4. My experience with Price shoppers is that most don't understand the differences and only look at the price. Many people I talk to just think that every vet does it the same way so why not go with the cheaper one..

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  5. Oh, I agree, Elizabeth. That was one of the reasons for my post, and I try to make sure my staff talk about what our surgeries include and don't simply give the price. Not all surgeries are performed the same way!

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