Dr. Angie Krause (00:00)
Welcome back to Tails of Truth where we tell the truth about veterinary medicine. I'm Dr. Angie, and this is my co-host and veterinary nurse extraordinaire. And today we are talking about anesthesia and how scary it might feel to let your pet go under anesthesia. It's such a common concern. Yeah.

JoJo (00:18)
I feel it's so common, so common.

I feel like you probably get an email in your inbox multiple times a week about people wanting to avoid anesthesia.

Dr. Angie Krause (00:28)
Yes. People go to great lengths to avoid anesthesia. And I think once a day I recommend a procedure that requires anesthesia and people say, well, do you think that's safe? And the most common concern is, do you think it's safe at my pet's age?

JoJo (00:41)
home.

Right, I was gonna say it tends to be for the older dogs and cats that people feel really afraid.

Dr. Angie Krause (00:48)
Yeah.

Yeah, so we should talk about it.

JoJo (00:53)
which is valid. Yeah, it's valid

to feel afraid. I just want to name that. But I wonder where that fear comes from.

Dr. Angie Krause (01:01)
⁓ I think I know. I think that fear comes from the decades of veterinary medicine where anesthesia protocols weren't that great. Animals weren't monitored. They weren't screened before anesthesia and there were more anesthetic deaths. I think the longer I practice, the less stories I get of like, I had a dog that went in for a dentistry and then died.

JoJo (01:12)
Mm-hmm.

Dr. Angie Krause (01:27)
or I have a friend who knows somebody that lost their dog during the spay. And so I think it just happens less and less as medicine gets better and better.

JoJo (01:37)
Yeah, I think that's fair because I've been really into reading studies. That's kind of my jam. And the older studies, the rate of death is just a smidge higher. It is still extremely low. But I wondered as we continue to see the data come out, if it's just going to continue to lessen. And I was a surgery tech for years. And I can only think of one death that we had.

Dr. Angie Krause (01:50)
Yes.

And do you remember anything about the case, how old the dog had?

JoJo (02:05)
I remember

it was post, it wasn't even during, which is a more fragile time, if you will, after when they're coming out of anesthesia, rather than the actual anesthetic procedure itself. It's in the recovery period. I don't remember specifically about that animal, but I've only had one, and I've done a lot of surgeries.

Dr. Angie Krause (02:13)
Yes.

Yes.

Right.

Yes. Yeah.

Yeah. Think how many animals you've anesthetized. Yeah. I'm gonna knock on wood when I say this. I've never had any.

JoJo (02:29)
so many. Yes.

Dr. Angie Krause (02:35)
So, but I mean, I've definitely, you know, had cases, that another veterinarian was handling. And I'd say, the most common, reason for an anesthetic death is there was underlying disease there that we didn't know about. And so always tell people if we've done blood work and that looks good and we've assessed your dog or cat's heart function, if they have a murmur.

then those are two things that really put your pet in a better position to have a successful anesthetic event.

JoJo (03:08)
Absolutely. Which, how do you feel about that same day, blood work? there are clinics it needs to be within two weeks. And then there are clinics like, okay, just morning of we'll just run some basic labs.

Dr. Angie Krause (03:21)
I think it's six, one half dozen the other. The nice thing about doing it ahead of time is that if there's something wrong and we need to investigate it before we do anesthesia, then you haven't fasted your animal and brought them in to be hospitalized for the day. Cause sometimes on that same day, anesthesia, you find like the same day blood work, I should say, you find something that prohibits that procedure from going forward.

And your dog had to skip breakfast, which is for some dogs very psychologically harmful.

JoJo (03:48)
Or your cat. Yeah. Totally. Especially if they

have an afternoon procedure. Yeah.

Dr. Angie Krause (04:00)
But the

upside of doing it the same day is that they're not having another trip in. You're just doing it all in one day. So I think it's fine either way. What do you think?

JoJo (04:06)
Mm-hmm.

Okay. So,

well, I mean, it's such a bummer when you come in the day of surgery and find out, yeah, that's not happening because we find something on labs, but you know, we found it. So it, yeah, exactly. So I am glad that they are doing blood work period.

Dr. Angie Krause (04:23)
We found it.

Yes,

and I try to run it ahead of time if I can, just because I know then that's one less thing for the whole surgery crew to do the morning of surgery. So I look at it from that viewpoint too. It's like I want to, I want to make their morning easier.

JoJo (04:46)
I was going to say, you mentioned as senior pets that people tend to feel really risk averse in terms of going under anesthesia. Maybe because that's just an awful way to think about losing your pet is if they're going in for something routine like a dentistry, you know, and it is scary. want to name it just, it is scary to no matter what that your pet is anesthetized and in the care of other people. Scary.

Dr. Angie Krause (05:02)
Yeah.

Yeah.

Yes.

And we're taught in veterinary school that age is not an anesthetic risk, like that you shouldn't even factor it in. But you know what? I do. Like if I had a 14 year old lab, I am going to be less excited about anesthetizing that dog than, you know, a seven year old lab. And technically, it should be just as safe, but I always think

JoJo (05:22)
Yeah, do.

Dr. Angie Krause (05:38)
man, I think it's harder to recover. I, so I, it, something has to be a little bit more dire for me to recommend that. Like I have to think they're in pain. If I think they're in pain, if I think they have dental pain, any of that, you want to take care of it. But at some point you do think about like, do we really need to remove the mass of this 14 year old dog? If we're not going to do any treatment or if it's not bothering

the dog or the people, like I feel like I anesthetize less often as they get very old. Because if you have a 14 year old lab they're like a hundred years old, maybe like 110, right?

JoJo (06:14)
Right.

So if they have a little gingivitis action going on, we might just let that live.

Dr. Angie Krause (06:22)
yeah, that tartar's staying there. Now if there's a broken tooth or like really bad breath, it makes me think there's an infection in there.

JoJo (06:24)
Yeah.

Dr. Angie Krause (06:29)
I, yeah, so even though age shouldn't matter, it does. And as animals age, their recovery time is going to be longer. So maybe it's just as safe, but maybe they wouldn't, they were seven, they would have bounced back in one day. It might take them three days.

And so I always like to prepare people for that.

JoJo (06:50)
That's a idea. Well, do you change the induction protocol based on age or does that stay the same?

Dr. Angie Krause (06:55)
I think a lot of things can change based off of like age and breed and temperament and like comorbidities, meaning other disease states. So, I mean, I think for the most part it would stay the same, but it really depends. Yeah.

JoJo (07:11)
All right, and in those

studies, the dogs that had problems in anesthesia were typically obese. So that was an interesting comoridity that was problematic. And I wonder if that's something to do, I didn't read the whole study, but I wonder if it has something to do with how their bodies are breaking down the anesthetic drugs. If it's a slower process.

Dr. Angie Krause (07:18)
Yeah.

Yes.

right.

JoJo (07:34)
If you're more obese, would assume it's slower. I don't know why I assume that. Am I wrong, Dr. Angie?

Dr. Angie Krause (07:34)
Mm-hmm.

Well, the fat, you know, can store certain anesthetic agents. And so that, that is true. And that does make sense. And also if you have an obese pet, there might be underlying disease that we're not detecting. And so I think that's a, that's a complicated one.

JoJo (07:45)
Yeah.

Mm-hmm.

what can we give people to help them feel safe about anesthesia?

Dr. Angie Krause (08:01)
I think that people need to understand the steps their veterinarian is taking. And I think if your veterinarian isn't willing to share this with you, it's a red flag. So I always tell people, and this is pretty standard that you want to have blood work done ahead of time for a surgery, especially if your dog's going to be inubated. We'll do minor procedures where we do injectable anesthesia.

JoJo (08:14)
Mm-hmm.

Dr. Angie Krause (08:28)
And we don't necessarily do blood work ahead of time. Like I had an urgent care recently. I had a dog that had a fish hook and I didn't do like in its paw and he wasn't going to let me get it out. Cause of course it hurt. And so I had to give him some injectable anesthesia. didn't do blood work ahead of time for that young dog. didn't have any reason to. So there are some things where you wouldn't do blood work ahead of time, although I'm sure your veterinarian would always love to do it.

JoJo (08:37)
Ouch.

Dr. Angie Krause (08:55)
And so I always ask, are they getting blood work ahead of time? Who is going to be monitoring your pet? You want to make sure.

JoJo (09:04)
pre,

during, and post.

Dr. Angie Krause (09:06)
correct. And so who's monitoring? You want someone dedicated. You don't want the same person that is maybe cleaning your dog's teeth also monitoring. At any given time, there's just a dedicated person that's checking your dog's heart rate, checking your dog's blood pressure, that's checking your dog's temperature, all of the vital signs. And so we're monitoring all of that.

for surgeries, most of the time we have an IV catheter in, it's now people are, it's like going in and out of vogue how much people are using fluids while under anesthesia. Like it used to be when I graduated that if you weren't running fluids, you were wrong. Yeah, now it's, you know, I think it's a little bit more on a case by case basis. And so those have.

JoJo (09:48)
always running fluids, yeah.

Dr. Angie Krause (09:58)
those guidelines have changed a little bit. So that would be more your vet's discretion. So it's not wrong to run fluids, but if your veterinarian isn't always running fluids, I don't think that that's wrong either. And then who's going to be there to recover your dog. And you know, I doing relief around the Denver Metro for the most part, most clinics are doing this very well, where someone's with your dog until they're completely awake.

and extubated, meaning the tube we use to deliver the gas anesthesia that's going down their throat is completely, it's gone, they're awake. And so I think if you're veterinarian and your veterinary team are doing those things, they're probably running pretty safe anesthesia.

JoJo (10:44)
Great, that's easy. So, and the blood work, are they just really checking the filtering systems of the body to make sure that their bodies can filter the anesthesia?

Dr. Angie Krause (10:45)
Yeah.

Yeah, more or less, like that is kind of a nice, you know, high level way. Like do the kidneys work? Because if the kidneys have disease and we do anesthesia, which we could possibly drop the blood pressure, we're really trying not to, but blood pressure does drop during anesthesia. We don't want that because less blood flow to the kidneys is bad. So that's one thing we'd be looking out for. Although cats with kidney disease can be anesthetized very safely.

Dogs with kidney disease, would definitely, I don't like to anesthetize them. I let the specialist do that with the anesthesiologist. that's my just personal preference. And the liver, we want to make sure there's no liver disease. our liver work? Do we have enough red blood cells and white blood cells? That's probably less for the anesthesia and more is there underlying disease. there's something we don't know about here. Yeah.

JoJo (11:43)
Right, the more we know, the better

we can do. And in that, the procedure, while that's happening, if you have a dedicated technician, it's typically a credentialed technician who's doing that work, they are monitoring, they're cycling through again and again, checking pulse, checking color, checking blood pressure, checking core temperature. And we have so many tools at our disposal right there in the surgery suite to just make sure that everything, we're communicating constantly with.

Dr. Angie Krause (11:45)
Yes.

JoJo (12:09)
with the surgeon or the veterinarian, it's just, that's why you want to dedicate an individual because it's all on cycle. It's not like we're catching it after it happened. We're hopefully catching anything that's happening in the moment that is happening. and we have some, I mean, I love the little Bair hugs that we have now. Like we old school was we heated up.

Dr. Angie Krause (12:21)
Yes. Absolutely.

JoJo (12:31)
you know, water or LRS lactated ringer bags and wrapped them in a towel to keep your pet warm during surgery. Now they have all these like wonderful little.

Dr. Angie Krause (12:32)
Yeah.

Bair huggers. Yeah, they're great. Yes. We have all this great technology and things to help and anesthetic time matters too. And so if you have an elderly dog or cat and you want to do an anesthetic procedure, I always think about who's going to be the fastest and the best at that. So even though at Boulder's Natural Animal, we can do dentistry. Sometimes we choose to send off

JoJo (12:40)
Yeah. Yeah.

Dr. Angie Krause (13:08)
older patients to the dentist because maybe they can do it more quickly, they have more options, it's just going to be a better fit for them. So don't be afraid to ask for a specialist or if you have specialists in your area or if you're in a specialty clinic they probably will employ an anesthesiologist to help the anesthesia be even safer. I have a lot of cases where I think

I'm not doing that. I'm going to let the anesthesiologist do that. And so like, it's just above my pay grade and I want someone that knows more to be there.

JoJo (13:44)
Hmm. You also, what I know of you is you are very consistent in, I feel like it happens with cats more with murmurs, like get that echocardiogram before your anesthetic event. And those are actually really noninvasive and relatively inexpensive and can give you a lot of security and the team a lot of security in knowing what your animal's presenting with. ⁓ are they? I'm sorry.

Dr. Angie Krause (13:53)
Yeah.

Well, they're really, they're really expensive now. They're really expensive

now. So.

JoJo (14:12)
Maybe I should just, that should

be on the umbrella. Everything is expensive in veterinary medicine right now.

Dr. Angie Krause (14:16)
Yes.

Yes. It got more expensive and maybe it's just Boulder County. but now we have to have the cardiologist come to us because we don't there. We have no cardiologist at CASE There's no cardiologist. Yeah. Pet Cardia left. I know. I mean, not to like get off on a little side quest, but we have the cardiologist come to us now. And this can be a whole different episode, but

JoJo (14:26)
⁓ that's problematic.

Dr. Angie Krause (14:41)
⁓ Yeah, so they have to come to us. So then they, it's more expensive for everybody. ⁓

JoJo (14:45)
⁓ okay, what does an echo

roughly cost?

Dr. Angie Krause (14:49)
I mean, I

would bet like seven or $800.

JoJo (14:52)
Okay,

I was thinking in the 450 range, which to me was relatively inexpensive for that added security. If a cat or dog has a one or two murmur, a grade one, grade two, are you still recommending an echo before surgery? Okay. I love stories. Of course, yes.

Dr. Angie Krause (14:56)
Right. No.

Oh yes, I had, do you want a story, story time? Okay. Couple

weeks ago, I had a cat that had a dynamic murmur and it, well, at least it was dynamic to me, meaning that I could only hear it sometimes. And I found that this cat had a broken tooth and I was like, I really want to take care of this tooth, but I don't want to do this until we get the echo done, like the ultrasound of the heart.

So she's like, no problem, we scheduled it. And this cat had such severe hypertrophic cardiomyopathy that he was at risk of literally dying at any minute. And so I always tell people my stethoscope is such a crude measurement of heart function. In fact, it doesn't measure it. All I can tell you is that blood is going the wrong way.

JoJo (15:49)
Hmm.

Yeah.

Dr. Angie Krause (16:03)
And you can have a small murmur and big disease. can have a big murmur and small disease. You can have no murmur and big disease. And so I like to get ⁓ anything and everything checked out if I can, or if you just have a high risk dog or cat, like a purebred, like a Bengal cat, or if you have ⁓ a Cavalier King Charles Spaniel, like just get, just do that. Go, just get it.

JoJo (16:28)
Mm-hmm.

Dr. Angie Krause (16:31)
If you have $700, just, just do it. Murmur or not. Yeah. Yes. Yeah.

JoJo (16:33)
Right. You're buying peace of mind. Definitely. So how did, then

how did you take care of that cat's tooth? You didn't, okay. Yeah, no stress for this cat, period.

Dr. Angie Krause (16:41)
we didn't. The cardiologist was like, you're not anesthetizing this cat. ⁓

no, like that probably would have put him over the edge. yeah.

JoJo (16:54)
So

what I'm hearing is that anesthesia is safe. And when I say safe, I mean the studies, you guys, it's like less than 0.05 % of anesthetic deaths happen. I mean, I think I could have said that in a much cleaner way, but it's like, it's somewhere in that range. I mean, there's some variability depending on set and setting, if you will.

Dr. Angie Krause (16:57)
Yes.

yeah. Yeah. It's... That's fine.

Yes,

JoJo (17:21)
Ahem.

Dr. Angie Krause (17:21)
honestly, the quality of the anesthetic protocol and the education of the team and the experience of the team, that's where it's at. Yeah.

JoJo (17:27)
Mm-hmm.

Yep. And if you're

scared and you're concerned, that should be heard and that should be validated. I just want to say that because it is valid and it is scary. And it's even scary because you're signing paperwork that's asking you DNR questions. Do you want to resuscitate? I mean, as soon as that question is asked, that's terrifying. Like, what am I doing? What am I saying yes to?

Dr. Angie Krause (17:38)
Yes.

Yeah.

I know.

When I drop off my own animals at a specialist for a procedure, like I'm nervous all day. And it's not because I think there's a high likelihood something's going to happen, but you're still nervous. Just like with people, like if you have a loved one that's going in for a knee replacement or something that's done so frequently, you're still nervous.

JoJo (18:16)
Well, I always feel nervous too, just because the recovery period and how they're going to come out. And I'm like, how do they feel feeling disoriented coming out of surgery? It's disorienting. Like those huskies scream. There are dogs that are just like, ⁓ this is rough for you.

Dr. Angie Krause (18:24)
Yes.

I know. I know they really do.

I can't tell you

how many dogs I rescue from their kennel or their crate and put in my office. If they're, cause I'm like, you're coming with me. You're sitting with me at my desk. but you know, a lot of times the teams are really good about noticing, okay, are they anxious? Are they painful and making them more comfortable? But I mean, the Huskies are just going to be Huskies and they're going to tell you everything.

JoJo (19:01)
Yeah.

They're not just telling you, they're telling everybody who's in that building that.

Dr. Angie Krause (19:11)
And

sometimes the more drugs you give them, you think, this husky's nervous or whatever. And then you give them more and it makes it worse.

JoJo (19:14)
⁓

Yeah,

which is, yeah, it's interesting. So, vet your vet, ask the questions. If they're recommending a procedure, it's probably important. And if your dog is a senior dog, I mean, some of these things can really add to quality of life. And I wanted to go back to you said you sometimes don't do blood work, like if you're doing an injectable for a quick, like the fish hook story you told. And that's...

Dr. Angie Krause (19:27)
Yes.

JoJo (19:39)
a lot the injectables are reversible is that so I mean if they're getting an injectable are you calling it are you still calling that Twilight would you consider that Twilight yeah

Dr. Angie Krause (19:42)
Yes.

I mean, it really depends.

It's dose dependent. Sometimes I'm just doing Twilight and the dogs are still kind of, you know, moving a little bit. Yeah. It depends on what I need to do. Like if I need to sew something up, we're not just, I don't want them to remember it at all. but if I like a thing I commonly see is a torn nail and if I can rip it off right away, I'll do it. But if it's going to take more than me just like taking it off.

JoJo (19:54)
drunk, loopy, yeah.

Dr. Angie Krause (20:14)
then I will give them some sedation, because I don't want them to remember. And so I will make them be all the way asleep for that.

JoJo (20:20)
Yep.

All right. And I was going to say,

and that's the safety piece in that is that we have reversibles that once we inject it, we're waking your pet up pretty quickly.

Dr. Angie Krause (20:32)
Right. And sometimes we don't want to use those reversibles for dogs, like with heart disease or older dogs, or there's some breeds where I just don't use reversibles. And so it really depends on, it depends on what we're doing and the dog.

JoJo (20:47)
and cat, right? We're not using those injectables very often with cats, I feel like.

Dr. Angie Krause (20:53)
yeah, I use them less. I use them less with cats. I feel like cats need less sedated procedures. Yeah, they're just, are cats just superior that way? Yeah. And they're just.

JoJo (20:55)
Yeah.

It seems that way. They don't get into quite as much trouble. Yeah. Even though they're super serious.

mean, although we do have that one cat in the practice that if there's something that this cat can do to itself, it will. Like, wow, it's totally a cat in a dog body. But yes, dogs do seem to do more.

Dr. Angie Krause (21:15)
⁓ yes! Like eat chocolate cake.

Yeah. mean cats are better.

JoJo (21:24)
Intensive

needing.

challenges, I guess, if you will.

Dr. Angie Krause (21:27)
Yeah.

Cats are making better life choices. But we can't do the same reversible sedation in cats. We just do it less. So, yeah.

JoJo (21:30)
That's a good way to say it. They are.

Okay, how should we wrap

this? Any last thoughts?

Dr. Angie Krause (21:42)
Well, I'd love to hear from everybody that's listening what you're concerned about. What didn't we cover? What do you want to know? Like we'll tell the whole truth. We'll tell it like it is. What do you want to know? how can we help you feel safe about anesthesia? And can you talk to your veterinarian about this? Hopefully you can.

JoJo (21:51)
Mm-hmm.

Hopefully if it were me, I love anesthesia to me. like one of the best feelings in the world to go under anesthesia

Dr. Angie Krause (22:07)
yeah, I got an endoscopy a few years ago and I was like, that's a nice nap. I used to feel bad about, ⁓ gosh, I felt good the rest of the day.

JoJo (22:10)
Yeah, I'm like, so restful. That moment of going in, I'm like, I'm so happy.

So I always bring that to my patients thinking maybe this actually feels okay.

Dr. Angie Krause (22:22)
Yeah.

Yes, no matter what that husky tells you, those drugs feel good.

JoJo (22:29)
Yeah

No, know. My smoker's cough is coming out. I have been sick for so long that I can't laugh. I can't laugh. I have noticed I've been being a little bit more stoic in this episode because I don't want to laugh.

Dr. Angie Krause (22:40)
I'm so sorry.

See you through it. Yeah, Jojo and I are both getting over like, I don't know, we've been sick for six weeks. Yeah.

JoJo (22:51)
Six weeks, super,

super fun. I'll take some of that anesthesia about now. Just gas me, I don't care. My lungs probably couldn't take it.

Dr. Angie Krause (22:54)
Everyone at the clinic is tired of hearing me coughing.

Well, if you want to talk about your own pet, you can want to get my opinion if they're safe for anesthesia, or if you just want to talk about your pet's health, you can go to boulderholisticvet.com and you can click on book a consultation. You can grab some time on my calendar. If you don't find any time, reach out to us and we'll make a time for you. Jojo's really good about making it happen. we will

JoJo (23:25)
was her way of

saying, JoJo's really good at nagging me.

Dr. Angie Krause (23:30)
Jojo manages me to the best of her ability and we'll collect all your pet's records. I'll review them. We'll meet on zoom. It'll be recorded and we'll make a plan for your pet. And before you leave, if you would just leave us a comment, a review or a like, and even better, if you could subscribe to our podcast, we would so appreciate it.

JoJo (23:51)
All right, take care. Bye-bye.

Dr. Angie Krause (23:53)
See you later, bye.