In The Know

There are many very different drugs and methods of anesthesia used by veterinarians. The safety and the cost of these drugs vary greatly. You may wonder why a veterinarian would choose anything other than the safest technique.

Anesthesia for an ovariohysterectomy (spay) can cost a veterinarian from $5.00 for cheap injectable anesthetics with no monitoring to over $220.00 for inhalant anesthesia monitored with EKG, blood pressure, pulse oximeter, computers that breath for your pet during the anesthesia, and highly trained anesthesia technicians. That is why low cost spay and neuter facilities are so profitable.

In today’s current economy, a veterinarian who does low quality, high risk anesthesia can actually charge ½ the fee that a veterinarian doing high quality, safe, low risk anesthesia surgery can charge. On top of that, the veterinarian offering the less expensive high risk anesthesia can earn twice as much money from a surgery such as an ovariohysterectomy (spay) or neuter. Low cost surgery is much more profitable for veterinarians.

Mistakenly, most discount spay neuter facilities do not explain the shortcuts that they take – using inexpensive but high risk injectable anesthetics, little to no monitoring, poorly trained low wage staff, using the same instrument pack for multiple patients, not autoclaving instrument packs, using discount suture.

Discount low cost spay and neuter facilities provide a great service in providing a low cost alternative for families that have financial difficulties. At the same time low cost surgical centers reward veterinarians with a much higher profit. But, rarely do these facilities explain to clients the shortcuts that they are taking, the lower standards of care and the higher risk for anesthetic death and infection for the dogs and cats. Like many things in life you get what you pay for.

A Safer Way

The only way to reduce a pet’s anesthesia risk to the same or lower than people is to use the same techniques and equipment used by human anesthesiologists. That is why veterinarians whose primary concern is about their patient’s safety purchase such expensive anesthetic equipment and use more expensive anesthetic drugs.

• The first step is preanesthetic blood screening and exam to determine if your pet is healthy enough for anesthesia and if they have any conditions or problems that could affect anesthesia.
• Then an intravenous catheter is placed in the vein with sterile technique. Then the pet receives pre-anesthetic drugs that reduce anxiety along with pain medications. Pain medications before surgery are much more effective than pain medications after surgery.
• Then a short acting anesthetic is given so that a tracheal tube can be placed. This tube prevents aspiration pneumonia and provides a safe and effective path for oxygen and gas anesthesia.
• High tech veterinary anesthesia utilizes very safe gas anesthetics balanced with intravenous medications such as morphine, lidocaine and ketamine. Veterinarians providing state of the art safe anesthesia always give intravenous fluids during surgery.
• The pet is monitored with a pulse oximeter, EKG, blood pressure monitor, body temperature, breathing rate, and attached to a computer that gives a specific amount of oxygen and anesthetic by body weight algorithms. In this way the pet’s lungs are safely fully inflated during surgery reducing anesthetic hypoxia.

Not only is the type of anesthesia critical for the safety of your pet, but also the skill and level of training of the veterinarian and anesthesia technician determines the safety of your pet’s procedure.

The type of anesthetic drugs, the surgical equipment, and level of training of the technicians and veterinarian determines the safety of your pet’s surgery more than any other factor.

The number one cause of complications leading to death for a pet is cellular hypoxia. This happens when cells are starved of oxygen. When the cells of the heart are starved cardiac complications occur.

Oxygen is transferred to the blood stream through the lungs. Then the heart is responsible for pumping the oxygenated blood to the cells. During anesthesia, pets do not expand their lungs and breathe in as much air as when awake. This combined with lower cardiac output can lead to dangerous cellular hypoxia.

Cellular hypoxia varies greatly with different anesthetic drugs and anesthetic protocols. Less expensive drugs and techniques greatly increase the risk of fatal cellular hypoxia. To prevent cellular hypoxia anesthetized patients need positive ventilation that expands the lungs to get more oxygen into the body. Close monitoring of both the heart and body oxygen levels. This requires special anesthesia equipment and highly trained anesthesia technicians.

The Animal & Bird Medical Center uses expensive ADS 1000 computers that breathe for your pet while under anesthesia, Nelllcor pulse oximeters to monitor oxygen, blood pressure and ekg’s to closely monitor cardiac function. Our technicians are required to go through extremely comprehensive training.

Another complication in surgery can come from improperly sterilized surgical instruments. There is only one acceptable method of sterilizing – extreme heat and pressure created by an autoclave that kills all bacteria, fungi, and viruses. Quality veterinary hospitals use a single pack of autoclaved instruments for each surgery, just like in human hospitals. A common practice in discount veterinary hospitals is to use one surgical pack for many patients to reduce costs resulting in cross patient contamination of bacteria and viruses.

A lower and less sanitary option of cleaning is immersion in a cleaning solution and using the same surgical pack on multiple patients. Since the late 1800’s, we have known poor sterilization results in sepsis and the spread of disease.
Also surgical instruments vary greatly in quality. Poor quality surgical instruments have poor tissue handling resulting in more trauma and higher complications. Quality veterinary practices purchase expensive German instruments. Other hospitals purchase low quality cheap instruments made in Pakistan.

The most common cause of fatal hemorrhage is poor surgical technique, often from using inexpensive and inferior instruments and cheap suture that has poor tissue handling capabilities. Discount spay and neuter clinics often purchase second rate products in rolls, just like fishing line. Rolls do not remain sterile as they become used and frequent handling can weaken substandard sutures. Quality suture is sold in individual, sterile packs with an individual needle.

At the Animal & Bird Medical Center all routine surgeries are done with an individual autoclaved surgical pack. The surgeon wears a sterile surgical gown, cap and gloves exactly like in human hospitals. We use the most expensive German instruments because our patients deserve the best. We use the same sutures used by plastic surgeons because this high quality suture causes less reaction and discomfort for our patients.

In human medicine doctors are required to do advance training after medical surgery before doing surgery in hospitals. In veterinary medicine, no such training is required. That is why there is such a wide range of surgical abilities and training in veterinarians as compared with human surgeons.

It is up to each veterinarian to get advanced surgical training and develop their surgical skill after veterinary school. The skills of veterinarians vary widely from extremely unskilled to high levels of mastery. Surgical fees reflect the additional costs of advanced training and continuing education of veterinarian’s that are highly skilled. Veterinarians are very aware of their personal level of proficiency and charge according to their surgical expertise.

The skills of the veterinary technician and anesthetist in assisting the doctor before, during, and after the surgery are critical in your pet’s surgery and recovery. Dr. Murphy personally trains all veterinary technicians in his hospital to meet his level of expertise. Because they are highly motivated people, Dr. Murphy hand picks each technician for training. He pays for his staff to attend continuing education classes. The veterinary technicians at ABMC are very capable in phlebotomy (taking blood samples) , running laboratory panels, intubation and monitoring all devices like the pulse oximeter, EKG, blood pressure, etc. during surgery, among other procedures.

Before one is allowed to assist in surgery, a vet tech needs to show the ability to follow doctor instruction and also the aptitude to think ahead and anticipate circumstances, as well as adapt to fast changing conditions. They become the connection between the doctor, pet, and machines as the surgery progresses. After surgery, nurses lovingly care for your pet and vigilantly watch for changes in your pet’s condition, alerting the doctor if anything seems unusual.