What are anesthesia "accessories"?
These consist of all the extra things that we do and give to make your cat's surgical procedure as safe, smooth, and pain free as possible. We say "accessories", but while some of these are optional, many of them are not, and depending on the health status of your cat, and the length of the procedure being done, your cat may end up having almost all of these done. One thing that is never optional in any of our surgeries is pain medication. All cats receive pain medication before, most after, and in many cases, also go home with pain medication.
Acepromazine. This is a sedative that we will commonly give to cats as a pre-medicant with no pre-existing cardiac or neurological issues. Acepromazine will just help your cat feel a little more sleepy, and will help reduce the amount of anesthesia needed for your cat. Acepromazine does lower blood pressure to a small extent which is why it is not used for cats with cardiac disease, and it can lower the seizure threshold which is why it is not used for cats with neurological disease.
Midazolam. This is a tranquilizer that we will give as a pre-medicant to cats that have pre-existing cardiac disease, or suspected cardiac disease. We will also give this in place of acepromazine to cats with pre-existing or suspected neurological disease. Midazolam is in the same drug class as Valium, and can help minimize seizure risk. Midazolam can just help your cat relax a little, and minimize the amount of anesthesia needed.
Atropine. This is an anticholinergic that is also given as a pre-medicant to cats with no pre-existing cardiac disease. Atropine can help keep the heart rate up and to a small extent, the blood pressure up during surgery.
Morphine. Ahh, the good stuff. This is a potent pain medication that is given to almost all of our surgeries as a pre-medicant. It can cause some brief nausea, but the pain blocking effects far outweigh the brief nausea episode experienced after administration. This is also given shortly after surgery as well in most surgeries.
Buprenorphine. This is a longer lasting, but a little less potent narcotic in the same drug class as morphine. We will give this to cats as the last pain medication of the day, to keep them covered with pain medication throughout the night. We will also send this home as a pain medication for some of the more painful surgeries. For our low cost spays, this is the primary pain medication that is used. In cats, this is a very effective pain medication.
Butorphanol. This is a short acting slightly less potent narcotic in the same drug family as morphine that is used for some of the shorter surgeries that have minimal pain associated with them. For our low cost neuters, this is the primary pain medication that is used.
Meloxicam. This is a non-steroidal anti-inflammatory medication that is approved for injectable pain medication in cats. To keep it as safe as possible for your cat, we do not give it before surgery, rather, once your cat is fully awake after surgery, they will get an injection of this as an additional pain medication. One injection can last 24-48 hours, and in conjunction with a narcotic such as buprenorphine, can have a similar pain suppression effect to Vicoden.
Lidocaine. This is a local anesthetic that is used to help block nerve pain for procedures such as declaws or small skin tumor removals. This is very short acting, and lasts about 15-20 minutes after injection.
Bupivicaine. This is a local anesthetic that is used to help block nerve pain for more prolonged procedures. This is long lasting and lasts about 6-8 hours. We will often mix lidocaine and bupivicaine together to get a faster onset of nerve blocking with a longer duration.
Pre-surgical blood work. This consists of a mini-blood panel that checks just your cat's key kidney and liver enzymes, a couple of electrolytes, blood proteins, and your cat's red blood cell percentage. This can tell us if there are any previously unknown anesthesia risks, or if we need to take additional precautions to keep your cat safe and healthy before and after the surgery. This is required for all cats over 10 years of age and recommended for all cats between 5 and 10 years of age. It is an option also for cats under 5 years of age.
IV placement. We do this if we are planning to administer IV fluids during surgery, or if we just want quick venous access in the event of an emergency. We do have to shave your cat's arm to do so, but the fur will grow back.
IV fluids. This is an ideal procedure for all surgeries of any kind. That being said, to keep costs low for shorter routine surgeries such as spays, neuters, and declaws, we do not routinely perform this unless your cat is older. It is always an option however, and we do require it on all lengthy surgeries and on older cats, or cats with pre-existing health issues. By having an IV running during surgery, we can help protect your cat's kidneys by keeping your cat's blood pressure up. We can also use an IV to continuously administer pain medications directly into the bloodstream for extremely painful surgeries such as a limb amputation or bowel resection. And, by having the IV catheter in place for the IV fluids, if there are any anesthetic complications, we have instant venous access.
ECG. This stands for electrocardiogram, also known as EKG. This monitors your cat's cardiac electrical activity during the procedure. By having this in place, we will know instantly if your cat's heart rate starts to drop, or if they develop any cardiac arrhythmias while under anesthesia. A heart rate that is rapidly increasing can also indicate that a cat is starting to wake up, and needs a deeper level or anesthesia, or additional pain medications. This is optional monitoring except on cats with pre-existing cardiac disease, or high risk cats.
Blood Pressure monitoring. One of the primary risks anesthesia is that after about 20-30 minutes, your cat's blood pressure can start to drop. If it gets low enough, it can potentially lead to kidney or other organ damage. By monitoring your cat's blood pressure, we can increase IV fluids, decrease anesthetic depth, or give drugs to increase your cat's blood pressure, to help reduce the risks of organ damage during and after anesthesia. This is optional monitoring for short routine procedures since those procedures are usually over before blood pressure starts to drop. However, for longer procedures, this is recommended, and may even be required.
Body temperature monitoring. We take measures to keep your cat's body temperature up during surgery, from keeping them on a heated water blanket designed for surgery, to covering them with a plastic drape for long cooling surgeries such as abdominal exploratories, to covering them with warmers for longer dental procedures. We can also use an IV warmer to warm the IV fluids going into your cat. Even with all of those measures, your cat, especially if they are underweight or in poor health, may have problems keeping their body temperature up during a lengthy surgery. By monitoring their body temperature, we know if we need to take extra measures, or if just need to stop and finish up the surgery quickly. For routine or shorter surgeries, this is not generally a concern, although it is an option. For longer surgeries or for cats that may have a less than ideal health status, it may be required.
Respiratory monitoring. This consists of a sensor that is placed in your cat's esophagus while your cat is under anesthesia. This measures your cat's respiratory rate and depth during anesthesia. If your cat is not breathing often enough, it may be an indication that we need to lighten anesthesia. If your cat is breathing too often or too shallow, it may mean that we need to either deepen your cat's anesthesia, or add on additional pain medications. Because your cat must be intubated for this, this is not always an option, but may be required on more advanced surgeries.