Question about dog whimpering during surgery??

[pinkkarisma]

Hi! Long time lurker, first time poster! 🙂

I am interested in being a vet, obviously! 😀 I'm still in high school so I am a long way off from applying, but I recently took my first job as a kennel assistant in a clinic. It's pretty small since it's only one doctor, but I love that I am able to gain some first hand experience!

So this might seem like a really stupid question. I asked the doctor if I could watch one of the dog neuter surgeries. He said that was fine! I don't really know if this is normal or what to expect. He only used an injectible anesthetic (don't know what it was) to keep the dog under. I know a lot of clinics use gas but he does not. Also, the dog almost sounded like it was whimpering a little! It obviously wasn't conscious, but sometimes it's chest would start heaving and it would start making a whimpering sound, then he would inject a little more of the anesthetic or whatever, and it would stop.

I didn't want to ask and sound stupid. Is this normal during surgery??? Is he really old school because he doesn't use gas?

It sort of disturbed me in a way I guess. The blood and stuff I can get used to but for some reason the heaving chest/whimpering noises kind of got to me. I'm sort of second guessing my thoughts about bieng a vet, if this is what it's all about. 🙁

Thanks for the advice.

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[dreamvet]

the heavier breathing and whimpering signals that the dog was feeling what the dr was doing. he might not have been totally aware, but he was feeling pain/discomfort.

I am not a fan of using only injectable during any surgery that's not really minor (minor meaning: suturing bite wounds, drain placements, etc).

BUT. . . .I'm not a dr yet, so what do i know. Also, i have never seen a dr only use injectable during a spay/neuter. . .

 

[GellaBella]

In the veterinary practice I shadow at they use gas anesthesia and intubate the patient during surgeries. It sounds like the dog was waking up/coming out of anesthesia but I'm not really experienced enough to say for certain whether his methods are antiquated or not. The fact that each time the dog whimpered the dr gave another shot of anesthetic is also suggestive that the anesthesia used was not properly keeping the animal asleep. Whether thats a drug problem or a dr problem, I don't know. But as for your question about whether thats what being a vet is all about..I would say no its not. I have only been shadowing about 4 months now, but I have yet to see an animal that was not completely out during surgery. I HAVE seen rabbits anesthetized that make a crying noise, but we were not performing surgery on them and the drs did not give more anesthetic, explaining to me that some rabbits do make noise as they are falling asleep...I'm not sure if i'm really answering your question but I don't think those types of situations would be common in your own veterinary practice if you don't want them to be.

 

[karmapple]

I've never worked anywhere that didn't use gas anesthetic. We usually just use injectible to make them sedate enough so they can be intubated, then they are kept under anesthesia with gas, usually Isoflurane.

I would be very suspicious of this as well. How do you regulate the anesthesia/ oxygen flow rate administered if only using injectibles? If they aren't intubated, how would you breathe for them if something went wrong? How would you wake them up quickly? That sounds pretty scary.

 

[hizarlow]

I'm guessing the anesthetic was Propofol. The doctors I work with use it alot as a pre-anasthetic, and as an anesthetic during minor surgeries, as was mentioned earlier. I have also seen it used aone on the nueter of a cat.

During the minor surgeries it is normal for it to wear off, and the doctor would push a small amount more to finish the surgery. I have worked with five doctors and have seen all of them do this, so I would assume it is normal.

We don't do alot of spays/nueters so I don't know what is normal in a dog, but I have seen dogs breath hold under gas, until they wake up.

I have taken x-rays of animals with fractures, had to muzzle animals with lacerations on their neck, and many other necessary things that caused the animal immediate pain so that their lives or limbs may be saved.

I think you should keep getting experience, get a varied experience, go to an emergency clinic and shadow there. The more experience you get, the better you will know if you want to be a vet.

 

[No Imagination]

Mmm... I've seen it done both ways - Injectable then gas vs. Injectable only.

Not going to give my personal opinion on it, as like everyone above me mentioned, were not even in vet school yet, but the explanation I was given:

If it is a fast procedure, why bother intubating and catherizing if you can be done before it takes time to do that? So many problems with that explanation obviously, as I later learned. I think its a matter of dice rolling on the vets part. They are HOPING and betting that the **** doesn't hit the fan before they can finish.

Maybe it is an acceptable method, but I've only seen old school vets do it that way.

With that said, I've never seen or heard of a vet intubating for a cat neuter...

EDIT: Gotta second what Hizarlow said - Your lucky to have landed such a job while still in HS. Given time, you can learn a lot from a small (1) doctor practice. Don't let one possible issue change your mind so soon. I think you will find that your mind will change about many things, many more times, before you actually apply and thats normal. Knowledge is POWER! 🙂

 

[bunnity]

At the shelter where I volunteered it was standard to do injectable only for neuters. Whoever was prepping the animal would do a toe pinch and make sure they were really "out," and if they reacted at all we would add the gas at that point (this was all pre-surgery). However our vet was really really fast and could do the neuter about as fast as it would take to hook up the gas.

For spays or other procedures we would do injectable + gas or if it was a rabbit then gas only. The vet would only intubate if it was a dental or really high risk patient.

I think this is fairly common for shelter style surgeries where it is really high volume, and it worked out pretty well from what I saw.

To the OP, from these responses you can see there are a variety of protocols for anesthesia, and as a vet you would probably choose the one you felt most comfortable with. I agree with the advice above to keep getting experience and try out a couple different places before you decide.

 

[robeezy08]

From what I remember, there are several planes of anesthesia but not sure if what I found below is universal among vet schools. I know injectables are used for minor procedures (wounds/lacerations) and have seen neuters done on intubated dogs (only) and then done w/ injectables only but just on cats. I'm not sure what the rules are as far as what should be used on neuters and what not (don't they castrate farm animals w/o anesthetics?) But my intuition tells me that the animal shouldn't feel anything during the procedure - first incision, use of cautery, closure/suture. If he/she does, they are too light and the vet should re-evaluate their anesthesia protocols. Increased heart rate, blood pressure and temp are all signs that the animal can feel pain and at least a few of these parameters should be monitored.

This might be a bit more info than you were looking for but it seems useful to know:

Stage 1 anesthesia is the period between administration of an anesthetic
and loss of consciousness. In people there is reported to be some
disorientation prior to the loss of consciousness but in pets this is
rarely obvious.
Stage 2 anesthesia is the period after loss of conciousness. In this stage
there is sometimes uncontrolled movement, delirium, breath holding,
irregular respiration, whining or howling and dilation of the pupils. This
stage can be worrisome and most anesthetic protocols seek to keep this
period as short as possible without endangering the patient.
Stage 3 anesthesia is the level at which surgery can be performed. The
transition from Stage 2 to Stage three is usually denoted by the return of
regular respiration, constriction of the pupils and the stopping of
involuntary motion or vocalization by the patient. Stage 3 anesthesia is
divided into four planes:
In Plane 1 Stage 3 anesthesia the patient still has blink reflexes and
swallowing reflexes but has regular respiration with good chest motion.
This stage would be considered "light" for surgical anesthesia.
In Plane 2 Stage 3 anesthesia the patient loses the blink reflexes, the
pupils become fixed in one position (usually central) and respiration is
still regular with good use of the chest muscles and diaphragm. This is the
plane at which most veterinarians are comfortable performing surgery.
In Plane 3 Stage 3 anesthesia, the patient starts to lose the ability to
use the chest muscles and abdominal muscles for respiratory efforts, so
breathing becomes shallow and assisted ventilation is best when the patient
must be maintained at or near this level in order to allow control of pain
in surgeries that are unusually painful (such as extensive abdominal
exploratories).
In Plane 4 Stage 3 anesthesia, the patient does not use the chest muscles
and abdominal muscles at all, which means that all respiratory effort is
produced by the diaphragm. This plane of anesthesia is very close to the
point where the patient will stop breathing entirely and it should be avoided.
Stage 4 anesthesia is basically an anesthetic crisis. It is the time
between respiratory arrest and death from circulatory collapse. Assisted
ventilation is absolutely essential in this stage, as well as support for
the circulatory system through IV fluid administration and medications to
stimulate respiration and the cardiovascular system. Hopefully, this stage
of anesthesia is never encountered in practice.





Hope this helps 🙂

 

[pinkkarisma]

Thanks everyone for the responses! 🙂

So the whimpering noises shouldn't have been happening? It was like, the dog would be whimpering for some time, before the doctor would give more of the anesthetic. So could the dog feel pain then?? Isn't that really cruel?

-so confused- 🙁

 

[dyachei]

Whimpering doesn't necessarily mean that the dog was coming out of it, just that they were feeling it (maybe they weren't deep enough to begin with). The dog probably was not deep enough or did not have enough in the way of pain medications. And there are injectible and gas protocols. Most people use gas because of the risk of aspiration. And it can be cruel, depending on the medications used (there are some that have amnesia in their list of effects). It also negatively affects outcome of surgery because pain can delay feeling.

 

[WhtsThFrequency]

Doing neuters under injectable only is certainly done in some practices, and it acceptable. I neutered a cat only under injectable, and the boy did fine. This is generally because neuters are so quick and easy, it is not worth all of the inherent risks (and espense) of inhalant + premeds.

 

[kittenj]

Without having been there to witness it sounds to me like the vet was performing with acceptable protocols. As others have said, there are times/places where an injectable-only protocol is used and even preferable. Certainly the breathing and whining responses you noticed could indicate the dog was light/feeling things, but I would give the Dr the benefit of the doubt on that. Perhaps he prefers his patients on the lighter side of things, feels there is less risk. Or perhaps this particular patient was not maintaining very consistantly... I know I have monitored many patients who just wouldn't maintain without practically constant adjustment.

I agree with the others you are lucky to get your position while still in HS. Be a good worker and keep asking the doc questions. If he knows you are interested and smart he will likely keep teaching you new things, and might start using you for more technical jobs.

 

[robeezy08]

It seems there's alot of variability in how vets assess and respond to pain/discomfort during surgical procedures. But I think ethically, animals shouldn't feel anything during the surgical procedure, irregardless if they are just about to jump off the table vs. being "light" and just shaking/whimpering. If it were my pet on that table, I know I wouldn't want him/her in pain. At what point do you question how much pain the animal will endure and for how long? I too have seen questionable procedures and it has bothered me esp when I first started out vet tech'ing, but today I know better and will ask questions if needed.
On a side note, there are pre-med cocktails that can be given, that will def keep the patient under a constant plane of anesthesia w/o having to adjust iso too much.

 

[thereservoirdog]

Wondering if the animal can feel pain during surgery has always bothered me more than anything else. I've asked several doctors how likely it is for an animal to feel pain during surgery, and I've never really gotten a straight answer. I'm not sure how it works, for humans, I guess you don't really have to worry about pain during surgery because you get a cocktail of drugs, anesthetics and analgesics. But with animals it's usually only sevo or iso, and they are very poor analgesics. Once you get the animal deep enough under I guess it doesn't matter, but I still wonder whether loss of reflex always mean loss of pain.

 

[incendium04]

I thought I would give my own two cents.... I work at an emergency/general practice hospital and we use both injection and gas anesthetics to keep pets under for routine castrations/spays. For dog neuters, typically an injection is used to knock the dog out for intubation and gas anesthesia is used to maintain it. The only time we use only an injection for anesthesia is for cat neuters, and the injection is never repeated.

Just because the vet you shadowed is doing things different doesn't mean it's wrong. Though I have to say, good job thinking critically about it and not just letting it slide. I wouldn't let this one experience dissuade you from becoming a vet. As a vet, you can make different choices and choose to keep the patient more deeply anesthetized to prevent this from occurring. One vet I work with hates when animals show any sign of pain and gives a lot of local anesthetics and tends to like animals a little deeper in surgery. Another vet prefers to 'rough it' a bit more (he is pretty old school) rather than use locals when not necessary.

Out of curiosity, how long did the castration take? And how did the dog recover?

Oh and good luck on your road to becoming a vet. It's a long one! 😳

 

[david594]

There is more than one way to skin a cat. There is also more than one way to achieve surgical anesthesia.

Without having been there and knowing exactly what the doctor was doing and using none of us can really critically judge his actions. It does sound like he was using propofol based on the redosing.

I bet if we made a list we could come up with easily a dozen different drug protocols used for cat neuters.

 

[robeezy08]

"Without having been there and knowing exactly what the doctor was doing and using none of us can really critically judge his actions. It does sound like he was using propofol based on the redosing."

Hmmm... nice try david but I'm totally criticizing his actions - not the vet, just his actions, b/c I'm sure he's a really nice guy 🙂 Seriously though, I feel like i'm the only one here that thinks it's not OK nor acceptable for an animal to start whimpering and breathing heavily on the surgical table...during surgery 😕

 

[WhtsThFrequency]

With that said, I've never seen or heard of a vet intubating for a cat neuter...

Me neither.

But with animals it's usually only sevo or iso, and they are very poor analgesics

Yes they are, and no it is never "usually only sevo or iso". Yikes. You ALwAYS either 1) pre-medicate with analgesics or 2) administer analgesics once they are down, during surgery...usually a morphine derivative. Honestly, I cannot think of ANY time you ever use ONLY inhalants for a surgery without pain relief in another form. Dogs and cats can make noise, twitch, etc if they become light. But they cannot feel anything because you have blocked pain receptors with the appropriate pre-meds - assuming you did your job correctly. The movement comes from getting mentally light....sort of like dreaming (anyone have dogs that dream vividly?) not physically being in pain.

I've seen dogs that are coming into the light plane, after being extubated and in recovery, that are twitching, jerking, howling, snapping (seriously, you need to watch your hands), whining, ....not because they are in pain but because they don't know where they are and the brain isn't quite back yet. Same thing happens if the animals is too light. Doesn't mean pain, it is just strange....but you need to get used to it.

 

[168135]

🙂 Seriously though, I feel like i'm the only one here that thinks it's not OK nor acceptable for an animal to start whimpering and breathing heavily on the surgical table...during surgery 😕

I feel the exact same way. I've seen some shady surgical practices, but I'd be be pretty upset if a dog started whimpering on the table too.

 

[david594]

Hmmm... nice try david but I'm totally criticizing his actions - not the vet, just his actions, b/c I'm sure he's a really nice guy 🙂 Seriously though, I feel like i'm the only one here that thinks it's not OK nor acceptable for an animal to start whimpering and breathing heavily on the surgical table...during surgery 😕

What happened the last time the dog was put on Iso? I dont know, do you?

Maybe he crashed, had an allergic reaction to the gas, anything. Maybe thats why the doc was doing it really light with propofol(or whatever) this time.

We don't know the patient, the history,the anesthetic protocol, or really even the procedure for that matter. None of us are in any position to judge. We are also relying on story of a high school student with no experience watching his first surgery. We really know nothing.

 

[StealthDog]

Seriously though, I feel like i'm the only one here that thinks it's not OK nor acceptable for an animal to start whimpering and breathing heavily on the surgical table...during surgery

You aren't the only one. Whether or not the doctor "likes his patients light", vocalization indicates too light a plane of anesthesia, and the procedure should be stopped until the animal gets deeper with readministration (or addition of another anesthetic agent like an inhalant). There is no excuse for not adequately controlling pain- keeping a patient as light as possible needs to be balanced with providing adequate anesthesia.

I'm okay with the idea of using only injectables for anesthesia for relatively quick procedures like a neuter, but I would be really concerned if a vet were doing any surgery aside from neuters without inhalant anesthesia in the practice...

 

[david594]

You aren't the only one. Whether or not the doctor "likes his patients light", vocalization indicates too light a plane of anesthesia, and the procedure should be stopped until the animal gets deeper with readministration (or addition of another anesthetic agent like an inhalant).

It obviously wasn't conscious, but sometimes it's chest would start heaving and it would start making a whimpering sound, then he would inject a little more of the anesthetic or whatever, and it would stop.

Stealth, from the original poster it sounds like he could very well have been doing exactly what you said.

I'd more curious about exactly how much sterile technique he was practicing during this procedure than anything.

 

[robeezy08]

"What happened the last time the dog was put on Iso? I dont know, do you?

Maybe he crashed, had an allergic reaction to the gas, anything. Maybe thats why the doc was doing it really light with propofol(or whatever) this time.

We don't know the patient, the history,the anesthetic protocol, or really even the procedure for that matter. None of us are in any position to judge. We are also relying on story of a high school student with no experience watching his first surgery. We really know nothing."

True, I don't know the dogs history however I still think its OK to question the ethics of pain control/management b/c ultimately this is something we will all be faced with - either as a tech or vet student or veterinarian.
But back to the story, if there were other medical reasons this animal was kept light he/she should've been considered a high risk surgical patient in which case, proper precautions should have been taken just in case he/she crashed...intubating and using iso/sevo would've been a nice place to start 😉

 

[david594]

True, I don't know the dogs history however I still think its OK to question the ethics of pain control/management b/c ultimately this is something we will all be faced with - either as a tech or vet student or veterinarian.
But back to the story, if there were other medical reasons this animal was kept light he/she should've been considered a high risk surgical patient in which case, proper precautions should have been taken just in case he/she crashed...intubating and using iso/sevo would've been a nice place to start 😉

You totally just blew off my "what if he had an anesthetic reaction in the past?" part of my point and said they should have used inhalant anesthesia.

I'm just naming off a specific case where inhalant anesthesia would be counter-indicated which could have possibly been the case(again, we don't know). If the ISO almost killed him once, we might as well just try it a second time....

 

[robeezy08]

You totally just blew off my "what if he had an anesthetic reaction in the past?" part of my point and said they should have used inhalant anesthesia.

I'm just naming off a specific case where inhalant anesthesia would be counter-indicated which could have possibly been the case(again, we don't know). If the ISO almost killed him once, we might as well just try it a second time....

If the dog was somehow allergic to inhaled anesthetics whats to say he/she wasn't going to react to the injectable? Point being, high risk patients should be intubated. But I think the main point of the OP was whether or not it was OK for an animal to respond to pain during surgery and my answer is no.

 

[littlelisa]

Let's assume this was propofol. Would the dog have even remembered any pain during the procedure? I thought this would prevent any memory of the event, but correct me if I'm wrong I'm not completely familiar with the drug.

 

[alliecat44]

You totally just blew off my "what if he had an anesthetic reaction in the past?" part of my point and said they should have used inhalant anesthesia.

I'm just naming off a specific case where inhalant anesthesia would be counter-indicated which could have possibly been the case(again, we don't know). If the ISO almost killed him once, we might as well just try it a second time....

Allergic reactions to iso are pretty darn rare. But let's assume you are correct--in that case, it becomes even MORE important to protect/establish a patent airway when a patient is under anesthesia. Plenty of high-risk surgeries are done with little to no inhalant anesthesia flowing through the endotracheal tube but with oxygen and intravenous anesthetic (fentanyl CRI, etc).

btw, it is (slowly) increasingly common for veterinarians to place IV catheters and intubate for feline neuters. Canine neuters are invariably considered more involved and longer procedures...

 

[karmapple]

Everyone keeps using the example of cat neuters - but this was a dog. Dog neuters take longer and are more involved. If this had been a cat neuter, I probably wouldn't have thought twice about no gas anesthetic. For a dog neuter, though, I don't see how one could say "Why bother intubating when that would take longer than the procedure?" Perhaps my vets are slow neuterers?

I must say that even with extremely cautious anesthesia protocols, I have still seen animals get too light occasionally, and it is unsettling - probably even more so to a high school student who isn't sure what they are seeing. Medicine isn't perfect, unfortunately. I still would be uncomfortable with the described situation though.

 

[david594]

In general I think its largely in bad taste for people to condemn a doctors actions as wrong when we have no idea what the situation actually was.

What do we know? Injectable anesthetic and it was a dog neuter. What else? Nothing
No idea what the anesthetic agent was.
No idea the patient history.
No idea on the patients age. Prepubescent or not?
No idea on the method of neuter. Incision forward of scrotum, scrotal incision, or abdominal for cryptorchid?

 

[alliecat44]

In general I think its largely in bad taste for people to condemn a doctors actions as wrong when we have no idea what the situation actually was.

What do we know? Injectable anesthetic and it was a dog neuter. What else? Nothing
No idea what the anesthetic agent was.
No idea the patient history.
No idea on the patients age. Prepubescent or not?
No idea on the method of neuter. Incision forward of scrotum, scrotal incision, or abdominal for cryptorchid?

Please give me an example of when it is inappropriate to intubate a dog for a neuter.

It's useful to point out that we don't know the whole story, but I don't think anybody is condemning this practitioner; rather, I see people relating their own experiences and interpretations of those experiences.

 

[david594]

Please give me an example of when it is inappropriate to intubate a dog for a neuter.

I never said it was. They should have intubated. They should have done a more thorough pre-surgical workup. They should have also had the dog on maintenance fluids during the procedure. They should have have also used more advanced patient monitoring during the procedure.

There is almost always a more ideal approach to something. But veterinary medicine is also heavily dictated by what the clients can actually afford so compromises are made on a daily basis. Again, every situation is different and we don't know any of the details of this one. The doctor has some reason behind his protocol, we just have no idea what it is.

 

[thereservoirdog]

But with animals it's usually only sevo or iso, and they are very poor analgesics

Yes they are, and no it is never "usually only sevo or iso". Yikes. You ALwAYS either 1) pre-medicate with analgesics or 2) administer analgesics once they are down, during surgery...usually a morphine derivative. Honestly, I cannot think of ANY time you ever use ONLY inhalants for a surgery without pain relief in another form. Dogs and cats can make noise, twitch, etc if they become light. But they cannot feel anything because you have blocked pain receptors with the appropriate pre-meds - assuming you did your job correctly. The movement comes from getting mentally light....sort of like dreaming (anyone have dogs that dream vividly?) not physically being in pain.

I've seen dogs that are coming into the light plane, after being extubated and in recovery, that are twitching, jerking, howling, snapping (seriously, you need to watch your hands), whining, ....not because they are in pain but because they don't know where they are and the brain isn't quite back yet. Same thing happens if the animals is too light. Doesn't mean pain, it is just strange....but you need to get used to it.

Thanks, your completely right. I can't believe I forgot about pre-meds, total brain fart. *slaps forehead* I used to worry about this back when I worked on wildlife projects and we only used iso to put an animal under.

 

[alliecat44]

I never said it was. They should have intubated. They should have done a more thorough pre-surgical workup. They should have also had the dog on maintenance fluids during the procedure. They should have have also used more advanced patient monitoring during the procedure.

There is almost always a more ideal approach to something.quote]

The questions you asked in your previous post could lead someone less experienced to believe there are MEDICAL reasons for not pursuing intubation, IV catheter placement, fluid support, etc etc. And that would be incorrect. Thank you for acknowledging that.

That said, it is still relatively common for veterinarians to perform neuters with injectable-only anesthetic protocol. We can tell the OP that 1) this is usually done at high-volume/low-cost practices such as in a shelter situation, and that 2) places with a higher standard of care typically do not do this, but that 3) the owner's financial situation can dictate what level of care a veterinarian is able to provide. And that's really all we can say regarding the veterinarian.

Again, I don't think anybody was outright condemning the veterinarian. If the OP has more general questions regarding anesthesia, then those can be discussed as well (and personally, I love love love the subject and know plenty of others would love to talk about it, too).

🙂

 

[JustCats]

Pinkkarisma--

Now that you've gotten all of this information, why don't you ask the vet himself in a non-judgmental manner. Tell him you've been thinking about it and you're curious about whether it's normal for this to happen. Then he'll probably tell you what anesthetic protocol he used and his philosophy on sedation and analgesia.

Come back and tell us what you find out. 👍

 

[sumstorm]

Has anyone stopped to consider that you can and do get similar 'behavior' on Iso while intubated? Dogs can and do huff, or hold thier breath then gasp, or have escalating breathing/heart rates, increasing BP, etc. Anyone who monitors should have seen at least some occasions when this happens during a surgery. Just because actual vocalizations aren't occuring doesn't mean the procedure isn't having the same physiological results. In my experience, intubation that is done properly prevents vocalization.

I do know several spay/neuter clinics that do neuters without gas. It isn't a preferred method by the vets that work those clinics, but it does keep costs down in poverty stricken areas, and it expedites the procedures, and requires less staffing (in some places, only vets are allowed to intubate, and in others only liscenced techs). When you need to do 50+ surgeries as cheaply as possible, you have to balance things like costs, risks, and benefits. The vets at these places become extremly efficient at neuters, even dog neuters.

So, while I also don't like the idea of an animal in pain...and vocalizing raises my own BP and heart rate, I am not sure the criticism is justified unless we are also going to levy the same complaints about vets who shift the Iso up mid surgery to compensate for a dog that spikes HR and BP.

I would also note, from experience under anesthetics, both intubated and not, that pain is a very relative thing. What hurts one may not hurt another. What drug works on one, may not on another. We don't know the vet, we don't know the circumstances, and we don't know what a monitor might have revealed. For all we know, this was a donated surgery on an unowned animal for a rescue group and needed to be done as cheaply as possible. If you don't cover your costs, you don't stay in business, and then you don't do anyone or any pet any good.

Then again, I might be considered kind of heartless, since many livestock procedures are still done without anesthetic or pain killers, and I have participated in those procedures on our farm since I turned 8 years old.

 

[No Imagination]

Man Pink. You seem new to your job. I don't mean to disagree with Cats here, but don't blow it asking questions which may be above your understanding right now.

If your just observing surgeries, the vet is probably not going to give you details about the analgesics he uses.

I'd just take what you learned here, apply it to what you will continue learning from your vet, and keep your eyes open.

Not to mention, so many vets a weary about new tech's judging them on animal welfare.

This is just my take on it.

This little bit of information, while worth while will only serve to answer a forum debate. Not worth jeopordizing a nice set up you have going.

Sorry JustCats, just have to disagree with you on this one

 

[SmallAndLA]

I've always found that asking questions during the procedure is usually a much more appropriate way to gain information than waiting for a few days and then asking the question. It allows for a better explanation, and they don't have to think back to figure out what case you're asking about.

Now, in some procedures involving more serious concentration (i.e. ocular, orthopedic, emergency-based), it might be better to wait until the end of the procedure.

And of course, it all depends on the type of person the veterinarian is as well. I don't think he would have let you watch if he didn't want you to learn something or ask questions. And the more you watch, the more comfortable you'll get with him, so it won't be weird or awkward to go 'Why are you doing that?' or 'Why is that happening?'. Just make sure not to shirk your duties, since you're getting paid.

I don't know, that's just my opinion. (My vet told me to ask more questions about surgeries/cases while he was doing them, because he felt like I was being too quiet and I wasn't learning anything.😛)

Best of luck to you in your job!

 

[EqSci]

I agree, any vet I've ever interned with or shadowed with has always welcomed as many questions as possible! I think as long as they are asked in a polite, open-minded manner there is nothing wrong with questions, ever. I'm a quiet person and I know more than once in my life my 'observe but don't speak' manner has been mistaken for disinterest.

 

[StealthDog]

Stealth, from the original poster it sounds like he could very well have been doing exactly what you said.

Sure thing- there are lots of ways this vet could have been following standard of care, and lots of ways he may not have been. No one is saying that pinkkarisma should run out and report this guy to the board, or quit her job, or anything like that. I think we can talk about pros and cons to various protocols without automatically attacking the practitioner.

Having spent some time at a practice that followed what I'd now consider below the standard of care (non-anesthetic dentals, anyone?), it's good that pink is questioning whether what she's seeing is normal or not. Anesthesia in general can be a really unnerving process to see for the first time! All I'm saying is that, if I were performing a surgical procedure on an animal and it started vocalizing, I would consider the animal too light.

Thio and propofol are also both known to cause respiratory depression and apnea, so I (personally) wouldn't use them without intubation.

Would the dog have even remembered any pain during the procedure? I thought this would prevent any memory of the event, but correct me if I'm wrong I'm not completely familiar with the drug.

As far as I know, the only drug thought to cause analgesia due to amnesia is ketamine, which we don't generally use in dogs, and don't generally use alone. It's questionable to rely on amnesia for pain control since, even if there is no psychological memory of pain, there is still physiologic pain, which inhibits tissue healing and recovery from surgery.

 

[twelvetigers]

Sorry for the general chaos, pink - can you tell we like a good debate here?

Take everyone's advice into account and then do what you feel is best. 🙂

 

[thereservoirdog]

Kind of off topic, but does this remind anyone of anything?? http://www.youtube.com/watch?v=txqiwrbYGrs

So the howling is normal then

 

[twelvetigers]

Lol! I bet if you put him in a cage, he'd rub his nose against the bars too. 🙂

 

[robeezy08]

Has anyone stopped to consider that you can and do get similar 'behavior' on Iso while intubated? Dogs can and do huff, or hold thier breath then gasp, or have escalating breathing/heart rates, increasing BP, etc. Anyone who monitors should have seen at least some occasions when this happens during a surgery. Just because actual vocalizations aren't occuring doesn't mean the procedure isn't having the same physiological results. In my experience, intubation that is done properly prevents vocalization.

I do know several spay/neuter clinics that do neuters without gas. It isn't a preferred method by the vets that work those clinics, but it does keep costs down in poverty stricken areas, and it expedites the procedures, and requires less staffing (in some places, only vets are allowed to intubate, and in others only liscenced techs). When you need to do 50+ surgeries as cheaply as possible, you have to balance things like costs, risks, and benefits. The vets at these places become extremly efficient at neuters, even dog neuters.

So, while I also don't like the idea of an animal in pain...and vocalizing raises my own BP and heart rate, I am not sure the criticism is justified unless we are also going to levy the same complaints about vets who shift the Iso up mid surgery to compensate for a dog that spikes HR and BP.

I would also note, from experience under anesthetics, both intubated and not, that pain is a very relative thing. What hurts one may not hurt another. What drug works on one, may not on another. We don't know the vet, we don't know the circumstances, and we don't know what a monitor might have revealed. For all we know, this was a donated surgery on an unowned animal for a rescue group and needed to be done as cheaply as possible. If you don't cover your costs, you don't stay in business, and then you don't do anyone or any pet any good.

Then again, I might be considered kind of heartless, since many livestock procedures are still done without anesthetic or pain killers, and I have participated in those procedures on our farm since I turned 8 years old.

Yea I agree, Iso isn't the most effective analgesic/anesthetic if used alone - but it also depends on the procedure and the species. Like you said, not all animals will react the same way to certain pain medications. But I think this is why this discussion on pain management is so important. I've worked with "old school" vets who won't use drug combinations to decrease the amount of pain intra-operatively or post-operatively in patients who's owners can afford the extra pain meds b/c "that's the way its always been done". As future vets, we can help change that type of mentality....It's a step in the right direction once we realize this isn't suppose to happen in surgery and it can be prevented.


Oh and thanks for mentioning the livestock procedures b/c I've always wondered about livestock "surgery." Is there a movement these days to use anesthetics/pain killers at all or are things still done the same way as before?

 

[eventualeventer]

I have no idea about food animals, but there is certainly more awareness of pain management/anesthetic issues than in years past in the equine world.

I'll explain about castration in a minute, but NSAID's are still the predominant analgesics used in equine practice. Opioids tend to cause an increase in locomotor behavior (inc. poss. agitation) when used by themselves in horses, and I think the decrease in gut motility is a concern since they eat so much forage. If NSAID's don't work, the horse is usually in a hospital setting, and I have seen the following used: lidocaine CRI (frequent), epidural or intrathecal catheter bolused with lido or bupiv, +/- morphine, +/- detomidine (sometimes), detomidine CRI (rare), butorphanol CRI (rare).

When it comes to horse castration, there are two general approaches to anesthesia.

Some vets do it standing: the horse is sedated, usually with detomidine/butorphanol, the area is scrubbed, then a twitch applied to the upper lip (thought to activate acupressure points and cause release of endorphins) while the area is blocked. The vets I have seen block the skin, then inject block into the testicle, then inject up around the spermatic cord. The twitch is taken off once the horse is blocked, and the surgery performed with the vet crouched/leaning under the horse.

Advantages: avoids risks of general anesthesia (greater for horses than dogs and cats), much faster (literally a fraction of the time as for general), cheaper. Easier to do with just the vet and the owner. Does not have the same space and/or weather requirements as field (general) anesthesia.

Disadvantages: although the sedation and block make it unlikely, there is still the risk of the vet getting kicked in the head; if the horse turns out to be a cryptorchid (not all of them will let you feel their scrotum until they are heavily sedated), you have to abandon ship and arrrange to lay the horse down in a sterile OR; if there is a bleeder or similar complication, it is much harder to deal with and you may have to lay the horse down under adverse circumstances (and the horse continues bleeding while you anesthetize it, which you just can't do very quickly in a field situation).

For the above reasons, many vets use general anesthesia for castrations. Perhaps some expensive racehorses (and certainly those who are known to be cryptorchids) are laid down in an OR with gas, but most are done in the field with injectable anesthesia -- premed with xylazine or detomidine, +/- butorphanol or acepromazine, followed by ketamine and valium induction. If it is a straightforward castration, then the initial dose of ket/val may be enough for the surgery, perhaps topped off with half the induction dose of ket/val halfway through. This may be done "off the needle" -- i.e., no catheter placed. More complicated cases, such as older animals or a slightly retained testicle, may have a catheter placed and maintained with "triple drip" -- guaifenesin, ketamine, and xylazine CRI.

Having the horse under general is a much more controlled situation, but induction and recovery take a lot more time and require more people around, including someone to monitor plane of anesthesia. You have to have the right place to lay the horse down -- if you are going to use a stall, it needs to be roomy and airy with good light. If you are going to do it outside, you need a flat, quiet, grassy place and good weather.

Just thought I'd share with you curious small animal types.

 

[HeartSong]

I see a dog all the time that has chest heaves and whimpers, my dog when he sleeps. That doesn't mean he is in pain. You shouldn't be so quick to assume that a dog is in pain just from these signs. They can be caused by many things. In fact, from my experience whimpering is seldom a sign of pain. It usually more represents confusion, loneliness, anxiety, etc. A dog that feels a sudden pain will generally yipe or gasp. A dog with a more constant pain will have a change in breathing pattern and may vocalize in more of a groaning sound. Unless they are milking it or wanting you to fix it, then they'll whimper as a way to communicate their pain - but that's usually just to an owner.

If you've ever seen a person or dog wake up from surgery and be in pain, you'll more likely notices a slowed, deeper breathing pattern and moaning rather than heaving and whimpering. This is because the kind of deep, chronic pain from surgery is only made worse by heaving breathing and whimpering.

So, with that and having recently completed my junior surgery, I would say that the dog in the original post was not actually feeling pain, he just thought he was having a really bad dream. He was waking up, feeling that something was going on, but not actually hurting from it. Our dogs in surgery would chest heave a lot especially as we got into pulling out the testicles and ovaries. They were under iso with a pre-op injection of xylazine and morphine plus a second dose of morphine toward the end of surgery. When they chest heaved, we increased the anesthetic, not the analgesic. They were not feeling pain, but they were getting too light. We were supposed to keep them light to minimize bradycardia/bradypnea.

We also went back that night to check to see if any of them were in pain post op. The ones that were in pain did not exhibit any chest heaving or whimpering. Instead they were being as quiet as possible. Very few were in pain, most of them were jumping around like idiots in their kennels trying to rip their incisions open! 😛

 

[jglovicz]

Pinkkarisma--

Now that you've gotten all of this information, why don't you ask the vet himself in a non-judgmental manner. Tell him you've been thinking about it and you're curious about whether it's normal for this to happen. Then he'll probably tell you what anesthetic protocol he used and his philosophy on sedation and analgesia.

Come back and tell us what you find out. 👍

As I was reading the posts I was hoping someone would mention this. NONE of us have gone to vet school. No one should be criticizing the vet. HE finished vet school. WE don't know anything about the situation so it's pretty bold to openly criticize a vet you've never met. Maybe his technique was dated...maybe it wasn't. Either way, I wouldn't feel awkward asking him about it. Again, nothing in a judgemental but in an educational way. The vet said he'd allow you to watch the surgeries so my feeling is that you should feel okay asking him questions about it. "Dr. _______, I was just curious as to whether this was a voluntary response". You're there to learn right? I can't imagine someone would be upset for you trying to gain a better understanding of what's going on. Good luck

 

[robeezy08]

I have no idea about food animals, but there is certainly more awareness of pain management/anesthetic issues than in years past in the equine world.

I'll explain about castration in a minute, but NSAID's are still the predominant analgesics used in equine practice. Opioids tend to cause an increase in locomotor behavior (inc. poss. agitation) when used by themselves in horses, and I think the decrease in gut motility is a concern since they eat so much forage. If NSAID's don't work, the horse is usually in a hospital setting, and I have seen the following used: lidocaine CRI (frequent), epidural or intrathecal catheter bolused with lido or bupiv, +/- morphine, +/- detomidine (sometimes), detomidine CRI (rare), butorphanol CRI (rare).

When it comes to horse castration, there are two general approaches to anesthesia.

Some vets do it standing: the horse is sedated, usually with detomidine/butorphanol, the area is scrubbed, then a twitch applied to the upper lip (thought to activate acupressure points and cause release of endorphins) while the area is blocked. The vets I have seen block the skin, then inject block into the testicle, then inject up around the spermatic cord. The twitch is taken off once the horse is blocked, and the surgery performed with the vet crouched/leaning under the horse.

Advantages: avoids risks of general anesthesia (greater for horses than dogs and cats), much faster (literally a fraction of the time as for general), cheaper. Easier to do with just the vet and the owner. Does not have the same space and/or weather requirements as field (general) anesthesia.

Disadvantages: although the sedation and block make it unlikely, there is still the risk of the vet getting kicked in the head; if the horse turns out to be a cryptorchid (not all of them will let you feel their scrotum until they are heavily sedated), you have to abandon ship and arrrange to lay the horse down in a sterile OR; if there is a bleeder or similar complication, it is much harder to deal with and you may have to lay the horse down under adverse circumstances (and the horse continues bleeding while you anesthetize it, which you just can't do very quickly in a field situation).

For the above reasons, many vets use general anesthesia for castrations. Perhaps some expensive racehorses (and certainly those who are known to be cryptorchids) are laid down in an OR with gas, but most are done in the field with injectable anesthesia -- premed with xylazine or detomidine, +/- butorphanol or acepromazine, followed by ketamine and valium induction. If it is a straightforward castration, then the initial dose of ket/val may be enough for the surgery, perhaps topped off with half the induction dose of ket/val halfway through. This may be done "off the needle" -- i.e., no catheter placed. More complicated cases, such as older animals or a slightly retained testicle, may have a catheter placed and maintained with "triple drip" -- guaifenesin, ketamine, and xylazine CRI.

Having the horse under general is a much more controlled situation, but induction and recovery take a lot more time and require more people around, including someone to monitor plane of anesthesia. You have to have the right place to lay the horse down -- if you are going to use a stall, it needs to be roomy and airy with good light. If you are going to do it outside, you need a flat, quiet, grassy place and good weather.

Just thought I'd share with you curious small animal types.

Hi eventualeventer - Thank you for the post, soooo interesting! Hopefully I'll get into vet school this year and can watch/assist in one of these procedures 😀