Anesthesia: It Ain’t Over Till It’s Over

February 1, 2010

01/18/2010 – Who should euthanize Leia?[1]
01/04/2010 – Changing the world, one patient at a time[2]
12/21/2009 – Would you have euthanized this patient?[3]

David Brodbelt, a British board-certified anesthesiologist, undertook a massive thesis known in the anesthesia world as CEPSAF.1[4] In the rest of the world, it is called the Confidential Enquiry into Perioperative Small Animal Fatalities. After the thesis was published, some more data has been published in various journals2[5].

Our colleague looked at anesthesia records of more than 98,000 dogs and 79,000 cats (OK, and more than 8,000 rabbits), from more than 100 practices.  Obviously, this represents unusually huge numbers for a veterinary study.

Anesthetic-related death was defined as perioperative death within 48 hours of termination of anesthesia. Countless interesting conclusions can be drawn from the study, and I would like to focus on one specific point.

Let’s start with a pop quiz: would you say that most perianesthetic deaths occur during induction, surgery or recovery?

The correct answer is that over half of the perianesthetic deaths occurred within 3 hours of termination of anesthesia.

It is difficult to know exactly why these patients died; only 10 percent had necropsies. Granted, some of these patients may have been very sick animals who may have “decompensated.”  In many cases, it may be lack of monitoring while the patients were still recovering.

In other words, the study suggests that recovering patients should be monitored at least as closely as anesthetized patients.

One conclusion from the authors is, “If closer monitoring and management of patients in this early postoperative period were instituted, then mortality might be reduced3[6].

So what could you do in your practice to decrease this risk?

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How can you accomplish this when there are so many other things to do?

One solution may be to have a dedicated technician for recovery patients if you have a busy surgery schedule. In fact, this should include all anesthetic procedures, including dentals. Even if you don’t have a big case load, the technician in charge of the anesthesia could remain in charge of the patient until it is deemed safely recovered.

The CEPSAF study is truly exceptional by its size and comprehensiveness. I wish we had more large-scale veterinary studies such as this one. Statistics would be immensely more reliable.

Ultimately, the greatest surgery, performed by the greatest surgeon, is only great if the patient goes back home. As they say, “There are routine surgeries, but there is no routine anesthesia.”

Footnotes:

1. DC Brodbelt.  “The Confidential Enquiry into Perioperative Small Animal Fatalities.”  2006 thesis.

2. DC Brodbelt et al.  “The Risk of Death: The Confidential Enquiry into Perioperative Small Animal Fatalities (CEPSAF).”  Vet Anaesth Analg 2008, Vol 35, N 5, p. 365-373.

3. DC Brodbelt et al.  “Risk factors for anaesthetic-related death in cats: results from the confidential enquiry into perioperative small animal fatalities (CEPSAF).”  Br J Anaesth. 2007, Vol 99, N 5, 617-623.

Endnotes:
  1. Who should euthanize Leia?: http://www.veterinarypracticenews.com/vet-editorial-blog/cutting-edge/who-should-euthanize-leia.aspx
  2. Changing the world, one patient at a time: http://www.veterinarypracticenews.com/vet-editorial-blog/cutting-edge/changing-the-world-one-patient-at-a-time.aspx
  3. Would you have euthanized this patient?: http://www.veterinarypracticenews.com/vet-editorial-blog/cutting-edge/would-you-have-euthanized-this-patient.aspx
  4. 1: http://www.veterinarypracticenews.com/Vet-Editorial-Blog/Cutting-Edge/February-2010/Anesthesia-It-Aint-Over-Till-Its-Over/#Footnote1
  5. 2: http://www.veterinarypracticenews.com/Vet-Editorial-Blog/Cutting-Edge/February-2010/Anesthesia-It-Aint-Over-Till-Its-Over/#Footnote2
  6. 3: http://www.veterinarypracticenews.com/Vet-Editorial-Blog/Cutting-Edge/February-2010/Anesthesia-It-Aint-Over-Till-Its-Over/#Footnote3

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