Starving for Anaesthesia

Re: Starving for Anaesthesia

Mark Holmes — Wed, 17 Jul 2013 06:50:01 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Iain McAllister"] dog with seed in ear - colleague admitted - had eat full meal at 730 - 6 months old so he tacked on a spay [/quote]

Why?

This seems such a weird thing to do, whether it had eaten or not. Does anyone else do this sort of thing, or have I been on my desert island too long?

I'd have no worry anaesthetising the dog on the spot to take the seed out of it's ear. That's not exactly in the same class as a laparotomy and guddling about inside and yarking on the ovarian ligaments.

[/quote] I do, maybe it's just the demographic I am working with but you cannot guarantee you will ever get another opportunity and there's a very good chance it will turn up pregnant in 6 months time. You take any opportunity you get.

Re: Starving for Anaesthesia

Evelyn Barbour-Hill — Wed, 17 Jul 2013 02:47:55 GMT

[quote user="Iain McAllister"] dog with seed in ear - colleague admitted - had eat full meal at 730 - 6 months old so he tacked on a spay [/quote]

Why?

This seems such a weird thing to do, whether it had eaten or not. Does anyone else do this sort of thing, or have I been on my desert island too long?

Re: Starving for Anaesthesia

Gillian Mostyn — Tue, 16 Jul 2013 22:43:39 GMT

[quote user="Iain McAllister"] - dog with seed in ear - [/quote]

[quote user="Iain McAllister"] - what would be the minimum starve people would be happy with - [/quote]

It would depend on the condition of the dog. If it was comfortable, or just a bit itchy, I would probably have booked it in for the following day. If it was doing somersaults and being driven mad/in pain with its ear, I would have sedated straight away but probably wouldn't have spayed at the same time.

Re: Starving for Anaesthesia

Glenn Hodgson — Tue, 16 Jul 2013 18:58:08 GMT

We would have sent the dog home and done on day that was mutually suitable for us and owner.

Re: Starving for Anaesthesia

CatherineThomas — Tue, 16 Jul 2013 18:03:37 GMT

I don't think I've had any dogs vomit with a domitor sedation but lots of cats do. We often have feral cats brought in by Cats Protection for neutering when they want them done and out as soon as possible. They pretty much always vomit before the sedation kicks in. I think I remember someone saying that they use domitor as an emetic for toxin ingestion and then reverse with atipam.

Re: Starving for Anaesthesia

james hunt — Tue, 16 Jul 2013 17:55:24 GMT

http://onlinelibrary.wiley.com/doi/10.1111/j.1467-2995.2009.00495.x/abstract

Re: Starving for Anaesthesia

Anthony Dennison — Tue, 16 Jul 2013 17:47:21 GMT

[quote user="Thomas Johnson"]I've had several dogs and cats that I've sedated with dom/torb prior to euthanasia vomit, usually when the owner has decided to give them a 'last meal' just before the euthanasia.[/quote]

Yup, that's happened to me too. And cats usually get a large amount of oily fish. Disgusting smell - one owner ran out retching.

Re: Starving for Anaesthesia

Thomas Johnson — Mon, 15 Jul 2013 15:37:46 GMT

[quote user="bob lehner"]

Puzzled by the comments on domitor causing emesis. I've used dom/torb to sedate dogs (0.1 ml of each/10 kg i.v.) for donkeys' years (ever since the drugs first came on the market) and honestly can't recall one ever vomiting. Similarly dom/torb/ket in cats - they never seem to vomit. Is it dose related or something ?

[/quote]

I've had several dogs and cats that I've sedated with dom/torb prior to euthanasia vomit, usually when the owner has decided to give them a 'last meal' just before the euthanasia.

Re: Starving for Anaesthesia

bob lehner — Sun, 14 Jul 2013 15:32:24 GMT

[quote user="Martin Atkinson"]The key is clearly getting a tube in asap, in a cat with laryngeal spasms this can take up to a minute [/quote]

One of the (several) good things about dom/torb/ket triple combo in cats is that the larynx is completely relaxed and intubation presents no problem - unlike propofol where there can sometimes be quite a long period of apnoea, with a stubbornly closed airway.

Re: Starving for Anaesthesia

Martin Atkinson — Fri, 12 Jul 2013 16:42:16 GMT

[quote user="Dagmar Steele"]

stop the Xylanzine you dino! :-)

[/quote]

The key is clearly getting a tube in asap, in a cat with laryngeal spasms this can take up to a minute although usually not more than 20 whereas a dog is 5-10, that's up to 55 seconds more for a cat to vomit and choke on it, I'd still rather it vomited before thanks.

Re: Starving for Anaesthesia

Dagmar Steele — Fri, 12 Jul 2013 10:19:04 GMT

Martin, exactly for that reason I have swapped from Xylazine to Medetomidine ages ago. I can't remember any cat throwing up for years now including the ones that were emergencies and haven't been starved at all! It's not nice for the cats nor for the staff so stop the Xylanzine you dino! :-)

Re: Starving for Anaesthesia

Martin Atkinson — Fri, 12 Jul 2013 09:42:53 GMT

Given the rate of incidence of vomiting due to anaesthetic is low anyway and inhalation of vomitus is very low provided the animal is intubated with a cuffed tube as soon as it is anaesthetised and the tube not removed until it has a swallow reflex the likelihood of this happening is pretty remote. Of course if you're stupid enough to do a GA without a tube then you're asking for trouble. However I would obtain informed consent from the owner, do a risk/benefit assessment and advise them of the risks, it they agree to proceed then I see no issue. In 38 years I've never had a patient inhale its vomit under anaesthetic. In fact I assume that every owner is an idiot and they have allowed the animal to eat, especially cats, and proceed accordingly. We premed cats with xylazine for this reason and 50% of cats which have allegedly been starved chuck up food and that includes some that we know have been starved because they've been kenneled overnight!

Re: Starving for Anaesthesia

Robin Grimmer — Thu, 11 Jul 2013 09:37:21 GMT

I wouldn't have done it in this case as the dog had a full meal in the morning. If necessary I would have done the grass seed under sedation (dom/torb) which would have induced emesis if anything in the stomach, and done the spay another time. Don't do something you're not comfortable with if a colleague has booked it in. If anything goes wrong it's your a** on the line.

Re: Starving for Anaesthesia

John Flynn — Thu, 11 Jul 2013 07:26:26 GMT

[quote user="Clive Ansell"]given it is the accepted norm to starve animals pre GA one would have to justify and defend any decision not to in the event of a problem and subsequent complaint.[/quote]

Your norm. Not mine.

I don't see why I would need to justify anaesthetising a dog wihtout starving it more than than you would need to justify starving it in the presence of a problem (e.g. oesophagitis/oesophageal stricture formation)?

Re: Starving for Anaesthesia

Clive Ansell — Thu, 11 Jul 2013 07:21:55 GMT

It depends very much on the case and the circumstances, each being a unique set of events.

I wouldn't be entirely happy leaving a grass seed in for >24hrs, but wouldn't be happy carrying out GA in a patient that had eaten.

If I were in this scenario yesterday, being busy, and the dog was bothered or distressed I would have cracked on and removed the seed and rescheduled the spay for another day.

I've anaesthetised animals that have eaten and never had any complications or problems at all, but given it is the accepted norm to starve animals pre GA one would have to justify and defend any decision not to in the event of a problem and subsequent complaint. I would discuss it with the client and point out the very small increased risk and get signed consent on that basis. Like Micheal, I've sometimes induced emesis with Xylazine.

Re: Starving for Anaesthesia

tess — Thu, 11 Jul 2013 00:15:39 GMT

Don't think I would have booked in the spay. Either do the two as separate procedures (better all round, including practice finances) or delay 24hours and do both together.

BUT what if in that time the seed migrated through the eardrum and you struggled to extract it, leading to complications etc, etc ? Would you be struck off for the delay?? We can hypothesise ad infinitum.

Re: Starving for Anaesthesia

John Flynn — Wed, 10 Jul 2013 20:52:13 GMT

Evidence-base for starving dogs prior to GA anyone?

I certainly wouldn't recommend a large meal just prior to anaesthetic, but I'm not sure that there's really an increased risk of serious adverse event from a small amount of food 2 to 4 hrs pre-GA.

Given that sometimes it can be hard to get patients to eat afterwards, I would actively encourage some feeding in many cases - if the owner gives a small amount of food at 6am, then I'm more than happy to give GA at 10am.

I once worked in a clinic that deprived water for >12hours prior to GA!!! Even in elderly cats... OK this might have been the dark ages, but even then it wasn't clear what the point of this was meant to be...

Re: Starving for Anaesthesia

Mark Holmes — Wed, 10 Jul 2013 19:57:23 GMT

Clive makes a good point about the Mr C case but I think general practice is always like that. You bend rules to fit the circumstances. I would probably just have got on with it to be honest. I guess it depends how busy tomorrow looks. If here is time today is it worth the extra stress if tomorrow is busy? Do you risk more doing it with too little time? Has anybody ever seen problems with aspiration in a dog in these circumstances? It's the same with surgery and dentals. In an ideal world you wouldn't do them together BUT if you have the chance to sort a foetid mouth do you miss the opportunity and risk it not coming back?

Re: Starving for Anaesthesia

Francisco Gomez — Wed, 10 Jul 2013 19:44:30 GMT

I have the opposite in a practice I used to work for. Receptionist was told by the partners to starve dogs and cats from 7pm the night before. Sometimes the op didn't start until afternoon.

Those poor animals were starving!

Agree that minimum should be 6 hours. what would you perceive as too long?

Re: Starving for Anaesthesia

Francisco Gomez — Wed, 10 Jul 2013 19:41:34 GMT

[quote user="Clive Ansell"]

Remember too, in the light of the Mr C case, that if you go ahead and it goes belly up (worse scenario = vomiting/regurgitation, choking or inhalation pneumonia etc etc) you as the professional, the MRCVS, take the flak and are very likely to be unsupported.

[/quote]

And the practice policy is not going to save you on these circumstances!

Re: Starving for Anaesthesia

Clive Ansell — Wed, 10 Jul 2013 17:56:24 GMT

Not a clinical emergency, so if you not entirely happy bounce it until tomorrow or later in the day. I would want to starve a minimum of 6 hours.

Where I am at the moment it is busy plus there is a 1400-1500 surgery, so no time for routine ops later in the day. Further, I don't like routine ops later in the day as recovery time is limited and in this practice doors close at 7 with no staff OOH. On balance do it tomorrow.

Re: Starving for Anaesthesia

Rob Loxley — Wed, 10 Jul 2013 17:52:43 GMT

Have GA'd a fair few emergencies that had eaten and didn't vomit/reflux and a number of animals stave >8hrs that did... For elective surgery in non-neonatal dogs and cats I'd go for 6-8hrs

Re: Starving for Anaesthesia

Michael Woodhouse — Wed, 10 Jul 2013 17:05:22 GMT

I have left things into early afternoon in similar circumstances, but if urgent then I just crack on. I have used xylazine pre-med with the hope of making them vomit if it is something you need to do now.

Not acid reflux but pressure on diaphragm and risk of regurgitation were my perceived risks.