Chances are, most of us have either
had, or know someone who has had a surgery that requires general anesthesia.
These surgeries can vary from appendectomies, cholecystectomies, coronary
artery bypasses, or even heart transplants. The World Health Organization
estimates that betwen 266.2 and 359.9 million global surgeries were performed
in 2012.1 This accounts for a 38% increase in just 8 years.1
As our global population continues to grow, and health continues to decline,
this number is estimated to be even higher by 2020. Whether elective or
emergent, my question is: are we really aware of what happens beyond the staff
door of the operating room? The ability to give ultimate trust when we sign the
consent form for surgery is what we’ll continue to discuss.
It is common to have anxiety while
waiting in pre-op (i.e., before operation) the morning of surgery. That is
where the induction of drugs begins. Benzodiazepines are commonly used as an
antianxiety medication during pre-op to aid in calming patients. In fact, one
study even measured the administration of benzodiazepines and its correlation
with patient satisfaction.2 Spend an hour with anyone working in
healthcare and you’ll hear about the harp on patient satisfaction scores.
Benzodiazepines are commonly used both preoperatively and intraoperatively.
Benzos for short, are used primarily for their amnesic and anxiolytic effects.3
This drug acts as a positive allosteric modulator on the GABA receptor, efficiently
helping to reduce the excitability of neurons.3 The fact that you’re
given a drug to help you forget may come as a bit of surprise, but this is just
the beginning. The benzos given to just “take the edge off” doesn’t come close
to the effects of the normal intraoperative medications.
Understandably so, no one wants to
feel pain or even discomfort when going in for an operation. In an effort to
make his patients more comfortable, Dr. James Young Simpson started to work on
anesthesia in the early 1800s.
Anesthesia is a state of controlled, temporary loss of sensation or
awareness. It was in 1847 that Dr.
Simpson first used chloroform to accomplish the first narcosis, on himself.4
Lucky for you and I, general anesthesia has come a long way. Upon arriving in
the operating room, you are met by a team of skilled physicians and medical
personnel; all of whom are tasked with providing a smooth and induction into
the unknown realm of general anesthesia. I would imagine that having a 7.5mm plastic tube shoved down your
throat as an access for ventilation (i.e., intubation) could be extremely
uncomfortable. Before a patient can be intubated and put on a ventilator, which
we’ll come back to, they must be sedated. Uptodate, a website containing
thousands of peer-reviewed clinical topics, a common agent used to induce
sedation is etomidate (Caro,2019). Similar to benzos, etomidate works on the
GABA receptor to inhibit the excitation of neurons.5 This loss of
neuronal activity is what contributes to its sedative/hypnotic effects. In a
nutshell, this drug is used induce the actual asleep effect we commonly hear
about during surgery. Once administered, etomidate will have increased
GABAergic transmission and allowed for reversible desensitization which is
responsible for the physiological effect of being put to sleep.7
So that’s it, you are blissfully
asleep for surgery. Except for the fact that you can still move. Your muscles
may contract or twitch, you may try to roll on your side, or you may even move
your limbs. This could could cause quite the problem for a surgeon who may be
wrist deep in the abdomen, or performing microsurgery in a highly vascularized
area. Just as with benzos for anxiety, and hypnotics like etomidate for pain
and discomfort, there is a pharmacological solution for this problem of
undesired movement. Succinylcholine is a neuromuscular blocker that prevents
acetylcholine from connecting with its nicotinic receptor at the neuromuscular
junction.8 Basic muscle physiology principles outline muscle
contraction via the help of cholinergic receptors. Commonly referred to as
Succ, succinylcholine has a high affinity to bind to the nicotinic receptors of
skeletal muscle. This competitive inhibition blocks acetylcholine therefore
preventing muscle contraction.8
It is important to note that this blog just
begins to scratch the surface on drugs given in the operating room. Other drugs
that need to be considered are anesthesia maintenance medications, pressure
regulators, and the reversal medication used for waking a patient up after
surgery. In a nutshell, these medications are extremely important in today’s
surgical cases. All harbor different mechanisms of actions, different side
effects, and different interactions with each other. The amount of knowledge one must know to
safely administer these is unimaginable. When your shadowing a surgeon, or
going in for your own surgery, remember to thank an anesthesiologist.
By Cody Russell, Master of Medical Sciences Student, University of Kentucky
By Cody Russell, Master of Medical Sciences Student, University of Kentucky
References:
1. Weiser, Thomas G, et al.
“Size and Distribution of the Global Volume of Surgery in 2012.” World Health
Organization, World Health Organization, 16 Apr. 2018, www.who.int/bulletin/volumes/94/3/15-159293/en/.
2. C. Boncyk, A. S. Hess, A.
Gaskell, J. Sleigh, R. D. Sanders, on behalf of the ConsCIOUS group, Does
benzodiazepine administration affect patient satisfaction: a secondary analysis
of the ConCIOUS study, BJA: British
Journal of Anaesthesia, Volume 118, Issue 2, February 2017, Pages
266–267, https://doi.org/10.1093/bja/aew456
3 . Griffin CE 3rd, Kaye AM,
Bueno FR, Kaye AD. Benzodiazepine pharmacology and central nervous
system-mediated effects. Ochsner J.
2013;13(Alexander):214–223.
4. Wawersik J (1997) History of
chloroform anesthesia. Anaesthesiol Reanim 22(6):144–152
5. Caro MD, David (2019).
Induction Agents for Rapid Sequence Intubation Outside the Operating Room. In
J. Grayzel MD (Ed.), UpToDate. Retrieved
October 1, 2019, from https://www.uptodate.com/contents/induction-agents-for-rapid-sequence-intubation-in-adults-outside-the-operating-room
6. Arivazhahan, Avinash
& Patil, Navin & Kunder, Sushil & Pathak, Anurag & Shenoy,
Smita & Bairy, Laxminarayana. (2015). Unravelling Basic Concepts in
Perioperative Pharmacology. Research Journal of Pharmaceutical, Biological and
Chemical Sciences.
7. Olsen RW, DeLorey TM. GABA
Receptor Physiology and Pharmacology. In: Siegel GJ, Agranoff BW, Albers RW, et
al., editors. Basic Neurochemistry: Molecular, Cellular and Medical Aspects.
6th edition. Philadelphia: Lippincott-Raven; 1999. Available from: https://www.ncbi.nlm.nih.gov/books/NBK28090/
8. Hager HH, Burns B.
Succinylcholine Chloride. [Updated 2019 Mar 19]. In: StatPearls [Internet].
Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from:
https://www.ncbi.nlm.nih.gov/books/NBK499984/
Anesthesia and sedation in adults is a large and growing necessity and drugs in infants are also very similar but have very different criterias since they have a lesser developed immune system, less concentration of albumin and alpha-1-glycoprotein. A small, hydrophobic molecule with an intermediate size volume of distribution. Cannot pass through mammary epithelial cells, some drug will pass with compromised renal function
ReplyDeleteLarge volume of distribution, blood found in maternal blood can move into breast milk. Since most of the drug is tissue bound. Shorter half life results in relatively high clearance with any remaining drug. Also small positively charged molecule extensively bound to serum albumin are water soluble, they can easily enter through fenestrations and enter epithelial cells. An increase in unbound drug increases went entering circulation, because infants have lower concentration of albumin and alpha 1 glycoprotein depending on the concentration of the drug can be toxic since the bioavailability is increased by some factor. These factors must be taken into account when giving infants and small children dose of anesthesia or any other sedative drug.
This was a very eye opening blog post. It's overwhelming to think of how many drugs and mechanisms are involved in anesthesia, but to the average person it is just viewed as "going to sleep." While reading your blog, I kept relating it back to the work in an animal clinic. Many animal clinics use similar drugs to sedate/anesthetize their patients for surgery and have veterinary technicians that monitor the animals during surgery just as an anesthesiologist would. A huge difference, however, is that humans can be told what they are being given and the effects they will feel where animals cannot. Regardless of this difference, many people are still very unaware of what exactly they are given before, during, and after surgery, and I think many would be surprised to know how complex anesthesiology really is. Very interesting topic that raises questions about doctor-patient transparency.
ReplyDeleteI really enjoyed reading your post. Often we are so focused on the procedures being performed that we forget about the significance of anesthesia. We are truly so lucky to live in a time where anesthesia is as effective as it is. I appreciate that you went beyond just stating the general consequences of anesthesia by explaining the uses of the various drugs used during the process of anesthesia. It is so important to know the uses for each drug, but I also think it is critical to understand the risks associated with each drug as well because like you implied, it's not just a simple medication that is administered prior to surgery. Supposedly, hearing is the first sense that "comes back" which means that certain patients will typically recall conversations or sounds they heard while under anesthesia. While that is not as terrifying as seeing people elbow deep in your body, I imagine that hearing the sound of surgical instruments or conversations about surgery is traumatic. I wonder if there is a drug to combat this. I am curious if it is because certain people are not candidates for the full dose of anesthesia or perhaps it's just a case of neglect considering how low the incidence of awareness during procedures are. Overall, very interesting!
ReplyDeleteGreat commentary on general anesthesia. I've experienced procedures myself where I was very thankful for modern medicine in that regard; but it can frightening to think about the responsibility and margin for error in the hands of an anesthesiologist, especially in the case of neonatal procedures.
ReplyDeleteOnly a minority of drugs used for clinical neonatal care are approved by the FDA, as it's obviously difficult to perform clinical trials in these cases (Bang, 2015), so most are used off-label. Of the few approved for use by the FDA, only three anesthetics have labeling for neonates: emifentanil, rocuronium, and sevoflurane. Animal studies have also shown that the use of almost all anesthetics are associated with some degree of neural apoptosis when exposed during critical neurodevelopment periods.
Despite this, neonatal anesthesia generally is safe but this great risk of harm for such fragile patients does beg the focus of research to be shifted to how we can continue to improve on safety and efficacy of anesthetic clinical practice not only in neonates, but in patients of all ages.
Bang, SR. Neonatal anesthesia: how we manage our most vulnerable patients. (2015 Oct.) "Korean J Anesthesiology": 68(5): 434–441.
Love the post, Cody. I have had several surgeries in my lifetime, most of them when I was so young I barely remember anything, but at least one recently, and I never really considered what drugs were being used or why. One thing that I am very thankful to never have experienced but always been absolutely terrified of is waking up mid-surgery. I have heard horror stories of "anesthetic resistant" individuals, who will regain consciousness during the surgery despite being administered general anesthetic, but remain paralyzed from the neuromuscular blockers, and unable to notify the surgeons. It seems that these episodes are typically short, and patients usually slip back into unconsciousness quickly, but can retain post-operative memories of the surgery, such as sounds and sensations. As you can imagine, a lot of patients are traumatized from such an experience. Some of these cases can be attributed to improper anesthetic administration, or intentional low doses if the patient has other complications or during C-section surgery. However, there is also believed to be a genetic component to resistance, but this is yet to be confirmed with sufficient data. Regardless, I think solutions should be sought to mitigate patients waking up while a surgeon digs around inside their body.
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ReplyDeleteI really enjoyed this post Cody, it opened my eyes to areas of anesthesia that I had not given thought to before, such as medication solely for unwanted movements. The science of anesthesia has come bounds since the use of chloroform and the ability of our anesthesiologists to find the perfect homeostasis for an individual seems to be an art. The dose must be catered to the individual's size and weight, often requiring adjustments during the operation. This is only after the medication used has been delicately selected with the patient's medical history in mind. A case study examining all anesthesia mortality in the US from 1999 to 2005 found that 46.6% of the cases were from overdose, while another 42.5% were from adverse effects of the anesthesia. The rest were from pregnancy/labor complications and other anesthesia complications. Whether or not the adverse effects were foreseeable in the patients medical history for some of these cases is unknown, however, it just goes to show how much trust is put into the anesthesiologists hands. I have as well had a few surgeries in my life and never thought once about the time and effort put into the specific anesthesia used. I was always too busy worrying about the possible hurdles I could be faced with after, trusting my anesthesiologist fully to keep me safely unconscious. I had no grasp on the fact I was trusting my anesthesiologist with much more than just keeping me unconscious but also keeping me calm before the operation, inhibiting me from moving during, ensuring the appropriate amount is used and much much more. This post really shines the light on how complex and fragile the job of an anesthesiologist really is.
ReplyDeleteLi, Guohua, et al. “Epidemiology of Anesthesia-Related Mortality in the United States, 1999-2005.” Anesthesiology, U.S. National Library of Medicine, Apr. 2009, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2697561/.
As a veterinary technician I found myself comparing your post to the surgical practices used for equine general anesthesia. Our clinic alone performs approximately 5,000 surgeries each year. And just as you mentioned in humans, for horses, we have a team of anesthesiologists and technicians that work together to ensure a safe induction of these large animals while utilizing certain drugs to aid in the elimination of sensation during surgical procedures. Obviously, the difference with horses is that they are not able to tell us how they are feeling and having a twelve hundred pound animal wake up on the table is safe for no one. Typically, horses are induced from a combination of xylazine, to relax the horse, and ketamine, to complete the induction. Other drugs, such as diazepam or midazolam, which are benzodiazepines, can also be used before ketamine induction to sedate the horse and relax the muscles without having major effects on the cardiovascular system. These two particular drugs act on the γ-aminobutyric acid receptor-chloride channel complexes in the central nervous system. Like you mentioned though in humans, there are many combinations drugs that are used when it comes to surgery and I am always interested in seeing how human medicine compares to that of equine medicine.
ReplyDeleteHubbell, John. “How to Produce Twenty Minutes of Equine Anesthesia in the Field.” AAEP PROCEEDINGS, vol. 59, 2013, pp. 469–471.
Jen Eccleston
DeleteAs a former college athlete, I unfortunately have been injured multiple times. I have undergone 7 orthopedic surgeries including 6 knee surgeries and 1 shoulder surgery all between the ages of 11 and 24. This blog is practically an outline of what happened for each of my surgeries.
ReplyDeleteBefore each surgery I had blood taken and was given antibiotics prophylactically. In pre-op I was given an intravenous benzo to relax and the nurse continued to hang my antibiotic. I was rolled into the O.R. and the anesthesiologist shoves a mask with cold nitrous oxide over my face and some cold medication into my I.V. (most likely Etomidate) and about 10 seconds later I am out.
During the surgery I was given a nerve block in my femoral nerve, most likely bupivacaine. Bupivacaine is a local anesthetic used for long-term nerve blocks. With my nerve block I couldn’t feel the wire stitches in my knee but I could feel a sharp pain in my thigh where the doctor injected the local/ regional anesthetic right into the meat of my quadriceps muscle. But with this nerve block I didn’t need to take pain medication until 48 hours after my operations.
After surgery I was given Zofran to stop my nausea and a NSAID for inflammation. My surgeon did prescribe oxycodone for post-op pain, which I didn’t use. My surgeon was big on using the least amount of pain medication needed, he instead insisted on using ice to relieve pain. This blog is extremely interesting to me because I have undergone multiple surgeries but especially due to my pursuit of medical school. I have two more surgeries needed and will be using my knowledge of anesthetics to annoyingly ask multiple questions to my surgeon and anesthesiologists. -Erin Harris
This blog is really informative. I enjoy learning about anesthesia and how different individuals react to anesthesia/sedation. It is also really interesting to learn about the different anesthetics such as sevoflurane, propofol, etc. and when/why they are used. Anesthesia/sedation is almost like an art, because they are so many different factors and everyone responds differently.
ReplyDeleteI really appreciate you writing about the importance of anesthesiology. Most people think that this job is just about a simple injection setting you to sleep. There is just so much that occurs behind the scenes. The anesthesiologists are the most important part of the surgery. Without them it is not possible to perform a surgery. They have to carefully watch the vitals of the patient throughout the surgery for any changes and then adjust according to those changes. And since there is health variations from one person to another, each case is handled accordingly.
ReplyDeleteHowever, anesthesia is quite expensive and recently there has been news on patients getting their surgeries without anesthesia. The patients can watch and respond to whatever is happening during their surgery. This has started a new issue on what doctors can say or respond like in the situation when the patient can see and hear them. An article from NY Times identifies and elaborates on this problem in detail.
Hoffman, Jan. “Going Under the Knife, With Eyes and Ears Wide Open.” The New York Times, The New York Times, 25 Mar. 2017, www.nytimes.com/2017/03/25/health/surgery-awake-anesthesia.html.
This blog post has brought awareness to a topic that typically is overlooked in most medical or biology classes. We know that anesthesia is used to put a person to sleep and allows for doctors and surgeons to do their job. We never learn the mechanism and never know what drug does what. It was interesting to learn about benzo, etomidate, and succinylcholine in terms of what they do for patients. In some cases it has been found that anesthetics can induce widespread cell death and cause neurocognitive impairments (1). It has been observed that in some cases children who undergo surgeries with anesthesia have behavioral abnormalities and issues with academic performance, which has raised issues about the use of anesthetics in children (1). A study by Glatz et al, looked at children form ages 5 to 18 years who underwent surgery with the use of anesthesia to see what neurocognitive issues arose (1). The researchers also used MRI scan to assess the brain structural comparisons of these children (1). It was founded that in early childhood those children who had used anesthesia in surgery showed issues with language abilities and cognition (1). These children were also observed to have changes in regional volumetric alterations in brain structures as well (1). Thus, it seems the use of anesthesia seems promising and helpful it has to be better researched and assessed before being used in children. It is critical for future researchers to examine how the use of anesthesia can cause potential dilemma for children’s health (1).
ReplyDelete1. Glatz, Pia, et al. "Association of anesthesia and surgery during childhood with long-term academic performance." JAMA pediatrics 171.1 (2017): e163470-e163470.
This is a very interesting topic! As you stated this only scratches the surface, and there is much to be discovered in this field. The potential occurrence of adverse reactions during pre-operation, operation, and post-operation greatly informs how providers tackle certain cases. Ideally, surgeons want their patients in a stable condition during surgery; but when complications arise, it changes the narrative and ultimately how the patient will recover. Post-operation analgesic regimens also have to be dialed in; in accordance with the patient's level of pain. The subjectivity of pain is a topic of much interest here; and represents a huge hurdle for providers. There is great diversity in response to these drugs, and a slew of different reactions can occur. I believe the future for pre-operative, operative, and post-operative analgesics will involve a patient-centered treatment regimen catered to an individual's specific needs; with stability and recovery as the driving factors behind pharmacological intervention.
ReplyDeleteI love this topic! I have always been so fascinated with anesthetic drugs. Very complex reactions occur in our bodies while we are under anesthesia, and I think it is very interesting that even our genetics play a huge role in how we metabolize and react to anesthetic drugs. I also really like the fact that you addressed the progressive history of anesthetic drugs because they have drastically improved since the 1800s. Your blog post reminded me of when I had my wisdom teeth removed; I remember I waking up halfway through the procedure and the anesthesiologist administered more drugs, or turned up my levels of isoflurane to make me go back to “sleep”. As a patient, I was never told what drugs were being used or what I could expect as I was waking up from my oral surgery. This makes me wonder how physicians know if a patient is having an allergic reaction to an anesthetic drug while they are under anesthesia, and what actions they would take to save the patient if the surgery were more invasive than an oral surgery. Your blog post was so interesting, and it has definitely made me more curious about this topic! Very well done.
ReplyDeleteThe operating room used to be called the operating theater and your article reminds me of why that is true. In the OR there are so many smaller intricate details that go into performing a successful surgery, each member of the surgical team has an important role to play. You gave a great explanation of the countless drugs used during surgery and their mechanisms. However, I believe your comment that “are we really aware of what happens beyond the staff doors of the operating room” needs clarification. Performing any medical procedure by a physician or surgeon without informed consent is illegal and considered medical malpractice. Patients are required to sign various papers detailing the procedure, including drugs they will be given. Therefore, in a sense, this question is rhetorical because by law patients are given all this information prior to surgery, and no respectable medical professional would do anything “beyond the staff door of the OR” without informing the patient or their family.
ReplyDeleteThe real question is if the patient truly understands the information they are given regarding their surgery. Surgery of any kind can have fatal consequences; this fact incites anxiety even in patients with a medical background. With that being said, is it really in the patient’s best interest to completely understand every aspect of their procedure? There are countless peer-reviewed research articles regarding the negative impacts of a patient’s preoperative anxiety and stress on the success of their surgery. So, I agree that preoperative education is important. For some patients, preoperative education can significantly reduce their preoperative anxiety, but this is not true for all patients. Every patient is different and requires a different approach to ensure their procedure is successful, so it is the physician’s responsibility to modify their approach with each of their patients.
I agree that a patient gives the ultimate level of trust to their surgical team, but do surgeons and anesthesiologists not earn that trust? After completing eight years of collegiate education these men and women continue their medical education for another three to seven years. If patients wanted to truly comprehend every aspect of their surgical procedures, that information is readily available for their research and from my own personal experience with shadowing several surgeons of various subspecialties they would be more than happy to answer any question their patient has before and after surgery.
Cody, what an interesting concept for a blog post. As students in this class we are all well aware of the varying effects that different drugs have and how no one drug holds the answer for all concerns addressed in surgical anesthesia. Prior to joining this class I had no idea that it took so many drugs to reach the so called “anesthetic state” and maintain that state for the duration of surgery, yet I was aware that it takes careful dosing and continued control to correctly administer these drugs. This concept was especially surprising considering the humble roots of anesthesia that you talked about. To think that the contemporary use of complicated anesthetic drug cocktails began with a physician dosing himself with chloroform is both entertaining and inspiring. Today we have so many drug options that anesthesiology has become an entire field of study and countless researchers have spent entire careers attempting to better define and understand the complex biochemical and neurological reactions that occur. Truly anesthesiologists are tasked with quite the job.
ReplyDeleteThis blog was a great breakdown of what many of us are vaguely aware of but don't fully understand the complexities of. I think anesthesia is often considered a single injection before surgery and possibly during and then it wares off, and thus begins the healing process for whatever required you to be sedated in the first place. This blog did a great job of going set-by-step to outline what really happens. I never knew that anti-anxiety medications were given to patients in pre-op. As a person who suffers from anxiety on a normal basis, I have found several health professionals who don't seriously consider my mental health. I appreciate that that is taken into consideration in the preparation for a surgery, because it is such an important factor. Patients have the right to be taken seriously and maintain a certain level of comfort while in such an unfamiliar and uncomfortable situation. I think the fact that there is a specialty just for anesthesia shows how complex and instrumental it is for all patient care.
ReplyDelete-Alivia Larkin
This blog post is very interesting as well as very eye opening. Despite having spent my life around medicine, it had never occurred to me how difficult anesthesiology might be. Even though they are exceptionally skilled at their profession, there is still a lot of pressure on the anesthesiologist that is not readily apparent. I did some research and I found a study discussing the phenomenon of awareness during anesthesia. This is a very big problem for everyone involved and makes up 2% of the legal claims against hospitals (Kotsovolis G, 2009). This causes very serious psychological damage to the patient as well as physical damage to them. The study preformed observes the patient and tries to determine how aware the patient really is under anesthetics. I have linked the article below, great work on this blog entry!
ReplyDeleteKotsovolis G, Komninos G. Awareness during anesthesia: how sure can we be that the patient is sleeping indeed?. Hippokratia. 2009;13(2):83–89.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2683150/
This very informative, if slightly scary, post reminded me of the worst reaction that can happen to an anesthetic: anaphylactic allergic reaction. While these reactions are very rare, they often lead to mortality. Their rarity (1 in 20,000) often means that anesthesiologists have not encountered one in their practice, and therefore they must rely on their protocols rather than experience to properly deal with the situation. This could be especially dangerous considering that the symptoms may be difficult to recognize while the patient is already sedated. Unfortunately, the first time a patient will learn about this allergy is during the surgery, since there is “no gold standard for testing”. Hopefully there will soon be developments in testing for these allergies so that patients will no longer be exposed to drugs that cause them such harm during such a vulnerable time.
ReplyDeleteBevanda, Danijela Glibo, et al. “Allergic Reactions and Anesthesia.” Psychiatria Danubina, U.S. National Library of Medicine, Dec. 2017, https://www.ncbi.nlm.nih.gov/pubmed/29278624.
Really nice summary of experiences with anesthesia! I have been able to learn a lot more about this entire process at my job through the veterinary clinic. Since I have now worked there for a few years, I’ve been able to monitor a few surgeries. I definitely understand the very nerve wracking responsibility of ensuring a patient under anesthesia is maintaining vitals. I always found it astounding how many different reactions there potentially are to the drugs used, and how different aspects of a lifestyle can impact their vitals during surgery. It’s especially difficult within veterinary medicine when you’re dealing with different species that have a very wide range in weights and lifestyles. One of the most difficult issues I feel that I see with the use of anesthesia is the inability to use it in certain patients. Which is a common problem in human medicine as well, however there are many other alternatives that are usually available. One example I can think of in particular involves a cat that currently comes to our clinic. She’s 14 years old and has a very large mass on the top of her head that is growing and interfering with her sight. It’s obviously very painful for her and is often very bloody and irritated from her own doing. In a younger animal, surgical removal would be an option. However, because of her age she is unable to go under the anesthesia required to perform the surgery. This post really made me think about the future of the use of anesthesia in special cases and how we may come up with a solution in the future.
ReplyDelete