Surgery mornings are early ones for me – they start about 5:30 am so I can get to Patterson’s by 7:15. I’m not naturally a morning person (that’s why when I’m working up front you’ll pretty much only see me after 2pm!) but I do really love surgery.
So what’s my surgery day like?
It’s often a fun surprise – because I don’t work the day before, things get added to my schedule that weren’t there the last time I checked. That’s ok – as some of you already know, I worked emergency for a number of years and I still like the “don’t know what’s coming next” feeling.
I arrive, get myself settled and look at my schedule. I’ll read over the medical records of my patients so I’m up to date on what’s going on. At the same time, my fabulous surgery staff is taking care of getting patients admitted. They get current weights, confirm that the pets have been fasted (unless they are an exotic pet – that’s a post for a different day), make sure we know about any medications they are taking and then get the pet settled into our treatment/recovery rooms. We have 2 separate spaces – one for healthy cats and then one for healthy dogs and animals that are sicker and need ongoing treatment (like IV fluids or a urinary catheter). We try to keep cats and dogs separate as much as possible because, well, cats really don’t like dogs much and get stressed when they can smell and hear them up close.
If the pet is 7 years old or older, we make sure pre-anesthetic blood work is done and if it isn’t, we get that done right away. Then we take x-rays of the chest. Why do we insist on doing these things? Pets age a lot faster than we do and by the time they are “middle-aged”, there can be changes in how their organs work that haven’t yet made them sick. We need to check things like kidney and liver function and whether there’s any enlargement of the heart or other problems in the chest before we proceed with anesthesia. Because of how much safer anesthesia now is, just because we find something doesn’t always mean we can’t go ahead with anesthesia but sometimes it is safer for the pet to cancel anesthesia and address a problem. My staff takes care of getting the xrays done and then my job is to review them. Then we are ready for the next step.
My staff figures out dosages for anesthesia (can you tell yet how much veterinarians depend on our support staff? We really couldn’t practice without them) and I double check everything. Most pets will get a dose of anti-nausea medication when they arrive. Exactly which medications we use changes depending of a number of factors – cat vs. dog, old vs. young, underlying medical conditions and what surgery is being done – but all patients get “pre-medicated”. This is usually an injection of at least one medication that acts as a tranquilizer and anti-anxiety medication before actual anesthesia. Most pets have an IV catheter placed. When the pet is relaxed from the pre-med, it’s time to get started. There are two stages to anesthesia – induction and maintenance. Induction is a drug (or combination of drugs) usually given in the IV catheter (sometimes in cats it is given in a muscle) to make the patient unconscious. We use the same drugs that your physician would give you for an outpatient procedure! Once the pet is asleep, a tube is placed in the windpipe of the animal. A hose from the tube is connected to the anesthesia machine and then a measured amount of anesthetic gas and oxygen is given to the pet to breath and this keeps them asleep. We keep the pet warm with special heating equipment, because they will get too cold while they are anesthetized if we don’t.
Most of the time we have to shave hair off of the area where surgery will be done. Then the skin is scrubbed with rubbing alcohol and a surgical disinfectant. While this is going on, I’m scrubbing my hands with disinfectant. We wear surgical caps to cover our hair and masks to cover our noses and mouths. There are even special covers for beards but I don’t have to wear one! Depending on the surgery, I might wear a sterile gown with sterile gloves or I might just wear sterile gloves. The technician will open up a pack of sterile instruments and suture material so it’s ready for me.
We do a lot of monitoring while a pet is anesthetized. The most important monitor is the surgery technician. She sits at the pet’s head and pays constant attention to the pet and to the equipment monitoring the pet. She doesn’t just watch the machines – she has her hands on the pet to make sure that anesthesia isn’t too deep or too light. With machines, we monitor the heart (an EKG monitor and stethoscope), along with blood pressure, breathing rate, temperature, how much oxygen is in the blood and how much carbon dioxide is in the breath coming out of the pet. This information is written down and goes into the pet’s medical record.
How long surgery takes depends on the surgery. A cat neuter might only take 2 or 3 minutes for the surgery part of anesthesia but a surgery to explore the abdomen and possibly remove a tumor or foreign object might take an hour or longer. Throughout that time, the pet is monitored and anesthesia is adjusted as needed. If antibiotics are needed they can be given during surgery. Almost all pets are on IV fluids during anesthesia – we adjust how much they get to help keep the blood pressure normal and to keep their internal organs working properly.
Once the surgery is finished, if bandages are needed, they are put on. Anesthetic gas is stopped and we wait for the pet to start swallowing. Then the surgery technician removes the tube from the pet’s windpipe. Usually pets wake up pretty quickly. The technician holds or sits with the pet until the tube is taken out. Pets recover in our main treatment area, where there are more people who can be monitoring just to make sure everything is going smoothly. For many dog surgeries, we put an e-collar on during recovery. Pets don’t understand that they had surgery and one of the more serious problems after surgery is damage dogs do when they lick or chew at the surgery site. (Cats can also do this but generally are much better behaved after surgery than dogs!) It’s usually about this time you’ll get a call from either a technician or me letting you know that surgery is done, how the surgery went and arranging the time to go home.
We always use some sort of pain medication after surgery. For cats it is often an injection that can last 1-3 days and sometimes oral medication as well. For dogs, it’s usually an injection that lasts a day and oral medication. Surgery hurts and its important to use pain medication after. We know that animals heal better and faster if they have medication for the pain they experience as they are recovering.
While my patients are recovering, I’m working on paperwork and calling owners. The paperwork includes an actual surgery report that describes everything that happened that day. Then there is the discharge information that you get when you pick your pet up. I go over all of it and make sure it is complete. If anything concerns the technicians as they are monitoring recovery, they inform me and I’ll decide if we need to change anything. When the pet is awake enough, they are ready to go home.
Depending on the surgery, it will be either a technician or a doctor who talks to the owner when the pet goes home. We go over the instructions for home care, answer questions and make an appointment for a recheck exam if that’s going to be needed. At this point, if all my paperwork is done, I will check my messages one last time and then I’m done and get to go home too. Surgery days can be early and long but I wouldn’t trade them for anything.
This blog was written by Dr. Gretchen Humphries. For more information about Dr. Humphries, please visit our Team Member page.