Surgical Services

Pet owners are often very anxious about veterinary procedures that involve anesthesia. Rest assured that your veterinarian and the surgery team take every precaution to minimize risks during your pet's anesthesia, and will only perform the surgery AFTER a risk assessment has been completed. We use cutting edge technology and advanced equipment in the surgery suite at Harmony Animal Hospital, in addition to a well trained and experienced staff.

The word anesthesia comes from the Greek meaning "lack of sensation". Anesthesia is accomplished by administering drugs that depress nerve function. With general anesthesia, the patient is made unconscious for a short period. During this unconscious state, there is muscular relaxation and a complete loss of pain sensation.

Other types of anesthesia include local anesthesia such as numbing a localized area of skin or a tooth, and spinal anesthesia, such as an epidural block, that results in anesthesia of a particular part of the body.

What are the risks of anesthesia?
There is always risk of an adverse reaction when we use any anesthetic agent, no matter whether it is for a minor, short-term sedation or for a complete general anesthesia lasting several hours.

It is estimated that approximately 1 in 100,000 animals will have some sort of reaction to an anesthetic agent. These reactions may range from mild swelling at the site of injection or a mild decrease in cardiac output, to a full-blown episode of anaphylactic shock or death. However, many experts put the risk of anesthetic death as less than the risk of driving to and from the hospital to have the anesthetic procedure.

Another potential danger associated with anesthesia arises if the dog is not properly fasted prior to anesthesia. Anesthetized patients lose the normal reflex ability to swallow; during swallowing, the epiglottis, a cartilage flap that closes over the entrance to the windpipe, prevents food or water from entering the lungs. If there is food in the stomach, the dog could vomit while under anesthesia or in the early post-anesthetic period. If vomiting occurs before the swallowing reflex occurs, the vomited material can be aspirated or enter into the lungs, causing aspiration pneumonia, a potentially life-threatening condition.

Other rare complications of anesthesia include organ system failure such as kidney liver or heart failure, visual impairment, clotting disorders and seizures. We will take every precaution to minimize these risks during your pet's anesthesia. Only when the benefits outweigh the risks will we perform anesthesia on your pet.

Before Surgery
While newer, modern anesthetics minimize risks, there are things we can do to minimize it even further. Depending upon the physical condition and age of the patient, there are important pre-surgical procedures we may recommend specifically for your pet including:

• pre-surgical physical examination,
• preoperative blood and urine tests,
• blood clotting test,
• radiographic examination,
• electrocardiogram

All of these procedures may help detect clinical and sub-clinical problems in your pet. Certain medical conditions will increase the risk of having an anesthetic complication. These conditions include heart, liver or kidney disease, diabetes mellitus, anemia, dehydration, and certain infectious diseases such as heartworm disease.

Blood tests will increase the chance of detecting a hidden problem that could prove to be life threatening. In older animals, chest radiographs are recommended to ensure there is no pre-existing pathology in the heart or lungs that might increase the risk of an adverse reaction.

Immediate intravenous access for emergency drug administration is one of the most important factors in the successful treatment of cardiovascular or respiratory failure in either the awake or the anesthetized patient. By placing an intravenous (IV) catheter and line before anesthesia, your veterinarian can ensure that this lifeline is already in place, should the need arise. Anesthetics, fluids and emergency drugs can be administered through the IV line.

Intravenous fluids help maintain blood pressure in the anesthetized patient and will replace lost fluids (during surgery, fluids are lost through evaporation from body cavity surfaces, through bleeding, and in any tissues that are being removed). Upon completion of the procedure, intravenous fluid therapy speeds the recovery process by diluting the anesthetic agents circulating in the blood stream and by enhancing their metabolism and elimination through the liver and kidneys. Patients that receive IV fluid therapy generally wake up faster than those that do not. For these reasons, all surgery patients should receive intravenous catheterization and fluid therapy.

You should ensure that your pet's complete medical history is available to your veterinarian, especially if your pet has been seen at another veterinary clinic. Before anesthetizing your dog, your veterinarian needs to know about any medications or supplements that your dog has received in the past few weeks, any pre-existing medical conditions, any known drug reactions, the results of previous diagnostic tests, and whether the dog has undergone any anesthetic or surgical procedures in the past. Other useful information includes the pet's vaccine status and reproductive status, (i.e. when was its last estrus or heat cycle).

In the great majority of cases, a technique called 'balanced anesthesia' is used. With balanced anesthesia, the patient receives a combination of sedatives and anesthetic agents that is based on its body weight and best suited to its individual needs. The most common combination is a pre-anesthetic sedative and analgesic combination that is administered by injection, followed by an induction agent that is also administered by injection, and maintenance of the anesthetized state with an anesthetic gas mixed with oxygen. In order to ensure accurate delivery of the gas anesthetic, a breathing tube, called an endotracheal tube, is inserted into the windpipe or trachea. In addition to delivering the gas to the lungs, the endotracheal tube seals off the airway so that the patient does not accidentally aspirate fluids or other foreign material while s/he is unconscious and unable to swallow.

Safety Measures During Surgery
As you can see, we are already minimizing risk before surgery is even begun. During surgery, anesthetic monitoring in a veterinary hospital is similar to that found in any human hospital. Below is a list of common methods of monitoring anesthesia:

• The Surgery Assistant is the most important monitor during an anesthetic procedure. This professional staff member is trained to observe and monitor the patient throughout the entire procedure, from induction until recovery. The assistant adjusts the anesthetic levels according to the patient's vital signs and ensures that the patient remains stable throughout the procedure.
• The Electrocardiogram, abbreviated as ECG, is also known as an EKG (from the German term). An ECG shows the rate and pattern of the heartbeat. It will detect and show abnormal heartbeats called arrhythmias. If an arrhythmia is detected, the anesthetist will make appropriate changes in anesthesia and/or administer emergency medications.
• The Heart Rate Monitor measures the number of heartbeats per minute. Heart rate must be maintained within a certain range. The depth of anesthesia and surgical stimulation can both affect heart rate. By monitoring heart rate, increases or decreases can be detected early and anesthetic adjustments made quickly, resulting in smoother anesthesia for our patients.
• The Blood Pressure Monitor measures the systolic (when the heart contracts or pumps) and occasionally the diastolic (when the heart relaxes or refills) blood pressure. Coupled with other monitoring equipment, this gives detailed information on the cardiovascular status of the patient.
• The Respirometer measures the number breaths per minute.
• The Core Body Temperature is monitored, especially during a prolonged surgery, by inserting a temperature probe into the esophagus or rectum. Low or high body temperature can cause dangerous complications. Maintenance of normal body temperature is especially important in small or pediatric patients.
• Pulse Oximetry may be used to monitor the amount of oxygen in the patient's blood (Sp02) and the pulse rate. This instrument should always be used in conjunction with other pieces of monitoring equipment.
• The End-tidal C02 Monitor is often used in conjunction with a pulse oximeter. This device measure the amount of expired C02 and helps determine of the patient is receiving adequate oxygen during anesthesia.
  We also use a special water-circulating heating pad below the patient to help maintain normal body temperature. All of these advanced safeguards are routinely used to help minimize any risk to the patient during the surgical procedure and provide a faster and more comfortable recovery.
• Safety And Comfort After the Surgery
  During the recovery period after the surgery, your pet is closely and continually monitored, not only with our modern technology, but by specially trained veterinary staff. With today's anesthetics, many of which are reversible, your pet should be almost completely alert and ambulatory by the time of discharge. Many pets are sleepy or tired for twelve to twenty-four hours after anesthesia. If your pet appears to be unusually sluggish or you cannot arouse him/her easily, contact the hospital immediately to receive specific advice.
  
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Pain Management & Comfort of Your Pet

You pet's safety and comfort during surgery are very important to us. At Harmony Animal Hospital, we utilize a series of anesthetic protocols and pain management guidelines designed to keep your pet comfortable and free of stress during surgical procedures. Pets experience the same degrees of pain as people do following surgery, but they cannot express it to us. Therefore, pain management must be strategically planned and tailored to your pet's procedure and implemented to minimize the degree of pain your pet experiences.

Managing pain is a critical part of our strategic plan before, during, and after your pet's surgical procedure. We make every attempt to minimize or preempt the transmission of pain, perception of pain, and the biochemical changes that cause painful sensations in the post-operative recovery period. Please carefully follow the instructions provided if pain medications are dispensed. It's important to keep the pain receptors from reaching a pain crescendo and causing your pet extreme stress and discomfort. It is easier to keep pain at a manageable level than to try to decrease a serious level of pain. If we can manage your pet's pain and comfort and keep it at a very low or undetectable level, then we can speed healing and recovery. Please read the information in the link below. It has more detailed information about our pain management philosophy here at Harmony Animal Hospital.

What you should know about pain management

Laser Surgery

Harmony Animal Hospital offers laser surgery as an exciting option for safer, more comfortable treatment. In many procedures, the laser can replace the scalpel and provide a better alternative to traditional surgery.

Why laser surgery? • Less Pain - The laser seals nerve endings as it "cuts." As a result, your pet will experience less pain and be more comfortable post operatively. • Less Bleeding - The Laser seals small blood vessels during surgery. This speeds many procedures, reducing the time your pet needs to be under anesthesia, which further reduces possible complications. • Less Swelling - Laser energy does not crush, tear or bruise tissue because the only thing that touches your pet is an invisible beam of light.

• Reduced risk of infection - As the laser removes diseased tissue, it seals the skin and reduces the amount of bacteria present.
• Precision - The laser can remove unhealthy tissue while minimizing adverse effects to healthy surrounding tissue.
• Quicker return to normal activities - Healing is rapid and there is less post-operative discomfort and a better course of healing.

What types of surgical procedures?

The laser is ideal for a wide variety of surgical procedures for dogs, cats, birds, reptiles, exotics, horses and other pets. Laser surgery is commonly used in soft-tissue surgical procedures. Your veterinarian will be able to tell you if your pet's procedure can benefit from laser surgery. Common procedures include:

• Spays, neuters, cat declaws
• Oral/dental procedures
• Mass removals/dermatology

How does a Laser work?

The way a particular laser works is determined by the specific wavelength of light that it produces. For example, the most commonly used surgical laser is a CO2 laser which produces an invisible beam of light that vaporizes the water normally found in the skin and other soft tissue. Because the doctor can precisely control the laser, only a thin layer of tissue is removed, leaving the surrounding areas unaffected.

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