Decreasing Anesthesia Anxiety

Dr. Carolyn McKune is a board certified veterinary anesthesiologist who knew she wanted to be a vet since she was a kid. However, she took the long road to figuring out what she wanted to do with her veterinary career, which you can read more about here (https://mythosvet.com/). After two decades of practicing veterinary medicine, she’s found her “happy place” as a veterinary anesthesiologist providing excellent anesthesia to any patient, anywhere, through both physical and virtual presence. Visit her at mythosvet.com to elevate your anesthesia.

In this article, Dr. Carolyn McKune discusses the stress that anesthesia can impose on both veterinarians and pet owners. Did you know that there are veterinary anesthesiologists who teleconsult and can help veterinarians create safe and gentle approaches to anesthetizing a wide variety of patients in their own clinics? In addition to Dr. McKune, a selection of veterinary anesthesiologists who provide these types of services is included at the end of this article.

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Have you ever lost sleep over a stressful anesthetic event for a high risk patient? I’m willing to bet the answer is “yes”. I remember the first time this happened to me: I was an anesthesia resident at the time, and the following day, I had (you guessed it) a sick patient for a comprehensive oral health assessment and extractions. My case was a geriatric feline with renal failure and hypertrophic cardiomyopathy presenting for full mouth extractions. I was awake into the early morning hours, with thoughts like “I could do <intervention X> that would help the kidneys. No, wait, that’ll stress the heart. So I could do <intervention Y> that may alleviate the stress on the heart. No, wait, that will hurt the kidneys.” Back and forth. When the alarm finally shocked me awake that morning, I felt drained and emotional about what I was tasked to do.

Older cats are more likely to have co-existing disease that may complicate anesthesia management. What do you with the kitty that desperately needs his oral health addressed but has a murmur, an abnormal proBNP, and a creatinine of 2.8 mg/dL?

There is a tremendous amount of investigation going on right now, examining psychological stress in veterinary medicine. In fact, one of my internmates has made it her focus in veterinary medicine to help veterinarians with these complex issues facing the field. I applaud all of those souls who are working to understand this complexity with greater clarity. I also feel like one person can make a difference.

So what is my role as a boarded veterinary anesthesiologist in all of this? Well, I don’t have the training to address all the complexity of psychological stress, but I can help definitively in one area: decoding anesthesia into digestible pieces, so the veterinarian has the confidence to approach the high risk patient with as many tools in their tool box as possible. While I’d love to go over each of them in profound detail, that is the subject of a recent VIN/NAVAS session my dental colleague, Dr. Sharon Hoffman and I recently did together - and would create quite a lengthy blog. Instead, I’m going to focus on one of a handful of life lessons just under two decades of anesthesia has taught me:

Two shorter, well performed anesthesia events is better than one long, rocky anesthesia event.

Sounds simple, right? But as Dr. Hofmeister mentions in his well done blog here, it’s all about setting expectations with owners. We may not realize it, but there is an inherent fear of anesthesia among people, which can be affected by a variety of things including level of education and gender. They may believe that multiple anesthetic events will shorten their pet’s life span, so they need to hear these critical words: “It is a safety decision for your pet that we may perform this dental procedure in two or more parts. We’d rather have two shorter anesthetic events than push the limits of safety by trying to get years worth of dental disease taken care of in a single session.” Preparing the client is key. How do I know? I meet regularly with clients whom I am called upon to provide anesthesia services for, both remotely and in person. There is one thing I say that makes them visibly relax: “You may think I’m here to provide your pet exceptional anesthesia. While I most certainly am here for that, I’m also here to say when anesthesia needs to end. I am your animal’s advocate and I will never put them in harm’s way.” Instantly, their shoulders fall, their face relaxes, and some even cry. Clients want to know that their veterinary team cares more about the safety of their animal than about providing a service.

Communication is key. Most pet owners just want to know that you care about their pet as much as they do.

I think back to that night I spent tossing and turning. If I had been able to say the above words to the owner of that cat, I’m positive I would’ve slept soundly that night, knowing that I would do the best I could do and that safety would be first priority. After all, that is my mission, my “why” I do the work I currently do: every animal deserves the opportunity for gentle and safe anesthesia, free from memories of the event and with preemptive, high quality pain management. But, safety, is listed first.

Who knows? Maybe it’ll even help you get a better rest one of these nights!

PS: Like many patients with dental disease who have a well designed protocol, my elderly kitty patient did fine.

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Veterinary anesthesiologists are board certified by the American College of Veterinary Anesthesia and Analgesia. About half of them work in private practice settings and many are available to practitioners either in person or via teleconsulting to help develop and carry out specific anesthesia management plans for their patients. Here is a list of some of these amazing folks:

Bryce Dooley DVM MS DACVAA

www.alliedvetanesthesia.com

sbdooley@alliedvetanesthesia.com

Bernd Driessen DVM PhD DACVAA DECVPT

driessen@upenn.edu

Jaime Gaynor DVM DACVAA DAAPM

www.PeakVets.com

Kim Hassen DVM DACVAA

kimberly.hassen@gmail.com

Jennifer Hess DVM MS DACVAA

Jhess300@gmail.com

Nathaniel Kalpaldo DVM MPH DACVAA

Kapaldo@vet.k-state.edu

Stephanie Krein DVM DACVAA

stephkrein@gmail.com

Kris Kruse-Elliot DVM PhD DACVAA

http://www.krusevetanesthesia.com

Janyce Seahorn DVM DACVAA

Jcseahorn@aol.com

Melina Zimmerman DVM DACVAA

mzimmermandvm@gmail.com