CLIENT GUIDE |
Setting Up for Surgery Day Success
Anesthetized procedures like surgeries can feel like a big undertaking for you and your companion. The good news is, there are plenty of ways to help your companion have a smooth and successful experience. This information will let you know what to expect, help you understand how we make your companion’s surgical procedure is as safe as possible, and outline how you can support them when they return home.
PREPARING FOR SURGERY DAY
Setting Up For Success
Surgical procedures can feel like a big undertaking. The good news is, there is plenty that can be done ahead of time to help make sure your companion has a smooth and successful experience. This information is designed to let you know what we’ll be doing at the hospital to make sure your companion is healthy and that their surgery is as safe as possible. It also includes information that will help you prepare your home, family, and companion beforehand, so that they’re set up for success right from the start.
STEP ONE | Bloodwork and Assessment
Once you and your veterinarian have confirmed that a procedure involving anesthesia will be taking place, the next step toward a safe and uneventful surgery is completing pre-anesthetic bloodwork. This bloodwork may be done the morning of surgery, but preferably we arrange to have this testing completed ahead of the procedure. These test results are very important – they will alert your vet to any potential health problems that need to be addressed before your companion can safely be anesthetized.
In particular, your vet will focus on how the kidneys and liver are functioning; bloodwork helps here because it is often difficult to tell just from external symptoms if there are problems. Because these organs play a key role in how your companion processes the medications they will receive, it is important to be sure that they are in good shape. This information also gives your vet the chance to customize their surgery plan (the type and amount of drugs used for sedation and anesthesia, the drugs they will choose to manage pain and anxiety) to make it as safe as possible for your companion.
In this case, ‘bloodwork’ typically means two distinct tests: a Complete Blood Count (CBC) and a Serum Biochemistry. Between the two, these tests provide a wealth of information for your veterinarian.
The CBC is a basic blood test which shows the levels of red blood cells, white blood cells, and platelets. Each of these cells has an important role to play during surgery: red blood cells carry and distribute oxygen, white blood cells combat inflammation and infection, and platelets are responsible for helping blood to clot. Your vet wants to make sure that there are no abnormal levels in any of these three cell types before going ahead with the procedure.
The Serum Biochemistry test shows how well the kidneys and liver are working by measuring the levels of a number of different chemicals in the blood. Exactly what your veterinarian is checking for will depend on your companion’s age and condition, but in addition to assessing kidney and liver function they could be checking glucose levels (elevated levels can be an indicator for diabetes), serum proteins (low protein levels can lead to slower post-surgical healing, while high levels can indicate dehydration), and electrolytes like potassium, sodium, and chloride (levels outside the normal range can suggest a number of concerns that your vet might want to explore further).
Your veterinarian will interpret the results of the bloodwork in the context of your companion’s particular condition. Some minor abnormalities might not be concerning. Others might require additional tests or treatment before the procedure can take place, or an adjustment to the sedation and anesthetic protocol your vet had planned. In more significant cases, your vet might decide that it is safer to postpone the surgery until the issues are addressed, to ensure that your companion is in the safest position possible before undergoing anesthesia.
Two days before your procedure, you’ll also be emailed an admission form specifically for the surgery. This includes a pre-surgery questionnaire to confirm some key information about your companion, like current medications and supplements, as well as your preferences and permissions for the surgery. Feel free to ask us if you have any questions about the information in the form.
STEP TWO | Good Grooming
As you are preparing your companion for Surgery Day, it is helpful to make sure that they are as clean as possible. At minimum, try to avoid mucky outdoor areas and give them a good brushing ahead of time – arriving for surgery clean and tangle-free will make for a smoother experience and prevent your technician from spending extra time scrubbing and snipping to gain clean access to the surgical site. Any excess dirt or debris increases the risk of contamination or infection.
STEP THREE | Prepare Your Space
Take the time before Surgery Day to prepare your home to welcome your companion back after their procedure. It’s much easier to make sure your space is prepared ahead of time, rather than struggling to sort things out with a groggy companion on your hands. Because you will need to restrict your companion’s movement after surgery so they can rest and heal, make sure you have an enclosed area of your home set up for them. You might want to move their crate or bed into the area, getting them used to where they will be spending most of their time. Consider giving their bedding a good wash – keeping their sleeping space as clean as possible will help reduce the chance of infection after surgery.
If you have several family members, take the time to brief everyone on what to expect after surgery – if everyone is on board with how to help keep their recovering family member quiet and calm, and knows what to look out for as they heal, they can all be part of the caregiving solution!
STEP FOUR | Fasting Before Surgery
One of the most important instructions to follow when preparing for Surgery Day is to stop offering your companion access to food about 12 hours before the procedure (but in most cases they should retain access to water). We generally flag 10 PM the night before as the cut-off time for food, although your vet will let you know if they recommend any changes to this (younger animals are sometimes fasted for a shorter time than older animals because younger animals’ metabolism may be faster, they may digest their food more quickly, and they typically have less robust energy reserves).
If your companion has diabetes, they might also be fasted for a shorter period of time, offered a very small morning meal, or require an adjustment to their insulin dose. Your vet will also let you know whether or not your companion should be given their evening or morning dose of any medications they normally take on Surgery Day.
If you have a cat in a multi-cat household, or your cat typically goes outdoors, it can be more difficult to make sure that they have fasted. If you have multiple cats, you can either remove all of the cats’ food overnight, or keep your cat headed for surgery in a separate room with water and a litterbox. If you have a free-roaming cat, make sure to keep them indoors the night before surgery – this ensures that they haven’t found a meal elsewhere that you don’t know about, and also makes sure that they are present and accounted for when it’s time to leave for the hospital!
The reason it is so important to fast animals before surgery is to prevent them from accidentally inhaling any regurgitated food into their lungs while they are under anesthetic. Sometimes the anesthetic drugs can cause vomiting; because your companion’s muscles will be relaxed under sedation, their swallowing reflex is suppressed and it is easy to choke or inhale material into the lungs. For this reason, it is much safer to enter surgery with an empty stomach.
As difficult as it might be to refrain, remember that fasting also means no snacks or little treats, in addition to skipping breakfast! We understand that your companion is probably pretty crafty at finding food, and might accidentally consume something within the fasting window. Don’t be embarrassed to let us know that your companion might have eaten something – this definitely happens, and we would rather be aware of the risk and adjust plans accordingly.
The case is slightly different for our smaller patients – rabbits, for example, need to have a constant intake of food and should not be fasted before their surgery. Rats can go a little longer between meals, but it is not necessary to fast them before their procedure either. For birds, we recommend that they do not have anything to eat for four hours before surgery.
STEP FIVE | Keep a Regular Routine
As the day of the procedure approaches, maintain your regular routine as much as possible so that your companion feels settled and secure. The day before, make sure to take them for a good walk or have a good play session so that they have a chance to burn off some extra energy, but avoid excessive roughhousing to make sure they’re not starting their day with sore muscles. Feed them their dinner at a regular time, and allow them to settle down for the evening as normal.
Depending on your companion’s condition and demeanour, your veterinarian might recommend starting a few medications at home the night before. One option is giving them a dose of an anti-nausea medication, to set them up well to combat the disorienting effects of anesthesia. They may also recommend an anti-anxiety medication, to help your companion remain calm and relaxed for their procedure. We know that our patient’s psychological and emotional health is just as important as their physical health, and we have found that adding these pre-procedure medications helps make the experience smoother and less stressful.
In the morning, plan ahead to make sure you’ve got a bit of extra time. Take your companion for a short walk so they have a chance to go to the bathroom – if this isn’t successful, let the team know when you drop your companion off so we can make sure that they have another chance to go out before their procedure. Also allow plenty of travel time to get to the hospital, helping to minimize stress for everyone involved.
When you arrive, please feel welcome to ask us any final questions. We are happy to clarify anything, and will be looking forward to connecting with you after the surgery to let you know exactly how things went.
SURGERY DAY PROCEDURE
SURGERY DAY | Staying Calm and Comfortable
We know it might feel unnerving to say farewell to your furry friend at the door of the hospital, trusting us to make sure that their procedure goes well. Rest assured, there are many elements in place on surgery day to keep your companion calm and comfortable, and to make sure they return home safe and sound.
One of the most important things we can do to alleviate the fear and anxiety your companion might experience during their surgery is to make the day as smooth and pain-free as possible. Based on your companion’s specific condition and medical history, we create a custom treatment plan designed to reduce anxiety and minimize pain during and after their procedure.
Here’s an overview of what the day will hold:
STAGE ONE | Arrival and Sedation
When we welcome your companion into our hospital on dental day, they will be taken to a kennel lined with cozy blankets that will be their own ‘home base’ for the day. They will have a chance to rest and acclimatize to their space while the team gets everything ready for a smooth procedure.
We often have several surgical and dental procedures scheduled each day, so it might be the case that although you drop off your companion in the morning, their dental ‘appointment’ will be in the early afternoon. By welcoming all of our patients in the morning, we have a chance to see exactly how they are all doing and to make a plan for the day that creates a logical order and gives each one the time they will need to go through the preparation, procedure, and recovery process. Please don’t worry, we’ll make sure that everyone is comfortable and well-cared for as they await their big moment.
The team will start with an overall physical examination, including a check of your companion’s temperature, pulse, and respiration rate. One your veterinarian is satisfied that all is well, they will give the go-ahead to start the day’s treatment. The first medication your companion will receive, soon after they arrive, is an injection of an analgesic (pain reliever) and a sedative. The sedative will help them relax and reduce their anxiety – they will become calmer and maybe a little drowsy.
This makes the unfamiliar hospital environment a little less nerve-wracking, and helps keep their stress response from kicking into gear. Just like us, when that ‘fight or flight’ reaction occurs, their heart rate, blood pressure, and breathing rate all increase. By making sure your companion starts the day with effective sedatives and pain relievers, we help them stay calm and comfortable. It also often means that we can use a smaller amount of the other drugs needed to induce and maintain anesthesia during the procedure.
By starting analgesic (pain-relieving) medication before the procedure even begins, we also prevent your companion’s pain receptors from winding up in the first place. Preemptive pain medication acts a bit like friends saving seats at the theatre – just as they might place jackets over empty chairs to prevent strangers from sitting down, the pain medication ‘fills up’ pain receptors, preventing them from receiving the pain signals. It is much easier to prevent pain than to relieve it once it starts (much like asking strangers to give up a comfy seat once they’re settled!). By starting pain management early, and by choosing a combination of medications that have different strategies for blocking pain receptors, we have the best chance of keeping your companion comfortable during and after surgery.
STAGE TWO | Catheter Placement - Fluids and Medication
Before your companion is placed under anesthesia, we typically place a catheter (usually in their front leg – you’ll see a small shaved patch there when they return home). A catheter acts like a ‘quick access’ route for any drugs that might be required during surgery, and also makes sure that your companion is ready to receive IV fluids as needed in the course of the procedure.
IV fluids help maintain proper blood pressure and replace any fluids lost during the procedure. During surgery, fluids can be lost through evaporation, bleeding, or along with any tissue that is removed in the course of the procedure. During recovery, IV fluids help dilute any remaining anaesthetic drugs circulating in the bloodstream, and help the liver and kidneys clear the drugs more quickly from your companion’s system.
STAGE THREE | Induction
When the doctor is ready to begin the procedure, your companion’s technician will start the anaesthetic process by giving them an IV injection of a short-term, quick-acting sedative. In human surgery, this is the point where the doctor might ask you to ‘Count backwards from ten…’ – a peaceful and controlled way to enter anesthesia, for humans and animals. Once the sedative has taken effect and the patient is unconscious, the surgical team will slide a breathing tube into your companion’s windpipe. This helps keep their airway clear and open against the muscle-relaxing effect of the sedatives, and prevents your animal from accidentally inhaling any liquid while they are unconscious and unable to swallow. The breathing tube is also how your companion will inhale a combination of oxygen and anesthetic gas during the surgery.
STAGE FOUR | Anesthesia
An inhaled anesthetic gas is used to keep your companion unconscious during surgery. Gas is generally preferred over injectable drugs at this stage because it is relatively easy to control how deeply the animal is under anesthesia, and because the gas clears the system quickly once the procedure is complete.
Throughout the entire process, but particularly immediately before, during, and after anesthesia, your companion is closely monitored by a technician who is dedicated to this task. They will monitor key indicators for your companion, such as their blood pressure, blood oxygen levels, carbon dioxide levels, heart rate and pulse pattern and electrical signals, respiration rate, and body temperature. They have specialized monitoring equipment to help them track these vital signs, but they also stay by your companion’s side and use their own observation and experience to make sure their patient is safe and stable.
STAGE FIVE | Pain Management During Surgery
Depending on the procedure, in addition to a general anesthetic the doctor will often inject a local nerve block to cause numbness right at the surgical site. This site-specific pain control is longer-lasting (usually between 4 and 8 hours) and minimizes sensation in the area as your companion regains consciousness. This is similar to our experience having our mouth ‘frozen’ for dental procedures, with sensation gradually returning to the area in the hours after we leave the clinic.
A general pain control medication (usually a non-steroidal anti-inflammatory drug – NSAID) is usually given by injection before your companion even wakes up from surgery. This ensures that the protective barrier of pain management that began right when your companion arrived at the hospital continues to be effective. These medications are similar to drugs like Advil for humans – they relieve pain, inflammation, and fever.
Once the procedure is complete, the surgical team will withdraw the anesthetic gas, allowing your companion to breathe in pure oxygen to help clear their system of any residual gas. As the anesthetic effect wears off and your companion begins to regain consciousness and muscle control, the breathing tube will be removed. The technician keeps a vigilant eye on your companion during the recovery process, making sure that they are warm and comfortable, breathing well, and eventually sitting up on their own.
Once the team is satisfied that the recovery process has gone smoothly and your companion is fully awake (although still groggy) they will remove the catheter and allow the patient to rest quietly back in their kennel. These kennels are adjacent to our main treatment room, allowing everyone to check in frequently on recovering patients, offering comforting words and snuggles as they pass by.
STAGE SIX | Calm and Comfortable at Home
Now that the procedure has been successfully completed, the equally important stage of recovery begins. Surgical sites can sometimes be painful, itchy, and swollen. It may be quite tempting for your companion to lick or chew at the site, but preventing them from doing this is the best way to avoid post-surgical complications.
Because we cannot explain to our animals why leaving their surgical site alone is in their best interest, we can use a combination of ongoing pain management (to reduce swelling and pain in the area and throughout their system) and E-collars or surgical onesies to create a physical barrier that stops them from accessing the site. Although they might tempt you with sad eyes and hanging heads to remove their collar or onesie prematurely, this is an important tool to keep your companion healthy in the long run. Hang in there!
Once your companion starts to feel better, they will likely be tempted to resume their usual range of activities – running, jumping, and playing. It is very important to keep them calm and quiet during the days after their procedure to prevent them from re-opening their surgical site and to make sure they have the opportunity to heal completely. Because we cannot explain to them why they must stay quiet and restricted, it can help to provide a mild sedative (similar to a nice glass of wine for humans) to help them stay relaxed and decrease any anxiety, agitation or distress they may experience during their post-surgery confinement.
Recovery At Home
When you return home after surgery, your companion will likely still be showing mild to moderate signs of sedation. You might notice they seem a little off-balance or unsettled. They might feel nauseated. They will be most comfortable if you give them a quiet, dimly-lit place to lie down and rest until the sedatives have cleared their system.
While your family members will likely be thrilled to have their furry friend home, keeping things calm and quiet is best – your companion will likely be more sensitive to light, loud noises, touch, or other stimuli after anesthesia. Some experience dysphoria, a state of unease and disorientation where they might be restless and unable to settle down, sometimes vocalizing and panting, and seeming a bit discombobulated. As the effects of the day work their way through your companion’s system, you should notice these symptoms ease.
When they’re starting to feel more alert and active, you can offer your companion a small amount of food. If they’re interested and the food stays down, you can continue to offer them small snack-size portions of their normal food through the evening. They might also need to go to the bathroom more often than normal, because of the volume of IV fluids they received during their procedure. However, it might be the case that they do not have a bowel movement for a day or two following their surgery.
What to Watch For:
There are a few things that it is important to be on the lookout for after surgery. Keep a careful eye out for any of the following:
- Chewing, licking, or scratching sutures
- Sutures that have come out
- Gnawing at the bandage, or a bandage that has become wet/dirty
- Any displays of pain or depression
- Fluids leaking from the incision site
- Abnormal odours, swelling, or heat at the incision site
- Weakness or difficulty getting up after lying down
- Loss of appetite or refusal to drink for more than one day
- Vomiting, diarrhea, straining to urinate or defecate
- Discharge from the animal’s eyes, ears, or nose
Check in with your veterinarian right away if you have concerns about how an incision is healing – you can send a photo, or schedule a brief appointment. This is a good example of a case where early intervention can help ward off a much bigger problem. Never be embarrassed to ask questions when your veterinarian or technician is going over the initial instructions, or at any point along the recovery path.
POST-OP TIP ONE | Keep Up With Medication
You will be sent home with medications that are specially selected based on your companion’s condition and post-operative needs. They will likely include medication to control pain and inflammation, and a sedative to encourage your companion to stay relaxed and calm during their recovery period. Post-surgical medications may also include antibiotics, depending on the nature of the surgery. It is important to follow your companion’s prescribed medication schedule to make sure that their discomfort is minimized. Although it may be tempting to stop giving the medication once your companion seems to be returning to their old self, completing the full prescription will give them the best chance of a smooth recovery.
To encourage your companion to take the pills, you can try concealing them inside a small piece of cheese or other soft yummy treat – Pill Pockets, for example, are specially designed treats for both cats and dogs that have space to tuck medication inside. If you’re having any difficulty getting them to take their medication, please let us know – we can walk you through some tips and tricks, or sometimes alternative medication forms (like liquids) are available.
POST-OP TIP TWO | E-Collars or Medical Onesies
We know that it’s tough to keep that big plastic cone on your companion when they are gazing at you with the sad eyes, bumping into door frames and furniture, and generally looking disconsolate. However, we also know that excessive licking, chewing, and scratching at surgical sites are the top reason that complications arise after surgery, and no one (neither you nor your furry friend) want a return visit to the vet for a surgical repair.
It’s so important to restrict your companion’s access to their incision during the healing process – just like in humans, that area can feel inflamed, painful, or itchy, depending on the stage of healing. Unlike humans, we can’t explain to our animals why they need to stop licking! The best thing we can do for them is keep the collar on at all times, so they become used to its presence more quickly.
If the E-collars aren’t working, another option is a medical onesie (like baby pajamas!) that is designed specially for animals. These full-body coverings prevent animals from licking or chewing their incision directly, depending where it is located, and might be a good option for those who are not tolerating the collar. Note that, depending on your companion’s gender, we recommend that these onesies be rolled up before your companion goes to the bathroom. This means they may not be ideal for some cats who are more independent with their bathroom habits.
POST-OP TIP THREE | Limiting Range of Motion Inside
In order to help your companion get the rest they need, and to prevent them from straining the surgical site after their procedure, it is important to keep them quiet and confined. If you have a smaller companion, setting up a small playpen that can be moved around the home so they can stay near you while they rest is a nice option; otherwise, choose an area of your home where your companion can be easily confined when you can’t keep a direct eye on them.
Make sure to set up barriers across the top or bottom of stairs to prevent them from running up and down unescorted, and if you have smooth or slippery floors, set out a few mats over the areas your pet might use. If they are used to getting up on a particular piece of furniture that is a bit of a jump, add a sturdy step so that they can reach their favourite spot without strain. If you have other companions in the home, make sure to keep an eye on their antics to prevent them from playing too vigorously with the recovering patient.
POST-OP TIP FOUR | Limiting Range of Motion Outside
Just like inside, it is important to make sure that your companion has a limited range of motion when they’re heading outside. Even in an enclosed yard, they can spot something interesting and dash off very quickly – it is safest at first to always keep them on a leash and under your control. As their recovery progresses it will be possible to go for short, gentle walks on the leash. While keeping their activity to a minimum (no running or jumping), several short walks during the day will probably make their recovery time more interesting. Also ensure that your companion does not get their surgical site wet or dirty – another good reason to keep them on a leash and within your sightline.
Typically, your companion can return to their normal activity level two weeks after their procedure. One of the trickiest times of the healing process is when your companion begins to feel better – they will be excited to escape their confinement and return to their normal activities. However, just as it is important to complete the entire course of medication, their best chance of avoiding complications after surgery is to follow the vet’s instructions regarding recovery time.
POST-OP TIP FIVE | Mental Stimulation and Boredom Busters
To make recovery time less trying for your companion, you can create opportunities to keep their mind occupied. For example, snacks and meals can be served in stuffed Kong toys or puzzle feeders. If you don’t have those handy, even a low-key game of hide and seek with their kibble is a great distraction. This is also a great time to work on trick training – perhaps their basic commands (sit, down, stay, stand) could use some brushing up. Or maybe you would like to get ambitious and try to work on some novelty tricks – shake a paw, turning left or right, or ‘speaking’ are all crowd pleasers that aren’t too active. Save stretchier tricks like high five or roll over until your furry friend is fully healed.
Also keep in mind that you are one of your companion’s favourite boredom busters. Think of activities that you can do next to your companion while they’re recovering – spending time with you will make their confinement much less taxing. When you’re making phone calls, reading or watching TV, crafting, napping, or doing other stationary activities, try to do so in the room your companion is resting in, or bring them in with you. We know it goes without saying, but plenty of snuggles will also help speed up that road to recovery!
We wish you and your companion all the best after their surgery – feel welcome to reach out to us at any point if you have questions or concerns. We’re here to help.