By Heidi Lobprise, DVM, DAVDC

Back in August, we started the discussion of "Just how old IS your dog or cat?" Even with tables and guidelines, you can come up with an estimated range of relative age. But there are so many variables with individual patients, it still comes down to a comprehensive evaluation of each patient and determining their needs. Some fairly young patients can have significant health issues, while the general wellness of a very mature patient can be exemplary.

This evaluation is particularly important when preparing a senior or geriatric patient for an anesthetic event, such as a dental procedure. While dental disease can significantly impact the systemic health of the patient, and logically we know care should be provided, the inherent concerns of general anesthesia in older patients often makes us hesitate in doing what we know is best. We know that the presence of an ongoing infection can have a substantial impact on organ dysfunction and even diabetes, even if direct proof of oral bacteria causing a specific infection may be difficult to attain. Most practitioners have experienced the anxiety of the pet owner and even clinic staff when having to anesthetize a dog or cat with critical issues. Yet time and time again, once the dental disease is managed well, that individual often feels and acts years younger. So, despite the challenges that may accompany such procedures, with good patient workup and personalized anesthetic protocols, those risks can be minimized to provide optimal care for the pet.

As a veterinary dentist, I am very grateful for all of the dental knowledge and skills from human dentistry that we have assimilated for our patients. Dogs and cats are not humans, however, so there are a couple of areas in which I think we need to pay special attention. Pre-operative blood work is questioned at times with human anesthetic events, but as our patients cannot tell us specific details of their history or how they have been feeling, it is important for use to use all the tools at our disposal to get the best idea of their health status. In senior pets, this might include a CBC and chemistry panel with UA, as well as an ECG and thoracic radiographs. While this can add to the costs of an already pricey procedure, they should be offered in order to get good baseline data on the patient, and on the occasion when you uncover hidden problems, that ounce of prevention will definitely be worth the pound of cure.

The other situation in which my opinion may differ from RDs (real dentists) is the use of pre-operative antibiotics. Now reserved for humans with prosthetic devices or a history of endocardiosis, most people with murmurs are no longer medicated prior to their dental procedures. With my patients, I evaluate them for ANY underlying sys­temic disease that could be exacerbated; in particular with hypovolemia, hypothermia, hypotension and bacteremia combined. It might be that poodle with a heart murmur, but I have even greater concern for a senior cat that has had borderline high-normal BUN and creatinine values in the past. I want to try to protect my pa­tients with a pre-operative dose of a broad spectrum antibiotic for the surgical time period when the organs are stressed. From there, each patient is evaluated as to the extent and type of present and potentially maintained infection in order to deter­mine if any other antimicrobial therapy is needed. With simpler cases and minor pockets, a perioceutic may be sufficient, but so many of our dental patients have complicated infections along with surgical sites that may need further protection for the post-operative period.

Anesthetic and analgesia regimens should be tailored specifically for that patient's health status and anticipated procedures.While alpha-2 agonists may have to be avoided due to cardiac issues, pre-operative combinations of opioids and anxiolytics can be used to help minimize the total amount of induction medication and maintenance inhalant doses. Local and regional anesthesia, in the correct amounts and accurately placed, can help decrease the pain response both during the procedure, so the general anesthesia can be minimized, and for the post-operative procedure as well. Maintaining blood pressure and body temperature are key for these patients, so having a technician dedicated to being that patient 's monitor throughout the procedure can be helpful. Early detection of any of these parameters becoming critical may necessitate a delay or halting of the procedure, but the patient always comes first.

One of the most common dental problems in senior pets is periodontal disease, particularly in small breed dogs. The challenges of extensive bone.loss in a mandible that is small to begin with can be daunting, but the option of leaving the infection in the patient is not the solution. While you want to minimize the time under anesthesia, you cannot rush procedures or extractions that could further damage the jaw, so be patient. Have all equipment sharpened and ready before you start,and make sure the monitoring technician keeps you informed of any anesthetic issues.

If a mature patient has a number of worn or broken teeth that have become non­-vital and need extraction, intraoral radiography is essential to be able to evaluate the status of the periodontal ligament,the dark line just around the tooth. If the periodontal ligament is not present, the tooth could be ankylosed or resorbing, and extraction may be difficult. Planning more aggressive bone removal to facilitate elevation may be necessary. Oral masses also are more prevalent in older animals than in younger ones, so radiograph any suspicious areas and never hesitate to take tissues for histopathology.

Recovery time can be critical in these senior patients, so just extubating when the first cough happens may not be enough. Continue to monitor gingival perfusion, evidence of productive breathing, and continued return to consciousness. When possible, continue IV fluids to maintain hydration within appropriate limits for surgery. If dysphoria or discomfort is shown, minute doses of an alpha-2 may smooth the recovery period, but use with care. Continued discomfort may show the need for additional analgesia.

Pain management and antibiotics will be dispensed according to each patient's needs, and post-operative care should also pay attention to nutrition intake, particularly in seniors. A product such as REBOUND^® Liquid Diet may be dispensed for the pet to enhance nutrient intake, particularly after any oral surgery.

So, while there may be concerns for general anesthesia in senior pets, with good protocols and monitoring,your team can minimize the risks for those patients. Just because they're old doesn't mean they don't deserve the best care you can provide!