Teamwork for Shaumbe

This morning we had a challenging anesthesia procedure I thought would be interesting to tell you about. I am very proud of my team that worked well together and resulted in an excellent outcome for our patient.

Shaumbe is an 18 (yes, 18!) year old Abyssinian cat that came to us last week for the first time. He has had excellent care during his long life. His very astute owner noticed a slight swelling of his lower lip and that he was having some difficulty eating. During our exam we noted that Shaumbe was missing many teeth due to extractions from prior dental procedures, as well as gingivitis(inflammed gums) and apparent broken teeth. The external swelling on his lip was really just the surface of a more concerning problem. When I opened his mouth to get a better look, I could see there was a large mass or growth involving most of that side of his mouth, possibly down into his throat. It was difficult to evaluate completely with him awake (and likely in pain,) so we discussed the need for anesthesia to get a better look, get samples of the mass for histopathology (microscopic examination of the tissue for identification) as well as treatment of the dental disease we knew to be present.

You can bet that Shaumbe's owner was concerned for his safety due to his very advanced age. I certainly couldn't blame him! But he had experienced how dental disease took its toll on his friend in the past and how treating it made Shaumbe feel so much better. He also recognized the need to identify that mass so we could make a plan for treating it if possible. He asked me what we could do to make this anesthetic procedure as safe as possible for his beloved 18 year old cat.
I explained that anesthesia has risks for any patient, young or old. Look what happened to my own Verbal during the short procedure to remove the pin in her jaw. Our hospital takes numerous precautions to help minimize those risks. We treat each patient as an individual, so each anesthetic procedure is tailored to that one patient and his or her specific needs.

Shaumbe was admitted to the hospital this morning by Kayla and Kaylena, doing their best to reassure his owner that we would do our best to care for his buddy. Amber, Shaumbe's veterinary technician, started by running a pre-anesthetic blood profile where we got an idea what his metabolic state was, how the organs were functioning (the liver and kidneys are especially important because they are the organs that will get the anesthesia back out of the blood stream,) whether there was any anemia, diabetes, infection or other underlying issue. Shaumbe's blood work told us he had some kidney insufficiency, so we knew to use good IV fluid therapy during his procedure to help take some of the work load off the kidneys. We also now knew that certain medications like the NSAID's we commonly use for pain relief would not be appropriate because of his poor kidney function. Amber placed an IV catheter in his cephalic (arm) vein and started a balanced fluid solution.

We used multi-modal anesthesia as we have talked about on this blog before. Small amounts of several drugs rather than larger doses of one can often be safer and have lower incidence of side effects. Since we knew Shaumbe was going to have a painful procedure done, he got some pre-op pain relief medication as well as some antibiotics due to the necrotic (infected) appearance of the mass in his mouth. He also received inhalent or gas anesthesia, which is much safer than injectable drugs as we were able to control levels of the drug throughout the procedure as well as have direct access to his airway in case of emergency. Shaumbe also was connected to several monitoring devices for blood pressure, heart rate, percent oxygen, respiration rate and body temperature and Cori, one of his nurses, was there to alert me to any abnormalaties during his procedure.

Body temperature is especially important during long anesthetic procedures because it can drop quite low in some patients and thus compromise bodily functions and recovery. I read just that morning on VIN, the VeterinaryInformation Network, an online resource for veterinarians, about a neat trick of using the bubble wrap used for packaging as insulation for anesthetized patients, so Shaumbe got a layer of bubbles on him. Our hospital attendant, Kristina, placed warmed fluid bags against him (not too hot as to cause damage to his skin or be uncomfortable if he was awake) and also tumbled some blankets in the clothes dryer for awhile, getting them nice and toasty and wrapped him up in those, too.

Amber got his teeth (what were left of them!) cleaned up for him, then took over his anesthesia monitoring while I did the biopsy on the mass and sutured him up.

His recovery was pretty uneventful....we like that! He did have some nasty greenish-yellow material on his endotracheal tube(the tube placed in his airway to deliver his anesthetic gas and oxygen) when we removed it from his trachea, likely from the infection brewing in his mouth from his teeth, the masses or both. It was a good thing he was already on antibiotics if that stuff was in his airway. His post-operative temperature was 98.8, a degree or two below ideal, so his nurses placed him in a heated recovery kennel, covered him with some newly warmed blankets and cuddled him up with those heated fluid bags. The bubble wrap worked nicely so we'll probably try that again on other patients. We will allow Shaumbe to sleep and have his IV fluids run through him most of the day, monitoring his vital signs and pain level, then send him home towards the end of the day when we feel he is good and stable.

I just gave his owner a call to let him know he could stop holding his breath, that Shaumbe came through his procedure like a champ. I could hear the relief in his voice and was so glad I could give him that good news. I hope that will be the case when we get the results of his biopsy back, but we'll do our best for his friend no matter what the results might be.

I wanted you to see how it took our entire team to get Shaumbe through his procedure today, no one person more "important" than another. We all work well together, wanting more than anything a good outcome for our patients and the humans who love them.

Peace,
DrReneigh