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Paper summary: Pre-anaesthetic screening of geriatric dogs

Pre-anaesthetic screening of geriatric dogs. 

Joubert, K.E. 2007. Journal of the South African Veterinary Association. 78(1): 31-35.

What did the research find?

Nearly 30% (30 of 101 cases) of geriatric patients that underwent pre-anaesthetic screening were diagnosed with new sub-clinical disease. Following this diagnosis, 13 patients did not undergo anaesthesia as a result, and 1 had their elective procedure delayed pending clinical stabilisation. The study concluded that the screening of geriatric patients is important given the frequency of underlying yet unknown disease processes in this patient population.

How was it conducted?

This observational study was performed on 101 geriatric canine patients (those over the age of 7 years old) that presented consecutively to a given private practice for anaesthesia. In addition to their age, patients were only included in the study if the owner has given informed consent for pre-anaesthetic health screening and anaesthesia.

Health screening included full clinical examination, blood work for packed cell volume (PCV), select biochemical parameters (alkaline phosphatase (ALP), alanine transferase (ALT), urea, creatine, glucose and total protein (TP); the ‘pre-anaesthetic panel’) and urinalysis (specific gravity (SG) and dipstick analysis). Blood was collected for testing via a pre-placed cephalic intravenous catheter and urine was collected via either catheterisation, cystocentesis or free-catch.

Following full assessment, the owner was informed of any new clinical findings and given the opportunity to reconsider their earlier anaesthetic consent.

Patients that had conditions diagnosed that directly precluded anaesthesia and those that required further investigation and/or therapy for stabilisation were considered as having been denied anaesthesia. Those that the owner had voluntarily withdrawn anaesthetic consent but in the authors opinion could still have had anaesthesia performed successfully were recorded as having been anaesthetised.  

Results

The average age of patients was 10.99 ± 2.44 years old. There were 13 patients with pre-existing conditions and a total of 30 new diagnoses were made through the pre-anaesthetic screening process. These included 8 with neoplastic disease, 6 with chronic kidney disease, 5 with Cushing’s disease, 3 with liver disease, 2 with cardiac disease, 1 with chronic kidney disease and neoplasia, 1 with urolithiasis, 1 with osteoarthritis, 1 with a collapsed trachea, 1 with gastric necrosis and 1 with hypothyroidism.   

Of the patients that received new diagnoses, 13 did not undergo anaesthesia as a result, and 1 (a dog with atrial fibrillation and severe tachycardia) had its elective procedure delayed pending clinical stabilisation.

The biochemical parameters ALP, ALT, urine SG, urine protein content and heart rate were all significantly associated with the diagnosis of new sub-clinical disease. In addition, ALP and ALT, urine protein content and heart rate were all significantly associated with the postponement or cancellation of anaesthesia.

Why is it important?

Controversy exists regarding the proportion of outwardly healthy patients (i.e. American Society of Anaesthesiologists (ASA) Physical Status I and II) that would benefit from pre-anaesthetic screening, with some authors suggesting that less than 10% of anaesthetic approaches would change in light of such analysis (Alef et al. 2008). However, if such work is not performed then no abnormalities would ever be found. Some practices will perform basic bloodwork prior to anaesthesia unless the results of physical examination reveal abnormalities for which further information is needed whilst others will perform basic screening in all patients greater than 7 years old (Posner, 2016).

The value of screening prior to anaesthesia is questionable in terms of anaesthetic practice but, in terms of practicality is an ideal time for these tests to be performed. It is also prudent to mention that when abnormalities are identified on basic screening, unless pathognomonic, more detailed investigation should be performed to highlight their clinical significance.


This study concludes that the screening of geriatric patients (i.e. those over the age of 7 years old) is important and that sub-clinical disease, that could impact both the patient and the proposed anaesthetic procedure, could be present in nearly 30% of this patient population. 

Article by
Dr. Dan Cripwell
BSc (Hons) BVSc CertAVP (EM) PgCert (VPS) MRCVS

Veterinary Technical Advisor UK
RCVS Recognised Advanced Veterinary Practitioner

Originally published: Thursday, 23rd May 2019

References

Alef, M., Von Praun, F. and Oechtering, G., 2008. Is routine pre-anaesthetic haematological and biochemical screening justified in dogs?. Veterinary anaesthesia and analgesia, 35(2), pp.132-140.

Posner, L. P. 2016. Pre-anaesthetic assessment and preparation. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia (Third Edition). John Wiley & Sons.

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