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Doc Sara
Doc Sara, Veterinarian
Category: Dog Veterinary
Satisfied Customers: 952
Experience:  I am a dog and cat veterinarian with a lifetime of experience in our family veterinary hospital.
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7 year old dog dies of cardiac arrest during surgery

Customer Question

7 year old dog dies of cardiac arrest during surgery echocardiogram done that am looked great labs normal need to have a conversation with vet and find out what we can do differently we are willing to purchase better monitoring equipment etc to help how best to have this discussion?
Submitted: 1 year ago.
Category: Dog Veterinary
Expert:  Doc Sara replied 1 year ago.

Hi there, I'm Dr. Sara. I'm a licensed veterinarian who works exclusively with dogs and cats. I'm terribly sorry for your loss. I know that it is shocking and awful when something unexpected like this happens. It's also very stressful for us as professionals to lose a patient so unexpectedly as well. I've been on the professional side, having lost a patient unexpectedly under anesthesia myself.

There's a lot more that goes into anesthesia than just the monitoring. The whole process begins with the preanesthetic physical examination and testing, followed by premedication, induction, maintenance through the procedure, and finally recovery. How much do you know about what went wrong? An echocardiogram is a really advanced test. If performed by an experienced veterinarian, it can give a great deal of information on the functional status of the heart. What was he going under for?

~Dr. Sara

Customer: replied 1 year ago.
Removal of right forelimb for osteosarcoma. I have assisted in 2 c-sections and a dental on my dogs so have a pretty good idea of what it looks like in there. our approach to things going wrong is to search for reasons to improve future rather blame we have a very long standing positive relationship with this clinic and want to keep it that way. Younger doc has made a couple of errors but understandable for his level of experience. we all do What we are hearing is they have no clue what happened. i plan to meet with senior doc/owner and talk about any needs they may have for better monitoring - as usual in a small country clinic no dedicated anesthesiologist - and would like some ideas to best broach this in a positive way. We have a C-section coming up in the next few months and who knows what else so would like to help them as well as ourselves
Customer: replied 1 year ago.
Customer: replied 1 year ago.
Sorry didn't answer your first question- said heart stopped 20 minutes in and couldn't recusitate
Expert:  Doc Sara replied 1 year ago.

OK - thank you - all of that information is really helpful for me.

A forelimb amputation is a really "big" procedure! I'm sorry that you've had to deal with all of this - osteosarcoma is a terrible disease by itself. I'm really glad that you've got a strong relationship with your hospital and are so willing to be collaborative rather than accusatory. If you make that particular intention quite clear from the get go, it will take your vet off the "defensive" and help them relax in the discussion.

From my end as a vet, I will tell you that once I was grilled for over an hour by the grieving owner of a patient that passed away under anesthesia while under my care. This particular client was truly "out to get me" - grilling me looking for weaknesses in my "story" in order to find some way to blame me. It was, beyond a shadow of a doubt. the worst day of my professional life. I had been in practice for nearly 10 years at the time and I was more than experienced enough to feel that we did the best that we could for that particular pet. I was willing to explain in minute detail every single thing that was done with their pet from beginning to end and able to explain why each step was taken, why each drug was chosen, how each drug was administered in what format and why.

In order to get the best idea of what happened, I would start by asking to collaboratively review the anesthesia record - that is, to ask to go over it together and have them explain what the record shows and how they interpreted it. The majority of hospitals have at least an ECG and pulse oximeter in place during anesthesia, and a well equipped hospitals will also be monitoring blood pressure and CO2 levels in exhaled gas. However, a fancy monitor isn't an absolute requirement for doing a good job with anesthesia monitoring. I would take an experience technician over an electrical monitor any day. The tech should be monitoring mucus membrane (gum) color and capillary refill time, heart rate (can be done simply by palpating a pulse or listening with a stethoscope), respiratory rate, and indicators of overall anesthetic depth like jaw tone and palpebral (blink) reflex.

Monitoring isn't the only ingredient to a successful anesthetic event, though. If I am evaluating an anesthetic event, I want to know what premedications, inductions, and maintenance drugs were used and what rationale were used to decide on how these drugs were chosen. Really, that's probably almost more important than any kind of monitoring. While the majority of hospitals are running top notch anesthesia protocols, unfortunately there are still a few running "old school" anesthesia cocktails that aren't considered acceptable by current standards. Using the correct drugs is more important than all the monitoring in the world. Once again, I'd ask to collaboratively review the drug choices just as the monitoring.

I'm so sorry that you've been through this, but I'm so encouraged to hear that you're coming from a place of wanting to help more. I know I probably haven't answered all of your questions - please let me know where I can elaborate.

~Dr. Sara


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Expert:  Doc Sara replied 1 year ago.

I'm sorry that I'm not set up to do phone calls - it's still a legal "gray zone" in my state. However, your request has been opened to all experts, so one of them could still potentially accept it. I'd be happy to continue chatting if you'd like.

~Dr. Sara