Assessing your surgical patient’s fear, anxiety, and stress (FAS) in-clinic allows for targeted anxiety management, improving staff safety, patient comfort, and reducing anesthetic risk. Imagine one of us has a diagnosed medical condition requiring surgical intervention. We call a surgeon and ask to be put on their schedule, then show up the day of the surgery for general anesthesia to undergo some advanced procedure. It would not happen in any hospital I have ever heard of. Sure, there are emergency surgeries, but I am talking about planned procedures. As veterinarians, we can become so good at ovariohysterectomies and orchidectomies, as well as other “simple” procedures, that we categorize them alongside other minor ones, such as skin tag removals. The reality is many of the procedures we perform are complex and only seem minor by the number of times we have done them. Sterilization procedures, such as the ones I mentioned above, can be fraught with issues. There could be underlying problems, such as liver or kidney disease, or impediments to the surgery, such as a retained testicle, or life-threatening issues like heart disease. Even if it is a simple “lumpectomy” that requires sedation or anesthesia, there could be hidden issues that could increase the risk of morbidity or mortality. Why is this important? First, liability. Maybe a client will decline a diagnostic, but as long as you explain the importance of it and note in the patient records it was declined, it will go a long way if it turns out that particular declined test would have uncovered an issue should the client decide to report you to the state licensing board when things go bad. Second, time wasted; both yours and the client’s. Imagine your surgery schedule is booked way out, and it is not discovered your patient has a heart murmur until drop-off time. Depending on your particular hospital’s pre-operative procedures, the exam might not even have been done until moments prior to sedation. Your schedule now has a hole in it; the client may have taken time away from work for the drop-off, and they are now at work and must leave to pick their pet up. Third, it can show how much you really care. Explain to the clients this is how it works at your clinic because you care about every aspect of their pet’s health and want to evaluate for hidden issues. Finally, your surgical patient might have a fear, anxiety, stress (FAS) level, which can only be discovered by a visit to your clinic and handling the pet. Addressing this stress using anxiety drugs and Fear Free techniques can not only make it more pleasant for your staff and the animal, but it can also reduce the dosage of drugs needed for the procedure, which also reduces anesthetic risk. No virtual visit Sure, there are places for a virtual visit, but a pre-op examination is not one of them. Is your client really going to tell you both testicles are present, or can they find only one and that the other is up in the inguinal region? Are they going to auscultate your patient for heart murmurs or arrhythmias? Plus, how many cats have you seen with a name like Annie have turned out to be a male, or vice-versa? You also need to check for pyoderma in the region of the surgical site, as that can preclude the ability to safely cut in that area. Laboratory work The degree of lab work needed varies with several factors: age, breed, and lifestyle, to name a few. Obviously, the older the dog or cat is, the more likely it is to develop issues, such as kidney disease or diabetes. Recommendations vary between anesthesiologists and surgeons. In my clinic, I strongly recommend all animals get a pro-BNP to screen for heart disease. Although not 100 percent accurate, it is nice to know you have done what you can to discover hidden heart disease. Outdoor cats or cats with possible exposure to the feline leukemia or feline immunosuppressive virus should be checked for those diseases. Breeds with known bleeding disorders, such as von Willebrand’s disease in Dobermans, should have a bleeding profile done. It is beyond the scope of this article to make a complete list of all lab work for dogs and cats of differing ages and procedures, so I would like to direct the reader to the book Small Animal Anesthesia and Pain Management by Jeff C. Ko, DVM, MS, Dip. ACVAA.1 In the chapter, “Necessity of Preoperative Blood Work and Urine Analysis for Anesthesia,” Dr. Ko says: “Choosing an anesthetic protocol blindly without consulting the preoperative blood work? Think again! Discover the crucial role of preoperative blood work and urine analysis in ensuring safe anesthesia for dogs and cats. Peek inside the patient's health to gauge their ability to handle anesthesia and surgery stress.”1 Day of exam and testing I am not suggesting you should turn away a client who cannot make it in before the surgery date, but the client needs to understand for the safety of their animal, any issues found could change the surgery date while the problem is investigated, (e.g. referring to a cardiologist for a heart murmur), or it could change the cost of the procedure (e.g. in the case of a cryptorchid). A thorough exam can be done, and with reliable “tabletop” lab machines, we can do a good job looking for other issues. Botanicals, other supplements, and unknown prescription drugs My surgery release form has a line item that says: “Please list all botanicals, supplements, over-the-counter medications, and prescription drugs your pet is taking. Do not list any we have dispensed.” Do you want to send home NSAIDs to a dog that may be getting a corticosteroid from another clinic? Several herbal formulations may increase the chance of bleeding. Take the time to research anything you are not familiar with and discover possible side effects or drug interactions. There is not any one source to learn about herbs, but I find it handy to have on my smartphone the app “About Herbs” by the Memorial Sloan Kettering Cancer Center. It is for human patients, and does not contain everything, but it is my first go-to source for supplements. Conclusion Employing the above guidelines only adds minutes to each surgery, but since instituting them in my clinic, we have happier clients and have prevented several potentially life-threatening disasters. Michael C. Petty, DVM, is a veterinary school graduate from Michigan State University. Dr. Petty has devoted his professional life to the care and well-being of animals, especially in pain management. Petty is the past president of the International Veterinary Academy of Pain Management and current World Small Animal Associations Pain Council member. A frequent speaker and consultant, he has published articles in veterinary journals and serves in an advisory capacity to several pharmaceutical companies on pain management topics. Petty has been the investigator/veterinarian in 12 FDA pilot and pivotal studies for pain management products. He has lectured both nationally and internationally on pain management topics. Reference Ko, J.C. (Ed.). (2018). Small Animal Anesthesia and Pain Management: A Color Handbook (2nd ed.). CRC Press. https://doi.org/10.1201/9781315265643
