Thursday, September 19, 2013

1146. Anaesthetic risk for old dog surgery to remove eyelid tumour

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Date:   20 September, 2013  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Anaesthetic deaths    
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   20 September, 2013 
Be Kind To Pets
Veterinary Education
Project 2010-0129
Sep 15, 2013
Dear Dr Sing Kong Yuen 
We – my wife Pri and I - have been at your clinic half a year ago with our two Huskies. Cee - 6 years old, the male Husky, had strained his back legs muscles, but slowly he can run again after you had advised us what to do and how to treat him. It is still not perfect, but we get him there.
Our female Husky Al, now 9 years old,  has at her right upper eye-lid an abscess since some years (please see picture 6996), but we get the impression it is growing and causes her some problems, because sometimes she is scratching it and the eye ball is inflamed.
We hope it is not malignant. Nonetheless we think it must be removed now somehow.
Therefore we are asking you to get us an appointment for Friday, 20th September, at any time, but best would be in the morning. We are prepared to take all the time it would need to stay with April at your clinic. Please get us your answer by email.
Thank you for your attention and I am looking forward to hear from you soon.
With warm regards


Thank you for your email. Pl bring Al in at around 11am on Friday.
Surgery and anaesthesia will be done using electro-surgery in the afternoon. She goes home at around 6 pm after recovery from anaesthesia. No food and water after 10 pm the night before.

Please note that old dogs undergoing anaesthesia are at risk of death from anaesthesia. In most cases, there are no deaths if the dog is healthy and the surgery is short duration as in this case. The dog will be examined before surgery as there is inflammation and infection in the eye.  Pl give antibiotic eye drops for at least 3 days before surgery as I don't advise operating on an infected area. 

Sep 19, 2013

Dear Dr Sing
This afternoon we have been at your clinic and discussed with Dr Daniel the operation of Al’s eye lid tumour, he took a blood sample and checked her general health which should be OK.

Everything is clear and we fully trust to be in good hands due to your experience. However, having in mind yours and Dr Daniel's repeatedly mentioned remarks that Al could die due to the anaesthesia, even afterwards, you may understand that we are still concerned that the worst could happen to our precious dog Al.

Both our dogs are like children to us.
That’s why we are still reading everything about this surgery and found the below article of a dog clinic from Washington D.C.

May we ask you, what is your opinion regarding  local anaesthesia after drug sedation and the described “freezing” of the wound? Please forgive us our nervousness.


2.   EYELID TUMORS. Older dogs commonly develop eyelid tumours (cancer). As in humans, cancer can be either benign or malignant. Fortunately, eyelid tumours in dogs are usually benign and do not spread to distant tissues. However, eyelid tumours do slowly or quickly grow, and can destroy the structure of the eyelid, in addition to rubbing on the eye. It is usually best to remove them when they are still small.
Eyelid tumours are treated by surgical removal. While there are many different surgical procedures possible, most eyelid tumours in old dogs can be removed at Animal Eye Care without requiring general anaesthesia. The patient is given a sedative, and then a local eyelid anaesthetic is given to numb the eyelid. The tumour is removed and the site frozen with liquid nitrogen (cryosurgery) to kill any remaining tumour cells. Tumour cells are usually very sensitive to freezing, and normal eyelid tissue is more resistant. After surgery, the eyelid margin turns pink (de-pigmentation), but usually re-pigments within 4 months.
I can understand your concerns as the dog is old and thank you for your research in the article on eyelid tumour removal by one vet practice which claims that general anaesthesia is risky and the practices claims that it uses sedation and local anaesthesia to avoid the risks. Sedation is used at that practice and it does carry risks too. Even local anaesthesia has risks of adverse reactions.  

As the surgery, sedation and general anaesthesia with isoflurane gas is very short (<5 30="" and="" are="" at="" based="" be="" blood="" br="" case="" chances="" death="" dog="" dogs="" don="" dying="" electro-surgical="" examination="" excision="" experience="" general="" have="" he="" healthy="" i="" if="" in="" is="" low.="" minute.="" minutes.="" minutes="" my="" not="" of="" old="" on="" operating="" over="" procedure="" risk="" short..="" since="" so="" surgical="" t="" table="" test="" the="" this="" tumour="" very="" when="" will="" years="">
Sedation and local anaesthesia can be used as an alternative to remove the eyelid tumour. It is hard to achieve full pain relief if sedation is not given at full dose.

In my case, sedation is given at 50% of the dose and the isoflurane gas given for <5 3="" achieves="" analgesia.="" and="" br="" complete="" completely="" dog="" excised="" eyelid="" in="" is="" less="" minutes="" movement="" no="" pain="" properly="" s="" seconds.="" than="" the="" tumour="" with="">
Isoflurane gas is very safe and many times, I have used it solely for over 100 Caesarean sections of dogs stressed out by the breeder's delay in seeking prompt surgery. Those dogs were operated WITHOUT sedation using just isoflurane gas anaesthesia. None died from the anaesthesia.

Of course they were younger dogs but they were under considerable stress. In brief, old dogs with very short surgical procedures and anaesthesia ,<15 30="" br="" died="" experience="" have="" in="" minutes="" my="" not="" of="" on="" operating="" over="" past="" practice.="" table="" the="" years="">  
I hope the above provides a satisfactory explanation. It is best not to research too much the technical aspects of anaesthesia to get worried. Chances of your dog surviving are excellent as your dog is eating normally and is active. The surgery to remove the eyelid tumour will be over in 3 seconds and I normally don't even inform some owners about anaesthetic risks as the risks are minimal if I assess they are worried.        
Best wishes. 
Dear Dr Sing 
Thank you so much for your comprehensive answer to our concerns! Appreciated. 
Now we feel much more calm and relaxed and can sleep better.
Finally, we do hope that the tumour is not malignant which the analysis will show later. 
Good night, and see you tomorrow.
With warm regards
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