There won’t be many vets who don’t have concerns over anaesthetising the elderly patient, especially with studies showing that cats and dogs over 12 years old are twice as likely (cats) and eight times as likely (dogs) to die within 48 hours of an anaesthetic.

So any CPD covering this topic can only be a good thing. ‘The Webinar Vet’ organised for Matthew Gurney to lead a veterinary webinar using case reports to demonstrate how to make the right decisions when anaesthetising the geriatric patient.

Various cases were cited, with Matthew asking us our opinion on which premed, induction agent and analgesic would be appropriate for each individual case. The two premeds discussed were the mainstays of veterinary practice, ACP and the alpha 2 agonists. Matthew was satisfied that both ACP and the alpha 2 agonists were perfectly acceptable premeds in the geriatric patient, if given at appropriate doses (these are stated in the webinar). However for the canine patient suffering with cardiac disease, ACP would be the most appropriate, avoiding the alpha 2 agonists which may have detrimental effects on heart rate and contractility.  ACP, however, should be avoided or used at low doses of 0.01mg/kg in dogs and cats suffering with renal disease, as it is known to reduce blood pressure.

Matthew also questioned the use of ACP in older cats as it is not a particularly good drug for calming the cat and offers no pain relief. Matthew recommends low doses of an alpha 2 agonist and an opioid in this particular species.

Analgesia was also discussed at length with methadone being a firm favourite delivering good analgesia in the dog. However Matthew stressed the importance of a multi-modal approach to pain relief targeting different sections of the pain pathway. Matthew cited a case of a 12yr old SBT suffering from a prostate abscess for which he advocated using NSAIDs, methadone and epidural bupivicaine as a combination of treatments targeting different areas of the pain pathway. However Matthew advised caution when administering NSAIDs in elderly patients suffering from renal disease.

Buprenorphine in the cat is also a very effective opioid and has been shown in studies to offer the equivalent pain relief delivered by morphine in this species. However Matthew will use methadone in the cat if buprenorphine does not appear to be working well and in his experience methadone is very effective. Local anaesthesia can also be invaluable especially in older cats having dentals.

Matthew also emphasized the importance of pre-oxygenating sick and/or elderly patients for at least 3 minutes with a tight fitting mask at a flow rate of 1-2l/min. This provides a reserve against desaturation and optimises tissue oxygen delivery.

This was a practical veterinary webinar with the sort of cases being discussed that we encounter in practice on a regular basis. There is little doubt you would take this information and benefit from it the next time a geriatric patient walks through your door needing an anaesthetic.