Introduction

• Often older patients (and some very young ones). Both of these age brackets are not a contraindication for general anesthesia but these patients tend to have limited homeostatic reserves and are therefore more prone to anesthesia-induced insults of vital organs. Most sedative and anesthetic agents have cardiovascular side effects which may result in detrimental consequences in these patients. Young patients depend on their heart rate to maintain their blood pressure at an adequate level due to a less contractile myocardium and less compliant ventricles compared to mature animals. Stroke volume is limited and cardiac output therefore depends on heart rate. 
• Each anesthetic protocol, including intravenous fluid therapy Fluid therapy: for anesthesia , should be tailored to the individual patient. Drugs should be titrated to effect, rather than given as a standard, fixed dose.
• Presume all geriatric patients Anesthesia: in geriatric have some degree of renal impairment so treat them accordingly.
• Increased risk of aspiration of blood, saliva and irrigation fluids.
• Risk of hypothermia Hypothermia is often neglected because these patients are not clipped and prepped for surgery. However, using cold irrigation fluids in the mouth increases heat loss, especially when head and neck become wet and the patient is lying on a metal tub table. Most of these patients are geriatric with often a low body condition score making them prone to hypothermia. Body temperature should be monitored and both passive and active heating devices should be used to maintain body temperature Anesthesia: temperature regulation.  
• Surgery on the head can hinder the application of monitoring equipment and therefore increase the risk of complications. Repeated changes in recumbency and excessive manipulation of the head and neck area should be avoided during procedures.
• Good patient assessment and management during the entire peri-anesthetic period is imperative.
• Dental pain may not be obvious to the owner but when treated accordingly, the owner may notice a clear improvement.
• Dental pain is often chronic by the time the patient is treated.

Pre-anesthetic work up

Anesthesia

Local anesthetic techniques

Post-anesthetic care

Further Reading

Publications

Refereed papers

• Recent references from PubMed and VetMedResource.
• Beckman B (2013) Anesthesia and pain management for small animals. Vet Clin North Am Small Anim Pract 43 (3), 669-688 PubMed.
• Park Y W, Son W G, Jeong M B et al (2013) Evaluation of risk factors for development of corneal ulcer after nonocular surgery in dogs: 14 cases (2009-2011). JAVMA 242 (1), 1544-1548 PubMed.
• Stevens-Sparks C K & Strain G M (2010) Post-anaesthesia deafness in dogs and cats following dental and ear cleaning procedures. Vet Anaes Analg 37 (4), 347-351 PubMed.
• Nanai B, Phillips L, Christiansen J et al (2009) Life threatening complication associated with anesthesia in a dog with masticatory muscle myositis. Vet Surg 38 (5), 645-649 PubMed.
• Stepaniuk K & Brock N (2008) Hypothermia and thermoregulation during anesthesia for the dental and oral surgery patient. J Vet Dent 25 (4), 279-283 PubMed.
• Woodward T M (2008) Pain management and regional anesthesia for the dental patient. Top Companion Anim Med 23 (2), 106-114 PubMed.
• Rochette J (2005) Regional anesthesia and analgesia for oral and dental procedures. Vet Clin North Am Small Anim Pract 35 (4), 1041-1058 PubMed.
• Lantz G C (2003) Regional anesthesia for dentistry and oral surgery. J Vet Dent 20 (3), 181-186 PubMed.

Other sources of information

• Milella L & Gurney M (2016) Dental and oral surgery. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. 3rd ed. British Small Animal Veterinary Association, Quedgeley, UK. Eds. Duke-Novakovski T, de Vries M and Seymour C. Chapter 20, pp 272-282.  
• Gracis M (2013) The oral cavity. In: Small Animal Regional Anesthesia and Analgesia. 1st Ed. Wiley Blackwell, Ames, Iowa, USA. Eds. Campoy L & Read M R. Chapter 10, pp 119-140.

Further Reading

• The Webinar Vet - It doesn’t have to hurt! Analgesia for dental surgery