Sometimes a CKD cat needs to have a general anaesthetic. The most
usual reason in a CKD cat is dental surgery, but cats sometimes need anaesthesia for other reasons, perhaps to have a growth removed or to have
kidneys stones treated.
I know you don't want your cat to undergo general anaesthesia. The mere
thought of it terrifies me, and I'm a gibbering wreck whenever one of my
cats needs it. There are always risks associated with anaesthesia, but if
your cat is in pain or if s/he won't survive much longer without surgery,
then you will have to decide whether to take the chance. Many of
the risks can be managed, which reduces the chance of problems developing.
The first thing to do is to find a vet you trust to perform the surgery.
You also need to decide whether to use a specialist. Most vets can perform
a variety of procedures, but for certain types of surgery, such as kidney
stone removal and stent insertion, you will need a specialist. You may
also wish to use a dental specialist if your cat is undergoing dental
surgery - see
Problems for more information.
You should always have a physical exam and bloodwork done and blood
pressure checked before surgery, so any problems can be addressed. If your
cat has heart issues,
you may also wish to see a veterinary cardiologist prior to surgery.
f your cat
is on blood pressure medication such as amlodipine (Norvasc) or benazepril
(Fortekor), ask your vet if you need to stop the medication a couple
of days before the surgery (since anaesthetics may reduce
should be placed on IV fluids for a few hours before, during and after
any surgery. All cats should be placed on IV fluids during and after
procedures. This is to avoid falls in blood pressure during the
procedure, which may damage the kidneys.
Depending upon the type of surgery involved, antibiotics may need to be given to the cat for several days in
advance, and continued for 5-7 days afterwards.
You should discuss with your vet the type of anaesthesia that will be used
on your cat. Generally speaking, animals undergoing surgery receive two
types of anaesthesia:
an induction agent to induce unconsciousness; and
general anaesthesia to keep them unconscious whilst the procedure is being
Induction agents used in cats are usually in the form of injections. A
commonly used induction agent is propofol. Ketamine is not recommended
because it has to be cleared by the kidneys.
General anaesthetics take various forms. For CKD cats, inhaled anaesthetics are a good choice. These are gases, which put less strain on
the cat's body than other types of anaesthetic, and they also enable the
vet to stop the procedure and bring your cat round immediately if there
are any problems during surgery. A commonly used inhaled anaesthetic is isoflurane,
though some vets prefer another one called sevoflurane - either is
acceptable. If your cat is to receive an inhaled anaesthetic following
induction with an injectable induction agent, usually an endotracheal tube
is inserted into the cat's throat to administer the inhaled anaesthetic
and to help the cat to breathe.
Some vets do not use an injectible induction agent, but instead use the
inhaled anaesthetic both to induce unconsciousness and to provide general
anaesthesia. Using inhaled anaesthetics in this way is sometimes referred
to as "masking down." I would ask your vet not to do this, injected
induction agents are safer.
The main downside of inhaled anaesthetics is that they may cause low blood
pressure, which can damage the kidneys. It is therefore essential that
your cat's blood pressure is monitored during the procedure.
Intravenous fluids may
help reduce the risk of low blood pressure.
Any drugs which are used on a CKD cat which are cleared by the kidneys may
require a reduction in the dose, since damaged CKD kidneys may not clear
them as fast as healthy kidneys.
develop a low temperature following anaesthesia, so ensure that your
cat's temperature will be monitored afterwards. Your cat might benefit from a heatpad
immediately following surgery.
If inhaled anaesthesia has been used, your cat will have a tube down the
throat during surgery (intubation), which can cause the throat to feel a
little sore for a day or two afterwards.
Blood pressure should also be monitored for a week or so afterwards
because surgery and anaesthesia may cause increases in blood pressure
following the procedure.
After most types of surgery
are necessary. Make sure your vet does not give
to your cat.
Your cat may be able to come home a few hours after surgery, or may have
to stay in the hospital overnight or for a day or so. If you bring him or
her home soon after surgery, keep him/her in a warm, quiet place. Your cat
may be a little wobbly at first, but this should soon improve. If you have
any concerns, contact your vet.