Tanya's Comprehensive Guide to Feline Chronic Kidney Disease

Many cats will need anaesthesia at some point in their lives.
Anaesthesia always carries a small risk, and this risk can be higher in a CKD cat.
This page explains more about the precautions you can take to minimise the risks.

Risks of Anaesthesia Back to Page Index

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 risk of death: the confidential enquiry into perioperative small animal fatalities (2008) Brodbelt DC, Blissitt KJ, Hammond RA, Neath PJ, Young LE, Pfeiffer DU & Wood JL Veterinary Anaesthesia & Analgesia 35(5) pp365-73 reports on the anaesthesia of 79,178 cats and found the risk of death was 0.24%, rising to 1.4% in sick cats. The study states that "Greater patient care in the postoperative period could reduce fatalities."

Preparing for Surgery Back to Page Index

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 Dental 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 blood pressure).

CKD cats 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 any 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.

During Surgery Back to Page Index

All cats should be placed on IV fluids during and after any procedures. This is to avoid falls in blood pressure during the procedure, which may damage the kidneys.

The main concern during the surgery is the anaesthetic. Below I explain which options are available and which are commonly recommended for CKD cats.

Anaesthetic Choices Back to Page Index

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 performed.

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.

The Veterinary Anesthesia and Analgesia Support Group recommends a particular protocol for anaesthesia in renal patients. Ask your vet to follow this, or to explain any changes to you.

After Surgery Back to Page Index

Some cats 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 painkillers are necessary. Make sure your vet does not give Metacam 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.

Links Back to Page Index

Long Beach Animal Hospital has detailed information on anaesthesia written for laypeople.

Veterinary Anesthesia and Analgesia Support Group provides information on anesthesia protocol, along with its protocol for anaesthesia in renal patients.

The American Association of Feline Practitioners Senior Care Guidelines (2008) includes guidance on anaesthesia for older cats on page 8.

Pet Place gives an overview of anaesthesia.

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This page last updated: 29 October 2011

Links on this page last checked: 02 April 2012