Dog Sedation / Anesthesia – Is It Necessary?

Many procedures require a dog to be sedated or fully anesthetized. Every day, some dog owners hope this won’t be necessary and ask if the procedure could be done without it. This concern often stems from the owner’s fear that their dog “won’t wake up” or from a previous frightening or unpleasant experience.

Admittedly, whenever we interfere with the central nervous system and bodily functions, there are always risks involved. Hoping that nothing ever goes wrong is wishful thinking, and no one can guarantee it. However, in practice, when sedation or anesthesia is done correctly, under supervision, and with proper preparation for different scenarios, the risk of losing a patient is extremely low.

Sedation is, of course, a milder procedure than full anesthesia—though in many cases, the same drugs are used for premedication before anesthesia. Sedation is needed for minor, somewhat painful procedures (sometimes with the addition of local anesthesia), for X-rays, or to examine an extremely nervous or aggressive dog.

There are various sedation and anesthesia drugs available. The key is that the veterinarian knows what they are using, what they aim to achieve, and how the drugs affect the body. Dosages are calculated using specific formulas, but other factors must also be considered, such as the dog’s body condition (thin or overweight), age, level of nervousness, past experiences, and any underlying health conditions. In this regard, familiarity with the patient is an advantage—previously used medications, anesthesia monitoring records, and any special considerations should ideally be noted in the patient file.

Some drugs have reversal agents, meaning their effects can be counteracted once the procedure is complete. On the other hand, after a major, painful surgery, mild sedation may help the patient feel more comfortable—even if pain relief has been thoroughly managed using a multimodal approach, which combines different types of painkillers and anesthetics.

For longer surgeries, modern anesthesia is typically maintained using inhalant anesthetics (such as isoflurane). The advantage of this method is the relatively quick elimination of the anesthetic from the body, allowing for a faster recovery—since the drug is inhaled and exhaled via the lungs, rather than being broken down by the liver and kidneys like injectable drugs. The concentration of the gas in the inhaled air can be adjusted throughout the procedure, and the dog’s breathing can be assisted if needed. If the clinic has a ventilator, it can automatically calculate the required breathing rate and volume for the patient.

Anesthesia, regardless of type, must always be monitored. A competent veterinary nurse, in addition to the veterinarian, plays a crucial role in ensuring safety. Of course, monitoring devices are used—but compared to human observation, they are prone to errors and various interferences. During anesthesia monitoring, the patient’s heart rate, respiratory rate, body temperature, blood pressure, ECG, and exhaled carbon dioxide levels are observed. At the start of anesthesia, the veterinary nurse is often busy connecting sensors and adjusting machines. However, the most important thing is to use one’s eyes—to observe the patient’s pupils and eye reflexes, breathing patterns, gum color, jaw muscle tension, and so on.

Both sedated and anesthetized dogs have impaired body temperature regulation, so keeping the dog warm from the beginning is crucial. Items like wool socks, warm bedding, and blankets are useful—though in rare cases, some dogs may react to a drug by increasing their body temperature, in which case cooling may be necessary instead.

Respiratory rate always decreases under sedation and anesthesia (many owners are surprised when they notice this and hold their hand in front of the dog’s nose to check). Ensuring adequate oxygen supply is therefore critical. Providing oxygen via a mask or endotracheal tube is considered good practice until the dog fully wakes up. Certain breeds (such as brachycephalic, or flat-faced dogs) usually keep the endotracheal tube in place until they are completely awake.

Now, what happens if things don’t go by the book and complications arise? What if blood pressure drops? The dog stops breathing? The heart rate falls too low? Or becomes too high? Irregular heartbeats? Poor breathing patterns? Cardiac arrest?

Ideally, the team has prepared for all scenarios in advance. When planning anesthesia, the veterinarian should have already calculated doses for emergency drugs, so there’s no need to search for a calculator in a crisis. If something starts to go wrong during anesthesia, there are usually early warning signs, allowing adjustments to be made. The beginning of anesthesia may require some stabilization, while longer procedures may lead to signs of fatigue in the patient. It is common for some patients to breathe very slowly or not at all at the start of anesthesia due to certain drugs. In older animals, lung oxygenation capacity may already be reduced and may need support.

Sometimes, however, a situation arises where the best course of action is to shout “RESUSCITATION!”—at which point at least a three-person team should immediately respond, with one person (likely the veterinarian) taking charge. Resuscitation skills, procedures, and necessary medications should be well-rehearsed. This typically involves starting chest compressions, artificial respiration, rapid connection to monitoring devices (if not already in place), and administering appropriate emergency medications or reversal agents. Before any anesthesia, the owner’s wishes regarding resuscitation should also be known. Based on my personal experience, when I’ve encountered such situations in my career, the outcomes have been roughly 50/50—success or failure. More often than not, such patients are already critically ill.

However, in my experience, age itself is not necessarily a risk factor. Owners often say, “This dog is already 12 years old, so I won’t put it under anesthesia for dental work anymore, it’s too old.” But based on my 35 years of experience, I can tell you that a 15-year-old, white-faced, deaf, liver-compromised senior dog will likely sleep through anesthesia like a textbook case, while a three-year-old sporty dog may develop arrhythmia during a simple neuter procedure.

Additionally, if a dog reacts strangely at the start of anesthesia, and if the procedure is not an emergency or life-saving surgery, the safest option is to stop, wake the dog up, and schedule a new appointment in a few weeks—perhaps using a different premedication combination. In such cases, everything will likely go smoothly next time. If the patient is a regular visitor to the clinic, both the staff and the dog are at an advantage in handling anesthesia.

Today, sedation and anesthesia can be performed very safely, with careful monitoring and a focus on a smooth recovery. When taking a pet in for a procedure and seeing the owner’s teary eyes as they kiss their dog on the nose and say, “I hope we see each other again,” every veterinary professional feels the weight of that responsibility.