Anesthesia is an essential part of surgery, dentistry, and many diagnostic procedures. Many owners fear anesthesia — understandably so. However, the actual risk with modern monitoring and protocols is very low. A worldwide study (Redondo et al. 2024, 55,000 dogs) showed anesthesia mortality of 0.17% in dogs and 0.24% in cats — in healthy patients only 0.05% (1 in 1,849) in dogs and 0.11% (1 in 895) in cats.
Risk Factors and ASA Classification
The single largest risk factor is the patient's health status. In veterinary medicine, the ASA classification (I–V) is used to assess patient condition before anesthesia. In healthy patients (ASA I–II), the risk is very low. In sick patients (ASA III or higher), the risk increases 3.3-fold in dogs and 4.8-fold in cats. Other risk factors include emergency surgery, prolonged anesthesia, brachycephalic breeds (short-nosed), and very old or very young age. Brachycephalic dogs have a 4.3-fold higher risk of post-anesthetic complications due to their narrow airways.
Modern Monitoring Saves Lives
We closely monitor every patient under anesthesia. We have ECG for heart rhythm monitoring, pulse oximetry for oxygen saturation, capnography for carbon dioxide monitoring, temperature monitoring, and ventilators for respiratory support. We carefully auscultate the heart before and during the procedure. Most importantly, however, is a trained person who interprets the monitors and responds to changes — automated devices do not replace a vigilant professional.
Balanced Anesthesia and Pain Management
Modern anesthesia is based on a multimodal approach: by combining multiple drugs at low doses, a safer outcome is achieved than with a single drug at a high dose. We use intravenous anesthesia for induction (propofol or alfaxalone), inhalation anesthesia for maintenance (isoflurane or sevoflurane), and opioids, ketamine, and local anesthetics for pain management. This balanced protocol reduces the dose of each individual drug and its side effects — especially cardiovascular depression. Our clinic has two ventilators to ensure safe anesthesia.
Finnish Innovation — Vatinoxan
Veterinary anesthesiologist Vilhelmiina Huuskonen emphasizes in a University of Helsinki article (2024) that animal mortality during anesthesia is more common than in humans, and that a specialist in veterinary anesthesiology should be present during complex surgeries. Huuskonen defended her PhD on this very topic: her research demonstrated that vatinoxan (Zenalpha) makes sedation significantly safer. At the University of Helsinki, the research group led by Professor Outi Vainio developed vatinoxan — a drug that blocks the harmful cardiovascular effects of alpha-2 agonists (medetomidine, dexmedetomidine) — bradycardia and elevated blood pressure — without crossing the blood-brain barrier. Sedation and pain relief are preserved, while cardiovascular side effects are significantly reduced. EMA approved the drug in 2021 and FDA in 2022.
Before Anesthesia
Every patient is individually assessed before anesthesia. The pre-anesthetic evaluation includes a clinical examination, auscultation of the heart and lungs, and blood tests (complete blood count and biochemistry). Studies show that the anesthesia protocol was modified in 79% of cases based on blood test results. Blood tests can reveal hidden kidney or liver disease, anemia, or electrolyte imbalances that affect drug selection and dosing. If findings are significant, the procedure may be postponed for the patient's safety.