A thorough pre-anesthetic assessment prior to veterinary dental surgery is essential for patient safety and for ensuring a smooth anesthetic event. A boarded veterinary anesthesiologist can assist in developing an appropriate diagnostic workup and individualized anesthetic plan.
Patient History
Obtaining a complete patient history is a critical component of the veterinary pre-anesthetic evaluation. Important information includes any known comorbidities, current medications, previous anesthetic experiences, recent diagnostic results, and the patient’s behavior or temperament. This information allows the anesthesiologist to identify potential risks and recommend additional diagnostics or treatments prior to anesthesia.
Recent diagnostic testing is particularly valuable when evaluating anesthetic risk. For example, if a newly noted azotemia is identified on blood work, a veterinary anesthesiologist may recommend additional testing, such as blood pressure measurement or urinalysis, to further evaluate renal function. Similarly, records from previous anesthetic events or veterinary dental procedures can provide insight into how the patient responded to anesthesia and allow adjustments to improve the safety of the upcoming procedure.
An accurate and up-to-date list of medications is also essential. Certain medications may need to be temporarily discontinued if they could have detrimental physiologic effects under anesthesia. In other cases, additional medications may be recommended to improve the patient’s anesthetic experience. For example, anxiolytic medications may be administered the night before and the morning of surgery for patients who are historically anxious.
Physical Examination
A recent and complete physical examination is required prior to any anesthetic procedure. For veterinary dental surgery, it is particularly important to notify the anesthesiologist of any cardiac or respiratory abnormalities, as these findings may influence anesthetic drug selection and monitoring strategies.
Many veterinary dental patients are geriatric, and abnormalities detected during the physical exam may represent newly developed disease. Careful evaluation of the airway and oral cavity is also essential. Difficulty opening the jaw or evidence of jaw instability should be communicated to the anesthesiologist, as these findings may indicate potential challenges with intubation.
In cases where airway management may be difficult, the anesthesiologist may recommend additional equipment—such as an airway exchanger or endoscopic device—to facilitate safe intubation.
Diagnostics
The diagnostics that are recommended by your anesthesiologist will vary with the patient and overall clinical picture. For most patients, a full blood panel (CBC/Chemistry/T4) and urinalysis are recommended to be performed within the last 1-2 months. For geriatric patients, chest radiographs may also be recommended to look for underlying occult cardiac changes, metastatic disease, or pulmonary pathology. It is important to remember that recommendations for diagnostics will vary considerably with the specific needs of the patient. For example, same-day blood work to look at renal values and electrolytes may be recommended for a cat with chronic kidney disease, despite having blood work performed 2 months ago. A recent echocardiogram (3-6 months) may be recommended for a patient with known heart disease.
A newer diagnostic that has become more common in practice is the IDEXX SNAP feline proBNP. This is a rapid bedside point-of-care blood test that can be helpful in distinguishing feline patients with underlying cardiac disease. An elevated proBNP indicates increased stretch and stress on the myocardium. It is NOT a diagnosis of heart disease, but a potential indicator. SNAP proBNP is recommended to be performed in feline patients with a murmur or arrhythmia on physical exam or a patient at high risk for cardiac disease (e.g., maine coons, persians, bengals). If the SNAP proBNP is normal, it is unlikely the patient has moderate to severe heart disease. If the test is abnormal, it is recommended to follow up with an echocardiogram with a boarded cardiologist. An elevated SNAP proBNP can also be seen with hyperthyroidism, hypertension, and renal disease, so results should be interpreted carefully. A recent prospective cross-sectional study found that the SNAP proBNP differentiated abnormal and normal cats with a sensitivity of 43% and a specificity of 96%. If the feline patient had a heart murmur, the test differentiated abnormal and normal cats with a sensitivity of 71% and specificity of 92% (Lu et al 2021).
Assigning ASA Status
After an assessment of the patient’s physical status, co-morbidities, and recent diagnostics, an American Society of Anesthesiologists (ASA) grade is assigned to the patient. ASA grading scales from 1 to 5, with an increased grade associated with anesthetic death. This grading system is routinely used in small animal practice, horses, and humans. ASA grading is as follows:
- ASA 1 – normal healthy patient getting an elective procedure
- ASA 2 – patient with mild systemic disease (e.g., skin tumor removal, fractured limb)
- ASA 3 – patient with severe systemic disease (e.g., abdominal exploration on a hypovolemic patient)
- ASA 4 – patient with severe systemic disease that is a constant threat to life (e.g., a hypovolemic anemic patient with a bleeding abdominal tumor)
- ASA 5 – patient not expected to survive 1 day with or without operation (e.g., decompensated septic abdominal exploration)
While ASA grading between observers can vary with repeatability and agreement, it is still a valuable tool in forming an objective assessment of patient stability for anesthesia. Your anesthesiologists can help you determine an ASA grade for your patient and discuss the overall anesthetic risk.
Partner with a Board-Certified Veterinary Anesthesiologist
A thorough pre-anesthetic assessment is the most crucial aspect of developing a safe anesthesia protocol. Your anesthesiologists can aid in diagnostic and medication recommendations, interpretation of diagnostic results, and help determine the risks and benefits of anesthesia for your patient. Contact My Vet Anesthesiologist™ today to give your team peace of mind so they can focus on what they do best.
Images used under creative commons license – commercial use (4/22/2026). Photo by Anton Lochov on Unsplash