Anesthesia in Goats

Every goat owner has heard that goats don't do well with anesthesia, so we are always understandably nervous when our goats need to be sedated. Dr. Kelly Chen, Veterinary Anesthesiology Resident at Cornell University, joins us in this episode to talk about why goats are so challenging when it comes to anesthesia.

First, we discuss the difference between anesthesia and analgesia and then we talk about some of the common procedures where anesthesia is used.

Dr. Chen talks about pain associated with disbudding and what the options are for veterinarians who disbud, as well as owners who do their own disbudding.

For c-sections, there are three different anesthesia and analgesia options, and Dr. Chen talks about why general anesthesia is no longer preferred.

In severe cases of urinary calculi, anesthesia is required for a couple of the different treatment options.

Dr. Chen also talks briefly about other surgical procedures being done on livestock now, such as joint replacement, pacemaker placement, and mastectomy, which require anesthesia.

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Transcript

Introduction 0:03
For the love of goats, we are talking about everything goat. Whether you're a goat owner, a breeder, or just a fan of these wonderful creatures, we've got you covered. And now, here's Deborah Niemann.

Deborah Niemann 0:17
Hello everyone; welcome to today's episode. I am really excited to have with me today Dr. Kelly Chen, a veterinary anesthesiology resident at Cornell University, because I know this is probably one of the most stressful things for most goat owners, like we've all heard horror stories about goats who did not do well with anesthesia. So I was really excited that Dr. Chen agreed to chat with us today about this really important and confusing topic. Welcome to the show, Dr. Chen.

Kelly Chen 0:47
Thank you so much for having me.

Deborah Niemann 0:49
So the first thing, let's just talk about what is the difference between anesthesia and analgesia?

Kelly Chen 0:56
Yeah, that's a good question. So when we say 'Department of Anesthesia and Analgesia'- Anesthesia is kind of what you think about in terms of like, 'I'm getting a procedure done, it's gas or injectable, but I'm going completely asleep.' That's what we call general anesthesia. That's kind of what that encompasses. Analgesia specifically is just pain management. So that's not necessarily patients that are going under anesthesia, right? So this could be the dog with the chronic hind limb pain that comes to us, and we see it as kind of like an outpatient analgesia specific appointment. So we kind of encompass everything from sedation, general anesthesia, to pain control itself. So our department kind of sees quite a bit, but it all kind of has to do with ventilation, drug choices and pain control is kind of our big things that we take care of.

Deborah Niemann 1:50
Thanks for explaining the difference between those two, because I know a lot of people aren't really clear on that. Now, one of the first things that people think about when they think about anesthesia and stuff is disbudding. And this is something that varies from one vet to another vet in terms of if your vet is doing it, some may or may not do any kind of anesthesia. Most owners are doing it themselves. They don't have access to anything at all. And if people are listening from outside of the US, which I know I do have international listeners, they may be in a country where this is legally required. So they may be wondering what on Earth are you talking about? And so could you talk a little bit about what the options are in terms of anesthesia or analgesia for disbudding? 

Kelly Chen 2:40
Yeah, so for the disbudding process, most of the time we still do cautery disbudding. There's a bunch of different ways to disbud, but usually cautery disbudding is going to be your most reliable and your least invasive way to disbud.

Deborah Niemann 2:56
And what is that exactly, that type of disbudding?

Kelly Chen 2:59
So cautery disbudding is the one where there's like a little ring that gets heated up and then you create a thermal burn, basically, to prevent continued growth of the horn. In some other areas, some people are also used to kind of a cautery cream where they apply the cream and it kind of like slowly burns away at the tissue. That can be a little kind of dicey because it's a little less- it's not like a one time thing you do. The cream can also get on places that you don't necessarily want it to get on. If the kids need to nurse or if you need to handle the kids, it can also get other places where you don't want tissue damage to happen. There are also some ways where you can inject some sort of chemical into the tissue area and it causes the equivalent of a thermal injury. However, there are also kind of like issues with that one where you maybe don't have as good of a success rate, depending on your injection area, depending on how much you inject. There's just a lot more variables for that one as well. All of these, you know, very obviously pose risks, but the risk of having a kid with horns is also, you know, that side of the risk as well. Cautering itself is it's kind of like a one time thing; you do it. It's pretty reliable,but the risks of that come with  it, you do burn an area of skin, but you also can cause thermal injury to other things that are in that area.

Kelly Chen 4:24
So right below where their buds or their horns are is their skull. And then right under where their skull is, is their brain. So a lot of the times people find that if you hold it on for too long or anything like that, you can actually cause thermal injury to the brain, which is obviously bad, right? With that being said, it's a very painful procedure for patients that are so young. And we oftentimes recommend some kind of local block. We oftentimes block the corneal nerve or the infratrochlear nerve. And that'll kind of numb the area before we apply any painful stimulus. Usually these patients are just sedated. It's usually too quick of a procedure to warrant general anesthesia, but usually they do pretty well with a little bit of sedation and a local block so they don't feel it. So think of it as like when you go to the dentist and you have, you know, a filling or anything like that, it's less of a procedure that you need to get fully put under anesthesia for. But if you were fully aware of everything when they were drilling, it's still going to be painful, right? So when you go to the dentist to get a cavity filled, they're going to block that area as well so that when they drill, you don't feel anything, but you're still conscious. Some people might get a little bit of sedation or anything like that, but we can't really tell a goat to hold still. So oftentimes the combination of a sedative and a local block is kind of the standard of care.

Deborah Niemann 5:43
OK. Now, I remember when I first got my goats in 2002, the person who sold me to them said that when I had kids and I took them to the vet to get disbudded, she's like, "Don't let them sedate the kids because they don't need it and it could kill them." And you still hear this from a lot of people. And so what are the risks of sedation for baby goats and how common are complications?

Kelly Chen 6:07
That's a good question. So, I would say veterinary anesthesia as time goes on, we know more and more about the drugs that we are using and we know more and more about the complications of them. Right. So the same drug in a sheep, in a goat, in a dog, in a cow is going to act very, very differently. So as time goes on, we find more and more what drugs are safe to use, what drugs have a safety of index that are appropriate for us to use, which means if we use accidentally a little too much, is it going to kill the patient or are they just going to have adverse reactions for maybe like 30 seconds? So a lot of these things are still kind of like in the process of being found out for veterinary medicine. With that being said, oftentimes our mantra is pain is pain and pain needs to be treated and we can't really do ethical medicine without proper pain management, right? And so the thing that I always reference is we as a field are kind of going through this similar revolution that like pediatric anesthesia and human medicine did back in like the 70s, where it's horrifying to think about now. But people used to do open heart surgeries in babies with no anesthesia because they thought crying was a reflex instead of a pain response, right? Which we think about it now and it's like horrifying. But I think we're kind of catching up to that idea, too, where it's like if we do thermal cautery on these kids, they're going to scream.

Kelly Chen 7:27
And a lot of people are like, that's just goats being goats. You just hold them down for a little bit. But that has been shown as time goes on to kind of change a lot of different things, right? A lot of pain responses can be remodeled as a patient grows. And especially if a very painful stimulus is put upon them when they're really young, a lot of these pain stimulus' can become like behavior issues even. And we've seen that in people. So a lot of the times when I hear people say, like, "Oh, they don't need pain management or they don't need sedation for X, Y, Z", I think of how we used to think the same for babies. And now when we think about it, it's like that's not even a question. And I'm not saying any of these people are wrong or that the practice is wrong. But I think as we find out more information, it becomes very clear that, like, they still feel pain and that pain should be treated. They shouldn't be treated any differently than any surgical procedures that we would go through, for example. As far as safety goes, a lot of the drugs that we use nowadays, we're finding the safety index for them, what patients they should be used in and who they shouldn't be. One drug that I think of is dexmedetomidine or detomidine or even xylazine, which belongs to a big group of drugs called alpha-2 agonists. We use drugs like that on the daily in our small animal hospital. Every dog and cat that comes to our hospital that needs to be sedated gets one form of that drug. Similarly to horses as well. 

Kelly Chen 8:50
Cows, we found, are very sensitive to these types of drugs, but they're still tolerant of them. Goats and sheeps, we found some of them can get pretty significant reactions and actually get pretty significant pulmonary edema from them. So at our hospital, we don't necessarily- we really never use alpha-2 agonists in our sheeps and goats because of that reaction. And this is for young or older goats, just small ruminants in general, we try to stay away from those alpha-2 agonists. With that being said, there's a lot of situations where maybe you don't have a choice. Maybe you don't have any other drug on hand and this procedure isn't going to happen without some kind of sedation. As long as people know the risks, I would say not every small ruminant reacts very negatively to these drugs. But with that risk being known, we try our best to stay away from those. And we're lucky to be in a hospital where if the patient needs oxygen, if the patient needs drug reversal, we have it on hand very readily here. But that's not always going to be the case, especially if you work in a field environment or anything like that. So I always just warn people that our standard of practice is to not use those drugs. Understandably, there are situations where you are kind of forced to, but there are risks to those drugs. With that being said, there are a plethora of other drugs that you could use for sedation as well. So we've kind of found better protocols nowadays to sedate these baby goats.

Deborah Niemann 10:18
OK, so what you're saying is basically it's a lot safer now than it was when I got my goats in 2002.

Kelly Chen 10:25
I would say so, yeah, absolutely. I think there have been huge strides in veterinary medicine as time goes on. And we think about these local blocks that we do in our patients. But if you think about like in the dog and cat world or even we were talking earlier where people are doing like hip replacements for their farm animals as well. These local blocks are being developed like on a day-to-day basis, really. So there's new technology, new procedures, new techniques that we can do to mitigate pain and make things safer, developing on like a day-to-day, month-to-month basis.

Deborah Niemann 11:00
Yeah, exactly. So if somebody is going to be doing their own disbudding, how likely is it that they would be able to get some type of anesthesia from their vet to be able to provide pain relief for their goats?

Kelly Chen 11:17
So in terms of sedation and local blocks, a lot of these drugs are going to be controlled drugs. So think about like if you go to the doctor for whatever reason and, for example, when I was recently in the hospital, I needed to get a spinal tap and it inherently is not a super painful procedure. But just to give me like a little bit of sedation, they gave me a little bit of ValiumⓇ, which in itself is a controlled drug. So that can't leave the hospital, unfortunately. So a lot of the drugs that we use are kind of similar where they have to be administered by someone who is licensed to do so in a hospital. For things that you can prescribe at home, we use a lot of what we call non-steroidal anti-inflammatories. So think your basically sheep and goat equivalent to what we would take for like headaches and things like that. So ibuprofen is kind of in the same group of drugs. Obviously, you don't give your sheep or goat ibuprofen, but it's kind of a similar drug that we would give that can be kind of on an outpatient basis. But I would say a lot of these more sedative drugs and local block drugs are probably going to be more likely than not given in hospital or from a veterinarian in a field.

Deborah Niemann 12:23
So what is something specific that someone could ask their vet for?

Kelly Chen 12:27
In a situation where the vet is coming to do the disbudding?

Deborah Niemann 12:30
No, if they wanted to do their own disbudding, like could they get an NSAID from their vet that they could give the goat?

Kelly Chen 12:37
Yeah, I think it's situational dependent, but I think if they have a good relationship with their vet and the vet's comfortable with it, NSAIDs are something that we prescribe on a pretty daily basis here. And that's just think about like if you were to get a minor procedure and they sent you home with ibuprofen or TylenolⓇ, it'd be kind of the equivalent of what we do for patients here. So as long as you have like a good working relationship with your vet and they've seen your patient and they're legally able to do so, they're usually able to prescribe some type of non-steroidal anti-inflammatory to mitigate a little bit of pain on that end.

Deborah Niemann 13:09
Okay. Every now and then I hear somebody who says that like their vet showed them how to do a local block on the horn buds and gave them the medication to be able to do that. I'm always surprised when people say that. Do you hear about that very often or do you think, 'Wow, they've got a great relationship with their vet?'

Kelly Chen 13:29
I personally don't hear of that too much to be completely honest. I will say I kind of work in a capacity that's not as client-facing. So if you were to bring your goat to the Cornell hospital, your point person would usually be someone that's from the medicine or surgery department. And if your patient needs to be put under anesthesia, then we as an anesthesia service work with the surgical and medicine service. So we oftentimes are not the most client facing service. But in my years of working with large animals, I personally have not heard of a whole lot of people being able to do local blocks on their own patients because there are risks that are associated with these procedures. So I personally have not heard of a whole lot of clients doing it on their own goats, if that makes sense.

Deborah Niemann 14:12
Oh yeah, exactly. And that's what I always say when people have asked me about it. I'm like, 'I am not a vet. I don't know how to do that. And there's always risks associated with anything like that. So, you know, that's really something you have to talk to your vet about and see. And if your vet feels comfortable and wants to teach you, you know, how to use it and talk about the risks and everything, that's something you have to talk about personally.'

Kelly Chen 14:36
Yeah. And again, like each relationship can be so unique and special in their own way. But I personally don't have anyone that I've taught how to do a local block that's not in the veterinary field.

Deborah Niemann 14:47
Yeah, that makes sense, especially being at a university hospital. Yeah. So the next thing I want to talk about are C-sections. Like I know for me personally, as a goat owner, that's the place where I've had the most experience with anesthesia and we've had about 760 kids now and we've had three C-sections and it's really interesting. We really ran the gamut. They've all been done at a university vet hospital and the first one was just amazing. It was like a human hospital, you know. And I think a lot of this had to do with the time of day and what was happening because, I mean, this was an emergency. You know, it was in the middle of the day, we got an anesthesiologist, they did gas, it really felt like I was in a human OR, you know, with everything they did. The second time it was in the middle of the day, but they were swamped. Like there were so many people there and that time they gave her an epidural and then the next time it was on a weekend, where there was like really nobody around and when they realized we needed a C-section, they had to call in a surgeon and in that case they gave the goat a local, which did not provide great pain relief for her. She was screaming a lot and pushing her intestines out and so they wound up sedating her and then she took four hours to wake up and all the vitals went south, like everything was going in the wrong direction. So it was like, 'Wow, okay, after all these years of goat ownership, I have now seen a negative reaction'. And I've just, when people have asked me like, "Well, what should I request?" And I'm like, I really don't think you can request a specific anesthesia, you know, like if your vet comes to your barn to do a C-section, I think you're going to get the local plus sedation. I think that's what typical vets can do for you. So can you talk a little bit about C-sections?

Kelly Chen 16:47
Yeah, absolutely. So, like you said, there's a variety of different ways to do C-sections ranging from, you know, what you see in a human hospital to, like you said, kind of like field C-sections where it's some local and some heavy sedation. The way we do C-sections here has actually changed quite a bit too. We used to do them where we put them fully under general anesthesia, gas inhalant and everything, they get an epidural and then we deliver their kids via C-section that way. That procedure is really great for the mom, really analgesic, poses some risk to the fetuses because the fetuses are also put under anesthesia. Anything that we administer to the mom, depending if it can cross this thing called the blood-placental barrier, can pass to the babies as well. So a lot of the times in these procedures, we use super short-acting drugs and we use things that we know we can reverse. With that being said, there's some things we really don't have the option of reversing, so things like your inhalant anesthetics don't really have a reversal. You just kind of have to wait for them to metabolize. And then some drugs undergo a process called ion trapping, where if you give the mother this drug, it can actually concentrate more in the fetus because of the pH levels and the ion levels of blood. So we have to be really, really conscientious of the drug choices that we use for each individual patient.

Kelly Chen 18:07
That has kind of progressed as well to nowadays when we do C-sections here at our hospital, we'll do pretty heavy sedation and then either an epidural or a local block, and then they deliver them that way. I've seen really great success with both, but it's kind of just like, with the heavy sedation in the local, you might have better viability with the kids, but mom is still more conscious. And like you said, sometimes if they've been sedated really heavily, can take some time to wear off. So there's no one tried and true, there's no failure rate type of C-section. There's always going to be some sort of risk and always going to be some sort of pros and cons to every single type of procedure that we do. A lot of the times with the local block, the more you do them, the more practiced you become at them and the more effective they become. So I would say in a place that does a whole lot of epidurals, a whole lot of locals, they're probably going to be more effective at them. But yeah, I think there's a variety of different ways to do them. There's not necessarily a right or wrong, but there's kind of pros and cons to all sorts of different procedures.

Kelly Chen 19:15
The one big thing for us versus a human, like an OB ward that you would go to for your own C-section, is we can't really tell a goat to stay still for their C-section. However much we give them epidurals, however locally we block them, a goat's probably not going to just lay down for you to do surgery on them. So oftentimes we need to sedate them as opposed to in a human anesthesia OB ward, you're given an epidural and then kind of told to lay on a table. And then you basically don't feel anything from the waist down. However, if you're a goat, you're still going to try to stand up and like, you know, be aware of your surroundings during this time. So I think there's a couple inherent challenges that we have as an anesthetic service that maybe in the human world, you don't see as much. The other thing too is anatomically we're very different from goats, right? So a lot of the extrapolated data that we have from the human C-section world can be extrapolated to our world, but oftentimes we don't have all of the info that they always have. So for example, the dosing of epidurals, the dosing of locals, you know, if we give an epidural, what does their spinal cord look like in terms of anatomy? How cranially is it going to spread? What is the safety index of some of the drugs that we're giving? A lot of that is extrapolated from the human world, but may not always be true clinically, right? And so, like I said previously to the drug protocols that we use, we're kind of still finding out things on a day-to-day basis that work better or worse. I will say here we do the heavy sedation and the local epidural for them nowadays, but that's not to say that there's never going to be a complication, right? There's always going to be some level of inherent risk with anesthetics of any sort. And that goes for the human world as well. Like they can do 99 C-sections and one of them can be some kind of complication. You're never going to have like a 0% complication rate with any of these procedures, unfortunately.

Deborah Niemann 21:14
Yeah. And there's really nothing that anybody can do to prevent it. It's like, you know, I frequently say with my goats like, yeah, I failed crystal ball reading.

Kelly Chen 21:23
Yeah. And we wish that we could prevent C-sections all the time. And that's, I would say the safest thing to do is- natural birth is always going to be safest for the mom, safest for the baby. But unfortunately, like you said, we can't always predict that. That's not always going to be the case.

Deborah Niemann 21:40
Right. Yeah. Our last C-section was ‘cause the kid was a schistosomas

Kelly Chen 21:45
Okay. Yeah. That makes sense.

Deborah Niemann 21:46
Which is just like, yeah, the nickname for that is inside out kids. So it's like, this was not- there was no way that kid was coming out because it wasn't a little torpedo. It looked like it had been folded in half inside out.

Kelly Chen 22:01
Yeah, that makes sense.

Deborah Niemann 22:02
Yeah. So that was definitely a situation where like, we had to have a C-section.

Kelly Chen 22:10
Yeah, and you know, oftentimes we don't recommend it until it's absolutely necessary too.

Deborah Niemann 22:15
Yeah. So I know they definitely- We all tried. Like I tried before I took the goat to the hospital and they tried after I got her there and it was just like- nobody could figure out, like, this is just so weird. There's two front legs and a hind leg sticking out and like, it doesn't seem to be from two different kids. Like, how is this possible? It was so weird. And then, during the C-section, it all became quite obvious what was going on. So is there anything else that people need to know about anesthesia and C-sections?

Kelly Chen 22:50
I think it really just depends on like where you are and what's going to be available to you. And if you can see on the screen, this is one of our anesthesia machines that we use. So obviously you're not going to use something like this in a field situation. So putting a patient fully under anesthesia in the field, potentially is not the most feasible, right? If you don't have any. So I think there's no one tried and true way to do anything in the anesthesia world and it's all kind of patient specific, client specific, and what you have available to you. So I don't want anyone to take what I say as just like, 'This has to be the one way to do anything.' There's just a wide variety of what is possible out there. And we're still learning. We're still learning too, right? Like we're still learning day to day on what is the safest thing to do? What is the safest drug to give? Things like that. Those are still kind of like being found out. Like I said, because they're true in the human world doesn't always mean they're true in the veterinary world. And we have some inherent challenges that the human medicine world maybe doesn't have and vice versa. So, like I said, there's inherent risk regardless of putting any animal under anesthesia and the same goes for goats. If anything, goats are probably our higher-risk species to put under anesthesia. So it's, it's definitely not without risk. But we try to make it as safe as possible.

Deborah Niemann 24:10
Yeah. I'm really glad that you pointed out the fact that as a hospital, you've got so much more available to you than a vet would have in your barn. And that's one of the things I think a lot of people get frustrated. They're like, "Oh, a vet won't come out to my farm." And the reality to me- like I drive two hours to go to the university vet hospital. And I remember this last time with this goat who like, 'I can't get this kid out.' And I really thought long and hard cause like, we finally have a vet in our area who'll do small ruminants. And I really thought long and hard about like, 'Should I call her or should I drive the two hours?' And I finally decided, 'you know what, if I am having this much trouble, like if I really can't get this kid out and she's like'- I don't know how many kids we've had at that point. It was like over 650-700. I'm like, 'I'm betting she's going to need a C-section'. Like this is just really weird. And when we got there and then she had the problem with the anesthesia, I said to the surgeon, I was like, ‘she never would have survived a barn C section would she?’, and she said, ‘no.’Because we had that student there monitoring all her vitals and everything was going south. You know, like the student starts telling us how the blood pressure and the temperature and the blood sugar and everything was going bad and they had everything they needed right there to keep track of it, you know, to like do the labs they needed instantly to give her the medication they needed instantly. It doubled the cost of the bill.

Kelly Chen 22:10
Yeah. Unfortunately.

Deborah Niemann 25:41
To save her, you know, so I don't really feel like having a vet come to your barn to do a C-section is the best thing, you know?

Kelly Chen 25:49
And I mean, with that being said, it happens all the time, right? Like cow C-sections, people do them on the farm all the time. So it's not to say that they're never going to be effective, but I think the more we find out about veterinary medicine and the more similar it becomes to human medicine, we have all these great facilities and with these great facilities and people that are trained to do certain things, like I'm specifically trained to do just anesthesia. So people always ask me like, ‘what's the difference between you and the family doctor that we go to?’ And my answer is always your family doctor is probably not doing bypass, right? But like we have the capability to do that now. Like I said, we do transplants in animals, we do bypass. A couple of months ago, we put a pacemaker in a donkey, you know? So like there are more possibilities nowadays than I think we could have ever really thought about even just a couple of years ago. So you're going to get the gold standard, if you will, at a university. But that's not to say that anything else isn't possible. It's tough for a field vet to also make these calls, you know, 'do I do it or do I refer out to somewhere else?' Because like you said, the availability of equipment, availability of drugs isn't always going to be the same everywhere else, right? And here we've got tons of that anesthesia personnel, we've got a surgeon doing the surgery, they've got scrub nurses, they've got people handling equipment during their surgeries. And oftentimes when you call your vet to come out to your farm, it's just them plus or minus maybe someone who's helping them or maybe you're helping hold the patient, you know? So the availability is often very, very different in whatever setting you're in.

Deborah Niemann 27:29
Yeah, exactly. So the next thing I want to talk about is something I asked before we started, what are some of the other common uses of anesthesia and analgesia? And you mentioned urinary calculi, which I should have thought of that because I've just been doing a lot of extra reading on that lately because one of our members had a goat who couldn't pee and he'd already had urinary calculi and she could not get ahold of a vet and she's like, 'what do I do?' And so I was like looking at Goat Medicine and everything and it talked about anesthesia and stuff being required. And I'm like, 'you know what, I'm not seeing anything else here that you can do that doesn't require anesthesia.' So can you talk about that?

Kelly Chen 28:16
Yeah, absolutely. So male goats oftentimes will get urinary blockage and oftentimes that's from a genetic cause, from an anatomical abnormality, or more often than not, it's a diet difference. So we very, very often see that as a surgical emergency. And the reason for that is because if the patient can't pee- and that happens in people too, if someone can't pee, the thing that's going to kill you is your potassium is unable to be excreted. And when potassium rises, it can actually kill you fairly quickly because potassium is one of the main players in regulating your heartbeat. So if your potassium starts to increase, the first thing it's going to affect is the viability of your heart. And obviously, that's something you need to be alive. So surgical correction of that is oftentimes some sort of unblocking. So oftentimes we'll place a catheter and then see if we can do anything medically managed that route. However, more often than not, I would say these patients need surgical correction. So oftentimes they'll need what we call a tube cystotomy, where they kind of anatomically divert some of the urine and kind of clean out that bladder and make sure there's no more stones that are blocking the way and then kind of guide the client to better husbandry, or maybe we talk about what can be done surgically to help this goat pee. But that's kind of the main emergency that we oftentimes see.

Kelly Chen 29:41
That poses a risk to us for anesthesia oftentimes, because these goats don't come into us necessarily the most stable. So if you have a really, really high potassium, we try to give some kind of supportive care to bring that down before we put you under anesthesia, because a lot of the anesthetic drugs that we give are not the most, you know- basically what anesthesia is, is any of the anesthetic drugs that we give, if you overdose on any of them, they're going to be fatal, right? So we try to make sure that any patient that we put under anesthesia is at their most stable before we even attempt anesthesia. And so oftentimes these goats need quite a bit of supportive care before we think about putting them under anesthesia. But unfortunately, it is a pretty invasive surgery and it's not something that I would advise being done in like a field setting, just because sterility is really important, instruments that you need are pretty specific and the skill of the person doing the surgery usually has some requirement, if that makes sense. So, yeah, that's pretty often something that we see. Goat anesthesia in general, some of the challenges that we face are if we're using inhalant anesthesia, all of our patients need to be intubated. And so goats have a pretty long oral cavity and a jaw that can really open like, at most two, three inches if you have a big goat. And so intubating them, finding that trachea that's in the back of their mouth can be really difficult. So that's one part of it.

Kelly Chen 31:06
The other part of it oftentimes is goats are, you know, they're they're born to regurgitate. That's like part of their livelihood is regurgitating, chewing and swallowing again. So all of that kind of bites us in the butt when we're under anesthesia because of a lot of those sphincters that are being relaxed. And so goats inherently are already at risk of what we call aspiration pneumonia when they're under anesthesia. And that happens to people, too. Regurgitation is a huge risk where if you're under anesthesia and you regurgitate to some degree, it can cause trauma to your esophagus. If you inhale it, it can cause pneumonia. And of course, with animals that are kind of, like I said, born to regurgitate, the risk is going to be inherently a little bit higher. And so because our facility is great and we have these capabilities of appropriately sized endotracheal tubes, these great machines that can kind of control ventilation for us, it's something that we are able to monitor for pretty closely. But I would say for any goat procedure where they go under heavy sedation or full general anesthesia, it's a pretty big risk.

Kelly Chen 32:10
Those are kind of the big ones that I can think of. Another procedure that we often see that I mentioned to you earlier, we see them pretty often for mastectomies as well. And that's for goats that have mastitis and the teat itself just needs to come out. And those goats are generally a little bit more sick and because it can be a chronic disease sometimes, and we're removing such a big volume of tissue, some of those goats end up needing blood transfusions, they need a little bit more intensive care. And so some of those goats actually need to be hospitalized for quite some time. And then we sometimes also require owners to bring in like a goat friend that can be a blood donor for them as well. So it can become quite complicated. But oftentimes we see that they recover much better with the surgery than if we just let it fizzle. So I would say if a surgeon recommends the mastectomy, I would always choose it over medical management.

Deborah Niemann 33:01
Yeah, that makes sense. Is there anything else that people need to know about anesthesia in goats? This has been really helpful.

Kelly Chen 33:08
Yeah? OK, that's great. Not necessarily something that people need to know, but I think as an animal owner, I think being a big proponent of their comfort and pain under whatever procedure can go quite a long ways. Like I mentioned before, I think we're making such strides in veterinary medicine with pain control and with better procedures, better techniques that a lot of the times, if you're willing to go that route- if you're willing to come somewhere like an academic institution or a larger hospital where they have the facilities to do this, there are quite a lot of things that we can attempt and are quite successful at nowadays. So, a lot of the times we have even like human anesthesiologists come through and they're surprised that we use the same instruments that we do in human medicine, you know? So I think we've made some pretty big strides in veterinary medicine where a lot of these things are available to us nowadays and just denying a patient pain control is no longer an availability issue necessarily because we have such great facilities. So I think just being a good advocate and being like outspoken for your patient- for your animal, our patient- is, I think, important nowadays.

Deborah Niemann 34:21
Awesome. Well, thank you so much. I think this has been really helpful and will definitely make some people feel more comfortable about the idea of their goat getting anesthesia if it's needed. This is great. Thank you. 

Kelly Chen 34:35
Yeah, of course. Thank you so much.

Deborah Niemann
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