Perianesthetic death in dogs and cats: a scoping review

Perianesthetic death (PAD) is an uncommon yet devastating outcome in veterinary medicine, with incidence rates consistently higher than those reported in human anesthesia. In our scoping review, we summarize the current literature on PAD in dogs and cats and discuss definitions, risk factors, species-specific challenges, and the role of postmortem examinations. Although advances in veterinary anesthesia have occurred, inconsistencies in PAD definitions and follow-up periods have limited the ability to compare PAD incidence over time. Risk factors consistently associated with PAD include high American Society of Anesthesiologists physical status classification, age and weight extremes, species-specific traits, and procedural urgency. PAD risk is consistently higher in cats than dogs. Most studies rely on identifying clinical risk factors, with limited use of postmortem examination. When autopsies are used, they can reveal undiagnosed lesions that may have contributed to the animal's death. However, many PAD autopsy cases yield no identifiable lesions, complicating determination of cause of death. Additionally, the lack of standardized submission forms and autopsy protocols further hampers consistency in case evaluation. We highlight the need for a multidisciplinary, standardized approach to the investigation of PAD cases. Future prospective studies should incorporate structured autopsy protocols and anesthesiologist reviews to improve diagnostic yield, with the goal of improving patient safety in veterinary anesthesia.