Refining anesthesia protocols has been at the top of practitioners’ to-do lists since the American Animal Hospital Association released its anesthesia guidelines for dogs and cats. Patient safety is a primary goal in all anesthetic procedures, so to minimize risks, consider these tips for creating a successful outcome for patients undergoing anesthesia.
1. Pay particular attention to the induction and recovery phases, as these are the most critical, says the University of Georgia’s Jane Quandt, DVM, Dipl. ACVA, Dipl. ACVECC, of Athens, Ga.
“Induction [is critical because] we are taking animals to the point of unconsciousness,” said Dr. Quandt. “And in recovery they regain consciousness and must cope with the demands of tissue trauma and going back to room air if they were on inhalant anesthesia.”
She also notes that the recovery phase may be the most overlooked by general practitioners. “Recovery may be overlooked a bit because once [patients] are conscious we tend to move on to the next patient.”
Daniel K. Edge, DVM, MBA, veterinary liaison manager for Abbott Animal Health in Abbott Park, Ill., agrees, and notes the findings of a 2006 study.
“According to the Confidential Enquiry into Perioperative Small Animal Fatalities, 64 percent of anesthesia related deaths occurred during the recovery phase,” said Dr. Edge. “I think this is mostly due to veterinary staff believing the patient to be stable and safe after turning off the anesthesia. However, the effects of anesthesia can be long lasting.”
Both Quandt and Edge said that patients need close monitoring while waking up and that special attention should be paid to pediatric and geriatric patients, patients with low body temperatures and those with unique anatomies, such as brachycepalic dogs.
2. Assign a qualified member of the veterinary staff to monitor patients recovering from anesthesia.
“Even a few minutes of unsupervised recovery may lead to major problems,” Edge said.
Quandt designates at least one technician whose sole responsibility is to monitor waking patients.
“The ideal option is to assign recovery nurses and do regular rounds on recovering patients,” she said. They should be checking vitals, oxygen levels, assessing pain levels and keeping in close communication with the attending veterinarian, Quandt added.
Edge said that the technician or nurse should also “be trained to recognize when the patient is ready for extubation.”
3. Designate a quiet area of the hospital in which anesthetic patients can recover peacefully.
“Recovering a patient in a quiet, low-light area with heating is imperative to a smooth recovery,” Edge said. “Abrupt noises and bright lights during recovery can be disturbing to a noise-sensitive recovery patient, and this may make their recovery rougher than necessary.”
Quandt agrees, adding that the same could be helpful during induction. “Having a quiet area with friendly people will help relieve the stress of the animal.”
4. Tailor anesthetic protocols to each patient, including pre-medication and pain management.
“While assessing the individual needs, an anesthetist may note that a patient is especially anxious and may add an appropriate pre-med to address this need,” Edge said. “Another patient with a calmer demeanor may not have the same needs.”
Quandt is a proponent of pre-medicating her patients going under anesthesia. “I prefer to pre-med patients even if the techs are skilled enough to place IV catheters in awake animals,” she said.
“I think pre-meds make the situation less scary for the animal, and you have analgesia on board that can make recovery smoother. [Pre-meds] will also decrease the amount of induction drug you need.”
5. Have the right tools and equipment for monitoring.
A good stethoscope is probably the most obvious, but shouldn’t be overlooked. In addition, Quandt and Edge agree that a means for measuring blood pressure is a must.
“A Doppler can provide very good information during an anesthetic procedure,” said Edge. “Adjustments to anesthetic depth and rate/type of fluid administration can be based on blood pressure measurements.”
Empower Your Staff With Training
Abbott Animal Health of Abbott Park Ill., offers a series of continuing education programs on anesthesia at www.AbbottAnimalHealthCE.com.
“For every 30 minute video presentation watched, the participant receives one hour of RACE approved credit,” said Daniel K. Edge, DVM, MBA, veterinary liaison manager for Abbott Animal Health.
Quandt also noted that while there are other machines—including a Dinamap made by GE Healthcare—that monitor blood pressure, she prefers to use a Doppler, even though it can be cumbersome to attach and keep in place.
Pulse oximetry is also at the top of both veterinarians’ lists.
“Pulse oximetry gives you a heads up if [a patient is] having trouble oxygenating before anesthesia, so you’ll know they may have trouble during anesthesia, also,” Quandt said. “Newer pulse oximeters can measure CO2 and tell you how well a patient is ventilating.”
Other equipment suggestions include those that help maintain patients’ body temperatures.
“Even very short procedures under anesthesia can lead to significant decreases in core body temperature, which can in turn prolong the recovery period,” said Edge.
“A proper heating support system will help prevent the unnecessary hypothermia typically encountered during anesthetic procedures.” He suggests a forced-air heating system, such as a Bair Hugger.
Quandt would also like to see every hospital have a plan for administering emergency oxygen to a recovering patient, especially if the patient is in a recovery area away from the main anesthesia machine. She suggests having a secondary or portable anesthetic machine that can be easily transported to different areas of the clinic, as well as an oxygen cage.
6. Keep accurate anesthesia records for the medical records, said Edge.
“Beyond the legal need of these documents, the staff can use them as case studies during training of new employees or refresher topics for existing staff,” he said. “The experiences gained from a case study can be used to help improve the skills and situational awareness for future anesthetic procedures.”
Want more tips for making anesthesia safer? Click here to read Dr. Phil Zeltzman's two part column on the subject.