Abstract

• Risks associated with anesthesia can lead to complications or death.

• Implementation of guidelines, checklists, and training can help reduce anesthesia-related adverse events.

• The surgical process should be viewed as a continuum of care, starting from the patient’s home to hospitalization and back.

• Key components include staff training, client communication, perioperative analgesia, and safe handling of fractious patients.

• Detailed information on anesthesia equipment selection and maintenance is covered in these guidelines.

• Goal: Enhance the safety and efficacy of anesthesia care for dogs and cats.

Introduction

• "No safe anesthetic agents; only safe anesthetists" encapsulates the philosophy of anesthesia.

• The anesthesia team is responsible for identifying patient issues and minimizing preoperative pain and stress.

• Anesthesia is a continuum that begins before leaving home and ends upon patient's return home post-anesthesia.

• Phases of anesthesia:

  • Preanesthesia: evaluation and stabilization of patients, preparation, and drug selection.

  • Induction: intubation and monitoring.

  • Maintenance: ongoing support during surgery.

  • Recovery: communication with owners about care and analgesia.

Phase 1: Preanesthesia

Individualized Anesthetic Plan

• An anesthetic plan provides a structured approach to care during all anesthesia phases.

• The preanesthetic evaluation involves:

  • History: Identifying risk factors (medical history, adverse drug responses).

  • Physical examination: Necessary to detect abnormalities.

  • Patient’s Age: Physiologic changes occur with age; neonates and geriatrics have increased risk.

  • Breed/Size Considerations: Specific breeds may have unique anesthetic sensitivities.

  • Temperament: Fear or aggression might necessitate premedication.

  • Diagnostics: Minimum database analysis for patient-specific information.

Preanesthetic Evaluation Details

• ASA Patient Status Scale provides criteria for evaluation:

  • ASA 1-2 indicates minimal risk.

  • ASA 3-4 significantly increases risk of anesthesia-related death.

• Patient stabilization may be needed based on health status and surgical risks.

• Use of an anesthesia checklist can help organize preoperative procedures and prevent oversights.

Phase 2: Day of Anesthesia

Client Communication/Education

• Communication with pet owners is critical to mitigate their concerns about anesthesia risks.

• Discuss anesthetic procedures, risks, and establish a specific plan for the patient.

• The perceived risk of anesthetic-related deaths is low (0.05% in dogs; 0.11% in cats).

Anesthesia Begins at Home

• Owners should fast pets and administer pre-anesthetic medications as directed.

• Anxiolytics for anxious or aggressive pets should be given to ease stress during transport.

Equipment Preparation

• Ensure all equipment and monitors are functional and properly checked before administering anesthesia.

• Safety checks on equipment, including manometers and pop-off valves, are essential for patient safety.

• Equipment setup checklists and leak tests must be performed regularly prior to anesthesia.

Phase 3: Anesthesia Protocol

Pain Management

• Effective pain management is vital through the anesthesia continuum:

  • Use multimodal analgesia involving NSAIDs, opioids, and local anesthetics to minimize pain and adverse drug reactions.

  • Preemptive analgesia improves outcomes.

Anesthetic Induction and Maintenance

• Anesthetic induction typically uses IV drugs for rapid airway control.

• Proper intubation technique is crucial for airway management, using appropriately sized endotracheal tubes.

• Monitoring must include vital signs and making adjustments based on the patient’s condition during anesthesia.

Recovery and Postoperative Care

• Postoperative monitoring is critical as most anesthesia-related deaths occur in recovery.

• Care includes monitoring HR, RR, SpO2, and ensuring recovery is optimal.

• Extubation should occur when the patient can maintain airway protection and meet vital sign thresholds.

Final Considerations

• Staff education affects patient safety and risk management in anesthesia.

• Adequate training ensures staff is prepared for common challenges and emergencies.

• The continuity of communication and education between the veterinary team and clients is paramount in delivering quality care and support.

Conclusion

• Anesthesia is not merely a process of unconsciousness but requires a strategic and compassionate approach from home to recovery.

• Ongoing training and clear guidelines play crucial roles in enhancing patient and staff safety.