Improved standards of anesthetic care and patient safety (Proceedings)


Improved standards of anesthetic care and patient safety (Proceedings)

Apr 01, 2009

Anesthetic care of veterinary patients has not gotten easier over the years. Really, has any part of medical care become "easier"? It is clear, however, that anesthesia has become better and safer. Better and safer, in that we are now able to provide successful anesthetic management for patients who would not have had a reasonable chance a few years ago. In many cases, these are even managed as "out-patients", quickly returned to their owners in rather full recovery. Our choice of anesthetic drugs has greatly expanded and safer anesthetic agents are indeed responsible for much of the improvement noted. More sophistication in monitoring, and the use of better monitoring and physiologic support has become widespread, with continued rapid growth apparent in this area. In spite of the fact that veterinarians now have sicker patients; presented with concurrent diseases, injuries, or debilitation, and the increased expectations of their owners, we increasingly can manage them successfully with these improvements in anesthesia and related perioperative care.

Better training and ongoing training

This collection of articles on veterinary anesthesia helps to provide an update on current and developing methods. Continuing education seminars and numerous other contemporary publications attempt to further these same goals. The education of veterinarians and veterinary technicians now includes rather extensive attention to anesthesia and related topics. Veterinarians with advanced training in anesthesia and board certification by the American College of Veterinary Anesthesiologists are now involved in the training of new veterinary students at most all North American colleges of veterinary medicine. Through the North American Veterinary Technician Association, licensed veterinary technicians may now pursue certification to recognize advanced training and skills in veterinary anesthesia as members of the Academy of Veterinary Technician Anesthetists.

Monitoring and attention to detail

In addition to veterinarians, well-trained technicians continuously evaluate the patient through anesthesia. Awareness of the ever-changing condition of the anesthetized patient is a shared responsibility that can only be shared effectively and safely when the medical team works together. We intend to remain aware of even subtle changes in patient status under anesthesia. And we must always recognize that challenges to the welfare of our patients come not only from their underlying illness or injury, but also as undesired side effects that even the best anesthetic care may present.

Modern monitoring equipment is increasingly available at reasonable cost for veterinary use. We no longer need to rely upon out of date, poorly serviced, unsafe, and inappropriate equipment that has been discarded from human patient use. Fortunately, however, there is good quality equipment still available from the human patient market. Increasingly, that equipment now can be found with good warranty protection, currently serviced and, importantly, with design and function capabilities well suited to veterinary patient needs. There is also good quality equipment available specifically for the veterinary patient. Medical equipment sold exclusively for veterinary use does not receive the degree of oversight and approval required for human-use equipment. In spite of this, there is very good veterinary-specific medical equipment. The demands of veterinarians, and of the animal owners, for improved anesthetic delivery, monitoring, and support has fueled the growth of this industry.

No longer is the application of relatively advanced monitoring equipment and anesthesia machines limited to academic institutions or referral practices with heavy surgical caseloads. Monitoring of electrocardiogram, temperature, blood pressure and pulse oximetry are rapidly becoming more routine, even in general veterinary practices. Airway monitoring of carbon dioxide and anesthetic gases in the breathing circuit is also becoming more popular. Proper use of these technologies requires a good working knowledge of the normal values, the significance of deviations, and an understanding of appropriate management options.

New options in anesthetics

The recent introduction of several new injectable anesthetics, most popularly propofol, has greatly improved our options. Great anesthetic safety is possible for some of our higher risk patients, through the use of some of the other newly available injectable anesthetics. Isoflurane has become the strongly predominant inhalant anesthetic. The more newly available inhalant, sevoflurane, can be used to provide for a remarkably rapid, and yet smooth, induction and recovery from anesthesia. Appropriate use of these new agents requires skill and knowledge and will be addressed more fully. All anesthetics have a limited therapeutic index, or margin of safety. All can depress vital functions and inappropriate use can result in loss of life. It is useful to remember the old guideline: "There are no safe anesthetics, just safe anesthetists!"

While we recognize a wealth of new options and opportunities in veterinary anesthesia, we must make changes in our anesthetic strategies carefully, recognizing that experience is necessary so that we can recognize any abnormal responses from those that should be expected. Careful and conservative use of any new anesthetic or technique is crucial.

"Nobody likes an adventurous anesthetist!"