How Do We Prepare Animals For Anaesthesia?

Question 1

What does the pre-operative assessment involve and when is it performed and what influences questions and exam?

Answer 1

Taking a full history.
Questions for the owner.
Previous drugs / anaesthetics?
Considerations for the breed/species of patient.
Confirming pre-op fasting times.
MUST be performed before administration of med / premed.
The procedure taking place will influence to question and the exam.

Question 2

What is involved in the pre-operative clinical exam?

Answer 2

Full CE.
Check history.
Start from a distance – temperament.
MM/CRT.
Thoracic auscultation.
Check for heart murmurs.
Check pulse rate and quality
Ventilatory rate.
Temperature.
Swellings / distension.
Record findings.
Any concerns from the owner.

Question 3

ASA classification…
1. ASA I.
2. ASA II.
3. ASA III.
4. ASA IV.
5 ASA V.
6. What does E denote?

Answer 3

1. Normal healthy animal.
2. Mild systemic disease, compensating well.
3. Severe systemic disease, not compensating.
4. Severe uncompensated systemic disease that is a constant threat to life.
5. A moribund patient, unlikely to survive 24 hours.
6. Emergency.

Question 4

Why do we use ASA classification?

Answer 4

Helps identify those at-risk vs those at lower risk.
Helps increase patient safety.
Does not take much time to do.
Expected to be able to do this when in rotation/placements.

Question 5

What is the goal of pre-operative fasting?

Answer 5

To reduce volume of stomach contents.
To prevent GOR / regurgitation and aspiration.

Question 6

What does the evidence say about pre-operative fasting?

Answer 6

Prolonged starvation may actually cause increased GOR.
In cats, stress, meal size and lack of dietary moisture can slow gastric emptying.
Feeding a small canned food 3hrs pre-operatively reduced incidence of GOR.

Question 7

What should we do in terms of pre-operative fasting?

Answer 7

Species-dependent.
Cats approx 6-8hrs.
Dogs 8-10hrs.
Wet food may be better than dry food.
Rabbits / small furries are not to be starved but may be worth withholding food for 30 mins pre-operatively (to remove hay / food within oral cavity that could be pushed into the airways / inhaled).

Question 8

Informed consent.

Answer 8

Crucial step in anaesthesia planning.
Content may vary.
Legal document.
Must be filed away / stored on patient record.
MUST ensure that the owner understands what has been signed.
Gain consent in a quiet and private area! GDPR!
Give copy of consent form.

Question 9

Communication.

Answer 9

Give realistic time frames for communications and stick to it!
Utilise your team / text service / email.
Keep communication open!
Listen!
Have privacy and space!

Question 10

What should I understand about consent?

Answer 10

• What is the meaning of informed and what is the meaning of consent.
• Why is it important.
• How is informed consent gained in general practice.
• What should be included on an informed consent form.
• What are the legalities / consequences of not gaining informed consent.

Question 11

1. Who launched the safety checklist and when?
2. When was the safety checklist mandated for use in the NHS?
3. How much did studies show that risk of death was reduced by?

Answer 11

1. WHO in 2008.
2. 2009.
3. By as much as a third.

Question 12

What are the 3 sections of the surgical safety checklist (human)?

Answer 12

• Before induction of anaesthesia.
• Before skin incision.
• Before patient leave to operating room.

Question 13

What types of diagnostic testing could be carried out before anaesthesia?

Answer 13

• Bloods.
• Urine.
• Radiography.
• ECG.
• Echocardiology.
• Ultrasound.

Question 14

What is it important to have for anaesthesia and on rotations?

Answer 14

• Stethoscope.
• Notebook (w/ normal parameters).
• Pen.
• Thermometer.
• Calculator.
• ASA guidelines.
• Checklist.
• Watch with second hand / fob watch.
• Case exposure!