Updated: Mar 31, 2019
Years ago, I began asking technicians, students, and interns how they “felt” about anesthesia when I was training them. Over time I found when most veterinary professionals hear the word anesthesia, it conjures up one of two feelings: anxiety or interest. When I asked further why some felt anxious their replies were similar:
"I just don’t know that much about it”, or “I am afraid to kill the patient” were frequent comments.
These answers were so common I began to wonder if every clinic was full of technicians silently screaming inside every time they induced a patient! I have always believed that you should never feel too comfortable doing anesthesia - after all, anything can happen. But I would like everyone who does it daily to feel confident in their skills, knowledge, and abilities.
My big question is how do we as technicians move past this fear of anesthesia? How do we provide better quality anesthesia care for our patients (who many of us are afraid to anesthetize because we love them like our own). My answer to these questions involves many steps, but I promise these are tips and tricks you can start using right away😊
KNOW YOUR DRUGS!!
One of the essentials ways to provide anesthesia care is to be familiar with all the anesthetic agents, drugs, and fluids you are administering to your patients. If you are giving ketamine, can you tell me the dosage, concentration, and type of drug it is? What about possible side effects and other drugs it may interact with? I NEVER GIVE A DRUG WITHOUT KNOWING THESE THINGS. As the person giving these medications then monitoring the effect, it is so important to know this information. Now, I am not asking you to read all of Plumb’s drug formulary (I did, I admit it, and it’s a real snooze fest) but do be familiar with the drugs you use frequently.
KNOW NORMAL PARAMETERS
I cannot stress enough how important it is to know what normal physiologic parameters are for your patient. If you do not know what normal blood pressure, HR, RR, temperature, and carbon dioxide concentrations are, it will be impossible for you to properly watch your patient and ensure they stay within these parameters while under your care. Remember these vary by age and species. Having a hard time remembering? Hang up a chart in the OR, prep area, right on the anesthesia machine. Also, know what changes in these parameters are expected, acceptable, and unacceptable.
KNOW YOUR EQUIPMENT
As the person anesthetizing or heavily sedating your patient you should always know everything you can about every piece of equipment you will touch or attach to your patient. After all, how can you properly use something if you do not know everything about it? What oxygen flow rate will you use and why? How does the scavenging system at your practice work? What advantages and disadvantages do the different types of endotracheal tubes offer? How will you safely keep your patient warm?
BE PREPARED FOR EMERGENCIES
A good anesthetist thinks about potential emergencies, a GREAT anesthetist PREPARES for them! When dealing with healthy patients this may be nothing more than having all your emergency drugs calculated out ahead of time, checking available stock, and ensuring syringes are handy. For critical patients, this may could include things like crossmatching and checking blood supplies, placing central lines and arterial catheters, and calculating norepinephrine infusions, in addition to the routine basic preparation. Preparedness care made the difference in life and death in some situations!
HAVE YOUR CHECKLIST READY
Few things are more important for safety than checklists. Anesthesia and surgery are essential places for checklists. I personally have an anesthesia checklist and the surgery department has another that has some overlap. We could discuss this at length, but a near future blog will focus on Anesthesia and Surgical Safety Checklists. There are lots of benefits to using checklists, including improvement in communication amongst team members and reduction in errors. For some people, few things quell anxiety quite like a checklist.
PAY ATTENTION TO YOUR PATIENT FIRST, THE MONITOR SECOND
Anesthetic multiparameter monitors are an essential part of how we care for our patients. Objective physiologic information can give us an early warning that the patient’s homeostasis is imperiled.
Always remember, however, that the monitors are part of a larger clinical picture. Never rely only on the monitor. Keep your hands, eyes, and ears on the patient at all times. If something does not make sense to you, investigate it! The ACVAA has guidelines for monitoring small animal patients here: http://www.acvaa.org/;
AVA guidelines are here: https://ava.eu.com/resources/anaesthesia-guidelines/
and the ASAV has published guidelines here: https://onlinelibrary.wiley.com/doi/full/10.1111/avj.12762
MAKE A MANAGEMENT PLAN FROM PREMED TO RECOVERY
When making your anesthetic plan, in addition to calculating all the preanesthetic and induction drugs, be sure to have a post procedural plan. Have plans in place for a routine and not so routine recovery so you know exactly what to have nearby. Will your patient need continued heat support in recovery? How about oxygen supplementation? Who will watch the patient, and will objective monitoring continue? Is your patient at risk of a failed intubation and need a special plan to maintain airway patency? How will pain be assessed and managed?
STEP UP YOUR SKILLS GAME
Technical skills are a big part of performing anesthesia. Being able to get a catheter in very small patients and intubate a kitten with ease is something that does come with time. There are some great labs you can attend at regional and national conferences to really help you step up your game!
What I want every technician to take away from this is that EVERY ONE of you can provide high quality anesthesia care for your patients. You may not have the fancy equipment you want, or all the drugs of your dreams. But you can do all the above-mentioned things to be the most confident anesthetist out there.