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VeterinaryAnesthesia: from the preanesthetic exam to the anesthetized patient
You anesthetize a female dog for an elective spay that another candidate performs. You have 100 minutes from the moment you get the dog to have her examined, premedicated, intubated, on inhalant and IV fluids, at a surgical plane and monitored; then you keep her there until the last skin suture. It is part 2 of the Anesthesia section of the ECFVG Clinical Proficiency Examination.
Free to startScenarios
- A female dog of at least 6 kg, body condition 2 to 4 out of 5, not pregnant or in heat, for an elective ovariohysterectomy; she goes home after recovery.
- A rebreathing or non-rebreathing system and an isoflurane or sevoflurane vaporizer, depending on the site, with a technician who helps only when you ask.
The steps
- Do the preanesthetic physical exam and record it on the Anesthesia Record: heart rate, respiratory rate, mucous membranes and capillary refill, temperature.
- Request the minimum lab tests, then record and interpret the results (PCV, TP, BUN).
- Assign the ASA physical status from 1 to 5 and adjust your doses if it is not 1, telling the examiner.
- Give the premedication IM or SC only after examining the dog, at a safe site away from the sciatic nerve and the stifle. Critical point
- Calculate the fresh gas flow for the breathing system you chose and explain the rate. Critical point
- Choose the breathing system and the reservoir bag.
- Assemble the anesthetic machine, connect or open the oxygen and attach the breathing system. Critical point
- Explain to the examiner how the machine and the breathing system are assembled and how each part works.
- Test the circuit for leaks in front of the examiner. Critical point
- Gather everything for the IV catheter and the intubation: catheter, endotracheal tube, laryngoscope, fluids and monitors.
- Place and secure the IV catheter with aseptic technique. Critical point
- Check the catheter and tell the examiner before giving the induction drug. Critical point
- Within 5 minutes of starting the induction: intubate, check the tube is in the trachea, inflate the cuff so it holds up to 20 cm H2O, secure the tube and connect it to the machine. Critical point
- Set the inhalant and the fresh gas flow, keep the pop-off valve open and check pulse and breathing within 3 minutes of intubation. Critical point
- Start the IV fluids aseptically with the right fluid and rate. Critical point
- Record your monitoring and call for the surgery candidate once every task is done, all within the 100 minutes. Critical point
- Place the ECG leads, the Doppler or oscillometric blood pressure monitor, the pulse oximeter, the thermometer and the capnograph without contaminating the surgical site.
- Move the patient to the surgery area under anesthesia.
- During the surgery, monitor the depth of anesthesia and adjust it. Critical point
- Keep the analgesia adequate through the surgery and the immediate recovery, reacting to signs of pain. Critical point
- Monitor and record heart and breathing every 5 to 10 minutes and correct any problem, such as low blood pressure, slow breathing or low temperature. Critical point
- Answer the examiner's questions about the values on the machine and the monitors for your patient.
- Fill in the Anesthesia Record in real time: complications and how you fixed them, fluid type, rate and total volume, and the recovery and analgesia instructions; then sign it.
- Handle the dog humanely the whole time. Critical point
- Give the technician clear instructions.
- Report any equipment you think is failing to the examiner at once; if it was not fixed and affected your exam, file the Anesthesia Equipment Incident Report at the end.
Safety rules that stop the station
- Giving premedication before examining the dog, or intending to give a potentially lethal overdose, is a fatal flaw.
- Gross breaks in asepsis with the IV catheter, such as putting the opened catheter on the table, are a fatal flaw.
- Repeated attempts to intubate a dog with active laryngeal reflexes, not finishing the intubation within 5 minutes, or a tube in the esophagus not corrected before the dog wakes or becomes hypoxic, are fatal flaws.
- Leaving the pop-off valve closed until it reads 25 cm H2O, oxygen so low the dog wakes or becomes hypoxic, inhalant so high it causes loss of pulses or apnea over 3 minutes, or not checking pulse and breathing within 3 minutes of intubation, are fatal flaws.
- Not responding when the dog wakes or bleeds heavily, not reacting to pain so the examiner must give analgesia, or a machine assembled so it cannot deliver gas safely, are fatal flaws.
- Not having the dog ready for surgery within 100 minutes means immediate dismissal and a fail for the section.
To pass
- Anesthesia is pass or fail: failing 1 MAJOR skill or any 4 MINOR skills fails the section, and a fatal flaw dismisses you with a fail.
- Ready in 100 minutes means intubated with the tube secured, inhalant on, a patent IV catheter with fluids running, a surgical plane and monitoring begun; monitors can go on after the limit.
- The assessment goes on through the ovariohysterectomy and ends at the last skin suture or right after; passing takes more than a dog that survives.
Official source
AVMA · ECFVG CPE
Manual of Administration for the Clinical Proficiency Examination
The AVMA publishes the CPE Manual of Administration free: every station, its assessment sheet and the score needed to pass.
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