Colleges, private practice show disparity in anesthesia methods

Private practitioners favor less anesthetic drugs, perform more outpatient procedures and rarely check blood pressure in anesthetized animals compared to their public university counterparts.

A Colorado State University-commissioned survey of regional small animal practitioners was designed to enhance academic faculty's understanding of the anesthetic techniques employed in private practice.

Those are the findings of a study conducted by Colorado State University faculty and published in the Autumn 2002 edition of the Journal of Veterinary Medical Education.

Two anesthesia faculty members sat down with 20 Colorado-based small animal veterinary practices, drilling veterinarians and technical staff on their use of anesthesia for the study, "Observations of Private Veterinary Practices in Colorado, with an Emphasis on Anesthesia."

Drug overload

Despite widespread access to an array of anesthetic drugs, private practitioners, at least those surveyed, tend to revert to old stand-bys traditionally.

"The biggest difference for us (in the findings) was ... the difference between what private practitioners do and what we tend to do in a teaching veterinary hospital where we have access to a whole variety of anesthetic drugs for specific situations," says Dr. Ann E. Wagner, co-author and professor at CSU.

"What we found was practitioners tend to get very comfortable with one or very few drug protocols, use those very routinely and get very accustomed to them. We in the academic world tend to select different drugs for a wide variety of different patients," she says.

Use of few anesthetic drugs can be attributed to economic factors, the unfeasibility of stocking little-used drugs that will most likely expire before use as well as the familiarity of drugs shown to be effective.

Background

Although the findings were recently released, the genesis of the project dates to 1998, when Wagner and co-author Dr. Peter Hellyer, also of CSU, sent questionnaires to members of the Colorado Veterinary Medical Association, receiving 300 responses. Practitioners were questioned on the types of procedures conducted, what drugs they used, and how they managed patients during anesthesia.

The study was conducted in part "to provide academic faculty a better understanding of the anesthetic techniques used by veterinarians in private practice, in order to enhance their teaching of anesthesiology to veterinary students," the study authors report.

At the end of the survey veterinarians were asked if they would be willing to have CSU conduct a follow-up practice visit. CSU selected 20 from the affirmative responses based on convenience and proximity to the college, and interviewed them.

Indirect bonus

Although the study was designed with academia in mind, Wagner says private practitioners may have benefitted from the chance to visit with a trained anesthesiologist discussing how they used anesthesia and new options available.

"We did provide some continuing education, so to speak," says Wagner. "(But) we didn't really promote it in that way."

The research, instead, enabled CSU to get a leg up on what students and faculty should know about private practice's use of anesthesia prior to graduation.

Less is more

Based on results indicating that practitioners stick to a bare minimum in anesthesia drugs, Wagner decided to test the finding in the classroom.

"One of the exercises I give the senior students is that I give them five drugs and have them tell me how they'd use those five drugs to anesthetize a wide variety (of animals) from the dog having a gastric dilatation volvulus to a cat that's in for a dystocia C-section," says Wagner.

"Students find that daunting because they think you have to have all these different drugs and then they realize that it's really not the drugs that are safe but it's the anesthetist knowing how to use them that makes it safe for the patient."

Other findings

The study found that many practitioners did not routinely hospitalize animals undergoing routine procedures, such as castration or dentistry, but did often hospitalize patients for orthopedic procedures and major abdominal surgery.

Ketamine and isoflurane, according to study findings, are by far the most popular anesthetic drugs used in private veterinary practice in Colorado.

When practitioners were surveyed on their approach to anesthetizing patients, 90 percent chose, "I have incorporated new drugs, methods or techniques for anesthesia as I learn about them," while only 10 percent said "I anesthetize animals the way I was taught in vet school." When asked where they learned about new drug offerings, 71 percent mentioned continuing education, with other sources being journals, other practitioners, sales representatives and even one practitioner who cited, "trial and error on my own."

Authors noted that the standard of anesthetic care could be more improved by more widespread use of perioperative IV fluid administration and pain management, as well as by blood pressure monitoring.

"We found that very few practitioners monitor blood pressure during anesthesia, which most of our students realize early on in their anesthesia training is really important because they are all anesthetizing seemingly normal healthy animals that have low blood pressure during anesthesia, (which enables them to) realize that they have a problem. A lot of practitioners probably don't realize it's a problem," says Wagner.

Questions remain

Wagner and Hellyer concluded in their research that techniques of anesthesia and monitoring used in private veterinary practice are often unlike those used in large university teaching hospitals. They also concede that the way the practitioners were selected for the study may not be entirely representative of small animal veterinary practice nationwide.

The authors suggest their study participants are a "progressive group" confirmed by their willingness to incorporate new drugs and methodology into practice.

Wagner declined to name any of the practitioners interviewed for the study, due to university policy.