Leading Off: Be aware of the new anesthesia guidelines for dogs and cats

Prompted by the variety of anesthetic and analgesic drugs, patient monitoring equipment, and local and regional differences in anesthesia practice, the American Animal Hospital Association (AAHA) convened a task force in January 2011 to develop anesthesia guidelines for dogs and cats. The guidelines were published in the November 2011 Journal of the American Animal Hospital Association (download a PDF). As stated in the guidelines, "In recognition of differences among practices, these guidelines are not meant to establish a universal anesthetic plan or legal standard." Rather, they are intended to provide a framework for the delivery of safe and effective anesthesia and perianesthetic pain management.

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THE ANESTHETIC PLAN

Today it is not sufficient to define "good" anesthesia simply as that which does not result in patient morbidity and mortality. Providing appropriate patient comfort, sedation, and analgesia and minimizing the stress response associated with surgery and anesthesia define modern anesthesia. The emphasis should be on developing a comprehensive anesthetic plan for each individual based on that patient's physical status and signalment, the reason for anesthesia and analgesia, and the animal's temperament. Physical status is determined from a comprehensive preanesthetic physical examination and review of pertinent laboratory data.

No one anesthetic plan is suitable for all dogs and cats. A good plan includes appropriate drug selection, the need for the amount and type of perioperative fluids, an approach to patient monitoring, and support of patient homeostasis. Currently, a multidrug approach is preferred for general anesthesia. The key components of general anesthesia—unconsciousness, analgesia, muscle relaxation, and amnesia—are best met by choosing drugs from several pharmacologic categories: sedatives and tranquilizers, hypnotics, opioids, inhalants, and local anesthetics can be used in combination. Analgesic adjuncts including local anesthetic nerve blocks, epidural analgesia, and analgesic infusions should be considered where appropriate.

THE MONITORING PLAN

The most important aspect of safe anesthesia is patient monitoring. The American College of Veterinary Anesthesiologists (ACVA) developed a set of monitoring guidelines that emphasize its importance, which can be found at acva.org. A comprehensive monitoring plan includes determining at regular intervals adequate circulation, ventilation, oxygenation, and body temperature. A trained observant and focused individual who understands the clinical pharmacology and the patient adaptation to anesthetic drugs should be present with the patient. This person must be able to determine normal vs. abnormal response to surgery and anesthesia.

Untoward reaction to anesthetic drugs, blood loss, cardiac rhythm disturbances, inappropriate anesthetic depth, and inadequate analgesia need to be recognized early because recognition and rapid intervention are the keys to preventing irreversible changes. Regular palpation of a peripheral pulse, observation of mucous membrane color, and observation of patient ventilation are the minimum monitoring requirements.

Consideration should be given to obtaining and learning how to use modern anesthetic monitoring devices. These devices greatly enhance the ability to discern the unexpected. Modern anesthetic monitors can be configured for capnometry, electrocardiography, blood pressure, pulse oximetry, and body temperature to optimize the monitoring of cardiovascular and respiratory function. Monitoring should continue well into the recovery period at regular intervals until the patient is awake, warm, and comfortable.

CONTINUING YOUR EDUCATION

The measures outlined in the AAHA Anesthesia Guidelines for Dogs and Cats are a good step toward safe anesthetic procedures in all pets. For further guidance, numerous continuing education opportunities in anesthesia are available at local, regional, and national meetings. Anytime a question arises regarding any aspect of anesthesia, you should contact an ACVA diplomate. Contact the anesthesiologist at your alma mater, or refer to acva.org for a list of ACVA consultants.

Dr. Richard Bednarski, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, was the chair of the anesthesia guidelines task force.