What to expect with the updates to ACVAA's small animal anesthesia and sedation monitoring guidelines for 2025

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The American College of Veterinary Anesthesia and Analgesia (ACVAA) small animal anesthesia and sedation monitoring guidelines were last published in 2009. With 2025 comes updated guidelines, and Lydia Love, DVM, DACVAA, shares what that means for practitioners. The guidelines incorporate advancements in monitoring technology and provide a tiered approach to perioperative care across various clinical settings. Love discusses the rationale behind these changes, challenges in implementation, and their potential to enhance patient safety in veterinary practice.

dvm360: Can you introduce yourself and tell us a bit about your background?

Love: "I’m Lydia Love. I have served as a veterinary anesthesiologist for 15 years. Prior to my residency, I gained extensive experience across multiple areas of veterinary medicine—from high‐volume spay/neuter procedures with the Humane Society United States in the Appalachian region to small animal and emergency care in Memphis. My husband, a former large animal veterinarian now specializing in spay/neuter procedures, further broadened my exposure to the field. For the past 6 years, I have also held the position of clinical associate professor of veterinary anesthesia and analgesia at NC State."

dvm360: What prompted the need for revising the 2009 guidelines, and what key changes can practices expect in the 2025 update?

Love: "First, it is important to emphasize that these guidelines serve as recommendations rather than strict rules, acknowledging that each practice and clinical situation is unique. The original ACBA small animal monitoring guidelines were introduced in 1995, updated in 2009, and now, nearly two decades later, significant advances in technology and a refined understanding of safe anesthesia management necessitate an update.

In the 2025 revision, we have introduced a tiered approach comprising minimum, alternate, and advanced recommendations. For instance, in the cardiovascular monitoring section, oscillometric blood pressure monitoring is designated as the minimum standard; however, in the absence of this technology, Doppler blood pressure monitoring is suggested as an alternative. Additionally, every section now consistently underscores the need for a dedicated, knowledgeable individual to actively monitor the patient, as relying solely on automated monitors is insufficient. New sections have also been added on monitoring the depth of anesthesia, along with quick-reference charts for neuromuscular blockade monitoring and sedation levels to assist practitioners in promptly recognizing and responding to changes in patient status."

dvm360: The guidelines mention minimum, alternate, and advanced recommendations. Were these levels designed with access to care in mind, considering potential cost limitations in various practice settings?

Love: "Absolutely. The development of these tiered recommendations was driven by the need to accommodate a wide spectrum of practice environments. Our minimum recommendations are based on both the literature and our extensive clinical experience, ensuring essential safety standards. We recognize that resource availability varies widely, whether in shelter medicine, under-resourced areas, or academic institutions. Our goal was to create guidelines that are broadly applicable while still enhancing the standard of peri-anesthetic care."

dvm360: What challenges might veterinarians and veterinary technicians face in adopting these new guidelines? Do they need to re-train or abandon previous methods?

Love:"Challenges primarily include equipment availability and the requisite training. Many practices have transitioned from purchasing individual instruments to investing in multi-parameter monitors that integrate various recommended monitoring modalities. However, not every practice has access to these modern systems; hence, we have provided alternate recommendations. Training is equally critical. The individual responsible for patient monitoring must be thoroughly trained to interpret each parameter and intervene appropriately. While some indicators, such as low SpO₂, are straightforward, others—such as capnography—provide complex data about ventilation, pulmonary perfusion, and equipment integrity. In situations such as CPR, capnography is arguably the most valuable monitor. Therefore, ensuring that practitioners are well-versed in the nuances of these monitors through appropriate training is essential."

dvm360: When updating these guidelines, how did you balance evidence-based criteria with expert consensus? Has new research or a shift in clinical thinking influenced the revisions?

Love: "In veterinary medicine, data on perioperative care and outcomes is relatively limited. For example, while pulse oximetry has been associated with reduced mortality, much of our supporting data originates from older human studies. Consequently, many of our recommendations are extrapolated from human studies and our collective clinical experience. We sought input from experts across organizations such as NAVIS, ABTA, and the ACBA, and engaged in focused discussion groups over nearly two years. Looking ahead, we may adopt a modified Delphi model and a more structured literature review using a PICO framework to further refine and systematically grade the evidence for future revisions, potentially in 2035."

dvm360: When will these revised guidelines be available to the public?

Love: "They are currently available as a preprint in Veterinary Anesthesia and Analgesia articles in press. Although the final formatted version is forthcoming, the preprint is open access."

dvm360: Is there anything else you would like to add regarding the updates, particularly concerning monitoring during recovery?

Love: "Yes. One critical update is the enhanced detail provided on patient monitoring during recovery. Approximately 50% of veterinary anesthesia-related fatalities occur within the first 3 hours of recovery—a period during which monitors are frequently turned off as the patient is transferred back to its recovery area. We emphasize the physiological vulnerability during this phase and the necessity for continued monitoring. Additionally, I am particularly enthusiastic about the incorporation of strategies designed to facilitate adherence to best practices while minimizing the likelihood of errors. Recognizing that high cognitive load and stressful conditions can lead to mistakes, the guidelines now advocate for the use of cognitive aids, such as checklists for equipment setup and standardized safety protocols, to promote consistent communication and a shared understanding among the team. These measures are intended to preempt errors before they escalate into critical issues."