Dr. DeForge follows the ACVA Guidelinesfor Monitoring anesthetized veterinary patients
The ACVA recognizes that it is possible to adequately monitor and manage anesthetized patients without specialized equipment and that some of these modalities may be impractical in certain clinical settings. Furthermore, the ACVA does not suggest that using any or all the modalities will ensure any specific patient outcome, or that failure to use them will result in poor outcome.However, as the standard of veterinary care advances and client expectations expand, revised guidelines are necessary to reflect the importance of vigilant monitoring. The goal of the ACVA guidelines is to improve the level of anesthesia care for veterinary patients. Frequent and continuous monitoring and recording of vital signs in the peri-anesthetic period by trained personnel and the intelligent use of various monitors are requirements for advancing the quality of anesthesia care of veterinary patients.
Objective: to ensure adequate circulatory function.
Methods:1)Palpation of peripheral pulse to determine rate, rhythm and quality, and evaluation of mucous membrane (MM) color and capillary refill time (CRT).
2)Auscultation of heart beat (stethoscope; esophageal stethoscope or other audible heart monitor). Continuous (audible heart or pulse monitor) or intermittent monitoring of the heart rate and rhythm.
3)Pulse oximetry to determine the % hemoglobin saturation.
4)Electrocardiogram (ECG) continuous display for detection of arrhythmias.
5)Blood pressure:a.Non-invasive (indirect): oscillometric method: Doppler ultrasonic flow detectorb.Invasive (direct): arterial catheter connected to an aneroid manometer or to a transducer and oscilloscope.
Recommendations: Continuous awareness of heart rate and rhythm during anesthesia, along with gross assessment of peripheral perfusion (pulse quality, mm color and CRT) are mandatory. Arterial blood pressure and ECG should also be monitored. There may be some situations where these may be temporarily impractical, e.g. movement of an anesthetized patient to a different area of the hospital.
Objective: to ensure adequate oxygenation of the patient’s arterial blood.
Methods:(1) Pulse oximetry (non-invasive estimation of hemoglobin saturation).
(2) Arterial blood gas analysis for oxygen partial pressure (PaO2).
Recommendations: Assessment of oxygenation should be done whenever possible by pulse oximetry, with blood gas analysis being employed when necessary for more critically ill patients.
Ventilation
Objective: to ensure that the patient’s ventilation is adequately maintained.
Methods:(1) Observation of thoracic wall movement or observation of breathing bag movement when thoracic wall movement cannot be assessed.
(2) Auscultation of breath sounds with an external stethoscope, an esophageal stethoscope, or an audible respiratory monitor.
(3) Capnography (end-expired CO2measurement).
(4) Arterial blood gas analysis for carbon dioxide partial pressure (PaCO2)
(5) Respirometry (tidal volumemeasurement).Recommendations:
Qualitative assessment of ventilation is essential as outlined in either 1 or 2 above, and capnography.