Subject: Anaesthesia

Week 1

Pre-anaesthetic Assessment and Patient Preparation for Anaesthesia

Patient preparation

ASA status and patient assessment

Use of checklists

Breathing systems and checks

What are the aims of anaesthetic premedication

Practical considerations

What agents are available

Learning objectives
After completion of this week, participants should be able to:

Correctly identify an appropriate breathing system and safe fresh gas flow rates for individual patients

Confidently check an anaesthesia machine and breathing system to ensure they are safe to use

Have an understanding of the ASA grading system and be able to designate and apply which status is appropriate for their individual patients

Identify the benefits of using a peri-anaesthetic checklist and decide whether this can be advocated for their working environment

List the reasons for patient premedication and be able to identify practical aspects and factors within the clinic which may affect the efficacy of premedication

Identify the most common pharmacological agents used for sedation and anaesthesia

Week 2

Anaesthetic Monitoring – Neurological and Respiratory System

Basic, hands on monitoring (neurological system)

Respiratory monitoring

Other

Learning objectives
After completion of this week, participants should be able to:

Recognise what are normal physiological parameters with regards to the neurological and respiratory systems for individual patients undergoing anaesthesia

Name the most common pieces of monitoring equipment for the respiratory system and be able to recognise what is a normal value/trace for each of these pieces

Start to develop the skills to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 3

Anaesthetic Monitoring – Cardiovascular System

Cardiovascular monitoring

Basic, hands on

Blood pressure

Pulse oximetry

ECG

Learning objectives
After completion of this week, participants should be able to:

Recognise what are normal physiological parameters with regards to the cardiovascular system for individual patients undergoing anaesthesia

Name the most common pieces of monitoring equipment for the cardiovascular system and be able to recognise what is a normal value/trace for each of these pieces

Start to develop the skills to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 4

Principles of Perioperative Care including Anaesthetic Recovery

Anaesthetic risk

Airway management including tracheal intubation

Patient positioning

Eye care

Temperature

Fluid therapy

Patient recovery

Learning objectives
After completion of this week, participants should be able to:

Identify important factors which require attention and care during a patient’s anaesthetic in order to optimise the patient’s peri-anaesthetic experience

Accurately calculate fluid rates for individual patients and apply this to their clinical setting, whether this be with use of fluid pumps/syringe drivers or via gravity (calculating a drop rate)

List available methods for patient warming, with recognition of the need to counteract patient hypothermia and the potential risks associated with warming device use

Recognise the critical importance of patient monitoring during anaesthetic recovery.

Describe the potential difficulties that may be encountered during the anaesthetic recovery period

Week 5

Pain Assessment

Importance of pain assessment and management

Challenges of pain assessment in veterinary species

Pain assessment tools

Learning objectives
After completion of this week, participants should be able to:

Recognise the potential difficulties in performing pain assessment in veterinary species.

Name a number of pain assessment tools

Advocate a pain assessment tool that would be suitable for their working environment

Recognise when patients (cats and dogs) are deemed to be painful

Week 6

Analgesia for Acute Perioperative Pain

A brief overview on the pain pathway with introduction to the concepts of multimodal and pre-emptive analgesia

Analgesic options, including:

 A brief overview of the pharmacological means

Non-pharmacological methods

Learning objectives
After completion of this week, participants should be able to:

Explain why provision of analgesia is important for patient welfare

Describe the concepts of multimodal and pre-emptive analgesia, with emphasis on why these are important for patient analgesia

Explain why provision of analgesia is important

List potential analgesic options and apply this knowledge to consider appropriate therapeutic plans for individual patients

Have an appreciation of the important role that a veterinary nurse can play in providing non-pharmacological methods of analgesia and improving the patient experience

Week 1

Principles of Anaesthetising Critical Patients

Anaesthetic risk in the compromised patient

The importance of patient history and physical examination

Diagnostic tests

Patient stabilisation

Anaesthetic protocol, monitoring and recovery

Learning objectives
After completion of this week, participants should be able to:

Understand why critical patients are at an increased anaesthesia and sedation risk

Understand that improving patient safety requires a holistic, overall management process, not simply using “the best drug protocol”.  This will include consideration of:

What pre-anaesthetic tests may be required and the benefit they offer

What pre-anaesthetic stabilisation may be required

Recall an introduction into the type of patient monitoring which is required during the peri-anaesthetic period

Understand general principles for appropriate anaesthetic drug protocols for the critical patient

Week 2

General Approach to Adverse Events and Introduction to Anaesthetic Complications

Near misses and adverse events

Minimising adverse events by preparation

Checklists and non-technical skills

Common anaesthetic complications

Learning objectives
After completion of this week, participants should be able to:

Name the three steps necessary for approaching adverse events and discuss why they are important, including methods in which near misses and adverse events can be minimised in practice

Understand the role of human factors in patient safety and the value of checklist use in anaesthetic practice

Give an overview of what anaesthetist non-technical skills (ANTS) are and be able to begin using them in clinical practice

Know the most common anaesthetic complications encountered in small animal practice

Week 3

Cardiovascular Complications

Alterations in heart rate:

Bradyarrhythmias

Tachyarrhythmias

Alterations in blood pressure:

Hypotension

Hypertension

Learning objectives
After completion of this week, participants should be able to:

Recognise abnormal physiological parameters with regards to the cardiovascular system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in heart rate (bradyarrhythmias and tachyarrhythmias) during general anaesthesia

List some main treatments for the most common arrhythmias which present under general anaesthesia

Understand the most common underlying causes for alterations in blood pressure (hypotension and hypertension) during general anaesthesia

List some main treatments for the most common blood pressure alterations which present under general anaesthesia

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 4

Respiratory Complications

Alterations in ventilation:

Hypoventilation

Hyperventilation (including tachypnoea)

Apnoea or respiratory arrest

Hypoxaemia

Respiratory obstruction:

Upper respiratory tract

Lower respiratory tract

Restrictive pulmonary disease

Aspiration (and regurgitation)

Learning objectives
After completion of this week, participants should be able to:

Recognise what are abnormal physiological parameters with regards to the respiratory system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in ventilation, including hypo- and hyperventilation, apnoea and respiratory arrest

List the main treatments for the most common changes in ventilation under anaesthesia.

Understand the difference between hypoxaemia and hypoxia, listing the potential causes for these and therefore be able to suggest methods to manage these conditions

Recognise the clinical signs of respiratory obstruction and restrictive pulmonary disease and describe what steps could be taken to alleviate the underlying problem

State why aspiration is a risk under anaesthesia and how to manage a case of gastro-oesophageal reflux in order to minimise patient risk

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 5

‘Other’ Complications

Central nervous system:

Emergence delirium

Post anaesthetic blindness and deafness

Thermoregulation:

Hypothermia

Hyperthermia

Anaphylactic and anaphylactoid reactions

Embolism

Learning objectives
After completion of this week, participants should be able to:

Outline why cats are at particular risk for post anaesthetic blindness and deafness and describe methods which can minimise this risk

List available methods for patient warming, with recognition of the need to counteract patient hypothermia and the potential risks associated with warming device use

List risk factors associated with peri-operative hyperthermia and discuss steps which can be implemented to manage the hyperthermic patient

Recognise if an anaphylactic or anaphylactoid reaction is occurring and be able to suggest steps to manage the situation

Understand that embolisms are a rare, but potential complication during anaesthesia and be able to list the clinical signs associated with their occurrence

Week 6

Cardiopulmonary Resuscitation

Detecting cardiopulmonary arrest

Basic life support:

Chest compressions

Tracheal intubation

Ventilation

Advanced life support

Drug therapy

Oxygen supplementation

Intravenous fluid therapy

Correction of electrolyte and metabolic disturbances

Defibrillation

Monitoring during CPR

Post cardiac arrest care

Learning objectives
After completion of this week, participants should be able to:

Explain the purpose of cardiopulmonary resuscitation and describe its two main components

Recognise when cardiopulmonary resuscitation should be instigated

Understand the importance of regular CPR training within the practice team

Describe and demonstrate the method for effective chest compressions, tracheal intubation and ventilation during cardiopulmonary resuscitation

List what steps can be taken to provide advanced life support during cardiopulmonary resuscitation

Know what monitoring tools are recommended for cardiopulmonary resuscitation and be able to interpret the main waveforms that will be seen during a resuscitation event

Week 1

Pre-anaesthetic Assessment and Patient Preparation for Anaesthesia

Patient preparation

ASA status and patient assessment

Use of checklists

Breathing systems and checks

What are the aims of anaesthetic premedication

Practical considerations

What agents are available

Learning objectives
After completion of this week, participants should be able to:

Correctly identify an appropriate breathing system and safe fresh gas flow rates for individual patients

Confidently check an anaesthesia machine and breathing system to ensure they are safe to use

Have an understanding of the ASA grading system and be able to designate and apply which status is appropriate for their individual patients

Identify the benefits of using a peri-anaesthetic checklist and decide whether this can be advocated for their working environment

List the reasons for patient premedication and be able to identify practical aspects and factors within the clinic which may affect the efficacy of premedication

Identify the most common pharmacological agents used for sedation and anaesthesia

Week 2

Anaesthetic Monitoring – Neurological and Respiratory System

Basic, hands on monitoring (neurological system)

Respiratory monitoring

Other

Learning objectives
After completion of this week, participants should be able to:

Recognise what are normal physiological parameters with regards to the neurological and respiratory systems for individual patients undergoing anaesthesia

Name the most common pieces of monitoring equipment for the respiratory system and be able to recognise what is a normal value/trace for each of these pieces

Start to develop the skills to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 3

Anaesthetic Monitoring – Cardiovascular System

Cardiovascular monitoring

Basic, hands on

Blood pressure

Pulse oximetry

ECG

Learning objectives
After completion of this week, participants should be able to:

Recognise what are normal physiological parameters with regards to the cardiovascular system for individual patients undergoing anaesthesia

Name the most common pieces of monitoring equipment for the cardiovascular system and be able to recognise what is a normal value/trace for each of these pieces

Start to develop the skills to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 4

Principles of Perioperative Care including Anaesthetic Recovery

Anaesthetic risk

Airway management including tracheal intubation

Patient positioning

Eye care

Temperature

Fluid therapy

Patient recovery

Learning objectives
After completion of this week, participants should be able to:

Identify important factors which require attention and care during a patient’s anaesthetic in order to optimise the patient’s peri-anaesthetic experience

Accurately calculate fluid rates for individual patients and apply this to their clinical setting, whether this be with use of fluid pumps/syringe drivers or via gravity (calculating a drop rate)

List available methods for patient warming, with recognition of the need to counteract patient hypothermia and the potential risks associated with warming device use

Recognise the critical importance of patient monitoring during anaesthetic recovery.

Describe the potential difficulties that may be encountered during the anaesthetic recovery period

Week 5

Pain Assessment

Importance of pain assessment and management

Challenges of pain assessment in veterinary species

Pain assessment tools

Learning objectives
After completion of this week, participants should be able to:

Recognise the potential difficulties in performing pain assessment in veterinary species.

Name a number of pain assessment tools

Advocate a pain assessment tool that would be suitable for their working environment

Recognise when patients (cats and dogs) are deemed to be painful

Week 6

Analgesia for Acute Perioperative Pain

A brief overview on the pain pathway with introduction to the concepts of multimodal and pre-emptive analgesia

Analgesic options, including:

 A brief overview of the pharmacological means

Non-pharmacological methods

Learning objectives
After completion of this week, participants should be able to:

Explain why provision of analgesia is important for patient welfare

Describe the concepts of multimodal and pre-emptive analgesia, with emphasis on why these are important for patient analgesia

Explain why provision of analgesia is important

List potential analgesic options and apply this knowledge to consider appropriate therapeutic plans for individual patients

Have an appreciation of the important role that a veterinary nurse can play in providing non-pharmacological methods of analgesia and improving the patient experience

Week 1

Principles of Anaesthetising Critical Patients

Anaesthetic risk in the compromised patient

The importance of patient history and physical examination

Diagnostic tests

Patient stabilisation

Anaesthetic protocol, monitoring and recovery

Learning objectives
After completion of this week, participants should be able to:

Understand why critical patients are at an increased anaesthesia and sedation risk

Understand that improving patient safety requires a holistic, overall management process, not simply using “the best drug protocol”.  This will include consideration of:

What pre-anaesthetic tests may be required and the benefit they offer

What pre-anaesthetic stabilisation may be required

Recall an introduction into the type of patient monitoring which is required during the peri-anaesthetic period

Understand general principles for appropriate anaesthetic drug protocols for the critical patient

Week 2

General Approach to Adverse Events and Introduction to Anaesthetic Complications

Near misses and adverse events

Minimising adverse events by preparation

Checklists and non-technical skills

Common anaesthetic complications

Learning objectives
After completion of this week, participants should be able to:

Name the three steps necessary for approaching adverse events and discuss why they are important, including methods in which near misses and adverse events can be minimised in practice

Understand the role of human factors in patient safety and the value of checklist use in anaesthetic practice

Give an overview of what anaesthetist non-technical skills (ANTS) are and be able to begin using them in clinical practice

Know the most common anaesthetic complications encountered in small animal practice

Week 3

Cardiovascular Complications

Alterations in heart rate:

Bradyarrhythmias

Tachyarrhythmias

Alterations in blood pressure:

Hypotension

Hypertension

Learning objectives
After completion of this week, participants should be able to:

Recognise abnormal physiological parameters with regards to the cardiovascular system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in heart rate (bradyarrhythmias and tachyarrhythmias) during general anaesthesia

List some main treatments for the most common arrhythmias which present under general anaesthesia

Understand the most common underlying causes for alterations in blood pressure (hypotension and hypertension) during general anaesthesia

List some main treatments for the most common blood pressure alterations which present under general anaesthesia

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 4

Respiratory Complications

Alterations in ventilation:

Hypoventilation

Hyperventilation (including tachypnoea)

Apnoea or respiratory arrest

Hypoxaemia

Respiratory obstruction:

Upper respiratory tract

Lower respiratory tract

Restrictive pulmonary disease

Aspiration (and regurgitation)

Learning objectives
After completion of this week, participants should be able to:

Recognise what are abnormal physiological parameters with regards to the respiratory system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in ventilation, including hypo- and hyperventilation, apnoea and respiratory arrest

List the main treatments for the most common changes in ventilation under anaesthesia.

Understand the difference between hypoxaemia and hypoxia, listing the potential causes for these and therefore be able to suggest methods to manage these conditions

Recognise the clinical signs of respiratory obstruction and restrictive pulmonary disease and describe what steps could be taken to alleviate the underlying problem

State why aspiration is a risk under anaesthesia and how to manage a case of gastro-oesophageal reflux in order to minimise patient risk

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 5

‘Other’ Complications

Central nervous system:

Emergence delirium

Post anaesthetic blindness and deafness

Thermoregulation:

Hypothermia

Hyperthermia

Anaphylactic and anaphylactoid reactions

Embolism

Learning objectives
After completion of this week, participants should be able to:

Outline why cats are at particular risk for post anaesthetic blindness and deafness and describe methods which can minimise this risk

List available methods for patient warming, with recognition of the need to counteract patient hypothermia and the potential risks associated with warming device use

List risk factors associated with peri-operative hyperthermia and discuss steps which can be implemented to manage the hyperthermic patient

Recognise if an anaphylactic or anaphylactoid reaction is occurring and be able to suggest steps to manage the situation

Understand that embolisms are a rare, but potential complication during anaesthesia and be able to list the clinical signs associated with their occurrence

Week 6

Cardiopulmonary Resuscitation

Detecting cardiopulmonary arrest

Basic life support:

Chest compressions

Tracheal intubation

Ventilation

Advanced life support

Drug therapy

Oxygen supplementation

Intravenous fluid therapy

Correction of electrolyte and metabolic disturbances

Defibrillation

Monitoring during CPR

Post cardiac arrest care

Learning objectives
After completion of this week, participants should be able to:

Explain the purpose of cardiopulmonary resuscitation and describe its two main components

Recognise when cardiopulmonary resuscitation should be instigated

Understand the importance of regular CPR training within the practice team

Describe and demonstrate the method for effective chest compressions, tracheal intubation and ventilation during cardiopulmonary resuscitation

List what steps can be taken to provide advanced life support during cardiopulmonary resuscitation

Know what monitoring tools are recommended for cardiopulmonary resuscitation and be able to interpret the main waveforms that will be seen during a resuscitation event

Week 1

Principles of Anaesthetising Critical Patients

Anaesthetic risk in the compromised patient

The importance of patient history and physical examination

Diagnostic tests

Patient stabilisation

Anaesthetic protocol, monitoring and recovery

Learning objectives
After completion of this week, participants should be able to:

Understand why critical patients are at an increased anaesthesia and sedation risk

Understand that improving patient safety requires a holistic, overall management process, not simply using “the best drug protocol”.  This will include consideration of:

What pre-anaesthetic tests may be required and the benefit they offer

What pre-anaesthetic stabilisation may be required

Recall an introduction into the type of patient monitoring which is required during the peri-anaesthetic period

Understand general principles for appropriate anaesthetic drug protocols for the critical patient

Week 2

General Approach to Adverse Events and Introduction to Anaesthetic Complications

Near misses and adverse events

Minimising adverse events by preparation

Checklists and non-technical skills

Common anaesthetic complications

Learning objectives
After completion of this week, participants should be able to:

Name the three steps necessary for approaching adverse events and discuss why they are important, including methods in which near misses and adverse events can be minimised in practice

Understand the role of human factors in patient safety and the value of checklist use in anaesthetic practice

Give an overview of what anaesthetist non-technical skills (ANTS) are and be able to begin using them in clinical practice

Know the most common anaesthetic complications encountered in small animal practice

Week 3

Cardiovascular Complications

Alterations in heart rate:

Bradyarrhythmias

Tachyarrhythmias

Alterations in blood pressure:

Hypotension

Hypertension

Learning objectives
After completion of this week, participants should be able to:

Recognise abnormal physiological parameters with regards to the cardiovascular system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in heart rate (bradyarrhythmias and tachyarrhythmias) during general anaesthesia

List some main treatments for the most common arrhythmias which present under general anaesthesia

Understand the most common underlying causes for alterations in blood pressure (hypotension and hypertension) during general anaesthesia

List some main treatments for the most common blood pressure alterations which present under general anaesthesia

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 4

Respiratory Complications

Alterations in ventilation:

Hypoventilation

Hyperventilation (including tachypnoea)

Apnoea or respiratory arrest

Hypoxaemia

Respiratory obstruction:

Upper respiratory tract

Lower respiratory tract

Restrictive pulmonary disease

Aspiration (and regurgitation)

Learning objectives
After completion of this week, participants should be able to:

Recognise what are abnormal physiological parameters with regards to the respiratory system for individual patients undergoing anaesthesia

Understand the most common underlying causes for alterations in ventilation, including hypo- and hyperventilation, apnoea and respiratory arrest

List the main treatments for the most common changes in ventilation under anaesthesia.

Understand the difference between hypoxaemia and hypoxia, listing the potential causes for these and therefore be able to suggest methods to manage these conditions

Recognise the clinical signs of respiratory obstruction and restrictive pulmonary disease and describe what steps could be taken to alleviate the underlying problem

State why aspiration is a risk under anaesthesia and how to manage a case of gastro-oesophageal reflux in order to minimise patient risk

Begin to apply this knowledge to individual cases within the clinic with use of the available equipment

Week 5

‘Other’ Complications

Central nervous system:

Emergence delirium

Post anaesthetic blindness and deafness

Thermoregulation:

Hypothermia

Hyperthermia

Anaphylactic and anaphylactoid reactions

Embolism

Learning objectives
After completion of this week, participants should be able to:

Outline why cats are at particular risk for post anaesthetic blindness and deafness and describe methods which can minimise this risk

List available methods for patient warming, with recognition of the need to counteract patient hypothermia and the potential risks associated with warming device use

List risk factors associated with peri-operative hyperthermia and discuss steps which can be implemented to manage the hyperthermic patient

Recognise if an anaphylactic or anaphylactoid reaction is occurring and be able to suggest steps to manage the situation

Understand that embolisms are a rare, but potential complication during anaesthesia and be able to list the clinical signs associated with their occurrence

Week 6

Cardiopulmonary Resuscitation

Detecting cardiopulmonary arrest

Basic life support:

Chest compressions

Tracheal intubation

Ventilation

Advanced life support

Drug therapy

Oxygen supplementation

Intravenous fluid therapy

Correction of electrolyte and metabolic disturbances

Defibrillation

Monitoring during CPR

Post cardiac arrest care

Learning objectives
After completion of this week, participants should be able to:

Explain the purpose of cardiopulmonary resuscitation and describe its two main components

Recognise when cardiopulmonary resuscitation should be instigated

Understand the importance of regular CPR training within the practice team

Describe and demonstrate the method for effective chest compressions, tracheal intubation and ventilation during cardiopulmonary resuscitation

List what steps can be taken to provide advanced life support during cardiopulmonary resuscitation

Know what monitoring tools are recommended for cardiopulmonary resuscitation and be able to interpret the main waveforms that will be seen during a resuscitation event

Week 1

What are we Monitoring and Why?

What anaesthesia does to the patient and what we can do about it

Monitoring depth of anaesthesia

Temperature monitoring

Learning objectives
After completion of this week, participants should be able to:

Understand why good monitoring is essential for safe anaesthesia

Understand the challenges of monitoring depth of anaesthesia

Appreciate the importance of monitoring body temperature and the consequences of hypo- and hyperthermia

Week 2

Monitoring the Respiratory System

Capnography

Pulse oximetry

Learning objectives
After completion of this week, participants should be able to:

Understand the physiology involved in the formation of the capnograph trace

Interpret normal and abnormal capnograph traces

Understand the physiology behind pulse oximetry, and its limitations

Confidently troubleshoot abnormal capnography traces and pulse-oximetry readings

Week 3

Monitoring the Cardiovascular System

Physiology of heart rate and blood pressure control

The electrocardiogram

Blood pressure monitoring

Learning objectives
After completion of this week, participants should be able to:

Understand the causes of heart rate and blood pressure changes during anaesthesia

Describe how the electrocardiogram is generated

Interpret the electrocardiogram

Understand the different techniques for measuring blood pressure

Interpret blood pressure readings and understand causes of inaccurate readings

Week 4

Monitoring with Blood Work and Troubleshooting Equipment

Blood gas and acid-base

Glucose monitoring and other tests

Monitor-related artefacts and technical problems

Learning objectives
After completion of this week, participants should be able to:

Understand when blood gas analysis is useful

Interpret blood gas analyses in the light of the patient’s history and clinical problems

Decide when glucose monitoring and other tests during anaesthesia are important

Troubleshoot monitor-related issues