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