Fundamental Principles of Veterinary Anesthesia

Title: Fundamental practice principles of veterinary anesthesia
Preamble (preface, textbook reviews, about author, acknowledgments etc. 4 pages)

Section I: Fundamental foundational knowledge

Ch 1: Past, present and future of veterinary anesthesia

This chapter will focus on the beginning of veterinary anesthesia, where we are at this point in time and what the possible future could hold for this discipline. (5 pages; 1 table; 2000 words)

H1: Past, present and future

H1: Colleges and associations

H2: The American College of Veterinary Anesthesia and Analgesia (ACVAA)

H2: The European College of Veterinary Anesthesia and Analgesia (ECVAA)

H2: The Association of Veterinary Anaesthetists (AVA)

H1: Contributing to science

H2: How to find quality information in a hurry

H2: Evaluating scientific articles

H1: References

H1: Questions

Ch 2: Pre-anaesthetic patient assessment and preparation

This chapter will highlight practical points on patient assessment and how to prepare for an anaesthetic event. The outcome is to get the student to understand the various phases of the peri-anaesthetic period so that they may plan for the anaesthetic. Furthermore, based on the knowledge gained in the patient assessment they will be able to assign the patient an ASA score. (12 pages; 3 figures; 6 tables; 5000 words)

H1: Defining the purpose of the anaesthetic event

H1: Patient assessment

H2: History taking

H2: Physical clinical examination

H2: Haematology and biochemical investigation

H2: Other pre-anaesthetic assessments

H1: Patient preparation

H2: Principles of placing catheters into blood vessels

H2: Pre-anaesthetic withholding of food and water

H1: Sedation compared to general anesthesia

H1: Overview of an anaesthetic plan

H1: The phases of the peri-anaesthetic period

H2: Premedication phase

H2: Induction phase

H2: Maintenance phase

H2: Recovery phase

H1: Risk assessment and patient stratification

H1: Perioperative fluid therapy

H2: Basic concepts of water balance

H2: Fluid types

H2: Fluid selection and rates of administration

H1: References

H1: Questions

Ch 3: Pain and its approach to assessment and treatment

This chapter will focus on pain, its physiology and current techniques of scoring pain and the principles of treating pain. (20 pages; 8 figures; 6 tables; 8000 words)

H1: Pain physiology and the pain pathway

H1: Pain assessment and scoring systems

H2: Acute pain

H2: Chronic pain

H1: Principles of treating pain

H2: Concept of pre-emptive and preventive strategies

H2: Concept of multimodal drug therapy

H2: Concept of adjunctive therapeutic approaches

H1: References

H1: Questions

Ch 4: Injectable and oral drugs

This chapter will focus on all of the drugs that the student may be exposed to in an academic or private practice hospital. More emphasis will be placed on the commonly used drugs and mention will be made of the less commonly used drugs. Doses will be provided in the appendices. (22 pages; 8 figures; 8 tables; 10000 words)

H1: Drugs used for sedation

H2: Phenothiazine and butyrophenone derivatives

H2: Benzodiazepine agonists and antagonists

H2: Alpha-2-adrenoceptor agonists and antagonists

H2: Opioid agonists and antagonists

H1: Drugs used for induction and maintenance of general anesthesia

H2: Barbiturates

H2: Cyclohexylamines

H2: Neurosteroids

H2: Phenols

H2: Imidazoles

H1: Other drugs used during sedation and anesthesia

H2: Anticholinergic drugs

H2: Sympathomimetic drugs

H2: Corticosteroid drugs

H2: Neuromuscular blockade drugs

H2: Behavioural drug therapy

H1: Drugs used for analgesia

H2: Local anaesthetics

H2: Opioid receptor agonists

H2: Non-steroidal anti-inflammatory

H2: Adjunctive drugs

H1: Drug dose calculations for single injection or constant rate infusions

H1: Drug registers

H1: References

H1: Questions

Ch 5: The anaesthetic machine and breathing systems

This chapter will focus on explaining the components of the anaesthetic machine, gas flow through the machine. How vaporisers work and how to operate them. Explain how the breathing systems are classified and how to operate then safely. (24 pages; 12 figures; 8 tables; 14000 words)

H1: Overview of the different types of anaesthetic machines

H1: Overview of the basic anaesthetic machine

H2: Essential components of an anaesthetic machine

H2: Position of the vaporiser, VIC versus VOC

H2: The carrier gas

H2: Concepts of gas flow within an anaesthetic machine

H1: Overview of breathing systems

H2: Classification of breathing systems

H2: The circle breathing system

H2: The non-rebreathing systems

H2: Face mask and chamber systems

H1: Tips on identifying the anaesthetic machine and breathing system

H1: Calculating the fresh gas flow rate depending on the breathing system

H1: Tips on purchasing an anaesthetic machine

H1: References

H1: Questions

Ch 6: Inhalation drugs

This chapter will focus on the inhalation agents and the physics of gas movement and pressures. The student will be able to master the concepts of MAC and how to safely operate the vaporiser and fresh gas flow within a breathing system to safely anaesthetise their patients. (12 pages; 6 figures; 4 tables; 9000 words)

H1: Concepts of vapour pressure and solubility

H2: Vapour pressure and solubility

H2: Concept of wash-in and wash-out of inhalation drugs

H1: Concept of MAC and potency

H2: MAC and potency

H2: Operating the vaporiser

H1: Integrating the fresh gas flow rate and the vaporiser setting

H1: Inhalation drugs

H2: Halothane

H2: Isoflurane

H2: Sevoflurane

H2: Desflurane

H2: Linking MAC, potency and onset of action

H1: References

H1: Questions

Ch 7: Monitors and the principles of monitoring

This chapter will focus on introducing standards of practice to the student. Then to explain the principles of non-machine monitoring and machine-assisted monitoring. Importantly, there are many monitors available and a section will be added to provide purchasing tips to buy the best possible type of monitor for their private practice requirements. (22 pages; 8 figures; 6 tables; 10000 words)

H1: Overview of patient monitoring and standard of practice

H1: Principles and techniques of non-machine monitoring

H2: Monitoring the central and peripheral nervous system

H2: Monitoring the cardiovascular system and perfusion

H2: Monitoring the respiration system

H1: Types of patient monitors

H1: Principles and techniques of machine monitoring

H2: Monitoring arterial blood pressure

H2: Monitoring oxyhaemoglobin saturation

H2: Monitoring body temperature

H2: Monitoring airway gases, especially capnography

H2: Monitoring electrocardiographs

H2: Monitoring of other physiological variables

H1: Tips on purchasing a patient monitor

H1: References

H1: Questions

Section II: Fundamental aspects of clinical anesthesia in private practice

Ch 8: Standards of practice for performing veterinary anesthesia

This is a short focused chapter to guide students in the concepts of standards of practice and how to manage situations when conditions are not meeting the minimum standards of practice. (5 pages; 2000 words)

H1: Overview of the concept of standards of practice

H1: Regulatory bodies that set minimum standards of practice

H1: Associations and committees that publish guidelines and standards of practice

H1: Handling situations where the minimum standards of practice are not met

H1: Record keeping

H1: References

H1: Questions

Ch 9: Approach to healthy dog and cat anesthesia and analgesia

This chapter focuses on training the student on how to approach dog and cat anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. (20 pages; 6 figures; 8 tables; 9000 words)

H1: Risk of anaesthetic mortality in dogs and cats

H1: Known breed concerns

H2: Dogs

H2: Cats

H1: Intravenous access sites and procedures

H1: Routine drug protocols and techniques for performing sedation

H2: Diagnostic imagine related procedures

H2: Other non-painful procedures

H2: Painful procedures

H1: Principles of tracheal intubation

H1: Routine drug protocols and techniques for performing general anesthesia

H2: Protocols for non-painful procedures

H2: Protocols for painful procedures

H2: Protocols for high volume spay and neuter procedures

H1: Routine local anaesthetic block techniques

H1: References

H1: Questions

Ch 10: Approach to healthy horse anesthesia and analgesia

This chapter focuses on training the student on how to approach horse anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. (18 pages; 6 figures; 8 tables; 8000 words)

H1: Risk of anaesthetic mortality in horses

H1: Known breed concerns

H2: Horses

H2: Ponies

H1: Intravenous access sites and procedures

H1: Deciding between performing standing sedation or general anesthesia

H2: Concept of return to function

H2: Access to equipment and facilities

H2: Horses within the food chain

H1: Routine drug protocols and techniques for performing standing sedation

H2: Estimating the pain experience of the procedure

H2: Drug combination for short term procedures

H2: Drug combination for long term procedures

H2: Constant rate infusion of drugs

H1: Principles of tracheal intubation

H1: Routine drug protocols and techniques for performing general anesthesia

H2: Protocols for non-painful procedures

H2: Protocols for painful procedures

H1: Enhanced recovery protocols

H1: Routine local anaesthetic block techniques

H1: References

H1: Questions

Ch 11: Approach to healthy small stock, cattle and pig anesthesia and analgesia

This chapter focuses on training the student on how to approach small stock, cattle and pig anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. (18 pages; 8 figures; 8 tables; 9000 words)

H1: Risk of anaesthetic mortality in small stock, cattle and pigs

H1: Known breed concerns

H2: Small stock

H2: Cattle

H2: Pigs

H1: Intravenous access sites and procedures

H1: Deciding between performing standing sedation or general anesthesia

H2: Concept of return to function

H2: Access to equipment and facilities

H2: Animals intended for food production and consumption

H1: Routine drug protocols and techniques for performing standing sedation

H2: Estimating the pain experience of the procedure

H2: Drug combination for short term procedures

H2: Drug combination for long term procedures

H2: Constant rate infusion of drugs

H1: Principles of tracheal intubation

H2: Small stock

H2: Cattle

H2: Pig

H1: Routine drug protocols and techniques for performing general anesthesia

H2: Protocols for non-painful procedures

H2: Protocols for painful procedures

H1: Routine local anaesthetic block techniques

H1: References

H1: Questions

Ch 12: Approach to neonates, paediatric and geriatric patients

This chapter focuses on training the student on how to approach neonates, paediatric and geriatric anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. (10 pages; 2 figures; 4 tables; 5000 words)

H1: Difference in physiology compared to a healthy adult

H2: Total body water

H2: Differences in pharmacokinetics

H1: Neonates and paediatric patients

H1: Geriatric patients

H1: References

H1: Questions

Ch 13: Approach to a patient in shock

This chapter focuses on training the student on how to approach shock patients and anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. They will be introduced to different fluid therapies and how to recognise patients in shock. (16 pages; 6 figures; 5 tables; 7000 words)

H1: Physiology and classification of shock

H1: Concepts of pre-anaesthetic stabilisation

H1: Concepts of fluid resuscitation

H2: Isotonic crystalloid fluids

H2: Hypertonic crystalloid fluids

H2: Colloid fluids

H2: Blood transfusion therapy

H1: Pre-anaesthetic treatment of shock

H2: Compensated shock

H2: Decompensated shock

H2: Haemorrhagic shock

H1: Drug protocols for sedation and analgesia

H1: Drug protocols for general anesthesia

H1: Concept of damage control surgery

H1: References

H1: Questions

Ch 14: Approach to a patient with cardiac pathology

This chapter focuses on training the student on how to approach cardiac anesthesia. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. Various disease processes will be mentioned and how to diagnose them during the pre-anaesthetic assessment. (12 pages; 6 figures; 6 tables; 6000 words)

H1: Overview of cardiac pathology

H1: Valvular disease

H2: Valvular stenosis

H2: Valvular insufficient

H1: Myocardial disease

H2: Hypertrophic cardiomyopathy

H2: Dilated cardiomyopathy

H2: Myocardial contusions

H1: Cardiac arrythmias

H2: Bradyarrhythmia

H2: Tachyarrhythmias

H1: Intracardiac and extracardiac shunts

H1: Drug protocols for sedation

H1: Drug protocols for general anesthesia

H1: References

H1: Questions

Ch 15: Approach to a patient with respiratory pathology

This chapter focuses on training the student on how to approach anesthesia in patients with respiratory problems. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. Various disease processes will be mentioned and how to diagnose them during the pre-anaesthetic assessment. (12 pages; 6 figures; 6 tables; 6000 words)

H1: Overview of thoracic, lung and airway pathology

H1: Thoracic pathology

H2: Space occupying lesions

H2: Pathology altering thoracic cage function

H1: Lung pathology

H2: Dogs

H2: Cats

H2: Horses

H2: Other animals

H1: Airway pathology

H2: Dogs

H2: Cats

H2: Horses

H2: Other animals

H2: Techniques for securing a difficult airway

H1: Intrapulmonary shunts

H1: Mechanisms of hypoxaemia

H1: Drug protocols for sedation

H1: Drug protocols for general anesthesia

H1: References

H1: Questions

Ch 16: Approach to a patient with urogenital or hepatobiliary pathology

This chapter focuses on training the student on how to approach anesthesia in patients with common urogenital or hepatobiliary pathology. They will be able to select a logical anaesthetic protocol and perform an anaesthetic based on a solid peri-anaesthetic plan. Various disease processes will be mentioned and how to diagnose them during the pre-anaesthetic assessment. (16 pages; 6 figures; 6 tables; 8000 words)

H1: Overview of urogenital pathology

H1: Assessing urinary system function

H2: Linking pre-renal, renal and post-renal azotaemia

H2: Urine specific gravity

H2: IRIS classification of renal disease

H2: Protein losing nephropathy

H1: Drug related concerns in patients with urogenital pathology

H1: Overview of hepatobiliary pathology

H1: Assessing hepatobiliary injury and function

H2: Linking pre-hepatic, hepatic and post-hepatic icterus

H2: Intrahepatic and extrahepatic shunts

H2: Determining hepatic injury

H2: Determining hepatic function

H2: Coagulation and hepatic pathology

H1: Drug related concerns in patient with hepatobiliary pathology

H1: References

H1: Questions

Ch 17: Anaesthetic complications and cardiopulmonary resuscitation

This chapter focuses on training the student on current evidence-based CPR techniques and procedures. (14 pages; 8 figures; 6 tables; 7000 words)

H1: Anaesthetic incidents and accidents

H2: Classification of incidents

H2: Incidents converting to accidents

H2: Methods of monitoring errors and their prevention

H2: Skills laboratory training

H1: Overview of cardiopulmonary resuscitation in veterinary anesthesia

H1: Performing effective cardiopulmonary resuscitation

H2: Basic life support

H2: Advanced life support

H2: Post-return of spontaneous circulation period

H1: RECOVER initiative

H1: Refences

H1: Questions

Appendix 1: RECOVER CPR algorithms
Appendix 2: RECOVER CPR emergency drug dose charts
Appendix 3: Common drug protocols for dogs and cats
Appendix 4: Common drug protocols for horses
Appendix 5: Common drug protocols for small stock, cattle and pig
Appendix 6: Answers to textbook chapter questions
(pages: 15 estimated for the appendices)
Index
(pages: 6 for the index)

Gareth Edward Zeiler

BVSc, BVSc (Hons), MMedVet (Anaes), PhD (University of Pretoria), PhD (University of Witwatersrand), Dipl. ECVAA, Dipl. ACVAA; American, European and South African registered specialist in veterinary anaesthesiology. Extraordinary Lecturer (Associate Professor) in Veterinary Anaesthesiology; Section of Anaesthesiology, Department of Companion Animal Clinical Studies, Faculty of Veterinary Science, University of Pretoria

Daniel S. Pang

BVSc, MSc, PhD (Imperial College, London), Dipl. ACVAA, Dipl. ECVAA; American and European registered specialist in veterinary anaesthesiology. Associate Professor of Veterinary Anaesthesiology; Department of Veterinary Clinical and Diagnostic Sciences; University of Calgary.