PRACTICAL PROBLEMS WITH VETERINARY ANAESTHESIA MACHINES

Many types of anaesthetic machines are available to practicing veterinary surgeons, ranging from the obsolescent to the most modern. To practice anaesthesia safely, veterinary surgeons should understand the functions of the machines, vaporizers, and breathing systems with which they work. In addition, veterinary surgeons should employ procedures for evaluation of their anaesthetic equipment to assure, as much as possible, safety for their patients and the personnel who use the apparatus.     

A survey of anaesthetic equipment in veterinary practices in New Zealand

Sixty-four anaesthetic machines and 89 breathing circuits were surveyed in New Zealand veterinary practices. Each machine and circuit was tested for correct function. Sixty-six percent of machines checked were 10 years or older and vaporiser out-of-circuit machines totalled 72% of machines surveyed. Twenty-five percent of the temperature compensated vaporisers had been serviced within the previous 1 year, 33% serviced between 1 and 10 years ago, while the remaining 42% had no service record or had not been serviced for over 10 years. Sixty-six percent of machines had some type of scavenging device. Nineteen percent of machines had a leak in the high pressure system. Thirty percent of the anaesthetic machine low pressure systems leaked and 76% of the patient breathing circuits leaked. Overall, 91% of all anaesthetic machines and breathing circuits showed malfunctions which could increase practice operating costs, increase the exposure of practice personnel to anaesthetic agents, and increase patient morbidity.     

Muscle relaxants in canine anaesthesia 1: History and the drugs

The history of the introduction of muscle relaxants into medical and veterinary anaesthesia is discussed. It is interesting to note that the compounds were used in animals for therapeutic purposes some 100 years before their introduction into human anaesthetic practice. The concept of the triad approach to anaesthesia by separate consideration of the three components of narcosis, reflex depression and muscle relaxation is considered. The properties of the depolarising and non-depolarising muscle relaxant drugs are described. The only depolarising relaxant which is in common use is suxamethonium which produces an initial depolarisation of the muscle end-plate which is accompanied by fasciculation of muscle and is non-reversible. There are a number of non-depolarising or competitive muscle relaxants which are available for use in the dog. They are reversible by anticholinesterase drugs and are potentiated by volatile anaesthetic agents. The properties of the more recently introduced compounds atracurium besylate and vecuronium bromide are considered in the light of their differences when compared with the older compounds.     

Electrical nerve stimulation as an aid to the placement of a brachial plexus block

Most local anaesthetic blocks are placed blindly, based on a sound knowledge of anatomy. Very often the relationship between the site of deposition of local anaesthetic and the nerve to be blocked is unknown. Large motor neurons may be stimulated with the aid of an electrical current. By observing for muscle twitches, through electrical stimulation of the nerve, a needle can be positioned extremely close to the nerve. The accuracy of local anaesthetic blocks can be improved by this technique. By using the lowest possible current a needle could be positioned with in 2-5 mm of a nerve. The correct duration of stimulation ensures that stimulation of sensory nerves does not occur The use of electrical nerve stimulation in veterinary medicine is a novel technique that requires further evaluation.     

Managing stress in veterinary students

The process of obtaining a veterinary medical education creates a number of potential cognitive, emotional, physical, interpersonal, and developmental stressors for veterinary students. Although most universities offer stress management interventions for their students, these programs are often directed toward undergraduate students or non-veterinary graduate students, whose educational programs differ significantly from those of veterinary students. There is a need for specific stress management programs tailored to the needs of veterinary students. This article summarizes research drawn from the psychology, medical, and veterinary medical literature about the causes of stress that veterinary students experience. Interventions are discussed, and several Oregon State University (OSU) programs and liaisons are described. Stress management resources are suggested.     

Current economic trends affecting the veterinary medical profession.

This article explores the economic trends affecting the future of the veterinary medical profession. Key aspects of demand and supply are considered, as are several broad-based institutional factors. Demand for veterinarians and veterinary medical services is demonstrating a definitive upward trend across the profession, led by a remarkable in-crease in consumers' willingness to spend on animal health care.Supply is also expanding through increased enrollments at colleges and schools of veterinary medicine and increased productivity and efficiency in private practice. Veterinarians' incomes are increasing, and some sectors of the profession offer outstanding financial opportunities.Provided that critical needs are met for 1) increased diversity and 2) continued improvement in the nontechnical capabilites of veterinarians, the outlook for the economic future of the veterinary medical profession is strong.     

Clinical evaluation in cats of a new anaesthetic, GT 1341

The results of a co-ordinated multicentred clinical evaluation of a new steroid anaesthetic for cats, CT 1341, are presented. Forty-six practising veterinary surgeons were involved. Administration by the intravenous, intramuscular and combined intramuscular-intravenous routes was tried. It was concluded that CT 1341 is a safe anaesthetic in cat practice when given intravenously. When employed by the intramuscular route it induced deep sedation and in some cases anaesthesia, depending on the dosage used.     

AVMA guide for veterinary medical waste management

Lawmakers have enacted a variety of laws and regulations to ensure proper disposal of certain potentially infectious or otherwise objectionable waste. The veterinary medical profession supports scientifically based regulations that benefit public health. In 1988, Congress passed the Medical Waste Tracking Act, a federal program that mandates tracking certain regulated waste. Several types of waste generated in the typical clinical veterinary medical practice are considered regulated veterinary medical waste. Discarded needles, syringes, and other sharps; vaccines and vials that contained certain live or attenuated vaccines; cultures and stocks of infectious agents and culture plates; research animals that were exposed to agents that are infectious to human beings and their associated waste; and other animal waste that is known to be potentially harmful to human beings should be handled as regulated veterinary medical waste. Regulated veterinary medical waste should be handled with care. It should be decontaminated prior to disposal. The most popular, effective methods of decontamination are steam sterilization (autoclaving) and incineration. Chemical decontamination is appropriate for certain liquid waste. Waste should be packaged so that it does not spill. Sharps require rigid puncture- and leak-resistant containers that can be permanently sealed. Regulated veterinary medical waste that has not been decontaminated should be labeled with the universal biohazard symbol. Generators retain liability for waste throughout the entire disposal process. Therefore, it is essential to ensure that waste transporters and disposal facilities comply with state and federal requirements. Veterinary practices should maintain a written waste management program and accurate records of regulated veterinary medical waste disposal. Contingency planning and staff training are other important elements of a veterinary medical waste management program. The guide includes a model veterinary medical waste management program; however, it does not address all the variations in state and local regulations. Veterinarians should obtain copies of state and local laws and regulations and modify AVMA's model plan to create an individualized practice plan that complies with federal, state, and local laws and regulations. State and local veterinary medical organizations should monitor state and local regulation to influence decisions that affect veterinarians and to keep their members informed of changing requirements. Veterinarians and veterinary medical organizations must stay involved so that regulations do not unfairly burden the veterinary medical profession.     

ASVCP quality assurance guidelines: control of preanalytical, analytical, and postanalytical factors for urinalysis, cytology, and clinical chemistry in veterinary laboratories

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and documents recommendations for control of preanalytical, analytical, and postanalytical factors related to urinalysis, cytology, and clinical chemistry in veterinary laboratories and is adapted from sections 1.1 and 2.2 (clinical chemistry), 1.3 and 2.5 (urinalysis), 1.4 and 2.6 (cytology), and 3 (postanalytical factors important in veterinary clinical pathology) of these guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.     

Current practice relating to equine castration in the UK

This study aimed to characterise current practice relating to equine castration in the UK. A questionnaire was posted to all 655 veterinary practices specified to provide veterinary care for horses, or classified as specialist equine practices. Respondents were asked to cite the number of equine castrations performed annually by the practice, describe techniques used for castration, outline anaesthetic/sedative/analgesic drug protocols used and provide details of post-operative medication. There was a 43% response rate to the questionnaire. Considerable variation in techniques and analgesia provision was identified, with the majority of respondents using a number of sedation/anaesthetic protocols rather than a single technique. This characterisation of current practice provides a useful platform from which subsequent investigations into welfare implications of current equine castration techniques can be directed.     

Enhanced communication by developing a non-anxious presence: a key attribute for the successful veterinarian

In the recent past much has been written about non-technical skills in veterinary medical education. This dialogue has focused extensively on competence in behaviorally based communication skills for successful veterinary practice. Other relationship-based communication skills are also useful in communication, such as self-awareness, flexibility, non-judgment (compassion), and being present. All of these relationally based skills are present in the concept of non-anxious presence. This article will review the history of the term 'non-anxious presence' (NAP), discuss a proposed model of NAP for the veterinary medical environment, and review some methods useful in teaching NAP in veterinary medical education.     

Development and validation of a competency framework for veterinarians

Changing demands from society and the veterinary profession call for veterinary medical curricula that can deliver veterinarians who are able to integrate specific and generic competencies in their professional practice. This requires educational innovation directed by an integrative veterinary competency framework to guide curriculum development. Given the paucity of relevant information from the veterinary literature, a qualitative multi-method study was conducted to develop and validate such a framework. A competency framework was developed based on the analysis of focus group interviews with 54 recently graduated veterinarians and clients and subsequently validated in a Delphi procedure with a panel of 29 experts, representing the full range and diversity of the veterinary profession. The study resulted in an integrated competency framework for veterinary professionals, which consists of 16 competencies organized in seven domains: veterinary expertise, communication, collaboration, entrepreneurship, health and welfare, scholarship, and personal development. Training veterinarians who are able to use and integrate the seven domains in their professional practice is an important challenge for today's veterinary medical schools. The Veterinary Professional (VetPro) framework provides a sound empirical basis for the ongoing debate about the direction of veterinary education and curriculum development.     

A status report of veterinary education in Ethiopia: perceived needs, past history, recent changes, and current and future concerns

Ethiopia, which owns the most important livestock resources in Africa, opened its first faculty of veterinary medicine in 1979. In 2003, in response to a government mandate to increase the number of veterinarians, four new veterinary faculties were founded, but these facilities still have very limited resources. Currently, quality standards and controls for veterinary studies are not established in Ethiopia, and the country does not have any type of veterinary council or oversight body to establish such standards or the essential evaluation and credentialing procedures. The veterinary degree, as currently obtained in Ethiopia, is not internationally recognized. A second specific concern for veterinary education in Ethiopia is that it is not well adapted to the special needs of the country. Clearly, quality control of veterinary education needs to be established, and teaching methods and materials need to be adapted to the special needs of the country. So far, the veterinary faculty in Ethiopia has been more interested in partnerships with universities from developed countries than in partnerships and cooperation with other African universities. In 2002, after six years of cooperation with a German university, the Veterinary Faculty at Addis Ababa started its own post-graduate program, with some key contributions from foreign instructors and some foreign funding. While this has been a service to Ethiopian veterinary medicine, the cooperation of the Ethiopian veterinary schools with African universities must also be strengthened. Overall, the good efforts to date in Ethiopian veterinary medicine have only barely scratched the surface of its critical needs. In order to meet Ethiopia's needs for both a reliable and high-quality veterinary education and a trustworthy animal disease surveillance mechanism, it is important that veterinary education in Ethiopia be improved.     

World Small Animal Veterinary Association Global Dental Guidelines

Dental, oral, and maxillofacial diseases are some of the most common problems in small animal veterinary practice. These conditions create significant pain as well as localized and potentially systemic infection. As such, the World Small Animal Veterinary Association (WSAVA) believes that un- and under treated oral and dental diseases pose a significant animal welfare concern. Dentistry is an area of veterinary medicine which is still widely ignored and is subject to many myths and misconceptions. Effective teaching of veterinary dentistry in the veterinary school is the key to progression in this field of veterinary medicine, and to the improvement of welfare for all our patients globally. These guidelines were developed to provide veterinarians with the information required to understand best practices for dental therapy and create realistic minimum standards of care. Using the three-tiered continuing education system of WSAVA, the guidelines make global equipment and therapeutic recommendations and highlight the anaesthetic and welfare requirements for small animal patients. This document contains information on common oral and dental pathologies, diagnostic procedures (an easily implementable and repeatable scoring system for dental health, dental radiography and radiology) and treatments (periodontal therapy, extractions). Further, there are sections on anaesthesia and pain management for dental procedures, home dental care, nutritional information, and recommendations on the role of the universities in improving veterinary dentistry. A discussion of the deleterious effects of anaesthesia free dentistry (AFD) is included, as this procedure is ineffective at best and damaging at worst. Throughout the document the negative effects of undiagnosed and/or treated dental disease on the health and well-being of our patients, and how this equates to an animal welfare issue, is discussed.     

Perspectives on academic veterinary administration

It is important for veterinary administrators to apply knowledge bases from other fields to their own unique administrative needs. For example, although some resources are written for business managers, the discussions of four key management competency areas, guidelines for mastering these skills, organizational assessment tools, and other self-help tools may provide interesting food-for-thought for veterinary administrators.(76) In developing their own administrative styles, administrators should seek to apply those principles that seem to intuitively fit with their personal research styles, work situations, managerial styles, administrative preferences, and unique organizational culture. Through strengthening their liaisons with community and university business programs, counseling agencies, employee assistance programs, and psychology researchers, administrators can continue to be exposed to and benefit from new paradigms for consideration in veterinary medical environments. Through these liaisons, the unique needs of veterinary medical environments are also communicated to individuals within the fields of psychology and business, thus stimulating new research that specifically targets veterinary medical environment leadership issues. Each field has unique contributions to help veterinary administrators work toward creating veterinary medical environments that are creative, energetic, visionary, pragmatic, and highly marketable in order to help administrators recruit and nurture the best and brightest veterinary researchers, teachers, and clinicians.     

Completeness of handwritten preanaesthetic records at two veterinary referral institutions

Objective

To retrospectively analyse handwritten preanaesthetic records for completeness at two veterinary referral institutions: a university veterinary teaching hospital and a private veterinary referral hospital. To evaluate if emergency records were less complete compared with non-emergency records. Animal or Animal Population Two hundred and fifty preanaesthetic records at each referral institution.

ASVCP quality assurance guidelines: control of preanalytical and analytical factors for hematology for mammalian and nonmammalian species, hemostasis, and crossmatching in veterinary laboratories

In December 2009, the American Society for Veterinary Clinical Pathology (ASVCP) Quality Assurance and Laboratory Standards committee published the updated and peer-reviewed ASVCP Quality Assurance Guidelines on the Society's website. These guidelines are intended for use by veterinary diagnostic laboratories and veterinary research laboratories that are not covered by the US Food and Drug Administration Good Laboratory Practice standards (Code of Federal Regulations Title 21, Chapter 58). The guidelines have been divided into 3 reports: (1) general analytical factors for veterinary laboratory performance and comparisons; (2) hematology, hemostasis, and crossmatching; and (3) clinical chemistry, cytology, and urinalysis. This particular report is one of 3 reports and provides recommendations for control of preanalytical and analytical factors related to hematology for mammalian and nonmammalian species, hemostasis testing, and crossmatching and is adapted from sections 1.1 and 2.3 (mammalian hematology), 1.2 and 2.4 (nonmammalian hematology), 1.5 and 2.7 (hemostasis testing), and 1.6 and 2.8 (crossmatching) of the complete guidelines. These guidelines are not intended to be all-inclusive; rather, they provide minimal guidelines for quality assurance and quality control for veterinary laboratory testing and a basis for laboratories to assess their current practices, determine areas for improvement, and guide continuing professional development and education efforts.     

The effect of the inspired oxygen fraction on arterial blood oxygenation in spontaneously breathing,isoflurane anaesthetized horses: a retrospective study

ObjectivesTo investigate the influence of two inspired oxygen fractions (FIO₂) on the arterial oxygenation in horses anaesthetized with isoflurane.Study DesignRetrospective, case-control clinical study.AnimalsTwo hundred equine patients undergoing non-abdominal surgery (ASA class 1–2), using a standardized anaesthetic protocol and selected from anaesthetic records of a period of three years, based on pre-defined inclusion criteria.MethodsIn group O (n = 100), medical oxygen acted as carrier gas, while in group M (n = 100), a medical mixture of oxygen and air (FIO₂ 0.60) was used. Demographic data, FIO₂, arterial oxygen tension (PaO₂) and routinely monitored physiologic data were recorded. The alveolar-arterial oxygen tension difference [P(A-a)O₂] and PaO₂/FIO₂ ratio were calculated. The area under the curve, standardized to the anaesthetic duration, was calculated and statistically compared between groups using t-tests or Mann–Whitney tests as appropriate. Categorical data were compared using Chi-square tests.ResultsNo significant differences in age, body weight, sex, breed, surgical procedure, position, anaesthetic duration or arterial carbon dioxide tension were found. Mean FIO₂ was 0.78 in group O and 0.60 in group M. Compared to group O, significantly lower values for PaO₂ and for P(A-a)O₂ were found in group M. In contrast, the PaO₂/FIO₂ ratio and the percentage of horses with a PaO₂ <100 mmHg (13.33 kPa) were comparable in both groups.ConclusionsAlthough a reduction of the inspired oxygen fraction resulted in a lower PaO₂, the P(A-a)O₂ was also lower and the number of horses with PaO₂ values <100 mmHg was comparable.Clinical relevanceIn healthy isoflurane anaesthetized horses, the use of a mixture of oxygen and air as carrier gas seems acceptable, but further, prospective studies are needed to confirm whether it results in a lower degree of ventilation/perfusion mismatching.     

Predictors of depression and anxiety in first-year veterinary students: a preliminary report

Historically, veterinary medical students' mental health has rarely been investigated, but recently there has been renewed interest in this topic. The present study evaluated depression and anxiety levels in a cross-sectional investigation of 93 first-year veterinary medical students enrolled at Kansas State University (KSU). During their first semester, students completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Mental Health Inventory's Anxiety Scale (MHI-A). Results indicate that 32% of these first-year KSU veterinary students were experiencing clinical levels of depressive symptoms. Additionally, students reported elevated anxiety scores. Predictors of depression and anxiety levels include homesickness, physical health, and unclear instructor expectations. Areas of intervention with a focus on improving veterinary medical student well-being are discussed.     

ASVCP guidelines: quality assurance for point‐of‐care testing in veterinary medicine

Point‐of‐care testing (POCT) refers to any laboratory testing performed outside the conventional reference laboratory and implies close proximity to patients. Instrumental POCT systems consist of small, handheld or benchtop analyzers. These have potential utility in many veterinary settings, including private clinics, academic veterinary medical centers, the community (eg, remote area veterinary medical teams), and for research applications in academia, government, and industry. Concern about the quality of veterinary in‐clinic testing has been expressed in published veterinary literature; however, little guidance focusing on POCT is available. Recognizing this void, the ASVCP formed a subcommittee in 2009 charged with developing quality assurance (QA) guidelines for veterinary POCT. Guidelines were developed through literature review and a consensus process. Major recommendations include (1) taking a formalized approach to POCT within the facility, (2) use of written policies, standard operating procedures, forms, and logs, (3) operator training, including periodic assessment of skills, (4) assessment of instrument analytical performance and use of both statistical quality control and external quality assessment programs, (5) use of properly established or validated reference intervals, (6) and ensuring accurate patient results reporting. Where possible, given instrument analytical performance, use of a validated 1_3s control rule for interpretation of control data is recommended. These guidelines are aimed at veterinarians and veterinary technicians seeking to improve management of POCT in their clinical or research setting, and address QA of small chemistry and hematology instruments. These guidelines are not intended to be all‐inclusive; rather, they provide a minimum standard for maintenance of POCT instruments in the veterinary setting.