It’s true, isn’t it, that there is nothing more stressful than having to prepare a patient for anaesthesia, thinking about the anaesthetic protocol, calculating the doses, arranging the operating theatre etc etc. and all this for an uncooperative patient? You cannot find the right tube, other unforeseen things happen, you start to feel rushed… And all this can be compounded if complications arise during the anaesthetic procedure  which, perhaps, if they had been foreseen and anticipated, could be better managed and the patient’s safety would not be compromised.

And not only the patient’s safety – the stress and anxiety that you will experience during this time will take its toll on you later.

As anaesthetists jokingly say, anaesthesia is “long periods of tedium mixed with brief moments of panic”. These moments of panic, which can sometimes cost an animal its life, can often be prevented if the right preparations are made beforehand for each and every anaesthesia. Which is why I am going to pass on some advice to you that was given to me many years ago and which will certainly greatly reduce the unforeseen events that can occur, and if they do occur, at least you will be ready to deal with them.

Bear in mind that we are talking about planned anaesthesia, not emergency cases. Planned surgical/anaesthetic procedures are normally performed in the morning, so that everything starts the afternoon or the evening before.

These are my 5 pieces of advice:

Review each patient in advance

Prepare the anaesthetic chart for each patient: enter the animal’s and the owner’s details, the weight of the patient, ASA classification, procedure to be performed etc, etc, - in short, all the details that are available in advance. Review the preoperative examination, blood tests, ECG… and note the details that are relevant. In this way, you will have it ready the next day and you will have saved time.

Seek solutions to possible problems and do all the calculations

• Think about and write your list of “problems and solutions”: think of all the problems that could arise with this particular patient. Any that could be linked to the actual patient and their pathologies/pre-existing condition, presurgical data, age, sex and breed, or anything that could be the result of the procedure itself (duration, degree of pain, position of the patient, stages of the surgical procedure etc). When you have the list of complications that could arise, then think of a solution to each of them or at least something that could help you to manage them or reduce their impact.

• Think about the protocol that you are going to use and calculate all the doses: choose which drugs you will use with this patient and calculate the doses that you will need in ml, including the intraoperative CRIs (of both fluids and drugs). Always use a balanced anaesthesia technique, with a combination of drugs that allow individual doses of each to be reduced and side effects to be minimised.

• Calculate all the doses of emergency drugs in ml: have ready calculated all the doses in ml of atropine, adrenaline, lidocaine, antagonists (if there are any) that are appropriate for this patient, then if there is a moment of panic, don’t waste time on calculations.

Keep a “patient box” ready to accompany the patient at all times.

Prepare the patient “box” (a tray will do). The patient “box” must accompany the patient wherever they go, including to the X-ray room if the animal has to be transferred there at any time. It will also contain things that will be used, for example additional quantities of the induction agent if the patient has to be moved from the room. This box should contain:

• Endotracheal tube, 3 different sizes (or more if it is a brachycephalic breed). One tube of the diameter that you think is correct, one size above this and one size below.

• Tape, gauze or the material that you use to attach the tube to the animal’s head

• Empty syringe to inflate the cuff of the tube (check that all the tubes have an intact cuff with no leaks)

• Intravenous catheters: prepare the catheters that you wish to insert, bearing in mind that you may need more than one until you find the vein/artery. Consider whether you will need one, two or more accessible intravenous lines for the procedure. I even include pieces of adhesive tape, ready cut, with which to attach the catheters.

• Needles and syringes to apply all the drugs that will be used.

• The laryngoscope for intubation. Check that the size of the blade is appropriate for this patient and check that the light is working.

• Gauze to grasp the patient’s tongue during intubation and in case there is any bleeding when the catheters are being inserted.

• Silicone catheter caps for injection.

• Lubricant for the eyes.

• Lidocaine spray (if needed)

Prepare the pre-anaesthetic room and operating room thoroughly:

In the pre-anaesthetic room, set up the table where the patient will be prepared. Put the underpad and mat in place, and nearby place the shaver (checking that it works), the products to clean the area where the intravenous line is to be inserted and what you will need for the patient before you go into the operating room.

Check and leave the operating room ready:

• Position and untangle the cables of the monitors, for example to enable the ECG electrodes to be attached as quickly as possible.

• Lay out the serum and infusion system that the patient will need, with extenders or three-way valves included.

• Consider which breathing system you will want to use and leave it ready in the anaesthetic machine, as well as the reservoir bag.

• Place the warming blanket or the heating system that you use (without switching it on, obviously), etc on the operating table.

• Fill the gas vaporiser and change the soda lime if necessary.

• Check that the anaesthetic machine is working correctly and ensure that there are no leaks, that the valves are working correctly etc.

• Check the amount of oxygen in the tank/canister and ensure that there is sufficient, see that the flowmeter is working properly.

Use the drugs that you are comfortable with and that give you peace of mind

The most important thing in anaesthesia is to know the drugs and the effects that they can have. If you know, for example, that alpha-2 agonists cause bradycardia and during your anaesthesia the patient has 50 bpm, but correct cardiac output and correct blood pressure are maintained, don’t panic! You already know what the bradycardia is caused by and it was expected, is that not the case?

Use drugs that you are familiar with, with which you can carry out anaesthesia safely and in a balanced way. Of course, everything evolves and you have to adapt, but use courses, webinars, etc for training in new techniques and drugs before taking the plunge. For example, you can view the “Best Anaesthesia protocols for everyday emergencies” to learn about anaesthesia in emergency cases. 

We hope that all this will help to minimise those “moments of panic” as far as possible.