Lost Confidence doing GAs

RE: Lost Confidence doing GAs

James Colver Cert. Ed, RVN — Sun, 17 Nov 2019 20:36:23 GMT

Some really good thoughts here :) My first boss told me when I first started that an animal will die on me during GA at some point sooner or later, and I had to be able to tell myself when it happens that it was not because of anything that I did or didn't do. And when it comes down to it that's all you can do.

20 years in and I still get anxious about GAs. I think there's something wrong with a person if that ever changes. The way I try to mitigate this is through learning as much as I can about it (and the more you learn, the more that you realise you don't know..!)

RE: Lost Confidence doing GAs

Sal the 1st — Sun, 17 Nov 2019 12:26:54 GMT

I still remember my 3 anaesthetic deaths vividly and one of those was 30yrs ago. one was a young fit border collie, routine spay and just dropped off the needle on induction - we tried everything and I mean everything but just couldn't get it back, another was a fat embolism following an incredibly long fracture repair - talking 7hrs plus, and the last was a cat with a diaphragmatic hernia, hernia successfully repaired, arrested twice during repair but got it back, the cat just never took a breath by itself afterwards and after over 1/2 hr of ventilating post op and trying everything the vet called time, I was devastated. A GA death does affect you, I know for me I will never forget them, even knowing there was bugger all I could have done to prevent I still went through weeks and months of the what ifs - but then you learn from them. Just remember all the successful anaesthetics you have monitored. I agree with MEOW1950 when you have done your very best there is just nothing more to be done and that is no reflection on your skills.

I still get nervous about very long anaesthetics even now

RE: Lost Confidence doing GAs

Meow1950 — Fri, 15 Nov 2019 17:27:21 GMT

Hi there, good on you for reaching out with how you’re feeling right now, it’s good to chat with others :)

I felt the need to reply as I went through a stage like this myself after an anaesthetic death and got very anxious and reluctant to do anaesthetics afterwards. But thankfully I’ve worked through it now, so hopefully some of what I say will be in some way helpful :)

First of all, I honestly believe the fact this has bothered you, and you are reflecting on it shows what a great nurse you are. Sadly, there are some nurses out there who would just go home and never give it a second thought.

Second of all, we tend to focus blame in on ourselves when we have a genuine concern for things. But the reasons for things like anaesthetic deaths are often multi-faceted. Just a random, fictional example: an animal admitted by a vet for an anaesthetic when it hasn’t eaten or drank in 4 days, o declined anaesthetic bloods , no fluids, you do the anaesthetic and something bad happens. Your fault? Although people tend to blame themselves there are probably many contributing factors outside of your control. So personal blame is often very unfair on yourself.

I’m not sure which mental illnesses you suffer from and don’t expect you to tell me but have you had any CBT or similar for these? Mindfulness? If so, this may be helpful. Because sometimes all the talking to people, doing CPD etc in the world won’t break the thought cycles. These need a bit more work :)

Anyway, I did a lot of anaesthetic CPD over the years to try and help with the anxiety. And it did help to an extent but I still had the niggling anxiety of just, but what if something still goes wrong? I’ve finally managed to settle myself by saying to myself all you can do is your BEST! You do you’re best, something goes wrong, you did EVERYTHING you could, and that’s nothing to feel bad about. I pay attention constantly, use all the equipment, use all my CPD knowledge, make sure I stay with them post op til I’m happy (no matter if I get a few funny looks for still being with them) etc.

That’s all you can do! Hope this helps

RE: Lost Confidence doing GAs

Susanna Taylor — Thu, 14 Nov 2019 07:47:58 GMT

Hi there

Sorry to hear you are having a rough time, but firstly well done for reaching out for support.

Anaesthetic deaths are never easy to bare, whether the likelihood is high or not, so you are not alone there. It sounds like both of these cases were high risk.

You are clearly on high alert with clinical cases at the moment, and while that is usually not a bad thing in anaesthesia, it can be emotionally draining and that is certainly not going to help your emotional health.

Please really take time to concentrate on your mental wellbeing - exercise, good nutrition, meditation in what ever form suits you, get plenty of sleep. Consider some CBT training to help you stop listening to the negative voices.

Doing some anaesthesia CPD is a good idea, but don't let it overwhelm you. Concentrate on the basics and try to simplify problems rather than expand them. Revisit your physiology for example, so you can link whats happening back to the basic science. Discuss things with your vet. The more you concentrate and understand WHY changes are happening, the less scary they are. For example, why does the RR go down when the iso goes up? what is the iso doing to the respiratory sensors...

Trust you are not alone, and you can get past this,

There is a nice facebook page called The anxious RVN that may be helpful to you as well.

Keep in touch on here or by PM

All the best, Susanna

RE: Lost Confidence doing GAs

VetNurse Anon a/c — Wed, 13 Nov 2019 21:29:54 GMT

Without going into too much detail, one was old and had a lot going on, that would have died without the GA, and the other was a rabbit which unfortunately got so stressed being in the veterinary environment, I think the GA was just too much for it to cope with (I have been in touch with a rabbit behaviour vet since and we have discussed the situation). Both incidents have been discussed with colleagues, so there’s nothing specific, it’s just with them being in close succession that has really knocked me.

RE: Lost Confidence doing GAs

Anne Watkins — Wed, 13 Nov 2019 19:58:32 GMT

Do you know why those two patients passed away under GA?