Judging anaesthesia depth

Re: Judging anaesthesia depth

Sammyannieantha — Wed, 17 Nov 2010 13:27:08 GMT

I am always on 'tent pegs' when monitoring even after years of doing so and i think even some experienced people can be quite blaise (think thats how u spell it) as regards to monitoring. I make a point of telling the vet when I am turning the dial up or down and make it clear if there are any probs e.g too deep/light. Some vets i know are unsure sometimes when I asked about patients under GA's because they dont simply dont monitor GA's. I have previously asked another RVN (who has more experience) to check the animal for me if I am worried simply because the vet either doesnt know or is having a complication of their own! I think its so so important to raise any worries or queries and i am not afraid to do so-at the end of the day i dont care if i look silly in front of a vet or other staff-i dont do it for my own pride I do it to make sure the animal wakes up and has a safe recovery. Most vets are very supportive and appreciate awareness but I have felt in the past that queries to vets about anaesthesia make you feel as you being incompetant or nervous or incapable of monitoring anaesthesia but just remember you are their eyes and ears and theres no point operating on a dead animal!Not saying it wont happen but so far i havent had any anaesthetic deaths during my watch (thank god) so i hope im doing something right!

Re: Judging anaesthesia depth

Kim Buckley — Wed, 17 Nov 2010 12:19:28 GMT

I agree with what you are saying Gillian and I totally understand that it on the vets head if it goes wrong.

But what I don't understand is how the vet can judge the level of anaesthesia without looking at the animal. If they were to stop what they were doing and observe the animal (with help from the nurse so they remain sterile) then fair enough but I don't think I have ever seen a vet do this.

Anaesthesia is quite a large part of the veterinary nurses training and if all the take away from it is what is normal and what isn't then they should be able to alert the vet to when something isn't right. If they aren't capable of that then they shouldn't be calling themselves a VN.

For example:

I was monitoring an anaesthetic the other day on a healthy, young dog who was having a routine orthopeadic procedure. It's blood pressure was creeping up so I checked the patient and couldn't see a reason for it so I asked the anaesthetist to come and have a look for me. They checked the patient and made some suggestions which I then followed and the blood pressure slowly went back to normal. I didn't go beyond what I should and alerted a vet to the problem who was able to check for me and sort it out.

Re: Judging anaesthesia depth

Deemus — Wed, 17 Nov 2010 06:04:14 GMT

[quote user="Gillian Mostyn"]It also depends on how much responsibility a vet is happy to pass onto someone else - some vets really are happier making the decisions themselves and it is best not to take this personally[/quote]

Thanks for your reply Gillian. You've raised a couple of points that I hadn't considered. Perhaps I am a little guilty of taking it more personally than I should.

I don't know if this particular vet has had a bad experience. Probably better to chalk it up to experience and personal difference.

Re: Judging anaesthesia depth

Gillian Mostyn — Tue, 16 Nov 2010 22:03:00 GMT

hmmm- very difficult subject and I'll give a view from the 'other side of the table'.

A lot depends on how much confidence the vet has in the person monitoring the anaesthetic - and it can be irrelevant how 'qualified' they are - I have worked with some excellent assistants who hold no qualifications, and also a couple of VNs who couldn't manage anaesthesia well to save their lives. Having a VN should mean that you can assume a certain theoretical knowledge base, but doesn't automatically indicate practical ability or common sense! (The same as with vets!)

It also depends on how much responsibility a vet is happy to pass onto someone else - some vets really are happier making the decisions themselves and it is best not to take this personally. Annoying, but they are the way they are.

As a VN I can understand that it must be really frustrating to feel like you aren't trusted to make the decisions yourself, but at the moment the anaesthesia is 100% the responsibility of the vet. Therefore, if anything goes wrong, regardless of the circumstances, it will be the vet who has to face the client, and occasionally the RCVS. This means the vet does feel like they want to be in control all the time. Putting it bluntly, if the animal dies then you would rather it was your fault than feel it was the nurses fault!

After you have to tell a client their animal has died accidently you never approach anaesthesia in the same way again - maybe that's why some vets tend to be a bit paranoid? Maybe they've had a bad experience?

Re: Judging anaesthesia depth

dinny_06 — Tue, 16 Nov 2010 20:40:28 GMT

In our practice the nurse (q or student) monitors the anaesthetic. When it is myself doing so i will give the vet my opinion with regards to the anaesthetic plane the patient is in and what i am and have done about it. This is only to make them aware of whats going on. It does my head in when the vets take over. I had an incident when i was told to keep the patient on a hgih level as it was gasping!!! Therefore according to the vet it was light. A hello i can see the eye position and reflexes, which were non-existant etc i know that it is far to deep. This had a bad outcome and i demanded that i was not doing this anymore that i was following my own feelings!!!

The vet cant do everything. Personnally i think that nurses are trained to a high enough standard that we can monitor anaesthesia well enough>

Re: Judging anaesthesia depth

Deemus — Tue, 16 Nov 2010 15:37:37 GMT

[quote user="Kim Blowing RVN"]Why was the request refused?[/quote]

Purely because the respiration at that time hadn't decreased. The patient in question (to me) had the vital signs of one that may become too deep quickly. I'd have preferred to turn down the Isoflo at that point to head off any potential problems.

The vet then gave me a "pop quiz" on how I determine that the patient has become too deep. This was in front of one of my juniors (I'm the HVN). Suffice to say I was embarassed for myself and for my junior who felt uncomfortable throughout this exchange. Then all hell broke loose as the respiration rate went down to 4 a minute (from 18)

I have for years taught nurses how to monitor anaesthetics, some through the NVQ route and some to work in my practice. I'm not trying to say that I know everything and am some sort of anaesthesia demi god but feel really restricted in my current role.

Re: Judging anaesthesia depth

Kim Buckley — Tue, 16 Nov 2010 08:36:17 GMT

[quote user="Deemus"]

[/quote]

Why was the request refused? This is what I don't get. Surely your judgement should be taken into consideration seeing as you obviously have a lot of experience and are the one who is monitoring the patient. I understand that anaesthesia can be very dangerous and you do have to follow the vets orders but I just don't see how they can judge how deep the patient is when it is under a drape and they are scrubbed up.

Re: Judging anaesthesia depth

Lolita — Tue, 16 Nov 2010 08:13:06 GMT

In my place, I monitor the anaesthesia, the vet is too consumed with the surgery and is not really able to monitor breathing properly, I do sometimes say when I think an animal is going to light or deep and just tell him what I am changing just so he knows. He is the kind of person who thinks you are getting too big for your boots if you just do stuff without the running commentary...yeah I know! I have had times where I have had to over rule what he says because he too thinks he can do both, and thinks he has spotted something I havent by glancing up at a particular time when the animal is too deep etc... grrr

Re: Judging anaesthesia depth

Deemus — Tue, 16 Nov 2010 06:47:50 GMT

Thanks for the replies guys. They've been really helpful.

I'm having a little trouble adjusting to the new way of doing things at my place. I'm a QVN with 14 years experience. For years at my current practice, I was left to get on with anaesthesia but knew I had back up from the vet with tricky cases.

We've got a new vet who had informed me that I will no longer be doing this and I am to provide a running commentary on the monitoring of the anaesthetised patients. I am all for improving safety during anaesthesia but find the new regime a little distracting.

It has led to a couple of heated exchanges where I thought the Isoflo should be reduced as the patient was going too deep. The request was refused and a few moments later, the respiration reduced greatly. At a later discussion I was informed that I was "afraid" of running patients deep for their surgery. Nope, not afraid of running them deep, afraid of them dying!

To be fair, I am the only QVN and my two girls are nursing assistants so I can see the point when they are monitoring anaesthetics (yes, I agree that they shouldn't as they're not students but try convincing the boss!)

I think a lot of it has to do with the fact that I am Listed rather than Registered although this hasn't been confirmed.

Ho hum, the vets' wish is my command!

Re: Judging anaesthesia depth

Steph Worsley — Mon, 15 Nov 2010 18:56:20 GMT

[quote user="Kim Blowing RVN"]

[quote user="Steph Worsley RVN MBVNA"]

[quote user="Kim Blowing RVN"]

I don't see how a vet can monitor an anaesthetic and judge how deep an animal is whilst they are scrubbed in and concentrating on the surgery that they are doing! This is why I do not think that unqualified people should be allowed to monitor anaesthetics.

[/quote]

Oh I agree Kim I'm just talking about tecnicalities of schedule 3!

[/quote]

Wasn't having a go Steph. Just think it is stupid!

[/quote]

Yeah I know, I agree!!

Re: Judging anaesthesia depth

Kim Buckley — Mon, 15 Nov 2010 18:54:17 GMT

[quote user="Steph Worsley RVN MBVNA"]

[quote user="Kim Blowing RVN"]

[/quote]

Oh I agree Kim I'm just talking about tecnicalities of schedule 3!

[/quote]

Wasn't having a go Steph. Just think it is stupid!

Re: Judging anaesthesia depth

Steph Worsley — Mon, 15 Nov 2010 18:53:20 GMT

[quote user="Kim Blowing RVN"]

[/quote]

Oh I agree Kim I'm just talking about tecnicalities of schedule 3!

Re: Judging anaesthesia depth

Kim Buckley — Mon, 15 Nov 2010 18:46:59 GMT

Where I work the operating vet has absolutely nothing to do with the anaesthetic. An anaesthetist will assess the animal and sorts out the pre med and help induce the animal. Once the animal is in theatre then it is up to the nurse to monitor the patient. If it is a tricky procedure or a problem anaesthetic then the anaesthetist is there to help.

Re: Judging anaesthesia depth

Steph Worsley — Mon, 15 Nov 2010 18:29:21 GMT

technically it should be the vet making those decisions as far as I am aware, however i have always been the one to change the iso etc in practice

http://www.rcvs.org.uk/shared_asp_files/GFSR.asp?NodeID=97577

Re: Judging anaesthesia depth

SmegSlayer — Mon, 15 Nov 2010 18:24:18 GMT

we usually make the descisions but we have one vet who has an anaesthetia certificate and she will monitor a dental while the nurse scales, talk to a client on the phone so the nurse does both scaling and monitoring, and then comes back, looks at the eyes and changes the isoflo. it's hugely annoying and quite frankly a bit demeaning.

Re: Judging anaesthesia depth

Sally Seddon — Mon, 15 Nov 2010 17:19:09 GMT

The nurses usually make the decisions but if unsure always ask for vets advice/decision.

Re: Judging anaesthesia depth

Lorena Williamson — Mon, 15 Nov 2010 15:09:48 GMT

Hey Dee,

In our practice, before and during the anaesthetic, the nurse usually judges on the inhalation agent, whether the patient is too deep/too light.

However, towards the end of the procedure, the vet usually informs us when to turn off, as only they know how long they take to do a procedure.

Sometimes the surgery itself is an indicator of who should make the decisions. If its routine, carried out everyday, the the nurse will be comfortable to make anaesthetic decisions. If its not routine, then our vet will usually make the decisions.

Luckily, for us, our vet is quite happy to both rely on us, or take charge if the procedure calls for her to.

hope this is helpful?

Ren :-)

Re: Judging anaesthesia depth

julie cozze — Mon, 15 Nov 2010 14:54:28 GMT

Hi Dee

at my practice we are all experienced qualified nurses and we are left pretty much to our own devices. If we ever have any problems we would of course keep the vet informed. I guess for less experienced nurses it may be different.