Nursing Anaesthesia

The anaesthetic machine and monitoring equipment

The anaesthetic machine is an essential tool for inhalation anaesthesia. A good working knowledge of both the machine and breathing circuit is essential to ensure the safety of the patient.

This course will cover the different types of machines available and will review available breathing circuits. The range of monitoring equipment in veterinary practice has increased significantly over the last few years and the latest thinking on this topic will be presented.

• The anaesthetic machine
• Breathing systems
• The anaesthetic record
• Ancillary anaesthetic equipment
• Basic and advanced monitoring of anaesthesia
• Ventilators

Key learning objectives.

At the end of this module, candidates should be able to:

1.1 Recognize the key components of the anaesthetic machine and the path of oxygen through it

1.2 Explain how the different anaesthetic breathing systems work

1.3 Be able to choose an appropriate breathing system for a patient and calculate the correct fresh gas flow

1.4 Describe the theory of rebreathing systems and show how to use low flow anaesthesia safely.

1.5 Outline the importance of the anaesthetic record and be able to complete them correctly

1.6 Have an overview from basic through to advanced monitoring

1.7 Be able to identify different pieces of ancillary anaesthetic equipment, describe how they work and demonstrate when to use each individual item.

1.8 Summarize when artificial ventilation is used, outline the pros and cons, and describe different types of ventilators.

Pre-anaesthetic assessment and premedication. Intravenous and inhalant anaesthetics

This course will cover how to assess the patient before anaesthesia and the different drugs available for pre-medication. General anaesthesia may be induced by injectable drugs or inhalational agents. These will be reviewed along with methods of maintaining anaesthesia.

• Principles of pre-anaesthestic assessments
• Pre-anaesthetic medication and patient preparation
• Injectable induction agents
•  Inhalational agents 

At the end of this module, candidates should be able to:

2.1 Describe the role of pre-anaesthetic assessment including clinical exam findings, history taking and additional tests

2.2 Memorize the American Society of Anaesthesiologists classification

2.3 Explain different aspects of patient pre-anaesthetic preparation including starvation

2.4 Outline the basic pharmacology of drugs used for pre-anaesthetic medication, anaesthetic induction and maintenance.

2.5 List the reasons to provide pre-anaesthetic medication 2.6 Consider the situations in which certain premedication, induction of maintenance drugs will be chosen over others.

2.7 Describe the newer agents available.

Cardio-pulmonary resuscitation, accidents and emergencies

The causes of cardiopulmonary arrest (CPA) will be covered as will how to recognise ‘at risk’ patients. The aim of cardiopulmonary resuscitation (CPR) is to support ventilation and circulation until natural functions can be restored and maintained. Equipment and resources needed for CPR will be included and a step-by-step ‘how’ to’ guide.

• Complications that may arise during anaesthesia
• Basic cerebro-cardio pulmonary resuscitation
• Advanced cerebro-cardio pulmonary resuscitation

At the end of this module, candidates should be able to:

3.1 Predict and identify common complications in anaesthesia, and recognize when to call for assistance.

3.2 Explain the use of anaesthetic checklists and be able to implement them in clinical practice

3.3 Outline the causes and identification of respiratory arrest

3.4 Outline the causes and identification of cardiac arrest

3.5 Use a step-by-step guide as to how to manage both respiratory and cardio-pulmonary arrests

3.6 Explain the principles of basic CCPR

3.7 Provide artificial ventilation and circulation

3.8 Summarize the RECOVER guidelines for the current recommendations for CCPR for veterinary patients.

Anaesthesia of equine and exotic species

There are naturally some important differences when planning anaesthesia in both equine and exotic species. This module will cover the different drugs and techniques available for both the horse and also common ‘exotic’ species

• Equine anaesthesia
• Avian anaesthesia
• Reptilian anaesthesia
• Small mammal anaesthesia.

At the end of this module, candidates should be able to:

4.1 Consider the horse as an anaesthetic candidate

4.2 Outline the procedures involved in equine anaesthesia

4.3 Describe the basic pharmacology of the drugs and the monitoring techniques used in equine anaesthesia

4.4 Identify the complications in equine anaesthesia and discuss how to prevent them

4.5 Recognise the special considerations for anaesthesia in different species including: birds, reptiles, ferrets, rabbits and other small mammals

4.6 Consider the difficulties and techniques to achieve endo-tracheal intubation, anaesthetic monitoring and vascular access in these species.

Fluid therapy in the perioperative period Nutrition in critical care

Fluid therapy is often seen as complicated by both nurses and vets. This module aims to demystify the subject and explain the reasons why every nurse should understand the basics of fluid balance, fluid therapy and fluid administration.

How to calculate fluid requirements, rates of administration and monitoring techniques will be covered. Nutritional support for the anaesthetised patient will also be included.

• Fluid balance in the body
• Types of fluid losses
• Crystalloids and colloids
• Transfusion medicine
• Critical care nutrition

At the end of this module, candidates should be able to:

5.1 Outline the fluid balance in the body

5.2 Summarize the different types of fluid losses a veterinary patient may experience

5.3 Evaluate dehydration and hypovolaemia in a patient.

5.4 Name the different types of fluids, and demonstrate when you might choose crystalloids or colloids

5.5 Devise a fluid therapy plan and perform the relevant calculations

5.6 Formulate a strategic plan to be able to monitor patients undergoing fluid therapy.

5.7 Describe the principles of transfusion medicine and outline the different blood components available.

5.8 Recognise appropriate candidates for feline and canine blood donation and be able to describe the technique of obtaining a blood donation.

5.9 Use calculations used to estimate amount of blood required to transfuse anaemic patients

5.10 Describe the importance of nutrition in the critical patient and identify which techniques would be suited to which patients.

Analgesia and pain assessment

This course will cover the pathophysiology of pain and how to recognise and assess pain in the different species.

The different types of drugs available for analgesia will be reviewed for short, medium and long term use. The concept of pre-emptive analgesia will be covered along with multi-modal analgesia.

• Physiology of pain
• Pain assessment
• Analgesic drugs
• Continuous rate infusions for analgesia

At the end of this module, candidates should be able to:

6.1 Describe the types of nociceptors and how they work

6.2 Outline the pain pathway and be able to identify where on the pathway different analgesic drugs work

6.3 Compare different pain scoring systems and recognise signs of pain in different species.

6.4 Outline the basic pharmacology of different analgesic drugs including opioids, non-steroidal anti-inflammatory agents, local anaesthetics, alpha 2 agonists and more

6.5 Identify different local anaesthetic techniques including epidurals, and justify the clinical cases in which they might be used.

6.6 Explain the basic pharmacology of continuous rate infusions for analgesic drugs

6.7 Be able to calculate a continuous rate infusion from information given.

6.8 Identify the tools used to assess and monitor chronic pain chronic pain 4.9 Outline the drugs and adjuncts to treat chronic pain.

Anaesthetic consideraItions for specific conditions I

Certain conditions require the anaesthetist to employ different techniques from those routinely used. The use of neuromuscular blocking agents will be covered in this course as well as planning anaesthesia for thoracic surgery, head and neck surgery, patients with cardiopulmonary disease and those with neurological problems.

• Neuromuscular blockade
• Anaesthesia for patients undergoing thoracic surgery
• Anaesthesia for patients undergoing head and neck surgery
• Anaesthesia for patients with cardiac disease
• Anaesthesia for patients with neurological disease.

At the end of this module, candidates should be able to:

7.1 Describe normal neuro-muscular physiology

7.2 Idenitify different neuromuscular blocking drugs and describe techniques to monitor blockade

7.3 Outline the principles of intermittent positive pressure ventilation (IPPV).

7.4 Recognise appropriate candidates for IPPV and be able to set basic ventilation settings

7.5 Outline the considerations for anaesthesia for thoracic surgery including IPPV and the need for appropriate analgesia

7.6 Explain the considerations for anaesthesia for head and neck surgery including airway protection and monitoring of anaesthesia

7.7 Explain the general considerations for anaesthesia for patients with cardiac disease

7.8 Describe the more specific considerations for patients with different murmurs and heart diseases

7.9 Recognise the signs and contributing factors to raised intra-cranial pressure (ICP) and describe the different treatment options to reduce elevated ICP.

7.10 Summarize the difficulties involved with anaesthetising patients in the magnetic resonance imaging (MRI) scanner

Anaesthetic considerations for specific conditions II

Certain conditions require the anaesthetist to employ different techniques from those routinely used. The use of neuromuscular blocking agents will be covered in this course as well as planning anaesthesia for thoracic surgery, head and neck surgery, patients with cardiopulmonary disease and those with neurological problems.

• Anaesthesia of the pregnant patient
• Anaesthesia of paediatric patients
• Anaesthesia of geriatric patients
• Anaesthesia of patients with liver disease
• Anaesthesia of patients with renal disease
• Anaesthesia of patients with endocrinopathies.

At the end of this module, candidates should be able to:

8.1 Outline the physiological changes present during pregnancy

8.2 Explain the considerations for Caesarean section and describe how to manage them

8.3 Summarize the physiological differences in geriatric and paediatric patients

8.4 Demonstrate ways to manage the anaesthesia of geriatric and paediatric patients

8.5 Outline the effects that hepatic dysfunction, renal dysfunction or different endocrinopathies will have on anaesthesia.

8.6 Demonstrate how to plan an anaesthetic for patients with kidney disease, liver disease and endocrinopathies to avoid worsening dysfunction.