Getting started

This chapter provides a basic overview of anaesthetic equipment and its safe use. Topics include the provision of anaesthetic gases, the basic components of the anaesthetic machine, breathing systems, positive-pressure ventilation, and airway equipment including laryngoscopes, endotracheal tubes and supraglottic airway devices. Methods of long-term venous access are discussed.

Effects of Propofol, Ketamine and their Combination (ketofol) as Total Intravenous Anesthesia (TIVA) on Haematological, Serum Biochemical and Hormonal Profile in the Surgical Management of Canine Patients

Background: The non-availability of the sophisticated anaesthetic machine and the necessary equipment to administer inhalant anaesthetic in the field hospitals make their use practically unfeasible for the field veterinarians. Therefore, the present study was undertaken to evaluate the effect of propofol, ketamine and their combination ‘Ketofol’ as a TIVA on certain haematological, serum biochemical and hormonal profiles in atropine and xylazine premedicated dogs. Methods: The study was conducted in eighteen clinical cases of dogs of either sex. The animals were randomly divided into three groups with six animals in each group. All the three groups were premedicated with Atropine sulphate @ 0.04mg/kg body weight and xylazine HCl @ 0.5mg/kg body weight intramuscularly. In group-I, propofol @ 5mg/kg body weight, in group-II, ketamine @ 5mg/kg body weight and in group-III, ketofol @ 4mg/kg body weight was administered intravenously for induction after 15 minutes of pre-anesthetic administration. Surgical anaesthesia was maintained for 90 minutes in all three groups viz. group-I, group-II and group-III with propofol @ 2.5mg/kg. b.w., ketamine @ 2.5mg/kg b.wt. and ketofol @ 2mg/kg b.wt. respectively by intermittent bolus injection (IBI) technique. Haematological, serum biochemical and hormonal profile were evaluated before administration of the anaesthetic agent (0 minutes) then at 15, 30, 60 and 90 minutes during and after administration of anaesthetic agents. Result: The study revealed that Hb, PCV and TEC were significantly decreased in all the groups at 60 mints and 30 mints respectively. The biochemical evaluation revealed that blood glucose level was significantly increased in all the groups until the end of the experiment. BUN and creatinine value was a significant increase in group-I and group-II than group-III at different time intervals up to the end of the experiment. In all the groups’ alanine aminotransferase (ALT) values significantly increased up to 60th minutes during TIVA whereas AST value was significantly increased in group-II at 30th and 60th minute of the experiment in compare to group-I and group-III. A higher level of cortisol values was recorded in group-I animals for the entire period of observation. There were no changes observed in the case of T3. Transient variables of haemato-biochemical have been reported following propofol, ketamine and their combination (ketofol) as total intravenous anaesthesia (TIVA). Thus, it has been concluded that diligent monitorization and electrolyte support are essential during the period of anaesthesia.

Exploring the use of high and low demand simulation for human performance assessment during multiorgan retrieval with the joint scrub practitioner

IntroductionThe National Organ Retrieval Service (NORS) 2015 review recommended a Joint Scrub Practitioner for abdominal and cardiac teams during combined organ retrieval. To evaluate the feasibility of this role, and to understand the functional implications, this study explores the use of simulation and provides a novel and comprehensive approach to assess individual and team performance in simulated multiorgan retrievals.MethodsTwo high-fidelity simulations were conducted in an operating theatre with porcine organs, en bloc, placed in a mannequin. For donation after brainstem death (DBD) simulation, an anaesthetic machine provided simulated physiological output. Retrievals following donation after circulatory death (DCD) began with rapid arrival in theatre of the mannequin. Cardiothoracic (lead surgeon) and abdominal (lead and assistant surgeons; joint scrub practitioner, n=9) teams combined for the retrievals. Data collected before, during and after simulations used self-report and expert observers to assess: attitudinal expectations, mental readiness, mental effort, non-technical skills, teamwork, task workload and social validation perceptions.ResultsAttitudinal changes regarding feasibility of a joint scrub practitioner for DBD and DCD are displayed in the main body. There were no significant differences in mental readiness prior to simulations nor in mental effort indicated afterwards; however, variance was noted between simulations for individual team members. Non-technical skills were slightly lower in DCD than in DBD. Global ratings of teamwork were significantly (p<0.05) lower in DCD than in DBD. Measures of attitude indicated less support for the proposed joint scrub practitioner role for DCD than for DBD.DiscussionThe paper posits that the joint scrub practitioner role in DCD multiorgan retrieval may bring serious and unanticipated challenges. Further work to determine the feasibility of the NORS recommendation is required. Measures of team performance and individual psychological response can inform organ retrieval feasibility considerations nationally and internationally.

Falsely low arterial blood pressure due to pressure transducer damage in three horses

Three horses undergoing general anaesthesia for orthopaedic procedures between August 2018 and January 2019 at Langford Veterinary Equine Services, Bristol University had falsely low arterial blood pressures due to damage of the non-disposable invasive arterial blood pressure transducer interface. The invasive arterial blood pressure transducer interface is not currently a component that is checked during the anaesthetic machine check prior starting a general anaesthetic procedure. Starting treatment for hypotension based on incorrect information due to faulty equipment can have severe negative consequences for the patient, such as extreme hypertension, increased myocardial workload and oxygen demand, and reduced perfusion of splanchnic and muscle tissue due to vasoconstriction. Therefore, we recommend routinely using the square wave test and checking the integrity of the blood pressure transducer interface before starting a general anaesthetic procedure, and when unexpected hypotensive readings are obtained and/or a state of hypotension is not responsive to treatment.

Anaesthetics

Anaesthesia is the field of medicine specializing in modifications of sensation or awareness, in particular in the setting of surgery and labour. Anaesthesia can be general, regional, or local. The chapter outlines preoperative anaesthetic assessment including the Mallampati score, fasting history, medication review, and risk stratification. Anaesthetic agents (inhaled/intravenous) are summarized, as well as the functions (and safety checks) of the anaesthetic machine. A standardized approach to the general anaesthetic is described including induction, airway control, intubation, maintenance, and emergence. An overview of regional and obstetric anaesthesia is also included, in addition to the principles of safe administration of local anaesthesia. The World Health Organization pain ladder is also described. Critical incidents and anaesthetic emergencies (the difficult airway, anaphylaxis, malignant hyperthermia) are explained.