You sign the consent form, your pet is led or carried away and you have full faith that they will be looked after, you will see them again in a few hours. But how do we ensure they are as safe as they can be during the procedure? Who looks after them and how do we make sure they come back to you happy and safe, if possibly a little sleepy?
Well, this is where our fantastic nursing team come in! You will all know that it is your vet who carries out the operation, but what you may not realise is that your pet’s anaesthetic is in the hands of our highly skilled and dedicated nurse team.
What happens in a general anaesthetic?
There are several stages to a general anaesthetic and different staff members have different responsibilities in each area:
Pre-medication
This is a combination of sedative drugs given a period of time before a full anaesthetic given. It is normally a combination of sedatives and pain relieving drugs. Which drugs are given depends on the patient and the procedure they are having, as well as the vets’ and nurses’ preference. Some procedures will require stronger pain relief, and some breeds, or pets with some conditions such as epilepsy, may be more susceptible to some drugs and the vet may choose to give an alternative. Choosing what drug to give, and what dose, is up to the vet, as they are the only ones able to prescribe prescription-only medication. Once they have decided what your pet will receive, it is often the nurse that draws up the required dose at the right time. They will often then administer the combination of medications to your pet.
This can be done in several ways: under the skin (subcutaneous); into the muscle (intramuscular); or into the vein directly (intravenous). Which route is used depends on what drug is used, and what effect is required. The purpose of the pre-med is to calm your pet, reducing the amount of anaesthetic we need to give to get them to sleep, and to keep them asleep. A pain relieving drug is also often used at this point so it is working before they have their operation.
Once the drug has been given, your pet is monitored by one of our nurses. They check the effect the drugs have on your pet, and monitor their respiration rate, their pulses, their heart rate, their temperature and the level of sedation your pet is currently experiencing. If they have any concerns, they will flag this to the vet who will assess your pet and together the vet and nurse will decide if anything needs to be done.
While your pet is getting sleepy the veterinary nurse will select the right breathing system for your pet, based on their weight and the risks of the anaesthetic. They will then set this up on the anaesthetic machine and complete important checks. These include ensuring that the oxygen is connected and flowing as it should, and that there is the right anaesthetic gas in the machine, and that this is topped up. They will also ensure that all the monitoring equipment needed is present and working, and also that all of the surgical instruments the vet will need are ready and waiting. This includes gowns, gloves and masks for the surgeon, drapes to keep your pets hair away from their wound, and suture material or staples for when the wound is being closed. By having these ready, it means that they are able to focus only on your pet once they are asleep.
Induction
Once your pet is sleepy enough and their pain relief is working, the vet and nurse will induce the general anaesthesia. The vet induces the anaesthetic while the nurse supports your pet, and monitors their initial response to the anaesthetic.
Once your pet is asleep, the vet or the nurse will pass a endo-tracheal tube into their mouth and down into their throat. The VN will then ensure this tube is tied in place and is situated correctly. They will then attach your pet to the anaesthetic machine and titrate the amount of oxygen and anaesthetic gas to exactly what your pet needs to keep them asleep. This will depend on many things, such as the pre-med they received, the procedure they are having, and their own reaction to these. The VN is trained to calculate the amount of oxygen needed (flow rate), and is able to determine what amount of anaesthetic gas by assessing the current plane of anaesthesia your pet is in. They do this by checking the following:
- Breathing
- Heart rate and pulses
- Eye position (the eye changes position depending on how asleep your pet is)
- Whether certain reflexes are still present, such as a blink reflex and jaw tone.
Once the nurse is happy that your pet is asleep and stable, they will attach the monitoring equipment. What equipment is needed will depend on your pet, their anaesthetic risk, and the procedure they are having. Our nurses are trained to use the following monitoring equipment to help them monitor the anaesthetic:
- Pulse oximeter – this measures the level of oxygen in your pet’s blood
- Capnograph – this lets us know how much carbon dioxide is present in the breath your pet breathes out.
- Blood Pressure Monitor – this allows us to check your pet’s blood pressure throughout surgery, and take action if it starts to drop
- Temperature probe – this allows us to ensure your pet stays warm throughout their anaesthetic
- ECG – this allows us to check your pet’s heart is beating properly throughout the procedure.
It is wonderful to have so many ways of checking our patients, but our vets all agree that the best one by far is the nurse themselves! Throughout the procedure they will be manually checking your pet and monitoring their vital signs. These are recorded every 5-10 minutes on an anaesthetic record. Based on these readings, the nurse will adjust the level of anaesthetic gas, with consent from the vet.
Overall, the operating vet still has responsibility for the anaesthetic, but they rely on our highly trained nurses to monitor and record your pets status under anaesthetic, and make their decisions based on that knowledge.
Recovery
Once your pet’s procedure is finished, the nurse will stop the anaesthetic gas being delivered, but they will keep them on oxygen. The nurse will take some final vital signs, including temperature, from your pet and will sit with them until they are able to swallow. Until they can do this, the tube stays in their throat and they stay in the operating theatre.
Once they are able to swallow, the nurse removes their tube and takes them back to recovery. Here they are passed to the care of our kennel nurses. These nurses look after your pet as they come round fully, ensuring their temperature remains normal, that they receive any medications they need after the operation, and giving lots of TLC and reassurance as your pet recovers.
Discharge
Depending on the procedure, it may also be one of our nurses who go through the aftercare needed with you, and reassure you on how the day went. They will talk through everything you need to know and will answer any questions you may have about what happens next. Once they are happy you have had all your questions answered and know what happens next, they will reunite you with your pet.
We are very proud of our highly trained nursing team and the level of care they provide our patients when they are here with us, we are all lucky to have them!