module c veterinary anaesthesia small animal anaesthesia ... · pdf filesmall animal...

CPD Unit

Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA

Tel: +44 (0)1707 666201 Fax: +44 (0)1707 666877 Email: [email protected]

Module C

Veterinary Anaesthesia Small Animal Anaesthesia and Analgesia (C-VA.1)

Module Leader - Elizabeth Armitage-Chan MA Vet MB DipACVA MRCVS

RCVS Specialist in Veterinary Anaesthesia

The aim of the module is to enable the candidate to extend and consolidate clinical knowledge and

skills gained at undergraduate level, and to develop an in-depth understanding of the application of

that knowledge in a practice environment in relation to anaesthesia of small animal species.

LEARNING OUTCOMES

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

Provide appropriate care for the unconscious patient, including support / maintenance of

normal homeostasis

Demonstrate a sound knowledge of the physiology, pharmacology and biophysics of

relevance to anaesthesia

Demonstrate knowledge of the anatomy of the thorax, abdomen, head and neck as they relate

to anaesthesia

Appreciate the impact of commonly encountered pathological processes in the various

species, on the conduct of anaesthesia, and be able to appropriately modify the anaesthesia in

light of these

Understand the pharmacology and clinical use of drugs used for premedication and sedation

Understand the pharmacology and clinical use of analgesic drugs (opioids, non-steroidal anti-

inflammatories, local anaesthetic agents)

Demonstrate familiarity with commonly performed regional nerve blocks

Understand the pharmacology and clinical use of intravenous anaesthetic drugs, and their use

in total intravenous techniques

Appreciate how a generic anaesthetic machine and vaporiser function, and be able to perform

appropriate safety checks

Understand the pharmacology of the inhalational anaesthetic agents, and how this dictates

their clinical use

Understand the functional characteristics of anaesthetic breathing systems (“circuits”)

Understand the pharmacology and clinical use of neuromuscular blocking drugs

CPD Unit



Appreciate the advantages and disadvantages of intermittent positive pressure ventilation,

and how this may be delivered

Understand in general terms how the electronic monitoring systems used during anaesthesia

function, and be able to interpret the information they provide

Plan and deliver appropriate fluid therapy (including an awareness of the principles of blood

transfusion) for the range of patients encountered in small animal practice

Provide appropriate anaesthesia for specific clinical situations, for example, paediatric and

geriatric anaesthesia, ophthalmological procedures, caesarean section, etc

Appreciate the unique characteristics of small mammals, birds, reptiles and fish which may

complicate the anaesthetic process

Recognise and deal with common anaesthetic emergencies

Review and constructively criticise current literature on the speciality, to determine its

relevance to their current practice

Utilise their understanding of Evidence Based Medicine and Decision Analysis to develop

practical treatment protocols for their patients

Review the outcomes of at least part of their clinical work, using the process of clinical audit

to improve performance

Recognise when they require support from more experience anaesthetic colleagues for a

particular case

LEARNING TOPICS

Aspects of physiology related to anaesthesia, including current knowledge of the function of

peripheral and autonomic nervous system, cardiovascular and respiratory systems and the transport

of gases, the control of water, electrolytes, hydrogen ions and buffers in biological systems, hepatic

and renal physiology and endocrinology.

Pharmacology: a knowledge of the actions of all drugs used in anaesthesia and supportive care

including an understanding of pharmacokinetics and metabolism, the effects of change in composition

of body fluids and transport across cell membranes.

Biophysics: relevant to anaesthesia, techniques of biological measurement used in clinical and

experimental animals and interpretation of results including statistics.

Species specific anatomy (mainly dogs and cats but including an appreciation of small pet mammals

and birds reptiles and fish): CNS, spinal cord and the main nerve trunks blocked in regional analgesic

techniques and a knowledge of the anatomy of the thorax, abdomen, head and neck as they relate to

anaesthesia.

Clinical small animal anaesthesia (including techniques and drugs) pre-operative clinical assessment,

sedation, analgesia, premedication, intravenous anaesthesia, inhalational anaesthesia, induction and

maintenance of general anaesthesia, monitoring during anaesthesia. Use of neuromuscular blocking

agents. Ippv. Local and regional analgesic techniques

Relevant anaesthetic apparatus: basic understanding of anaesthetic machines, breathing circuits,

vaporisers, monitoring equipment etc.

CPD Unit



Knowledge of the pathophysiology of common diseases and disorders of small animals – (mainly

dogs and cats but including an appreciation of small pet mammals and birds reptiles and fish ) as they

affect anaesthesia, as well as the way anaesthesia may affect pathological processes, particularly those

diseases which affect cardiovascular, respiratory and renal function and those which produce

metabolic disturbances.

CPD Unit



Module C


ASSESSMENT

A case diary that documents a broad range of cases requiring anaesthesia and documents the

candidate’s experiences over a minimum of 90 days and no fewer than 50 general anaesthetics.

10 cases should include critical commentaries on at least some of the learning resources and

describe the application of the learning process to these cases. These may also be used to

document achievement of learning objectives not covered by the three cases included in the case

book. All cases should be those that have been directly managed by the candidate. If the

candidate has chosen to spend time seeing practice with a diploma anaesthetist or in a more

specialised exotics practice, those cases they observe being managed can be included in the case

diary and may be mentioned in the synoptic essay but should be in addition to the minimum

case requirements for this module.

At the end of the case diary candidates should include a 1,000 word synopsis of what they have

learned from the cases. This might include what has changed in their approach to a case, any

new procedures or investigations that are now considered, any additional reading which was

helpful, and/or any unexpected features of a case which will influence decision making in the

future.

A case book of three cases, with a combined total word count of 4,000 words and each

individual case book being a minimum of 1,000 words. In combination, these cases should be

selected to demonstrate that the candidate has developed proficiency in the skills and

understanding of the learning objectives outlined in the module content. They should

demonstrate the candidate’s ability to use the competencies that have been acquired to cope

with a challenging situation, rather than necessarily using “textbook cases” of particular

conditions. The case reports should also include comparative aspects of other cases and

knowledge gained from other species as evidence of learning. To avoid repetition, it is

permissible to cross-reference between the components of the module work, for example where

the same principles have been applied to different cases.

It is important that there is evidence from the case diary, critical commentaries and synoptic

essay that the candidate is familiar with and has reviewed all of the specified learning topics for

the module. Failure to do so will result in the aggregate mark for the case reports being graded

below the pass mark of 50%.

CPD Unit



ANNUAL ASSESSMENT TIMETABLE

17th December If you are submitting work for assessment on the following dates,

please inform CertAVP Admin Manager by 17th December

31st January Case books and diaries to be submitted by 31st January

31st March Marking will be completed by 31st March

LEARNING SUPPORT ACTIVITIES

Interesting articles

Mixed anaesthesia and analgesia questions

Links to useful websites

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Module C


CASE REPORT GUIDELINES

Cases collected from up to 12 months prior to the date of enrolment on the CertAVP

programme can be submitted for assessment

Cases must not have been submitted for assessment for any other exam process

Cases should not be used for any other modules

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Module C


INSTRUCTIONS FOR SUBMITTING CASE DIARY / SYNOPSIS / ESSAY

Please ensure that at the beginning of your case diary/synopsis/essay is included:

your name

module name

case diary/synopsis/essay title

word count (excluding the above, tables, photo titles and references)

Case diaries/essays should be referenced and references cited in a standard format.

Use The Veterinary Record or The Journal of Small Animal Practice as guidance to both

citation of references within the text and format of references in the reference list.

The Harvard Guide to Referencing is also available to candidates enrolled for learning

support or online (various web sites allow the guide to be downloaded).

Please submit your synopsis/essay as a

MS Word document (97-2003 format or later)*

(Please ensure digital images are submitted in a compressed format so that they can be

easily transferred via e-mail)

and your case diary as a

MS Excel spreadsheet (97-2003 format or later)*

attached to an e-mail and send it to: [email protected]

*(Please note that as synopsis/essays/case diaries in alternative formats have been unreadable in MS

Office any other format will be sent back to the candidate.)

mailto:[email protected]

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Module C


SUGGESTED READING:

Veterinary Anaesthesia (2001) 10th edition, Hall, Clarke and Trim

BSAVA Manual of Small Animal Anaesthesia and Analgesia (2007) 2nd edition, Seymour and

Duke

Veterinary Clinics of North America: Small Animal Practice

o Clinical Anaesthesia (1999), Haskins

o Small Animal Pain Management (2000), Mathews

o Critical Care Cardiovascular Focus (2001), Dhupa

o Critical Care Respiratory Focus (2002), Dhupa

Lumb and Jones’ Veterinary Anaesthesia and Analgesia (2006) 4th edition, Tranquilli,

Thurmon and Grimm

Fluid, Electrolyte and acid base disorders in small animal practice (2006) 3rd edition, Di Bartola

BSAVA Manual of Emergency and Critical Care (2007) 2nd edition, Boag and King

Small Animal Critical Care Medicine (2008), Silverstein and Hopper

Pain Management in Animals (2000), Flecknell and Waterman-Pearson

Journals:

Veterinary Anaesthesia and Analgesia

Journal of Veterinary Emergency and Critical Care

Journal of Small Animal Practice

Journal of the American Veterinary Medical Association

C-VA.1 Small Animal Anaesthesia and Analgesia Case Log

Species

Canine 0

Feline 0

Equine 0

Exotics 0

Acknowledgements to the Residency Training Committee of the American College of Veterinary Anaesthesiologists,

for the provision of the template upon which this spreadsheet is based.

Canine

Date Identification Age Breed ASA Status Procedure Pre-medications Induction Agent Maintenance Duration Anaesthetic Complications Special Techniques Comments

x/x/xx Name/case no. 12 Lab 3 Enterectomy Methadone, ACP Propofol Isoflurane 1 hour Hypothermia Local anaesthetic splash block Patient was diabetic

Feline

Date Identification Age ASA Status Procedure Pre-medications Induction Agent Maintenance Duration Anaesthetic Complications Special Techniques Comments

x/x/xx Name/ Case No 12 3 Dental Buprenorphine, ACP Propofol Isoflurane 45 mins Hypothermia, mild hypotension None Underlying hypertrophic cardiomyopathy

x/x/xx Name/ Case No 6 2 Fibrosarcoma removal Methadone, ACP Propofol Isoflurane 1.5 hours None None Renal disease, pre-anaesth stabilisation: 24 hour fluid therapy

Equine

Date Identification Gender Age Wt ASA Status Procedure Position Pre-medications Induction Agent Maintenance Duration Anaesthetic Complications Recovery Details Special Techniques Comments

x/x/xx Name/Case No Gelding 2 450 kg 1 Arthroscopy Dorsal ACP Ketamine, midazolam Isoflurane 2 hours Hypoventilation Smooth, unassisted Intra-articular morphine None

Exotics

Date Identification Gender Age Wt ASA Status Procedure Pre-medications Induction Agent Maintanence Duration Anesthetic Complications Special Techniques Comments

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