Cloud-based monitoring offers a log of critical patient data for veterinarians to reference during an anesthetic event or for future care. Photo courtesy Digicare Animal Health Veterinarians understand anesthesia is a risky but necessary part of the job. Undetected underlying conditions or complications during an operation can quickly present themselves in small animals sedated under anesthesia and lead to patient morbidity or mortality. These complications can arise during the perioperative, operative, and postoperative stages of a procedure, and each stage contains unique potential obstacles for veterinarians to overcome to achieve patient safety. Despite the ever-present risk associated with anesthesia, modern veterinary equipment offers several tools to help veterinarians reduce cases of harmful complications. Learn about some equipment features to consider and how they can impact you and your patients. Automated anesthesia delivery and ventilation Administering anesthesia requires consistent and vigilant control of the dosage, with regular adjustments to the proportions of oxygen, air, and anesthetic gas that control a patient’s level of consciousness. Anesthetists can do this manually, but it takes their attention away from the patient’s procedure and leaves room for human error. Automated anesthesia delivery immediately reads and reacts to distal flow sensors in the inspiratory and expiratory limbs, combining this data with patient weight, species and procedure status information to determine the correct ventilatory parameters. These systems also rapidly detect potential respiratory complications and provide any required support. The seconds saved by automatic anesthesia delivery and ventilation can be highly impactful in critical moments. According to the American Animal Hospital Association (AAHA), complications during an anesthetic event in the cardiovascular and respiratory systems are “generally the most acutely life-threatening.”1 This makes every second critical in keeping patients from going into an arrest. Several complications fit into this category, and veterinarians dread seeing signs of any of them. A presentation done at the University of Florida’s College of Veterinary Medicine by Luisito S. Pablo, DVM, MS, DACVO, lists reduced cardiac output, hypotension, hypoxemia, dysrhythmias, and hypoventilation as some of the conditions known to reduce oxygen flow. As Dr. Pablo states, the consequential “absence or lack of oxygen delivery to the vital organs of the body will result in mortality and morbidity.”2 While they cannot rectify every cause of cardiovascular or respiratory complications, automated anesthesia and ventilation systems ensure oxygen intake remains steady when a patient’s breathing weakens, or breathing cannot occur without support. By sensing the need for respiratory support and either synchronizing with spontaneous breathing or providing full ventilation, automated delivery systems reduce risk and enable the veterinarian to focus on the task at hand. “Automated ventilation ensures I can be confident during an anesthetic event,” says Terri Fleming, CVPM, who has 22 years of veterinary clinical experience. “If a patient stops breathing and I don’t catch it right away, the machine will step in to ensure respiration continues and the patient is safe.” Cloud-based recordkeeping Another potential cause of complications that can impact anesthesia, ventilation, drug delivery, and other elements of a procedure is human error. Veterinarians are undeniably dedicated to providing every patient the highest level of care. However, humans are imperfect, and fatigue, lack of experience, miscommunication, faulty recordkeeping, and other factors can lead to errors in treatment that impact outcomes. As veterinarians know, patients in all stages of an anesthetic event are particularly vulnerable. The consequences of any negative impact on their health, whether it comes up naturally during the procedure or due to a mistake, can quickly become dire and pull other staff away from their assigned tasks, such as drug administration and record keeping for communication between practitioners. Given that all-hands-on-deck scenarios are not uncommon, these are unsurprisingly the two most common causes of error. They are both critical functions during an anesthetic event, making it a prime time for errors. To avoid mistakes in these two areas, veterinarians can rely on the consistency and clarity of a cloud-based charting system. “When I worked in emergency medicine, I was often the only other person in the room with the patient and the doctor,” says Fleming. “If the doctor needed me to jump in and help with the patient, no one else was around to record vitals. Cloud-based charting eliminates those gaps in critical patient information without taking a surgical assistant’s time or attention away from the patient.” A study published in 2019 monitored errors across three hospitals for three years. The researchers found approximately five errors per 1,000 patients across the three practices, many of which were avoidable if the proper systems had been in place.3 In each clinic, drug errors accounted for the most reported errors (>54 percent), followed by failures in communication that led to incorrect treatment administration.3 Not all of these errors were attributable to incidents during an anesthetic event, but they highlight both the presence and key causes of mistakes, as well as the importance of taking all available steps to avoid them. Uploading patient data to a cloud system provides a reliable method of communicating important care information from doctor to doctor. According to the study, drug errors are most often caused by administering the wrong dose, followed by other causes, such as the wrong patient, wrong drug, wrong route, and wrong time. A cloud-based system stores easily accessible information in a single patient file that can be accessed anywhere in the hospital to help avoid these causes and ensure veterinarians have the necessary input to administer the proper medication to the right patient at the right time. In addition to ensuring data is accurately recorded and saved across multiple procedures, cloud-based charting can also assist with reducing errors during a single visit. Handing off a patient’s care to another veterinarian or technician requires clear communication of all important details and accurate reception and memory of the message by the incoming care provider. Accurately communicating these highly detailed reports through conversation or handwritten notes is a challenge, as evidenced by the prevalence of errors due to miscommunication noted in the study. A cloud-based recordkeeping system standardizes data recording, collects all critical information, and keeps key details accessible in the cloud for the next care provider. Centralized monitoring with telemetry Another key tool in reducing complications from anesthetic events is a centralized monitoring system. A 2023 study documenting the impact of anesthesia on more than 55,000 dogs worldwide, found anesthetic mortality occurred at a rate of .69 percent, with 81 percent of those deaths in the postoperative phase.4 While many of these deaths are not preventable, the study states, “careful patient evaluation, drug selection, and monitoring can be associated with reduced mortality.”4 One barrier to ensuring careful monitoring is staff availability. Veterinarians understand the importance of vigilant patient care during the postoperative period and would prefer to provide each animal with their undivided attention. However, when multiple patients need care simultaneously from a limited veterinary staff, this is simply impossible. Veterinarians can rotate through patient areas and check on each animal periodically. However, this long process adds time between the initial onset of a potential complication and a doctor’s intervention. Central monitoring systems and transmitting patient telemetry devices allow one doctor to track all recovering patients from one location. Multiparameter monitoring options provide details for the doctor on several important measurements for each patient, ensuring the early indicators for many complications are seen as soon as they occur. This system streamlines the clinic’s staffing needs and ensures issues are found and diverted immediately. Accurate, real-time data and automated intervention when a patient needs it can help significantly reduce the risk of anesthetic events. Photo courtesy Digicare Animal Health Veterinarians at their best Ultimately, the most significant tool to ensure animal safety during anesthesia administration are veterinarians themselves and their ability to perform at their highest level. No matter the cause, medical errors have a major impact on those involved. The cited 2019 study states mistakes in a practice “have been shown to contribute significantly to emotional burnout amongst healthcare providers, and veterinarians have reported a negative effect on their confidence and mental health after serious errors.”3 In addition to decreasing the likelihood of these impactful errors, cloud-based records, centralized monitoring, and automated anesthesia and ventilation systems take small tasks off a veterinarian’s plate. This allows them to focus on the high-level procedures and do their best work to ensure positive patient outcomes. Eduardo Miranda is an electrical engineer with an MSc in Biomedical Engineering. He is also the president of Digicare Animal Health. References Troubleshooting Anesthetic Complications. (2024, December 9). AAHA. https://www.aaha.org/resources/2020-aaha-anesthesia-and-monitoring-guidelines-for-dogs-and-cats/troubleshooting-anesthetic-complications/ Akira Takeuchi, D. V. M. (2014). World Small Animal Veterinary Association World Congress Proceedings, 2003. VIN.com. https://www.vin.com/apputil/content/defaultadv1.aspx?pId=8768&id=3850180&print=1 Wallis, J., Fletcher, D., Bentley, A., & Ludders, J. (2019). Medical Errors Cause Harm in Veterinary Hospitals. Frontiers in Veterinary Science, 6. https://doi.org/10.3389/fvets.2019.00012 Redondo, J. I., Otero, P. E., Martínez‐Taboada, F., Domenech, L., Eva Zoe Hernández‐Magaña, & Viscasillas, J. (2023). Anaesthetic mortality in dogs: A worldwide analysis and risk assessment. Veterinary Record, 195(1). https://doi.org/10.1002/vetr.3604
