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 antiinflammatories, 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
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.
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.
Module C Veterinary Anaesthesia Small Animal Anaesthesia and Analgesia (C-VA.1) 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%.
ANNUAL ASSESSMENT TIMETABLE 17 th December If you are submitting work for assessment on the following dates, please inform CertAVP Admin Manager by 17 th December 31 st January Case books and diaries to be submitted by 31 st January 31 st March Marking will be completed by 31 st March LEARNING SUPPORT ACTIVITIES Interesting articles Mixed anaesthesia and analgesia questions Links to useful websites
Module C Veterinary Anaesthesia Small Animal Anaesthesia and Analgesia (C-VA.1) 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
Module C Veterinary Anaesthesia Small Animal Anaesthesia and Analgesia (C-VA.1) 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: certavp@rvc.ac.uk *(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.)
Module C Veterinary Anaesthesia Small Animal Anaesthesia and Analgesia (C-VA.1) SUGGESTED READING: Veterinary Anaesthesia (2001) 10 th edition, Hall, Clarke and Trim BSAVA Manual of Small Animal Anaesthesia and Analgesia (2007) 2 nd edition, Seymour and Duke Veterinary Clinics of North America: Small Animal Practice o o o o Clinical Anaesthesia (1999), Haskins Small Animal Pain Management (2000), Mathews Critical Care Cardiovascular Focus (2001), Dhupa Critical Care Respiratory Focus (2002), Dhupa Lumb and Jones Veterinary Anaesthesia and Analgesia (2006) 4 th edition, Tranquilli, Thurmon and Grimm Fluid, Electrolyte and acid base disorders in small animal practice (2006) 3 rd edition, Di Bartola BSAVA Manual of Emergency and Critical Care (2007) 2 nd 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