12 May 2025
Victoria Bowes-Keegan
Job Title
Image: GaiBru Photo / Adobe Stock
Assisting with the monitoring and maintenance of anaesthesia is an important part of an RVN’s and SVN’s role. With this in mind, it is important that all registered veterinary nurses maintain their currency.
As a requirement to remain as an RVN, a minimum of 15 hours’ CPD per year must be completed and reflected on. As the remit of the RVN continues to develop, especially with more practices allowing the delegation of Schedule 3 procedures – such as tail amputations – it is imperative that RVNs ensure to maintain their knowledge and use an evidence-based approach.
Under the Veterinary Surgeons Act 1966 (Schedule 3) amendment order 2002, RVNs and SVNs can be directed to assist veterinary surgeons, and this includes inducing anaesthesia by administering a specific amount of medicine. For SVNs, this must be with direct continuous and personal supervision.
The administration of dose to effect or incremental doses of anaesthesia medication is to be completed by a veterinary surgeon only. Maintaining anaesthesia is the responsibility of the veterinary surgeon. However, suitably trained RVNs and SVNs (under supervision) may assist by acting as the veterinary surgeon’s hands, for example by moving dials and flowmeters.
Monitoring patients during anaesthesia and in the recovery period is again the responsibility of the veterinary surgeon, but may again be carried out on their behalf. This must be by a suitably trained person (RCVS, 2024).
The pre-anaesthetic assessment of patients should not be discounted or its implications underestimated. Every patient should have a thorough assessment before considering its anaesthetic protocol (Grubb et al, 2020). This will be included as part of a practice’s admission protocol.
Some practices will complete a basic assessment, including a temperature pulse and respiration check with the owner still present. Some will admit the patient and complete within the veterinary environment.
It is important to gain any relevant history from the owner, especially previous anaesthesia and allergic reactions.
Many veterinary surgeons may delegate this to appropriate RVNs or SVNs with supervision. It is important that both RVNs and SVNs are competent at performing the physical examination and are aware when to report to the veterinary surgeon (Archer, 2015).
For a well-documented approach to patient safety and observation, all information should be recorded within the patient’s anaesthetic checklist or form.
When completing the assessment, focus will be on the cardiovascular and respiratory systems, with careful consideration on rhythm, rate and depth – along with neurological and metabolic systems. This should be reported to the directing veterinary surgeon.
This information can be invaluable, especially if the patient is unstable, and this may impact the patient’s anaesthetic plan and risk status (Louro et al, 2021). This will all form part of the signalment process where staff will review all other relevant information, which may include laboratory results, patient’s blood pressure, ECG, medical history and any current medical issues.
Consideration is also needed of patient’s age, stress levels and breed, as these can all impact the patient’s protocol. This information will all be considered so to determine the patient’s American Society of Anesthesiologists (ASA) physical status classification.
Anaesthetic equipment should be checked and prepared before the start of the procedures. This is an important role of the veterinary nurse as this has a significant link to patient safety. Most veterinary practices will have access to a variety of equipment for monitoring and provision of anaesthetic gases and agents.
It is important key staff understand not only how to prepare the equipment, but also have knowledge of the equipment. The equipment must also be regularly maintained as to practice protocol and each manufacturer’s instructions (Gerrard, 2024).
The anaesthetic machine and circuit must be checked for patient safety at the start of the day and before any anaesthetic procedure (Gerrard, 2024).
The Association of Veterinary Anaesthetists Anaesthetic Safety Checklist and ASA physical classification were developed to provide support and guidance for the veterinary team to plan and prepare for anaesthesia.
Checklists are an important tool when carrying out clinical skills. Having an anaesthetic checklist will ensure staff are aware of equipment, including any possible issues, and confirms safety checks have been completed. This also ensures that the patient is continually assessed and any plan changes can be implemented.
When preparing equipment and materials for the patient, it is important that the preparation of equipment and materials, including medication, is organised per patient requirements. Consideration should be given around the use of colour-coded stickers and trays to place medicines for the patient.
For additional safety protection when calculating animals’ medications, it is beneficial to calculate a patient’s emergency drugs in readiness for any emergencies. Many practices have introduced the use of do not resuscitate (DNR) – it is important that staff are aware of owners’ requests before attempting anaesthesia.
When considering monitoring of anaesthetics, this should not just begin when the animal is anaesthetised, but when the animal entered the building. The animal should be regularly checked prior to possible premedication and any diagnostics that may be completed.
Any supportive treatments, such as fluid therapy, should also be monitored as any changes can impact the anaesthetic and anaesthetic risk.
Staff should be aware of the practice’s medication protocols and work with the veterinary surgeon to plan the best-suited anaesthetic drug protocol. This will be based on the individual animal, with various considerations, such as breed, age, sex, surgical procedure, diagnostic results, ASA grade and any previous anaesthetics or allergies.
It should be noted this part of the protocol is key and all medication should be checked by multiple staff to reduce the risk of human error (McMillan, 2014). It may be beneficial to use the colour-coding method as discussed, with areas for signatures for the multiple checking of the medications.
Most veterinary practices will have a multiparameter monitor, which will commonly assess ECG traces, SpO2, heart rates, capnography, core temperature and blood pressure. It is important when moving between practices that all staff that use the equipment are aware of how it works and how to troubleshoot.
It must be remembered that hands-on monitoring should not be discounted and should be used in conjunction with monitoring equipment.
Anaesthetic depth will also be monitored – the most commonly used nerve reflexes include, palpebral reflex, anal tone, eye position and jaw tone. It is important that these are completed with care and the responses recorded (Archer, 2016).
Basic vital signs should be monitored throughout the anaesthetic, also during induction and recovery, and should include body temperature, heart rate, including peripheral pulses with consideration on pulse quality, mucous membrane colour, capillary refill time and respiratory rate and depth. These can all be impacted by various surgical procedures and anaesthetic drugs.
This should all be well documented on the anaesthetic monitoring form, which will enable mapping for any changes or possible issues.
It is extremely important that any changes are notified to the veterinary surgeon as soon as possible. The details should be fluidly communicated with the veterinary surgeons throughout the whole procedure.
Other multiparameter monitoring methods should be used in conjunction with basic vital signs, all staff should be trained to use monitoring equipment and it is important that staff also know how to interpret the results, along with troubleshooting for any problems. This should form part of the anaesthetic training for staff.
Staff may change or move jobs, so it is important that there is a standard operating procedure available to provide to locums and new staff.
When a patient attends the veterinary practice for an anaesthetic procedure, it is important to remember every single patient should have an individualised plan.
Staff should be trained and clinically up to date with anaesthetic monitoring equipment, procedures and medications.
SVNs may be able to complete certain tasks under Schedule 3 of the Veterinary Surgeons Act under the direct, continuous and personal supervision from either an RVN or a veterinary surgeon. Communication should be fluid between staff – which will in turn support a safer anaesthetic environment.
