Any anaesthetists out there not afraid of GA?

Re: Any anaesthetists out there not afraid of GA?

Mike Martin — Wed, 14 Oct 2009 08:51:32 GMT

In response to Alex asking (elsewhere),

The WHWT did not come my way, it was a telephone advice call.

But in general, I rarely have problems premedicating SSS or heart block using ACP + morphine. But I have encountered problems giving the induction agent (Thio or propofolol) in which an estimated 1 in 10 dogs with either arrest (flatlines) or goes into VF (needing defib). So, before induction, we do place a temporary pacemaker via the saphenous while sedated. Sometimes we use external defib pads for pacing, but then these dogs then require nerve blocking (which scares me) as they jump with each stimulus.

Re: Any anaesthetists out there not afraid of GA?

sam aldridge — Sat, 26 Sep 2009 09:28:07 GMT

www.youtube.com/watch

no offence to anyone meant!

I love the internet ;)

Re: Any anaesthetists out there not afraid of GA?

Fabian Kaelin — Sat, 26 Sep 2009 01:46:36 GMT

Brilliant!

Re: Any anaesthetists out there not afraid of GA?

sophia guymer — Fri, 25 Sep 2009 21:55:00 GMT

Absolutley brilliant! Made my day!

Thanks for that.

Sophia

Re: Any anaesthetists out there not afraid of GA?

Gillian Mostyn — Fri, 25 Sep 2009 19:36:31 GMT

Re: Any anaesthetists out there not afraid of GA?

Hannah Wynne Richards — Fri, 25 Sep 2009 09:42:40 GMT

Me too !!!

Wynne

Re: Any anaesthetists out there not afraid of GA?

Mike Martin — Fri, 25 Sep 2009 08:49:03 GMT

Made me laugh. Brilliant!

Re: Any anaesthetists out there not afraid of GA?

sam aldridge — Thu, 24 Sep 2009 23:41:41 GMT

thought you'd appreciate this:

www.youtube.com/watch

Re: Any anaesthetists out there not afraid of GA?

Clive Ansell — Wed, 02 Sep 2009 14:12:18 GMT

Mike,

I know what you mean. I think the "paranoia" of our younger colleagues is more precisely a fear of litigation (Not unreasonable as I think 1 in 6 or 1 in 7 new grads has a claim against them in year one, and we are 4 times more likely to be sued that in the US).

Many of my colleagues in first opinion practice avoid the high risk GA case, and in some cases avoid them based on old age alone. If it is carried out with care and after full discussion with the client advising of the risks, then we should all have the knowledge, necessary drugs, and equipment to carry it out as safely as can be expected.

Re: Any anaesthetists out there not afraid of GA?

Rajat — Fri, 28 Aug 2009 13:45:44 GMT

I'm not an anaesthetist but enjoy challenging/high risk anaesthesia cases in general practice...I can understand why someone who doesn't have access to external pacing might be nervous about this..in my first few months at work I anaesthetised a dog who had been noted previously to have a 'low HR' but never symptomatic or worked up - long story short dogs HR dropped to 20, went blue and I was sh***ing bricks! Incidentally the patient came to you Mike to have its pacemaker fitted straight away once I ECGd it ( I think your colleague Mike put it in)..

I'd say if its coming inf or a pacemaker for symptomatic/significant SSS then I'd anaesthetise it.. as the procedure is likely to be life saving, whereas for an asymptomatic dog who's having an MRI for a different problem, the anaesthetist may choose to not GA the dog so it can be GA'd somewhere with external pacing and MRI there..not sure you can pace while doing an MRI though..I guess having it hand is advantageous should it be needed... but I can understand your frustration at this situation!

Re: Any anaesthetists out there not afraid of GA?

Mike Martin — Sat, 22 Aug 2009 17:43:54 GMT

Alex, you and I have probably anesthestised a lot of such cases. The DVA was concerned by the sick sinus syndrome (SSS). Can I apply for a DVA by accredited experience as I GA dogs with SSS to fit their pacemaker.

I guess my point is that there seem to be a bunch of 'younger' vets too paranoid and afraid to get on with the job they're trained and qualified to do!

Re: Any anaesthetists out there not afraid of GA?

Alex Gough — Sat, 22 Aug 2009 15:39:27 GMT

Was the sick sinus syndrome ruled out Mike? If so, I cant understand the problem. I anaesthetise a lot of epileptic dogs for MRI and I see it as a low risk procedure unless they have raised intracranial pressure. There are ways of detecting raised intracranial pressure pre op (eg opthalmological exam), but even in those cases that have been shown to have elevated ICP on the MRI, complications are uncommon in my experience if you take steps to lower it once identified (mannitol, hyperventilation). And if it has got raised ICP and you dont find out why, its tricky to treat properly!

All IMHO of course - I'm not an anaesthetist!

Alex

Re: Any anaesthetists out there not afraid of GA?

ms1083 — Sat, 22 Aug 2009 13:30:14 GMT

So long as careful premed, induction and maintaince is chosen specific to the case, the full history known and the anaestheic fully planned, including possible complications, then once under GA surely this is a relatively stable state and in perfect situation to deal with any seizures? There may, of course, be worries of intracranial blood pressure changes?

Long term, if the cause of the seizures is found & understood then the dog may have a better chance of useful treatment and an improved quality of life. The liklihood of the MRI gaining a useful diagnosis and wether this will influence/change the treatment has to be weighed up against the anaesthetic risk. The anaesthetist may have made this risk assesment.