Veterinary Anesthesia and Reanimation

The main objective of the subject is the knowledge of the basis and main techniques of the veterinary anesthesia, and let the development of a critical knowledge related to another clinical sciences. On this work line the student will be able to apply phisiologic and pharmacologic concepts previously learned, to perform a most accurate and safe anesthetic technique, related with the health condition and treating the complications derived.
Since a point of view practice, capacities will be centered in the hospital rotation at the Anesthetic Service of the VTH.. This rotation will let the students to know the basic principles of the anesthesia. In addition to be familiar with the organization and protocols of a veterinary clinic (animal handling and basic techniques), being very useful for another future subjects. To improve the application of the practical sessions has been created a specific film library.

The general capabilities developed by the subject “Veterinary Anesthesia and Recovery” are as follows:
• Knowledge of the topics included in the program of the subject.
• Adquisición de un vocabulario científico y clínico adecuado a los conocimientos aprendidos.
• Be able to take decisions and self learning during the professional lifetime.
• Integrate the skills learned in the different subjects of the bachellor and be able to combine these to obtain a global vision of the animal and the disease.
• To learn preoperatory evaluations of the patients.
• To administer the sedating agents and handling of the patient previously to the general anesthesia.
• Use and performance of different anesthetic techniques in health and diseases animals.
• Lose the fear to basic interventions under patients (injections, vascular approaches, orotracheal intubation).
• Design of anesthetic protocols in different species and health conditions.
• Work capacities under anesthetic emergencies.
• Get in touch with the reality of the clinic of small and large animals by means of the hospital rotation.
• Learn how to circulate through a surgical area.
• Be able to make a correct preoperatory evaluation and take decisions about the possible or not stabilization of the patient previously to the surgery.
• Selection and development of a protocol about sedating, neuroleptoanalgesia or general anesthesia and the combination with local or regional anesthesia procedures.

THEORETICAL PROGRAM
CHAPTER 1: GENERAL TOPICS (1 hour).
History of animal anesthesia. Definitions and terms. Relaciones con otras disciplinas. Types of anesthesia. Balanced anesthesia. Stages and signs of general anesthesia. Steps of general anesthesia: Preanesthesia, induction, maintenance and recovery. Patient preparation.

CHAPTER 2: EQUIPMENT (1 hour).
Intravenous techniques: catheters, perfusors and infusion pumps. Inhalatory techniques: Parts of a anesthesia machine. Medical gases. Pressure gauges and regulators. Flowmeters. Vaporizers. Safety devices. Breathing systems. Scavenging waste anesthetic gases. Induction chambers, masks and endotracheal tubes.

CHAPTER 3: MONITORING ANIMALS UNDER GENERAL ANAESTHESIA (3 hours).
Introduction. Anesthetic record. Invasive and non invasive techniques. Cardiovascular monitoring (esophageal stethoscope, ECG, pulse oxymetry, arterial blood pressure, central venous pressure). Pulmonary monitoring (gasometry). Renal monitoring. Temperature monitoring. Laboratory monitoring. Monitoring anesthetic level.

CHAPTER 4: FLUID, ELECTROLYTE AND BLOOD COMPONENT THERAPY (1 hour).
Introduction. Osmotic and oncotic pressure. Composition of parenteral solutions (crystalloids and colloid). Considerations and assessment of fluid therapy. Blood transfusion.

CHAPTER 5: PRE-OPERATIVE ASESSMENT (1 hour).
Introduction. History and physical status. Patient evaluation. Anesthetic risk (ASA classification). Responsabilities and insurances claims: Informed consent form.

CHAPTER 6: PREANESTHESIA AND NEUROLEPTOANALGESIA (2 hours).
Objectives of preanesthesia. Classes of anesthetic adjuncts used in preanesthesia. Sedatives: guidelines. Phenothiazines. Benzodiazepines. Butyrophenones. Alpha-2-agonists. Anticholinergics: mechanisms of action and uses. Neurolept-analgesia: Objetives and indications. Combination of drugs and interactions.
CHAPTER 7: ANALGESICS AND PERIOPERATIVE PAIN MANAGEMENT (1 hour).
Introduction: The definition of pain and types. Implicaciones clínicas del dolor. Local and systemic responses to pain and injure. Pain measurement and scoring systems. Analgesic drugs: Opioids, nonsteroidal anti-inflammatory analgesics, local anesthetic agents and others. Non pharmacologic methods for management and control of pain.

CHAPTER 8: INJECTABLE ANESTHETICS (2 hours).
Introduction. Indications and uses. Advantages and disvantages General pharmacology. Mecanismos de acción. Barbiturate drugs. Propofol. Alphaxolone. Alphadolone. Chloral hydrate. Etomidate. Combined opioids anesthesia. Dissociative anesthetics: characteristics. Ketamine. Tiletamine. Total intravenous anesthesia: minimal infusión rate (MIR).

CHAPTER 9: INHALATION ANESTHETICS (2 hours).
Introduction. Physiochemical characteristics. Pharmacokinetics. Minimum alveolar concentration. Actions and toxicity under organs and systems. Inhaled anesthetics: Nitrous oxide. Halothane. Isoflurane. Sevoflurane. Desflurane.

CHAPTER 10: NEUROMUSCULAR BLOCKADE AND MECHANICAL VENTILATION (2 hours).
Introduction. Indications and precautions. Depolarizing and nondepolarizing drugs: mechanisms of action. Muscle relaxants in use in veterinary anesthesia. Factors affecting neuromuscular blockade. Monitoring and reversal of blockade. Mechanical ventilation: Guidelines for use. Indications and techniques. Anesthesia ventilators and classification of devices. Hazards associated with the use of ventilators.

CHAPTER 11: LOCAL AND REGIONAL ANESTHETICS (2 hours)
Introduction. Mechanism of action and uses. Classification and characteristics. Adjuvant agents. Most common used techniques of local and regional anesthetic techniques in Veterinary Medicine.

CHAPTER 12: ANESTHETIC EMERGENCIES AND PROCEDURES. (2 hours)
Introduction: Sistema ABC. Sistema respiratorio: Hipoxia. Insuficiencias respiratorias. Apnea. Hipotensión. Shock.. Hipotermia. Hipertermia. Otros accidentes: Rabdomiolisis. Accidentes producto de anestésicos locales.
Cardiovascular emergencies (hemorrhage and fluid loss, dysrhytmia, hypotension, shock). Cardiac arrest (cardiopulmonary resuscitation basic and advanced). Respiratory insufficiency (hypoxia, apnea), hypo and hyperthermia. Other emergencies. Rhabdomyolysis. Toxicity of local anesthetics.
ANESTHESIA, ANALGESIA, AND IMMOBILITATION OF SELECTED SPECIES AND CLASSES OF ANIMALS.

CHAPTER 13: ANESTHESIA IN DOGS (2 hours)
Introduction. Selection of the procedure. Patient preparation. Considerations in canines: preanesthesia, induction, intubation technique, maintenance and recovery. Neonatal patients. Anesthesia management in patients with genitourinary, orthopaedic or ocular diseases. Anesthetic management in thoracic surgery.

CHAPTER 14: ANESTHESIA IN CATS (2 hours)
Introduction. Special features in cats: nature, metabolism, size, endotracheal intubation. General anesthesia: pacient preparation, preanesthesia, induction, maintenance (injectable and inhalatory agents) and recovery.

CHAPTER 15: ANESTHESIA IN HORSES (2 hours)
Introduction. Preparation of patients. Sedation and chemical restraint. Adverse effects. Anesthetic induction techniques. Orotracheal intubation. Monitoring and perianesthetic supportive care. Recovery.

CHAPTER 16: ANESTHESIA IN RUMINANTS (2 hours)
Introduction. Preanesthetic preparation. Sedation and chemical restraint. Local and regional anesthetic techniques. Anesthetic induction techniques. Monitoring and perianesthetic supportive care. Recovery.

TEMA 17. ANESTHESIA IN SWINE AND LABORATORY ANIMALS (2 hours)
Anesthesia in swine: Introduction. Preparation of the patient. Preanesthesia. Anesthetic induction techniques. Recovery. Malignant hyperthermia. Laboratory animals: Rodents. Rabbits.


PRACTICAL PROGRAM. HANDS ON SESSIONS.

Day 1 (5 hours) (ANEST C1). - Knowledge of inhalation anesthesia teams and anesthesia monitors. This practice will be carried out in the operating rooms of HVU Rof Codina, students will learn how to handle the inhalation anesthesia equipment, anesthesia monitors and perfusion pumps.
Day 2 (5 hours) (ANEST C2). - Anaesthesia in horses. Management of the horse as an anaesthetic patient. Sedation techniques. Locoregional anaesthesia. Induction of general anesthesia. Maintenance with inhalation and injectable agents. Recovery of anesthesia.
Days 3 and 4 (10 hours) (ANEST C3). - Rotation in the Anesthesia Service of the Hospital Veterinaria Universitario Rof Codina. The current casuistry of the Hospital ensures the learning of the following practical skills/techniques:
• Venous catheterization.
• Knowledge two components of anesthetic machines.
• Management two different respiratory circuits.
• Anesthetic monitors.
• Cover the anesthetic sheet.
• Use of various fluidotherapy solutions.
• Patient sedation.
• Induction of injectable anaesthetics.
• Endotracheal intubation in various species.
• Induction of inhalation anaesthesia.
• Maintenance of inhalation anesthesia.
• Performing locoregional techniques in small animals.
• Recovery of anesthesia and post-anesthetic control.
• Postoperative analgesia. Pain control in hospitalized patients.

At the beginning of the semester there will be a tutorial where students will be presented with the subject and the evaluation process will be explained to them.

At the end of the semester there will be a seminar that will be used for the realization of anesthesia protocols.

BASIC BIBLIOGRAPHY

Alexandra Dugdale. (2020). Veterinary Anaesthesia: Principles to Practice. Wiley Blackwell.

Kurt A. Grimm, Leigh A. Lamont, William J. Tranquilli, Stephen A. Greene, Sheilah A. Robertson (2015). Veterinary Anesthesia and Analgesia: Lumb and Jones. Wiley Blackwell.

HALL, L.W., CLARKE, K.W., TRIM, C.M. 2001. Veterinary anaesthesia. 10th Edition. W.B. Saunders. London.

McKELVEY, D., WAYNE HOLLINGSHEAD, K. 2003. Manual de Anestesia y analgesia Veterinaria. Multimédica.

MUIR, W.W, HUBBELL, J.A.E., BEDNARSKI, R.M. 2008. Manual de Anestesia Veterinaria. Ed. Elsevier Mosby.

COMPLEMENTARY BIBLIOGRAPHY

Paulo Steagall., Sheilah Robertson., Polly Taylor. (2017). Feline Anesthesia and Pain Management. Wiley Blackwell.

William W. Muir and John A.E. Hubbell. (2008). Equine Anesthesia Monitoring and Emergency Therapy. Mosby.

Thomas Dohertyis, Alexander Valverde. (2006). Manual of Equine Anesthesia and Analgesia. Wiley Blackwell.

Lindsay G. Ross, Barbara Ross. (2008). Anaesthetic and Sedative Techniques for Aquatic Animals. Wiley Blackwell

Gary West, Darryl Heard, Nigel Caulkett (2014). Zoo Animal and Wildlife Immobilization and Anesthesia. Wiley Blackwell

Lindsey B. C. , Snyder Rebecca A. (2014). Johnson Canine and Feline Anesthesia and CoExisting Disease. Wiley Blackwell

Karol A. Mathews, Melissa Sinclair, Andrea M. Steele, Tamara Grubb (2018). Analgesia and Anesthesia for the Ill or Injured Dog and Cat. Wiley Blackwell

Lesa Longley. (2008). Anaesthesia of Exotic Pets. Saunders.

Cholawat Pacharinsak, Jennifer C. Smith. (2017). Handbook of Laboratory Animal Anesthesia and Pain Management: Rodents. CRC Press

CAMPOY, L, KORICH, J, BEZUIDENHOUT A. 2009. Peripheral Nerve blocks in the dog. Partners in Animal Health. Ithaca, New York.

SEYMOUR, C; DUKE-NOVAKOVSKI, T. 2007. BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. B.S.A.V.A. Gloucester.

P. Otero, D. Portela. (2017). Manual de Anestesia regional en animales de compañía. Intermédica.


PÁGINAS WEB:

- American College of Veterinary Anesthesia and Analgesia (http://www.acva.org/).

- European College of Veterinary Anaesthesia and Analgesia (http://www.ecva.eu.com/).

We recommend or use of basic and complementary Internet resources specified in the Bibliography section, as well as that electronic access bibliography available in the USC Library "A BUSC EN LIÑA" https://busconline.gal. Also, through Portico (http://sfx.bugalicia.org/san/az) and EZproxy (https: // ezbusc), managed by BUGalicia, it will be possible to search for scientific journals and electronic books (coas credenciais de a USC). For specific topics, teachers can provide aberto access papers or recommend searching through PubMed or Google Schoolar.

General competences
o GVUSC01. Capacity to learn and adapt.
o GVUSC02. Capacity to analyze and synthesize.
o GVUSC03. General knowledge of the field of work.
o GVUSC04. Planning and management of work.
o GVUSC05. Capacity to put knowledge onto practice.
o GVUSC06. Capacity to work both autonomously and in group.
o GVUSC07. Ability to work in an international context.
o GVUSC08. Leadership, initiative and entrepreneurship.
o GVUSC09. Capacity to communicate in different spheres of activity.
o GVUSC10. Ethic compromise to assume responsibilities.
Specific competences of the subject (Knowledge):
o CEDVUSC 09. General basis of medical and surgical treatment
Specific competences of the profession (how to do, day-one skills):
o D1VUSC 01. Make history and clinical examination of animals.
o D1VUSC 02. Collect and ship samples with its report.
o D1VUSC 03. Perform basic analytical techniques and interpreting results of clinical, biological and chemical.
o D1VUSC 04. Diagnose the most common diseases by using those complementary diagnostic procedures and techniques.
o D1VUSC 06. Deal with emergencies and perform first aid in Veterinary Science.
o D1VUSC 07. Perform basic medical and surgical treatments in animals.
o D1VUSC 08. Prescribe, manage and properly manage veterinary medicines.
o D1VUSC 17. Perform technical reports related to veterinarian competence.
Specific academic competences (will to do):
o CEAVUSC 01. Analyze, synthesize, solving of problems and taking of decisions in the different spheres of activity of veterinarians.
o CEAVUSC 02. Keep ethic behavior while exercising his/her responsibilities to the veterinary profession and the society.
o CEAVUSC 03. Spread the information reached while practicing as veterinarian in a fluent way, both orally and by writing, with other colleagues, authorities and the society
o CEAVUSC 04. Search and manage the information related to veterinary activity.
o CEAVUSC 05. Know and apply the scientific method while practicing, including evidence based medicine.
o CEAVUSC 06. Know how to look for professional help and advice.
o CEAVUSC 07. Have basic knowledge of a foreign language, especially in those technical aspects related to Veterinary Science.
o CEAVUSC 08. Be aware of the necessity to keep updating of knowledge, skills and professional competences by following continuing education.
Transversal competences:
o CTVUSC 01 Capacity to reason out and argue.
o CTVUSC 02 Capacity to obtain appropriate, diverse and updated information by the different media as bibliographic search by Internet, being able to analyze it with criticism.
o CTVUSC 03 Capacity to elaborate and present an organized and comprehensive text.
o CTVUSC 04 Capacity to expose to the public in a clear, consistent and concise way.
o CTVUSC 05 Ability to use ITs.
o CTVUSC 06 Use of information in a foreign language.
o CTVUSC 07 Capacity to solve problems by applying the integration of his/her knowledge.

SCENARIO 1 (normality adapted)

A.- EXPOSITORY SESSIONS Students/students will receive 2-3 weekly expository sessions of Anesthesia and Resuscitation in Veterinary Medicine in the first semester according to the schedules approved in the Faculty Board. There will be 30 50-minute expository sessions (see content of the subject). Students will have a resource in the Virtual Campus" network to support teaching. The presence in the classrooms will be combined with the application of hygienic measures (hydrogel, mask.). Exceptionally, face-to-face teaching can be combined with virtual teaching up to 10% of the total hours of the subject. (see Exhibition sessions in "Contents" of the subject and official calendar of the Center). We will also carry out 1 hour of seminar that will be dedicated to the resolution of doubts of the anesthesia protocols.
B.- INTERACTIVE CLINICAL PRACTICE SESSIONS: There will be 20 hours of clinical practice (see official calendar of the Center), which include the following activities:
Day 1 (5 hours) (ANEST C1). - Knowledge of inhalation anaesthesia equipment, anaesthesia monitors and how to prepare an anaesthesia protocol. This practice will be carried out in the operating rooms of HVU Rof Codina, students will learn how to handle the inhalation anesthesia equipment, anesthesia monitors and perfusion pumps.
Day 2 (5 hours) (ANEST C2). - Anaesthesia in horses. Management of the horse as an anaesthetic patient. Sedation techniques. Locoregional anaesthesia. Induction of general anesthesia. Maintenance with inhalation and injectable agents. Recovery of anesthesia.
Days 3 and 4 (10 hours) (ANEST C3). - Rotation in the Anesthesia Service of the Hospital Veterinaria Universitario Rof Codina.

TUTORIALS: 1 hour of tutoring per student (see official calendar of the Center). It will inform students of the characteristics of the subject and the programming.

SEMINARS: At the end of the semester there will be a seminar that will be used for the realization of anesthesia protocols.

The assessment of the learning process of the student will be made through CONTINUOUS EVALUATION (with short tests in the practice sessions, clinical case resolution, oral presentations or follow-up to the practice questionnaire), and with a FINAL TEST complementary to the continuous evaluation, which will consist of multiple-answer test-type questions, short questions and development of anesthesia protocols, the activities will be delivered on Mondays from 19 hours following the indications that the teaching staff will carry out in the Virtual Campus of the subject. For the FINAL SCORE the continuous evaluation with a total of 4/10 points will be evaluated, and the final test with a total of 6/10 points.
To overcome the subject the student will have to obtain at least a score 5/10 in each of the parts.
Class waiver is not allowed.
All those students who have not passed the subject at the first opportunity, will be maintained for the second chance the grade obtained in the continuous evaluation, having to repeat only the final test, which shall have the same characteristics and criteria of valuation as that carried out at the earliest opportunity.
In the case of fraudulent exercises or tests, the provisions of the "Normative de avaliación do rendemento académico dos estudantes e de revisión de qualificacións" shall apply.
The continuous evaluation of the practices will be kept for 1 year.

Face-to-face hours 52: 30 hours of expository sessions; 20 hours of interactive sessions, 1 hour of seminar and 1 hour of tutoring.
Off-site hours 60.5: 45 hours of individual study; 2 hours of literature review; 10 hours of resolution of practical anesthesia scenarios and 1,5 hours of oral presentations. Exams: 2 hours examination. Total 112.5 hours.

Students must attend and participate in the expository sessions, interactive sessions, and tutorials. It is recommended to consult the texts and the proposed web pages.
In the "VIRTUAL CAMPUS" of the USC, the students will have the "VIRTUAL CLASSROOM of the subject Anesthesia and Resuscitation in Veterinary" to support the teaching, and that the student must use in a regular way, accessing the contents and participating in the forums.
Following USC’s integration protocols for diversity, teachers in this field will ensure integration and equal opportunities for students with special educational needs.

No exemption is granted for any activity.
Based on Instruction No. 1/2017 of the General Secretariat in this matter, no exemption is granted, as attendance at all activities in person is necessary.