My first anaesthetic experience some twelve years ago was a terrifying ordeal following a couple of weeks of "watch and learn". I was monitoring an eight year old St Bernard undergoing bilateral aural ablation; the veterinary surgeon was concentrating on the surgery and gave few directions and the only nurse was on holiday! The anaesthetic machine was an ancient Boyle's bottle affair, and we had no equipment such as pulse-oximeters or oesophageal stethoscopes. Subsequently I felt ill-prepared and nervous. Fortunately, no harm came to the poor dog in my care, however I was so aware that I would have been next to useless in an anaesthetic crisis that I was very nervous of anaesthesia for many months. Indeed, it was only once I joined an Approved Training Centre and received much needed and much improved training that I finally began to gain confidence.

Veterinary nursing has progressed in leaps and bounds since then and crash courses in anaesthesia are a thing of the past. The latest new improvements such as the advent of the Portfolio, the S/NVQ Qualifications and subsequent improved work place assessment methods go even further to maximise efficient and effective education in the science of anaesthesia.

There is no excuse for inadequate training, and particularly with such an important subject, a junior staff member should never be expected to undertake tasks which he or she feels may be beyond their capabilities. The veterinary surgeon is responsible for the patient during anaesthesia, and in addition a qualified veterinary nurse should also be on hand to supervise the trainee.

It is also down to the individual to speak out in cases of doubt. This could mean the difference between the life and death of a patient, and any problems must NEVER be ignored or brushed under the carpet to be dealt with later.

A list of points to recap:

1. Has the consent form for anaesthesia and surgical procedure been signed?
   If the answer is NO it is ILLEGAL to go ahead with the procedure.
2. Are there any faults with the equipment?
   If the answer is YES the procedure MUST BE DEFERRED until all equipment is 100% reliable.
3. Are you able to set up the equipment and use it correctly?
   If the answer is NO you must ASK for assistance PRIOR to the procedure.
4. Has the patient shown any unusual or abnormal signs/symptoms since admission?
   If the answer is YES, inform the veterinary surgeon AT ONCE noting the time and full details; remember to record the information on the patient's notes.
5. Has the owner informed you of any unsual or abnormal signs/symptoms that they may have noticed?
   If the answer is YES, inform the veterinary surgeon PRIOR to admission of the patient since a further pre-operative assessment is likely to be necessary.
6. Are you competent and confident monitoring a patient's vital signs during anaesthesia?
   If the answer is NO, a qualified veterinary nurse must be on hand to provide guidance and assistance.
7. Can you remain calm and provide the necessary assistance should an anaesthetic crisis occur?
   If the answer is NO, you are likely to be a hindrance rather than a help during an emergency. ENSURE that a qualified veterinary nurse is on hand to perform emergency procedures; stand well back and refrain from asking questions until the crisis is resolved.
8. Are you aware of the potential risks to personnel involved in anaesthesia and do you always obey the local rules and follow the written systems of work?
   If the answer is NO, then you represent a risk to yourself, patients and other personnel and should IMMEDIATELY SEEK TO RECTIFY THE SITUATION. If the answer is NO due to inadequate training then you must IMMEDIATELY INFORM THE PRACTICE PRINCIPAL who is duty bound to provide training in matters relating to health and safety.

Always refer to the above list and if there are any doubts or queries ALWAYS ask a superior. Any information that may be relevant to the case must be imparted to the veterinary surgeon and details recorded on the animal's In-patient and Anaesthesia forms.

Finally, it is important to be familiar with the amendment to the Veterinary Surgeons Act of 1991. Guidance of administration of anaesthesia is as follows and is taken from the RCVS Veterinary Nurses Committee: Chairman's Letter July 1998:

What a veterinary surgeon alone should be responsible for:
Induction and maintenance of anaesthesia and the management to full recovery of consciousness including the integrated steps below:

a) Clinical examination of the patient to assess the fitness of the animal to undergo anaesthesia.

b) Evaluation of clinical signs, further examination, and where necessary additional diagnostic tests.

c) Planning of the anaesthetic regime and selection of a suitable technique for that animal and the type of procedure to be performed.

d) Selection of the appropriate sedative, analgesia and other agents which may have to be administered as premedication.

Only a veterinary surgeon should be responsible for these initial procedures and the selection of the anaesthetic agents and the selection of route by which they will be administered. Furthermore, only a veterinary surgeon should administer and monitor the anaesthesia where the induction dose is either incremental or to effect; ie. intravenous or inhalation.

What a Veterinary Nurse may do:
Provided the veterinary surgeon is physically present during anaesthesia and immediately available for consultation, it would be in order for a veterinary nurse, whose name is on the List maintained by the RCVS to provide assistance by:

a) Administering the selected pre and post operative sedative, analgesic or other agents.

b) Administering prescribed non-incremental anaesthetic agents on the instruction of the directing veterinary surgeon.

c) Monitoring clinical signs and maintaining an anaesthetic record.

d) Maintaining anaesthetic by administering supplementary incremental doses of intravenous anaesthetic agents or adjusting the delivered concentration of anaesthetic agents, under the direct instruction of the supervising veterinary surgeon. The above guidelines apply to companion animals only.