A decrease in adverse events in veterinary anaesthesia can lead to an increased risk of complacency.
Anaesthesia in veterinary medicine has advanced by leaps and bounds over the years. Nowadays, most progressive practices conduct anaesthesia using multimodal drug protocols and multi-parameter monitoring. Generally, adverse events during anaesthesia in otherwise young and healthy patients are a rare occurrence.
However, with the decreased incidence of adverse events comes an increased risk of complacency, on the part of the veterinary team. Take the following case as an example.
Case Study: The Balloon Kitty
The patient was a young and healthy cat that underwent a routine dental prophylaxis procedure at her vet practice. A few days after the procedure, she developed respiratory difficulties and presented to my emergency clinic. She was diagnosed as having severe subcutaneous emphysema, most likely from a tracheal wall compromise that would have occurred as an adverse event from tracheal intubation. Everyone knows that we need to handle cats very gently while they are intubated as their tracheas are nowhere near as robust as their canine counterparts.
Over inflating the cuff can also be a cause of tracheal necrosis, however, what we think happened was that this patient was re-positioned during the dental procedure and the endotracheal tube was twisted in the process, causing either ischaemic compromise to a portion of the trachea or direct damage to the trachea.
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The key lesson here is to always make sure the tube is secure to prevent movement.
Thankfully, this patient made a full recovery, but this case certainly highlights that we must never be complacent when it comes to handling our anaesthesia cases. Low incidence does not mean no incidence, and individualised anaesthetic plans, along with in-depth training for the anaesthetist (who most often are the veterinary technicians and nurses), will help reduce the chances of adverse events occurring.
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