approach was used to highlight the most commonly used equipment, identify differences in the confidence of VNs monitoring non-brachycephalic breeds compared with brachycephalic breeds, and highlight any statistically significant differences in terms of VNs ' experience, qualification route and confidence. As part of the study, VNs were also able to express their opinions regarding their practice ' s anaesthetic protocols for brachycephalic breeds and suggest areas for improvement.
Methods
RCVS statistics [ 25 ] revealed that the total population of UK RVNs at the time of the study was 18,100. To avoid bias and to ensure a representative sample, a desired sample size of 377( confidence level = 95 %, margin of error = 5 %) was calculated using a sample size calculator [ 20 ]. Only UK RVNs who were frequently involved in anaesthesia of brachycephalic dogs could participate. The first question in the survey was used to ensure that participants met the inclusion criteria.
Before publication, the questions were distributed to five RVNs via social media as part of a pilot study. All responses were gained, and participants advised that no further changes were necessary. Ethical approval was granted by the Hartpury University Ethical Committee. The finalised questionnaire( Appendix 1, see link on page 39) consisted of 25 questions and was shared in private Facebook groups. All answers were anonymous, and the participants were given the chance to exclude themselves from the study before data analysis.
Results
In total, 359 responses were gained over 6 weeks; seven participants were removed due to partial responses or not meeting the inclusion criteria. For detailed test results, see Appendices 2 – 7( links on page 39).
Demographics
The most common route to qualification was the BSc( Hons) degree( 28 %); the least common was the Green Book( 5 %), presumably due to the length of time that has passed since this was a route to qualification. A Kruskal – Wallis test identified a significant difference between the levels of confidence of VNs who qualified by different routes( H( 5) = 14.865, p = 0.011). An additional Bonferroni correction test revealed no significant difference in confidence between VNs with an HE diploma and a BSc( Hons) degree( z = 0.930, p = 0.352).
The most common length of time qualified was 3 – 4 years( 20 %); slightly fewer VNs had been qualified for more than 11 years( 19 %). A Kruskal – Wallis test identified a significant association between the number of years qualified and VNs ' confidence in monitoring brachycephalic patients( H( 6) = 40.354, p = < 0.001). Analysing this further, a Bonferroni correction test revealed that VNs who had been qualified for more than 11 years indicated higher confidence levels compared with those who had been qualified for less than 1 year( z = – 5.788, p < 0.001).
Practice anaesthetic protocols
Propofol was the most common induction agent selected( 71 %), with only 24 % of VNs indicating that their practice used alfaxalone. Within this, 49 % of respondents stated that they use the agent due to it being the‘ only one available’, whereas 17 % believed that their chosen agent‘ is safer for brachycephalic patients’. Interestingly, more respondents( 11 %) selected alfaxalone as the‘ safer agent’ compared with propofol( 5 %).
Isoflurane was the most selected maintenance agent( 89 %), and only 6 % of VNs stated that their practice used sevoflurane. The practice ' s choice of agent relied heavily on it being the‘ only one available’( 83 %). More VNs believed isoflurane is safer for brachycephalic patients( 3 %) compared with sevoflurane( 2 %).
Almost every respondent stated that they used a pulse oximeter while monitoring brachycephalic patients( 96 %)( Figure 1, page 35). Less commonly used equipment included electrocardiography( ECG)( 54 %) and suction( 15 %). When participants were asked to provide the reasons for their choice of equipment, a few stated that they‘ have not had the equipment for long’ or they have‘ only just started to use them’.
Generally, VNs indicated that they were satisfied with the anaesthetic protocols for brachycephalic animals used in their practice, although 2 % selected‘ not at all satisfied’( Figure 2, page 35).
VNs ' confidence
No VNs in the study indicated that they very rarely monitor brachycephalic dogs, with 57 % frequently monitoring them. The majority of VNs rated themselves as‘ very confident’ monitoring non-brachycephalic dogs( 63 %); no VNs selected‘ not at all confident’. Similarly, when VNs were asked to grade their confidence levels when monitoring brachycephalic breeds, 42 % selected‘ very confident’ and none selected‘ not at all confident’( Figure 3, page 36).
A Wilcoxon rank test revealed that the VNs felt more confident monitoring non-brachycephalic dogs compared with brachycephalic dogs( z = – 9.793, p < 0.001). VNs who reported that they‘ frequently’ or‘ very frequently’ monitored the anaesthesia of brachycephalic dogs rated themselves as‘ moderately’ or‘ very’ confident. A Spearman ' s correlation test indicated a significant difference and strong positive
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