Moderately confident Not very confident Quite confident Very confident
41.62 %
37.15 %
2.23 %
18.99 %
Figure 3. VNs ' confidence in monitoring brachycephalic breeds under anaesthesia.
correlation( rs = 0.314, p < 0.001) between frequency of monitoring and confidence, suggesting that VNs ' confidence increases with experience.
Discussion
Monitoring equipment
Brachycephalic animals are predisposed to low oxygen saturation( SpO 2
) levels. Pulse oximetry is highly recommended for monitoring these animals ' oxygen levels, particularly after extubation [ 26 – 28 ]. Almost all VNs in this study stated that they use a pulse oximeter to monitor anaesthetised brachycephalic patients. Hofmeister et al. [ 29 ] highlighted that 70 % of veterinary practices possess a pulse oximeter but only 45 % of veterinary professionals use them. Whereas many respondents were able to correctly identify an appropriate SpO 2 range, others were unable to understand plethysmographic waveforms. Despite this study being conducted in the USA, similar findings have been apparent in the UK literature, such as Richardson and McMillan ' s study [ 23 ]. Evidently, the challenges associated with SpO 2 waveforms are far more widespread than originally expected.
ECG should be used in all patients to monitor for arrhythmias, which are commonly detected during general anaesthesia [ 30 ]. However, VNs reported an overall lack of confidence using ECG, due to the waveforms being challenging to interpret [ 31 ].
Alongside this, suction is rarely used for brachycephalic patients. If most veterinary practices possess a suction machine, this raises the question as to why VNs avoid using them. This could be due to a lack of knowledge about the indications for – or benefits of – suction, or about how to use the equipment.
Evidence suggests that suction should always be available to enable easier visualisation of the airway for intubation [ 27 ]. In addition, suction helps to remove regurgitated stomach contents from the oral cavity, therefore reducing the risk of anaesthetic complications such as aspiration [ 28 ].
Overall, these gaps in knowledge can be minimised by additional training in practice, or by continuing professional development( CPD). However, it may be difficult to expect all VNs to participate, as there is a tendency to pursue additional training only in areas of interest [ 32 ].
Conversely, standard stethoscopes and oscillometric blood pressure machines were selected frequently by the respondents, highlighting some preference for traditional monitoring methods. Despite oscillometric measurement providing systolic, diastolic and mean blood pressure values, Doppler measurement is more accurate [ 33, 34 ]. Arguably, oscillometric measurement is easier to use, which may explain its popularity. However, it is worrying that many VNs could be relying on equipment that may give inaccurate readings [ 23 ].
36 Veterinary Nursing Journal