Align-ju RESEARCH BITES
Using a clinical audit to critically review the anaesthetic protocols used for elective surgical neutering procedures in a busy veterinary hospital
Phoebe Crawford , BSc ( Hons ), RVN and
Emily J . Hall , MA , VetMB , MRCVS , MRSB , AFHEA
Nottingham Trent University
Envelope phoebe _ crawford @ icloud . com
Introduction
Admissions for routine , elective procedures such as ovariohysterectomies and orchidectomies form a large part of the daily surgical caseload within many veterinary practices . Using consistent anaesthetic and analgesic protocols and checklists within the veterinary team can help to improve patient safety .
Recently within a practice , there had been some confusion about the timing of administration of nonsteroidal anti-inflammatory drugs ( NSAIDs ), and whether pre-operative administration compromised the renal system . The primary aim of the clinical audit was to evaluate the practice ’ s routine neutering anaesthetic and analgesic protocols for orchidectomies and ovariohysterectomies , with a focus on the effects of the timing of NSAID administration .
Methods
This project received ethical approval from Nottingham Trent University , School of Animal , Rural and Environmental Sciences Ethical Review Group . A retrospective audit was performed on anaesthetic records of canine surgical neutering procedures and feline ovariohysterectomies from a 6-month period . Patients underwent routine , elective surgical procedures and received a premedication combination prescribed by the operating veterinary surgeon .
The audit reviewed premedicant agent use , NSAID administration timing , completion of anaesthetic monitoring records ( heart rate , capnography , blood pressure ), inhalational anaesthetic use and complication occurrence , using descriptive statistics . Data were tested for normality and Spearman ’ s rank correlation was used to explore the relationship between NSAID administration timing ( pre- , intra- or post-operative ) and minimum mean arterial blood pressure , and between NSAID timing and maximum isoflurane administered .
Results
The audit included 140 patient records and found 100 % completion for heart rate and isoflurane percentage administered , 85.8 % completion for blood pressure , and 59.3 % completion for capnography records . Timing of NSAID administration was recorded on 138 ( 98.6 %) records : 58 ( 42.0 %) pre-operative , 31 ( 22.5 %) intra-operative and 49 ( 35.5 %) postoperative . One incident of accidental repeat NSAID dosing was recorded during the study period . There was a weak but significant negative correlation between NSAID timing and minimum blood pressure recorded ( r s
= – 0.274 , p = 0.003 ). No significant correlation was found between NSAID timing and maximum isoflurane administration ( r s
= 0.054 , p = 0.325 ). However , the median isoflurane maximum administration rate was lower for patients that received pre-operative ( 2 %) versus intra- / post-operative NSAID administration ( 2.38 %).
Conclusion
Current compliance with the practice ’ s anaesthetic monitoring protocol is high , although barriers to the use of capnography will be reviewed to increase uptake . The results from the audit suggest that pre-operative administration of NSAIDs provides multi-modal , preemptive analgesia , thus reducing the inhalational agent required , contributing to maintenance of a stable mean arterial blood pressure throughout the anaesthetic . A literature review found evidence to support this finding , with multiple papers reporting that pre-operative administration of NSAIDs had no significant effect on renal perfusion during anaesthesia . As a result , the team are reviewing the timing of NSAID administration , and another audit cycle is planned .
VOL 37 • May 2022
61