The primary aim for anyone working in veterinary medicine is to provide effective healthcare whilst minimizing harm to the patient. Progress has been made over recent years in terms of improved monitoring and pharmaceuticals, but the very real potential of anaesthesia causing harm remains. Anaesthesia, although considered routine by many, is a complex process involving a multitude of tasks that need to be performed in the correct way, in the correct order, at the correct time often in rapid succession. If any task in the process is missed or performed inappropriately the risk of harm to the patient increases. As such, anaesthesia lends itself to the application of cognitive aids.
Cognitive aids are visual prompts or decision guides, such as checklists or algorithms, which aim to reduce human error in critical processes by providing a supportive scaffolding that ensures tasks are performed and communicated appropriately. Unlike protocols or standard operating procedures, cognitive aids can be applied while a task is being performed. This reduces reliance on memory alone to perform tasks safely and effectively, and allows individuals to concentrate on other cognitive tasks, such as problem-solving and decision-making, while reducing the risk of cognitive overload, forgetfulness, distraction, fatigue or stress compromising the success of the task. They are particularly useful for critical steps that may not be readily recalled in high-pressure situations.
This guide can help reduce reliance on memory but it is neither a comprehensive step-by-step 'How to' guide for anaesthesia, nor an educational tool. It cannot prevent bad practice; ultimately, the onus to perform effective and safe anaesthesia remains with the individual and their team. Getting the most out of this guide will require familiarity with the content, engaging in practice sessions and applying checklists in clinics. However, it can hopefully help achieve the goal of providing our patients with the safest anaesthesia possible whatever the environment.

Foreword v

Preface vi

Section 1: Introduction and general information

1 Introduction 2

2 How to use this guide 3

3 How to run the checklists 6

Section 2: General cognitive aids

4 Pre-anaesthetic assessment 8

5 Anaesthetic planning questions 10

6 Essential drugs 11

7 Anaesthetic machine checklist 13

8 Breathing system checklist 14

9 Essential equipment checklist 15

10 Difficult airway equipment checklist 16

11 Crash box 17

12 Safety checklist: pre-induction 18

13 Post-induction checklist 19

14 Safety checklist: before starting procedure 20

15 Safety checklist: before recovery 21

16 Recovery and patient handover checklist 22

Section 3: Crisis checklists and cognitive aids

17 Rapid situational assessment 24

18 Diagnostic considerations 26

19 Cardiopulmonary arrest and basic life support 29

20 Cardiopulmonary resuscitation (CPR) drugs chart 31

21 Difficult airway 32

22 Post-induction apnoea 34

23 Hypoxaemia, desaturation and cyanosis 35

24 Hypotension 38

25 Bronchoconstriction 41

26 Haemorrhage 42

27 Hypertension 44

28 Bradycardia 46

29 Tachycardia 48

30 Hyperkalaemia - myocardial toxicity 50

31 Anaphylaxis and allergic reactions 52

32 Pulmonary embolism 53

33 Troubleshooting: pulse waveforms and pulse oximetry 54

34 Troubleshooting: capnography 56

Index of checklists 62

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