If you ask the surgeon why the anesthetist keeps filling out that record during anesthesia he will have an answer ready for you: 'to have something to do during the surgery. ' That, obviously, isn't the case, right? And that's what we're going to see after the clip.
Bring it on! Anaesthetic Record What's up NAVE crew! In today's Anaesthesia Unravelled video lesson we will be talking about the importance of the anaesthetic record.
Even though some surgeons may be under the impression that record is useless, it's just something to keep their hands occupied, we need to understand that the record is extremely important for the very surgical procedure. The first important purpose of the anaesthetic record is to register the animal's history during anaesthesia, to know what happened half an hour or one hour before that procedure, as well as after the anaesthesia, in case that animal needs to be anaesthetized again. Then we can check what went wrong, what went right, if that first protocol was adequate or not, this will provide us with a good start for the next anaesthesia.
The second important thing about the anaesthetic record is that it is a legal document, which means that the person responsible for the animal can request the record and we must provide it. It's useful, for instance, in case of death of insured animals, as horses. The third important purpose of the anaesthetic record is to provide us with data that correlates morbidity and mortality in that situation and these are the main reasons the records came into existence.
In the late 19th century, it was common for medical students or recent graduates to be in charge of anaesthesia, while the surgeons operated. Thank goodness that doesn't happen anymore. Anyway, in 1894, Ernest Codman was finishing medical school and frequently took care of anaesthesia for the surgery professor.
Soon, he felt the need to write down what he was doing, even to better understand what was going on during the anaesthesia. This is when we have the first report of an anaesthetic record. As we can see in this picture, DrCodman would basically write down the heart rate, the respiratory rate and the patient's temperature.
he also recorded some incidents during anaesthesia, but all very simple. One of his friends, Harvey Cushing, the very one from the Cushing syndrome also began to document the anaesthetic procedures, as we can see in this photo. Therefore, the first anaesthetic records came out of this pair, there's even a story that they kept competing for the spot of best anaesthesiologist, the winner had to treat the other to dinner, something like that.
but more importantly, they started doing this to better understand what happened during the anaesthesia, and try to decrease the mortality rate, that was high at that time. That means, my friend, that if the only things you write down are the heart rate, respiratory rate and temperature, you're 130 years outdated. They started to take an interest in it and realised that it wasn't too interesting for monitoring.
It was then that, in 1901, DrCushing met the Italian doctor Scipione Riva-Rocci It took me five minutes to learn how to speak that name. DrRiva-Rocci was the one who invented the blood pressure assessment through the sphygmomanometer. From then on, DrCushing began assessing the systolic blood pressure and obviously add it to the anaesthetic records.
Most relevant at the time, DrCodman started doing a morbidity and mortality study of the patients, using the data he had acquired, which is why it's important to record everything reliably because, besides being a legal document, we will learn from that anaesthetic record. Now, a controversial topic: Do tell me! A good number of anaesthetists agree that filling out paper records is only for old people.
Others have doubts as to whether the people using digital forms are really paying attention to the anaesthesia. This debate, very. .
. friendly, of course, isn't anything new. It started in the 80s.
In the early 80s, Duke University developed a computer that was able to process patient information and scan the data from the parameters during anaesthesia. They tried to further develop the computer with a company but it didn't work out at that time. But that's okay, that happened 40 years ago, technology today is completely different.
However, we can see in these two very recent articles here that things have not changed all that much. And remember, we are talking about medicine and not veterinary medicine. Nowadays we live in a digital world, and everything is moving towards that.
In that regard, the digital record has several advantages. Advantages The first one is the accuracy. The software can warn the anaesthetist that some data is missing and has to be completed, otherwise they won't be able to continue.
The second in the efficiency, that in my case wasn't that efficient, but as the person fills out the digital record more quickly, they can dedicate more time to the patient. Third is safety, because if the person makes a mistake on the record or if something wrong is happening, the software might be able to warn the anaesthetist that something is amiss, and also convenience, because the head anaesthetist, for instance, may not be in the surgery room, but can still keep an eye on the anaesthesia real-time. However, we've still got a few disadvantages Disadvantages The software is the main problem because, besides still being incredibly expensive, it comes in a standard form, which means everyone will have to addapt their reality to fit the software, as opposed to the software being adjusted to fit the hospital.
Obviously, if we want a more specific software, it will result in a greater cost. Another thing that is an advantage but can end up being a disadvantage is the accuracy, because during anaesthesia some monitoring artifacts can happen, as the monitor failing or providing readings that are not precise, and although we are aware of it at the time, the digital record will storage the data. Data storage can also be a problem because it will have to be stored on a server and this server has to be able to support all that data and, obviously, have a backup made frequently.
Also, accessibility, that can be a problem because we can't forget these are confidential data and within a digital network, it can be accessed by a hacker. Obviously, all these disadvantages will be improved in a few years and everyone will probably start using a digital anaesthetic record. Personally, I've been meditating a lot on the use of hand-filled or digital records.
Until recently, I was slightly opposed to the digital records, mainly because I think the digital record can interfere on the focus of the anaesthetist, but I've been making some progress. Today, I'm in favour of using the digital record, but for cost and practical reasons, here in Pirassununga we still use the hand-filled record. Regardless if the record is hand-written or digital, it needs to have information that are indispensable and others that can be added according to the hospital's routine.
Now we will show how the record is filled here in Pirassununga. This is very important, especially for our students, for the interns and newcomers. Just to be clear, I didn’t invent this record, ok?
It came from a series of ideas that we kept adapting over time. As we covered during the Checklist lesson, I'm not saying that our record is better or worse than any other anaesthetic records, it's just very interesting for our own routine. Each place has to adapt their own, alright?
The first part of our anaesthetic record has the patient data, date of the procedure, weight of the animal, the name of the anaesthetist, of the surgeon, of the procedure to be performed, some information from the anamnesis and also laboratory tests, physical exam, ASA score of the patient, whether the animal is fasting or not and if the anaesthesia checklist has been done. In the next section, we list the preanaesthetic medications, and it is very important to also put the name of the person responsible for that. The same goes for the induction drugs.
There are still some relevant information, such as the catheter gauge, which IV fluid is to be administered, which anaesthetic system will be utilised, the diameter of the tracheal tube, if the animal will be put under mechanical ventilation or not, do not forget to lubricate the eyes during anaesthesia, which type of anaesthesia the animal will receive, inhalation, TIVA or locoregional nerve block, type of heating and emergency drugs. The verse of the record is to register everything that is happening during anaesthesia. As we can see here, there is a place to write down the weight of the animal, if the animal is receiving only O2 or a mixture of gases, if it is receiving an inhalation agent and which one, and something important, that we can see here in the bottom left corner, are the captions used during the filling out.
We write down the parameters every five minutes. All parameters are written down according to the caption, as I mentioned before. This animal was put under mechanical ventilation so we also have to add that information to the bottom left corner.
An important thing is that the patient is receiving an IV infusion of fentanyl, lidocaine and ketamine, informally known as FLK. Their infusion rates should be placed in 'observations', as we can see here. The monitoring goes on, in accordance to whatever happens during the anaesthesia.
It should be mentioned that here, in this sample record, that at 09:10, a third episode of hypotension occurred. In order to manage that hypotension episode, the anaesthetist decided to administer a dopamine IV infusion, and the infusion rate must be included in the 'observations'. The monitoring continued, and we can see that at 9:30 the anaesthetist decided to stop the dopamine infusion.
Onwards, it seems that the patient remained stable. The surgical procedure ended at 10:20, and the anaesthesia at 10:30. The onset and offset of the procedure are written down.
Finally, the anaesthetist must sign the record and stamp it with his vet ID. We still have a space on the form to write down anything that happens during the post-anaesthetic period. In this case the information are at the front of the record.
There's a scoring for recovery quality, moment of extubation, moment that the animal achieved sternal recumbency, a few pain assessments and if this animal had to receive rescue analgesia or not. Finally, the post-operative analgesic prescription of the patient is written down. Well guys, I confess that there's real lot of information in this record, some that can even be a bit irrelevant sometimes, but I should remind you that we are in an educational institution, so we end up writing down everything that can be important for any study of morbidity and mortality Another important point is that we work with all species, and this record works out for all of them.
Just don't forget: the most important part of the record are the drugs administered the person responsible for it, all the physiological parameters assessed during the anaesthesia, and the signature of the Vet in-charge. As a conclusion to this video lesson, we have that the anaesthetic record is an indispensable register of the anaesthesia it has the purpose to show what is happening during the anaesthesia, serve as the patient's history, being a legal document of the anaesthesia and also serve as a database source . We must adapt the record to our individual needs, but always prioritizing the best monitoring possible.
Well folks, I hope you enjoyed this video lesson. The articles that I mentioned, our anaesthetic record and also other relevant information are just below, in the description. Before going, subscribe to our channel, like and share this link, which is very important for us, alright?
See you in the next video lesson! Hello What's up NAVE crew! No No No way.
That's not cool. Oosh. DrRiva-Rocci for the sphygmomanom.
. . I need to check my collar here because my mom complained.
. . This one is good.
