ACVAA common mistakes
ACVAA · Understand the traps and how to avoid them.
When asked to design an anesthetic protocol for a patient with a specific comorbidity (e.g., hepatic insufficiency, intracranial disease, GDV), the candidate lists drugs by class but never states how each choice is modified by that comorbidity, and never states what is avoided and why.
Candidates memorize standard canine/feline protocols and reproduce them regardless of the case, because they have not practiced mapping pathophysiology (e.g., decreased hepatic clearance, raised ICP, hypovolemia) onto drug selection and dose adjustment.
What to do instead
Before answering, write the patient's key physiologic derangements, then for each drug chosen state the mechanism it exploits or the risk it poses, and explicitly name at least one drug or class to avoid with the reason. Practice this on 10 common comorbidities until the pattern is automatic.
The candidate calculates a drug dose or infusion rate but omits units, or mixes mg/kg with mcg/kg, mg/mL with mcg/mL, or per-hour with per-minute, and reports a final number that is off by a factor of 10 or 1000.
Under time pressure, candidates skip dimensional analysis and rely on remembered numbers, so a unit slip goes undetected.
What to do instead
Always show a full dimensional-analysis chain (dose × weight ÷ concentration × time conversion) and cancel units explicitly on paper. Sanity-check every answer against a known clinical range (e.g., a CRI for a 20 kg dog should be a plausible mL/hr, not liters/hr).
When asked to interpret a capnogram or a sudden change in ETCO2, the candidate describes the waveform shape but does not commit to a differential or a next action (e.g., does not distinguish esophageal intubation, obstruction, hyperventilation, exhausted soda lime, or a leak).
Candidates learn waveform patterns as pictures but have not rehearsed the clinical decision tree that each pattern triggers.
What to do instead
For every capnogram abnormality, practice a three-part answer: pattern description, top differentials ranked, and the immediate confirmatory step or intervention. Build a one-page table of pattern-to-cause-to-action and rehearse it aloud.
The candidate describes monitoring equipment (pulse oximeter, Doppler, direct arterial line) without stating what physiologic variable it measures, its limitations, and the specific clinical scenario where it misleads (e.g., pulse oximetry with poor perfusion, hypotension, or methemoglobinemia).
Candidates equate 'knowing the monitor' with knowing its name and normal values, and have not studied failure modes of the technology itself.
What to do instead
For each monitor, prepare a 30-second summary covering measured variable, sources of error, and one clinical situation where it is unreliable. Include what to do when the reading is implausible.
When asked to assess depth of anesthesia or a patient that 'moved' or 'lightened', the candidate gives a single reflex (e.g., palpebral) as the answer rather than integrating multiple signs (eye position, jaw tone, response to stimulation, autonomic signs) and the context of the surgical stimulus.
Candidates memorize individual reflexes in isolation and do not practice synthesizing a depth assessment from several concurrent findings.
What to do instead
Practice structured depth assessments using at least three independent signs plus stimulus intensity, and state how each sign would change if the patient were too light versus too deep. Explicitly note that no single reflex is reliable alone.
The candidate equates 'analgesia plan' with 'give an opioid' and fails to build a multimodal plan that names drug classes at different points in the pain pathway (local anesthetic, NSAID, opioid, NMDA antagonist, alpha-2 agonist) with rationale and timing.
Candidates default to the most familiar drug class and have not practiced constructing multimodal analgesia as a framework rather than a list.
What to do instead
For each case, draw the pain pathway and place at least three agents at distinct sites (peripheral, spinal, central) with rationale for each. State pre-, intra-, and post-operative components separately.
The candidate describes pain assessment using only heart rate or a single physiologic variable, or uses a species-inappropriate scale, rather than applying a validated composite pain scale (e.g., Glasgow, Colorado, UNESP-Botucatu) and describing its components.
Candidates conflate physiologic stress responses with pain scoring and have not practiced using named validated instruments and their behavioral domains.
What to do instead
Memorize the categories of at least one validated species-specific composite scale (behavior, posture, interaction, activity, physiologic), and in answers state which scale, which categories, and how the score drives intervention. Note that tachycardia alone is nonspecific.
When asked about chronic or neuropathic pain management, the candidate applies acute pain logic (short-course opioid/NSAID) without addressing mechanisms such as central sensitization, wind-up, or the role of agents like gabapentin, amantadine, or ketamine, or without a plan for reassessment and tapering.
Training emphasis on acute perioperative pain leaves candidates without a framework for chronic/neuropathic pain, so they recycle acute protocols.
What to do instead
Prepare a distinct chronic/neuropathic framework: mechanism, drug classes targeting sensitization, non-drug modalities, measurable outcome goals, and a scheduled reassessment/taper plan. Practice contrasting an acute versus chronic plan for the same patient.
The candidate recommends an analgesic or anesthetic drug for a patient without accounting for species-specific contraindications or toxicities (e.g., NSAIDs or certain opioids in cats, xylazine/ivermectin concerns, local anesthetic cardiotoxicity if given IV, NSAID use with renal or GI risk).
Candidates learn drug classes generically and do not consistently retrieve species- and comorbidity-specific safety data at the moment of prescribing.
What to do instead
For every drug recommended, state one species-specific caution and one comorbidity-based caution, or explicitly state that none applies. Build a personal contraindication matrix by drug class × species × comorbidity.
The candidate answers a multi-part question (e.g., 'describe your anesthetic and analgesic plan, monitoring, and recovery') by addressing only the first part, or gives a plan with no contingency for a defined complication (hypotension, hypoxemia, bradycardia, prolonged recovery).
Under exam time pressure, candidates answer the first prompt they read and stop, and have not rehearsed contingency planning as part of a complete answer.
What to do instead
Read the full question and number each required component before writing. For every plan, include a named complication and a specific threshold-plus-action (e.g., 'if MAP <60 mmHg despite fluid bolus, start a vasopressor at X'). Practice timed answers that explicitly tick each requested part.