Anesthesia, Analgesia, and Surgical Assisting
This domain tests preanesthetic assessment, anesthetic protocols, monitoring, recovery, pain management, and surgical nursing.
Before anesthesia
Obtain history, physical examination, weight, and baseline packed cell volume and total solids when indicated. Assign an American Society of Anesthesiologists physical status class. Fast patients per clinic protocol, secure IV access, and calculate premedication doses. Confirm consent and machine checks.
Monitoring
Watch heart rate, respiratory rate, mucous membrane color, capillary refill time, blood pressure, pulse oximetry, capnography, and temperature. A mean arterial pressure below 60 mmHg suggests inadequate perfusion. End-tidal CO2 is normally about 35 to 45 mmHg. Hypothermia is common and worsens recovery.
Analgesia and recovery
Use multimodal analgesia: opioid, nonsteroidal anti-inflammatory drug when appropriate, local block, and nursing comfort measures. Extubate when swallowing and respiration are adequate, then monitor until sternal and alert.
Worked example
A 12 kg dog is ordered 0.2 mg/kg of a 1 mg/mL drug. Reasoning: 12 kg × 0.2 mg/kg = 2.4 mg; 2.4 mg ÷ 1 mg/mL = 2.4 mL. Draw 2.4 mL, verify the label and route, and record the dose and time.
Surgical assisting
Maintain sterile field, open supplies without contamination, count instruments and sponges, position the patient with padding, and monitor anesthesia. Handle tissue gently and keep the surgical site clean.
Traps
Assuming pulse oximetry measures ventilation; missing hypothermia; extubating before swallowing; confusing mg and mL; failing to calculate a dose before drawing it up; letting a monitoring gap go unreported.