PIL C Training Modules & Learning Outcomes

Module 20: Anaesthesia for Minor Procedures (MODULE PILB)

Module 20 Description

This module provides guidance and information to individuals who, during their work with animals, will need to apply sedation or short-term anaesthesia for a brief period and mild pain level procedure.

The objectives of this module are:

• to introduce the course candidates to the administration of anaesthetics to laboratory animals;

• to discuss anaesthesia under the following broad headings (pre anaesthetic considerations; effects of anaesthetic agents; anaesthetic administration; regional/local/ general anaesthesia; anaesthetic emergencies; recovery from anaesthesia);

• to provide information on the effects of drugs used during anaesthesia;

• to consider the potential adverse effects of anaesthesia and on recovery;

• to discuss anaesthetic emergencies and their treatment and

• to identify when anaesthesia may compromise science.

Module 20 Learning Outcomes

The Learning Outcomes aim to give the minimum knowledge necessary for the appropriate and safe application of such a sedation or brief anaesthesia, with simple induction, basic maintenance for the purpose of performing minor procedures such as illustrated defined below:

• Simple induction process (e.g. chamber induction or simple IP administration, no requirement for endotracheal intubation) and

• Basic “hands on” and “observational” monitoring of anaesthetic depth; maintenance is anticipated to be uncomplicated at a stable anaesthetic depth and maintenance rate.

• Brief duration (up to about 15 minutes in a rodent species – maintenance of anaesthesia for imaging - if the anaesthesia is expected to last longer than this, the trainee would require further modules)

• Use for minor procedures only - non-invasive / superficial procedures only (skin level, no access to body cavities unless terminal anaesthesia is used), superficial venous access and taking a blood sample, identification using SC microchip or, tail tipping (limited biopsy of tip of tail), anaesthesia for restraint.

• No pain or short / minor pain level, 

• No high-risk or sensitive animal

Trainees should be able to:

i. Define sedation, local and general anaesthesia

ii. Identify the three components of the triad of anaesthesia and understand that different anaesthetic agents produce these to different degrees.

iii. Define balanced anaesthesia and indicate that this is best achieved by using drugs in combinations to achieve all components of the anaesthetic triad to an acceptable degree

iv. Relate why and when sedation or anaesthesia might be used for restraint.

v. List the factors to be considered in pre-anaesthetic evaluation of animals - how to perform a basic health check, consider physiological or pathological status of the model they are working with and how these may influence the choice of anaesthetic agent.

vi. Discuss the relative merits / drawbacks and principles of selection of different agents and their application, including calculation of doses, in relevant species, including injectable and volatile agents (or dissolved agents in the case of aquatic species), including local anaesthesia regimes

vii. Indicate the importance of minimising stress prior to anaesthesia in reducing the likelihood of complications due to anaesthesia.

viii. Recognise when premedication is beneficial to incorporate into an anaesthetic regime.

ix. Describe and demonstrate the correct set-up, operation and maintenance of anaesthetic equipment appropriate to the species concerned.

x. Evaluate and appreciate the different levels and planes of anaesthesia (voluntary excitement, involuntary excitement, surgical anaesthesia (light, medium & deep), excessively deep).

xi. List the factors indicating that an animal is suitably anaesthetized (stable and of appropriate depth) to enable procedures to be undertaken and what actions should be taken if an adverse event occurs. This will include basic “hands on” and “observational” anaesthetic monitoring techniques, including assessment of reflexes appropriate for species.

xii. Describe methods of optimising post anaesthetic recovery (e.g. heat blankets, analgesia, reversal agents, access to food and water, environmental conditions) to ensure a smooth and rapid recovery from anaesthesia.

xiii. Demonstrate an understanding of safe / good working practices with regard to use, storage and disposal of anaesthetic and analgesic agents.

Module 21: Advanced Anaesthesia for Surgical or Prolonged Procedures (PART OF MODULE PILC)

Module 21 Description

This module is linked, but not exclusively, to the “surgery” module. “Surgical procedures” include all procedures not defined as “Minor procedures” in the Preamble to the anaesthesia for minor procedures module . Prolonged is defined as any duration greater than 15 minutes, which may require additional or continuous dosing (including anaesthesia for imaging). This module also discusses the alleviation of pain during painful procedures such as surgery, through the use of anaesthetic and analgesic drugs. Anaesthesia is also used for producing muscle relaxation, suppressing reflexes, and producing loss of consciousness for purposes other than prevention of pain perception. For example, anaesthesia is required for MRI, CT scans and other minimally invasive imaging modalities. Because of the wide variability of laboratory animal species and strains, as well as anaesthetic agents, an appropriate anaesthetic regimen should be developed in consultation with a veterinarian. If not used for restraint alone, the need to use an anaesthetic to perform a procedure implies that the procedure would be painful for an awake animal. In addition there may be some residual pain after the animal recovers from the anaesthetic and analgesics should be used. Some drugs described here appear in both the anaesthesia and surgery modules

Trainees should be able to:

i. Relate why and when anaesthesia might be used, including additional factors relevant for long term anaesthesia.

ii. Relate the need for and list the factors to be considered in pre-anaesthetic evaluation of animals, including acclimatisation.

iii. Discuss the use of pre-anaesthetic agents and analgesics as part of a balanced anaesthetic regime.

iv. Indicate that a range of drugs are commonly used for premedication and the induction and maintenance of anaesthesia in relevant laboratory species, and identify where to get advice on the different drug available and their use.

v. Describe how an animal’s concurrent pathology may require specific anaesthetic regimen, monitoring or nursing care.

vi. Indicate types of agents used for the induction and maintenance of general anaesthesia, their advantages and disadvantages and when each might be used.

vii. Describe how anaesthetic agents interact to produce the three components of the anaesthetic triad to different degrees, and how balanced anaesthesia might be best achieved by using combinations.

viii. Demonstrate a sufficient understanding of anaesthetic agents having a low analgesic effect, potentially requesting the use of an additional analgesia.

ix. List the factors to be considered when monitoring anaesthesia both for anaesthetic depth and physiological stability. Indicate how to determine that an animal is sufficiently deeply anaesthetised to enable painful procedures to be undertaken, and what action should be taken if an adverse event occurs.

x. List methods which can used to assist monitoring of anaesthesia (e.g. ECG, BP, Urine output, Oxygen saturation, CO2) and how these can be monitored.

xi. Monitor anaesthetic depth and the animals' vital signs, using both clinical signs, and electronic apparatus if appropriate.

xii. Describe and demonstrate the correct set-up, operation and maintenance of anaesthetic and monitoring equipment appropriate to the species concerned.

xiii. Demonstrate competence in maintaining and interpreting records of pre- and post-anaesthetic induction and whilst an animal is anaesthetised, as well as in managing the animal care adequately.

xiv. Indicate the problems that may occur during anaesthesia, and understand how to avoid these, or manage them if they occur.

xv. Demonstrate an understanding of mechanical ventilation.

xvi. Describe methods to optimise post anaesthetic recovery to ensure a smooth and rapid recovery from anaesthesia, as in Basic Module but with additional methods required, including analgesia and fluid replacement, for animals having undergone lengthy anaesthesia of surgical procedure.

xvii. Consider the consequences of anaesthesia and the surgical procedures on recovery.

xviii. Appreciate how the choice of anaesthetic agent will determine the rate of recovery and describe how duration and quality of anaesthesia governs the rate of recovery.

xix. Describe the problems that can arise (in the post-operative period), and indicate how to avoid these, or manage them if they occur.

xx. Discuss how to integrate a program of pain management into an overall scheme of perioperative care. 

xxi. Indicate some of the problems associated with pain recognition and pain management in animals.

xxii. Demonstrate a sufficiently detailed understanding of analgesics to be able to administer safely, including routes of administration and potential adverse effects.

xxiii. Demonstrate an understanding of safe / good working practices with regard to use, storage and disposal of anaesthetic and analgesic agents.

Module 22: PRINCIPLES OF SURGERY (PART OF MODULE PILC)

Module 22 Description

This module covers principles of pre-operative animal assessment and care, preparations for surgery including equipment preparation and aseptic technique and the principles of successful surgery. The module provides information about possible complications, post-operative care and monitoring along with details of the healing process. It also covers more practical elements for example the demonstration of commonly used instruments and provide an opportunity for trainees to practice some of the practical aspects of surgical technique, such as methods of suturing, using appropriate non-animal models

Module 22 Learning Outcomes

Trainees should be able to:

i. Explain the relevance and need for pre-operative assessment and, where appropriate, conditioning.

ii. Identify sources of reference for good surgical practice.

iii. Describe the process of tissue healing and relate to this to the importance of asepsis and hygienic practices, wound creation, the principles of tissue handling and selection of a suitable surgical approach.

iv. Discuss possible causes of delayed or impaired wound healing or other post-surgical complications and describe ways in which these can be avoided or, if they occur, treated.

v. Describe in general terms how personnel, animals, instruments and equipment should be prepared for aseptic surgery.

vi. List the principles of successful surgery (e.g. Halstead’s principles) and indicate how to achieve these.

vii. Describe the characteristics of different, commonly-used instruments, suture materials and needles.

viii. Relate the importance of good technique in accessing surgical sites, handling tissues and repairing incisions.

ix. Indicate the characteristics of different suture patterns and their applicability to different situations.

x. Demonstrate how to place a suture correctly.

xi. Describe common post-surgical complications and their causes. 

xii. Relate the principles of post-surgical care and monitoring.

xiii. Describe the planning of surgical procedures and discuss the competencies required of all personnel involved.

xiv. Demonstrate competence in surgical techniques, including ablations and incisions and their closure by methods appropriate to the tissue concerned.

xv. Describe particular aspects of care appropriate for animals before, during and after surgical or any other potentially painful intervention