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Veterinarian Technician June 2005 (Vol 26, No 6)

On the Cover: A Talk with Greg Hanson, RVT, VTS (Anesthesia)

    Technicians who specialize in veterinary anesthesia face unique challenges. It is a specialty that requires knowledge of every aspect of patient care, including pharmacology, physiology, equipment, and surgical procedures. Greg Hanson, RVT, VTS (Anesthesia), meets these challenges head-on and sees every day as an opportunity to learn while at the same time providing the best care possible for his patients.

    When did you first know you wanted to work in veterinary medicine?

    When I was in high school, I had the opportunity to work in a local clinic as part of my school's "work experience" program. This exposure was enough to pique my curiosity about veterinary medicine. From there I gained more experience and became more curious as I worked in other practices. Ultimately, I sought employment at the Veterinary Medical Teaching Hospital (VMTH) at the University of California-Davis — 25 years ago! I've worked in the wards, in the ultrasound and nuclear medicine departments, and — for the past 18 years — in the anesthesia department.

    What does your position at the VMTH entail?

    My responsibilities are to provide anesthesia care and support to small animal patients of the VMTH, act as a quasi-instructor for senior veterinary students participating in the small animal anesthesia clinical rotation, and supervise and coordinate the department.

    So what is a typical day for you?

    Every day is different, depending on the scheduled caseload, patient assignments, procedures, and personnel involved in the case management.

    An ideal day for me is to provide care for two patients, with time at the end of the day to work up the next day's patients. This involves developing and discussing their anesthesia plan with our faculty anesthesiologist. Since we are a teaching hospital, procedures take considerably longer than those in practice; a procedure lasting up to 8 hours is not uncommon.

    I am also the assistant supervisor for the unit, which means that when my supervisor is absent I take over his duties. I focus most of my time coordinating schedule changes (our anesthesia schedule is very fluid and changes at several points in the day), dispensing anesthesia drugs and equipment, and assisting students and technicians with anesthesia-related problems.

    What is special about your job?

    I never feel so responsible for a patient's well-being as when I am providing anesthesia support. Anesthesia is a continually evolving discipline, and providing care is a dynamic task in which my knowledge and skills are always challenged. With every day comes the opportunity to learn. I work in a great department, and I have a wide variety of resources available to me. My coworkers are perhaps my greatest resource. I have been fortunate to work with very skilled and intelligent technicians, residents, and faculty who are willing to share their knowledge and experiences. Networking with these individuals has provided an in-depth and diverse knowledge of anesthesia and its effects on my patients.

    Teaching adds another component to the job that is very special. Sharing my knowledge and experience with students and staff to help them understand the subtleties of anesthesia care without having to "learn the hard way" and possibly endanger a patient is very rewarding to me.

    It sounds like your job has some specific challenges.

    Working as an anesthesia technician in a large institution has several challenges. The logistics, perso­nalities, and changes in plan can all be distracting, but the focus for me is patient care. Meeting the patient's needs and providing the best care possible are always my biggest challenges.

    High-quality anesthesia management requires advanced knowledge of pharmacology, physiology, and anesthesia equipment and a well-developed understanding of the procedures being performed. This specialty requires the use of highly refined skills and a broad base of knowledge. Anesthesia is a specialty that has a high level of excitement, and it demands that I use all of my resources. To finish a case and be satisfied that I supported the patient through the procedure, managed its pain, and helped get the patient on the road to recovery is very rewarding.

    What skills do you need to have as an anesthesia technician?

    Anesthesia care requires many skills that are used by all technicians every day. Some skills are essential to anesthesia care, especially the ability to troubleshoot and solve problems. Other important skills include IV and arterial catheterization; cardiovascular, respiratory, and pain assessment; and endotracheal intubation. My skills have developed over the years working as a technician in many different environments. It has been said that when you perform a task and you don't get the result you want or expect, what you get instead is "experience." Anesthesia management is unpredictable. As a result, I have ac­cumulated a lot of experience, and I continue to learn from situations that do not go the way I plan.

    Can you give an example of a case that did not go as planned?

    One day a few years ago, I was helping move a patient into our magnetic resonance imaging trailer. As we were moving the patient onto the gantry table and transferring our monitoring instrumentation, the patient began to experience cardiac arrhythmias and hypotension, which progressed quickly to cardiac arrest. The patient was already intubated and being ventilated with oxygen, all anesthetic drugs were turned off, and the IV fluid rate was increased. We were fortunate to have an electrocardiograph, direct reading arterial blood pressure monitor, pulse oximeter, and capnograph connected to the patient at the time of arrest, which made it possible to monitor the effectiveness of our CPR efforts. As we administered CPR, we could evaluate the electrical activity of the heart, see the arterial pressure waveform with each chest compression, and measure CO2 exchange and oxygen saturation of arterial hemoglobin.

    It appeared that our resuscitation efforts were sufficient to provide marginal tissue perfusion (we had good arterial waveforms with each chest compression, oxygen saturation was about 94% to 96%, and end-tidal CO2 was about 18 to 24 mm Hg), but CPR efforts continued for several minutes with no return of spontaneous cardiac electrical activity.

    The part of this story that is disheartening is that as I was performing chest compressions, I happened to notice that the pulse oximeter probe was disconnected from the patient and was laying about 6 inches away, yet the monitor was reading a pulse rate that corresponded to our chest compressions. Looking at the patient's mucous membrane color, it was apparent that his perfusion and oxygen status were not adequate. Despite our early recognition of the arrest, a well-supported patient with good venous access, an established airway, and ventilation with 100% oxygen, our patient did not survive.

    What did you learn from that experience?

    I learned a valuable lesson about equipment. Any monitoring equipment can misinform, distract, and confuse the operator. As caregivers, we need to focus on the patient, always look at more than one parameter, and include the basic information in our evaluation, such as mucous membrane color, capillary refill time, pulse quality, and extremity temperature.

    What is the most fascinating aspect of your job?

    One advantage in working for a large referral center like the VMTH is that we are exposed to cutting-edge technology, and we have great resources in personnel and equipment. One of the most fascinating types of procedures I have had the opportunity to perform is anesthetizing patients for cardiac surgery using cardiopulmonary bypass. These procedures taught me the value of teamwork. For these patients to survive the procedure, all the team members have to do their part and work together. The skills and technical expertise of the surgeon, perfusionist, anesthetist, and critical care clinician are all challenged by these patients.

    Teamwork is an important factor in your job.

    Yes, and I am fortunate to work with individuals who are willing to work as a team. Teamwork can be an incredibly effective tool in improving patient care. We all balance each other with our strengths and weaknesses, and I work with several people who form a strong, diverse team that is a great resource of knowledge and skill. The job is great, but my coworkers make it truly enjoyable.

    What do you consider the highlight in your career?

    I'm not sure I have experienced the highlight of my career yet. Working with the Academy of Veterinary Technician Anesthetists (AVTA) to develop the technician certification process and administering the first anesthesia technician certification exam was certainly a high point. It has been a great opportunity to learn from other technicians and give something back to the profession. That "something" is an avenue for technicians to help improve quality of care.

    My association with the AVTA has also allowed me to network with some of the top veterinary technicians in the country from whom I have learned so much. It has changed the way I look at the profession and how I perform my job.

    What is on the horizon for anesthesia technicians?

    Technicians are always hungry for more knowledge and to develop our skills. More veterinarians are becoming receptive to using well-trained technicians in their practice. The specialty academies are providing an avenue for technicians to focus on more specific areas of veterinary medicine and gain in-depth knowledge and specialized skills to improve the quality of care. Anesthesia monitoring equipment is becoming more prevalent in veterinary practice, and this gives the anesthetist the tools to make better-informed decisions. Diligent, well-trained technicians coupled with appropriate monitoring equipment should help improve the quality of anesthesia care in veterinary medicine.

    NEXT: Toxicology Brief: Equine Yew Toxicosis
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