Anesthesia/Critical Patient Care Service

Anesthesia/Critical Patient Care Service

Anesthesia/Critical Patient Care Service

Welcome to the Anesthesia/Critical Patient Care Service at the UC Davis Veterinary Medical Teaching Hospital, where we are dedicated to our mission of educating future veterinarians and residents in the discipline and practice of anesthesiology and providing superior clinical service to our patients and referring veterinarians. The VMTH is the only veterinary hospital in Northern California with multiple board-certified anesthesiologists. We manage most of the patients that are anesthetized at the VMTH and provide dedicated attention to each patient before, during and after anesthesia. Our faculty members have all completed advanced training in veterinary anesthesiology and supervise the care provided by residents, technicians and senior veterinary students. We are also dedicated to the management of perioperative pain and use many different approaches and collaborate with the primary clinicians to ensure the comfort of our patients.

Residency Program in Anesthesia/Critical Patient Care

General Information
The residency program is designed to provide advanced clinical, non-degree, post-doctoral training in veterinary anesthesiology and critical patient care.

The knowledge and skills acquired from this three-year residency program will be of value in teaching/research careers in veterinary, medical or other health professional schools, in specialized private veterinary practice and/or in careers in physiological, pharmacological and/or surgical research programs.

The residency program conforms to current guidelines developed by the American College of Veterinary Anesthesia and Analgesia (ACVAA) and the European College of Veterinary Anaesthesia and Analgesia (ECVAA) for admission to examination for Diplomate status.

Objectives of the Program
To provide clinical training in anesthetic and perioperative pain management in major animal species. To prepare the resident for board certification by the American College of Veterinary Anesthesia and Analgesia, or the European College of Veterinary Anaesthesia and Analgesia.

Courses of Activities
The Anesthesiology Residency Program at UC Davis adheres to the Residency Training Standards established by ACVAA. The resident will spend a minimum of 94 weeks on primary anesthesia clinical duty, under the supervision of board certified anesthesiologists. After hours duties are shared by 4 residents and 2 after hours anesthesiologists; the residents are currently assigned 50-60 after hours shifts per year (includes weekday night, weekend day + night). In addition, residents also have clinical rotations in small animal critical care medicine, radiology, cardiology, companion exotic and avian pet medicine, zoo medicine, laboratory animal medicine, human anesthesia, and human pain medicine. The clinical caseload of the Anesthesia/Critical Patient Care Service is varied and more than sufficient to cover all core species as defined by ACVAA and ECVAA, plus occasional patients in a non-core species. This provides ample opportunities to develop the knowledge and skill sets essential to the practice of veterinary anesthesiology.

The residency in Anesthesia includes 3 courses. These courses take place 3 quarters/year, a total of 3 hours per week. VSR 491R provides information in physiology, pharmacology, and applied anesthesiology and spans the 3 years of the residency program (approximately 20 hours/quarter). VSR 493R is a discussion of anesthesia-related morbidity and mortality of the clinical cases presented to our service. It includes both systematic reviews of cases with significant morbidity or mortality (4 hours/quarter) and in-depth discussions of selected cases (4 hours/quarter). VSR 494R is a discussion of anesthesia-related scientific articles (“journal club”), with an emphasis on critical reading rather than review of a large number of articles (approximately 8 hours/quarter). As part of VSR491R 3 quarterly examinations, include a written and an oral section, are organized addressing the topics covered in that course. Moreover, an annual mock board examination (with multiple choice, essay and oral sections, mimicking the way the ACVAA examination is organized) takes place during the summer. These exams and are all aimed at preparing the residents to complete the ACVAA certifying examination successfully.

Anesthesia residents have limited participation in teaching activities. During the second and third years of their program they contribute to teaching anesthesia in the junior surgery spay and neuter laboratories. In large animal anesthesia, residents are commonly assigned cases along with a student and are expected to teach this student anesthesia principles and technical skills. In small animal anesthesia, residents may contribute to student teaching when not assigned cases. Senior residents occasionally lead topic rounds with students.

Residents are expected to conduct a prospective laboratory or clinical study during their residency program under the supervision of one or more of the anesthesiology faculty. Depending on their background and interests, the goals may include training in grant writing, experimental design, experimental methodology, manuscript writing, and presentation of experimental results at a conference.

Structure and Organization
Number of weeks in each area:
First year: Small Animal Anesthesia: 21, Large Animal Anesthesia: 18, Small Animal Critical Care: 4, Cardiology: 2, Radiology: 1, Research: 1

Second year: Small Animal Anesthesia: 13, Large Animal Anesthesia 13, Small Animal Critical Care: 3, Exotic Pet Medicine: 2, Zoo Medicine: 2, Laboratory Animal Medicine: 2, Research: 12

Third year: Small Animal Anesthesia: 16, Large Animal Anesthesia: 16, Small Animal Critical Care: 3, Radiology: 1, Human Anesthesia: 2, Human Acute Pain Management: 1, Human Chronic Pain Management: 1, Research/Study: 6
24 days of vacation/year.

Faculty Participating in the Program
All faculty participate in resident training:
Dr. Linda S. Barter     
Dr. Robert J. Brosnan (Service Chief)   
Dr. Alessia Cenani
Dr. Jan E. Ilkiw (Associate Dean)
Dr. Bernice Kuo (after hours)
Dr. Bruno H. Pypendop

Dr. Joao Soares

Dr. Pauline Wong (after hours)

Process of Evaluation
Residents will be evaluated twice a year, based on clinical performance and performance on the examinations. Residents in academic difficulty may receive additional evaluations, and will be given specific goals for remediation. Failure to achieve these goals may result in dismissal.

Certification
Residents who complete the 3-year program with satisfactory evaluations will be awarded a residency certificate.

State Licensure
California licensure is not required.

Advanced Degree during Residency
Advanced degrees are not offered as part of the residency program, nor can they be pursued during the residency.

Minimum Qualifications
•    Graduated from a college or school of veterinary medicine accredited by the AVMA; or possess a certificate issued by the Educational Commission for Foreign Veterinary Graduates (ECFVG); or are legally qualified to practice veterinary medicine in some state, province, territory, or possession of the United States, Canada, or other country.
•    Have demonstrated unquestionable moral character and professional behavior.
•    Foreign graduates must also be eligible for a TN (Mexico and Canada) or J-1 visa with no bars or home country requirement.

Service/Board Requirements
Certifications:
TOEFL    Yes
NAVLE     No
PAVE       No
ECFVG     No
OTHER     No

Additional Requirements
•    A 12 month rotating internship or equivalent practice experience is required prior to commencement of the residency (ACVAA guidelines).
•    A California driver’s license is not required but will be helpful.
•    We will have 1 residency position open in 2016. SELECTION WILL UTILIZE THE VETERINARY INTERNSHIP/RESIDENCY MATCHING PROGRAM.Register at www.virmp.org. THE DEADLINE FOR RECEIPT OF APPLICATION MATERIALS IS DECEMBER 2015. Please note: Foreign nationals must be eligible for either a TN or J1 visa with no bars or home country requirement. Information for Foreign Applicants
•    RESIDENTS MUST BE ABLE TO ARRIVE AT THE HOSPITAL WITHIN 15 MINUTES OF AN EMERGENCY CALL, THEREFORE, RESIDENTS MUST PLAN TO LIVE WITHIN 15 MILES OF THE HOSPITAL.
•    IT IS ESSENTIAL THAT NEW RESIDENTS BE AVAILABLE TO BEGIN THEIR RESIDENCY PROGRAM ON AUGUST 1, 2016.
•    The University of California, Davis and the Veterinary Medical Teaching Hospital are interested in candidates who are committed to the highest standards of scholarship and professional activities, and to the development of a campus climate that supports equality and diversity.


Frequently Asked Questions

  • Who supervises the anesthetic management of my animal?
  • The Anesthesia/Critical Patient Care Service is supervised by faculty veterinarians who have specialized in anesthesia and pain management. There are usually two such individuals present during the day and they review all the anesthetic protocols and check on each patient frequently. If you would like to talk directly with one of the anesthesiologists about the anesthetic management of your animal, please ask your clinician to contact us.
  • Who will be doing the anesthetic and taking care of my animal?
  • The Anesthesia/Critical Patient Care Service employs Registered Veterinary Technicians who do many of the anesthetics. These are individuals who have specialized in small animal anesthesia and some of our technicians have obtained specialized qualifications in this area. Since this is a teaching hospital, some patients will be managed by our residents - veterinarians who are specializing in anesthesia and who are training with the faculty at the VMTH and some patients will be anesthetized by veterinary students who are in their fourth year of their veterinary education. All anesthetized patients are under the supervision of veterinarians with specialist training in anesthesia.
  • What information is needed about my animal before anesthesia?
  • As for any clinician, it is important that the anesthesiologist have as much information about the patient as possible. It is important for the anesthesiologist to understand what is wrong with the animal, what treatments it is receiving, and what procedure is going to be carried out. Many of the drugs that are used in anesthesia cause some degree of depression of the heart and lungs. Therefore, we focus on these organs in particular, but the liver and the kidneys are also important in removing the drugs that are used, as well as good health after anesthesia. In order to better understand the functional condition of these organs, the anesthesiologist may ask for further diagnostics such as radiographs of the chest, ultrasound of the heart, or blood tests to determine liver and kidney function or blood coagulation. Because of drug interactions, it is important for the anesthesiologist to know if an animal is being treated with any drugs or herbal therapies so that the anesthetic can be tailored to the individual patient. Any previous history of problems associated with anesthesia should be mentioned to the clinician who admits your animal to the hospital.
  • What care will my animal receive during anesthesia?
  • At least one person, either a veterinarian (resident), anesthesia technician or senior veterinary student, will be dedicated to the care of your pet from the time it first receives the drugs until it is recovered from anesthesia. Typically, the first anesthetic related drugs animals receive are sedatives and pain medication. Your animal will then have a venous catheter placed, through which it will receive intravenous fluids and anesthetic drugs. A breathing tube is then placed and the animal is connected to an anesthetic machine that delivers the anesthetic gas which keeps your animal anesthetized. During anesthesia, we routinely monitor heart and breathing rates, blood pressure, and body temperature at frequent intervals. The VMTH is well equipped with anesthetic equipment and monitoring devices that we will use as appropriate to ensure the best care for every patient.
  • How do you manage pain associated with the treatment of my animal?
  • The Anesthesia/Critical Patient Care Service uses a comprehensive array of drugs and techniques to manage animal pain. Animals are usually given pain-killing drugs (analgesics) before the procedure, with the expectation that preventing pain is more effective than waiting until the animal feels pain before treating it. Before the surgery begins, we may use local anesthetics to block the pain signals coming into the spinal cord and brain during surgery. These drugs may be given close to the surgical site or may be injected around nerves or around the spinal cord itself (epidural injection). We may give other analgesics during surgery and then most patients will receive two different types of analgesic at the end of surgery - one type to help control the immediate intense pain after surgery, and one to provide longer lasting analgesia. Animals are watched on a regular basis after surgery, and are provided with further analgesics if needed.
  • Why does my animal have hair clipped from several sites on his/her legs?
  • During anesthesia, we require that we have at least one intravenous access in each patient. In some animals, it may be necessary to clip more than one leg because of difficulty getting a catheter into the vein or because we need to place more than one catheter (some drugs or fluids we may need to give your pet cannot go together). We may also clip areas on the legs, ear, or tail in order to place a catheter in an artery so that we can monitor blood pressure and obtain blood samples for monitoring purposes. An area over the back may also be clipped if we have done an epidural injection to help with pain management.
  • How long will it take my animal to recover after anesthesia?
  • Most young healthy animals recover very quickly after anesthesia, and it is often difficult to tell that they had been anesthetized within a few hours of the procedure. However, when your animal is anesthetized for a long time, is older, or is ill at the time of anesthesia, recovery may take longer and it may still be obvious that the animal is not back to itself for 24 hours or more. Some of this delayed recovery may be due to the anesthetic drugs, but some may also be due to the underlying condition that made the original procedure necessary. Though you may only meet one resident and one student, your pet is under the care of the entire service, with overall supervision provided by faculty veterinarians.
  • How do the drugs used in veterinary anesthesia compare with those used to anesthetize people?
  • Mostly, they are the same drugs. We use some drugs that are not commonly used in people because they work well in animals and have stood the test of time as being helpful for our patients. The frequency with which we use some drugs is different than for human patients, but for the most part, the drugs were originally developed for people and have been adapted for use in animals.
  • How do you schedule the animals for anesthesia on any particular day?
  • Any clinician who wants to have an animal anesthetized at a particular time provides our service with a request for the preferred time and date. At 3 p.m. on the day before the procedure, we look at all the requests and assign our residents, technicians and students to the patients. This allows them to look at the animal before the end of the day and to find out if we have all the necessary information. Once the assigned individual has had time to look at the patient and the patient's record, he/she writes up a plan for that animal and consults with one of the faculty anesthesiologists about this plan. The anesthesiologist may ask for further information or talk directly with the clinician involved to ensure that the planned approach is the best for the animal.
  • Why do you not want an animal fed before anesthesia?
  • When we anesthetize an animal, we insert a tube into the airway so that nothing can go into the lungs during anesthesia. This is essential because an animal will lose its own ability to protect its airway once it is anesthetized. However, if an animal regurgitates (food comes up from the stomach into the mouth) before we can get the tube in place, the animal could die from inhaling that material into its lungs. Withholding food from the animal for 12 hours prior to surgery will help ensure that the animal has an empty stomach and minimize the risk of regurgitation or aspiration. Water can be made available until close to the time of anesthesia since it poses minimal risk even if it is regurgitated. Healthy adult animals will suffer no untoward effects from having food withheld for 12 hours. Young puppies, kittens, and animals with stringent feeding requirements, like diabetic pets, will be dealt with on a case-by-case basis.
  • Is my animal too old to be anesthetized?
  • Not necessarily. Age, in and of itself, is not a disease but many older patients have trouble with their hearts and kidneys. We look at all the health issues our older patients are facing and assess them individually to see if it is in their best interest to be anesthetized and undergo the procedure and determine how to anesthetize each patient to minimize risks. We have anesthetized cats and dogs that have been over 20 years old, and they have done well following the procedure.
  • Why should my animal be in the hospital for the night before it is anesthetized?
  • This helps the animal to get somewhat acclimated to the hospital environment before undergoing anesthesia and surgery. Importantly, it is also to allow the anesthesia personnel to examine the animal and conduct additional tests that might be necessary, so we can come up with an appropriate plan for the next day when it is to be anesthetized.
  • How safe is anesthesia in animals?
  • We think it very safe, but the drugs and techniques do carry some risks. It is important to recognize that there are many things that can go wrong during anesthesia. A good history and thorough examination of your animal helps us determine the most appropriate anesthetic plan. We monitor all patients closely and use advanced technology to try to understand what is happening to the animal during the anesthetic in order to minimize the risk and then treat problems early, before they become life threatening. Our main goal is to anticipate the things that might go wrong and be prepared for them so that we can prevent problems.
  • I have heard that my particular breed is very sensitive to anesthesia. How do you handle this?
  • We hear this about many breeds, and for the most part, this has not turned out to be the case. However, we have many approaches that can be used for a specific patient. If there is a known or suspected sensitivity to a particular drug, we can use something else. We are very interested in this issue and are more than happy to look at any information you can provide on the concerns for your breed of animal.

Faculty

Robert BrosnanRobert Brosnan, DVM, PhD, DACVAA
Chief of Service

 

 

 

Linda BarterLinda Barter, BVSc, MVSc, PhD, DACVAA

 

 

 

Alessia CenaniAlessia Cenani, Dr.Med.Vet, MS, DACVAA

 

 

 

Amandeep ChohanAmandeep Chohan, BVSc, AH, MVSc, MS, DACVAA

 

 

 

Bruno PypendopBruno Pypendop, DrVetSci, DrMedVet, DACVAA

 

 

 

Wei-Chen (Bernice) KuoWei-Chen (Bernice) Kuo, DVM, MS
Staff Veterinarian

 

 

 

Joao SoaresJoao Soares, MV, MSc, DSc, DACVAA

 

 

 

Pauline WongPauline Wong, DVM, DACVAA
Staff Veterinarian

 

 

 


Residents

Harriet FlynnHarriet Flynn, MVB
Resident I

 

 

 

Juhana HonkavaaraJuhana Honkavaara, DVM
Resident III

 

 

 

Allison JaegerAlison Jaeger, VMD
Resident II

 

 

 

Genevieve LucaGenevieve Luca, DVM
Resident II