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Debating Anesthesia Foibles and Faux-Paws with Dr. Tasha Bartel
439 Plays4 months ago
In this special Thanksgiving episode of the North American Veterinary Anesthesia Society Podcast, we take a closer look at some long-standing traditions and practices in veterinary anesthesia. Joined by Dr. Tasha Bartel, veterinary anesthesiologist, chief medical officer at King Animal Hospital, and current NAVAS president, we explore myths, legends, and potentially outdated habits that have been passed down through generations. Together, we debate which of these “old recipes” still hold value and which might be ready for retirement. Grab your knife and fork as we dig into this thought-provoking discussion that challenges the status quo and encourages fresh perspectives in veterinary anesthesia.
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All opinions stated by the host and their guests are theirs alone and do not represent the thoughts or opinions of any corporation, university, or other business or governmental entity.
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Transcript
Introduction & Podcast Theme
00:00:06
Speaker
Hello, gas passers. Welcome to a special holiday episode of the North American Veterinary Anesthesia Society podcast. I'm your host, Dr. Bonnie Gatson. Our goal with this podcast is to advance and improve the safe administration of anesthesia and analgesia to all animals.
00:00:25
Speaker
We have cooked up a great episode for you today in the spirit of Thanksgiving. Imagine sitting around a table with your family for a Thanksgiving meal, discussing longstanding beliefs and opinions with your family and friends, which invariably may spark a few disputes and a little debate.
Challenging Anesthesia Myths
00:00:45
Speaker
If those vibes are not really giving you any happy feelings or fond memories, that's okay because this episode We are going to try to engage in some friendly debate while having a few laughs in between. Today we are going to gather around the metaphorical table to dig into some of the long-standing traditions and practices in veterinary anesthesia. We're diving into the myths, legends, and possibly outdated habits that are still common in the field.
00:01:15
Speaker
Much like our holiday feasts, these practices have been passed down from generation to generation. But today, we'll be debating which of these old recipes might need a little updating. Before we get started, we need to give thanks to our sponsor of this podcast, Decra.
00:01:34
Speaker
Their generous contribution allows us to provide monthly continuing education to all you gas passers with this podcast, so we are very grateful to them. Please visit www.decra-us s dot.com to check out their line of anesthesia-related products today. Also, if you are not yet a member of the North American Veterinary Anesthesia Society, now is the perfect time to join.
00:01:59
Speaker
NAVAS membership comes with a range of benefits, including access to continuing education events, focused on anesthesia and pain management, informative blog posts, fireside chats with board-certified anesthesiologists and specialty technicians, and just so much more.
00:02:17
Speaker
With the fireside chats, members can also join virtual discussions where you'll have the chance to share your insights or ask any pressing questions directly to experts in the field. Visit www.mynavas.org to take your anesthesia expertise to the next level.
Meet Dr. Tasha Bartel
00:02:35
Speaker
Back to today's episode for our metaphorical Navas Thanksgiving debate.
00:02:41
Speaker
We're thrilled to have Dr. Tasha Bartel as our guest to help us sort through these traditions. Dr. Bartel is a distinguished veterinary anesthesiologist, chief medical officer at King Animal Hospital in Toronto, and the current president of the North American Veterinary Anesthesia Society. With her expertise, she'll help us separate fact from fiction as we examine the must-haves and the, maybe we can skip this one, of veterinary anesthesia.
00:03:10
Speaker
So grab a plate, settle in, and join us as we give thanks for new insights and open-minded discussion in the world of veterinary anesthesia. We're here to question what we know and ask ourselves, are some of these practices still useful or are they just stale holiday leftovers?
00:03:32
Speaker
All right. Hello. Welcome to the Navas Podcast. Dare I say, Madam President? You dare. Do you want to start by just introducing yourself to our lovely listeners and telling us a little bit about why you love anesthesia? I ask that to everybody, but just introduce yourself and let us know what what tickles you about anesthesia.
00:03:55
Speaker
Absolutely. Well, hey everybody who's listening. So glad you could join us today. I'm Dr. Anna Tasha Bartel, but I usually go by Tasha. And I am a veterinary anesthesiologist, amazingly enough. And I trained at the University of Edinburgh. I trained at private practice.
00:04:14
Speaker
I did some GP and ER work and then I did residency at Cornell. And I've been doing this now, I guess, Betmed for 22 years. So it's definitely not my first day at this cray cray rodeo. Why did I pursue anesthesia? After a few years in GP and ER, I really found that like chronic disease management and like, the client interactions was not necessarily my jam. The other thing is, is that I've always been a personality that where I find something difficult or challenging, I have to pursue that until I feel capable. And certainly when I came out of a school, anesthesia, sedation, analgesia was an area that made me really nervous, but the more I pushed myself, the more interesting I found it.
00:04:59
Speaker
And really,
Fluid Therapy Practices Debated
00:05:01
Speaker
I mean, anesthesiologist, you know, smartest people in the room. Yeah, you get to preach. Yeah, right. I'm like blood-blowing burr. But yeah, anesthesiologist, you know, smartest people in the room, generally the most least respected and we're really there to we're the all seeing eye to advocate for good patient care and good patient welfare and even ethics and I do feel like in in our community we're sometimes underutilized or underappreciated and so that's really how I got involved in NAPSTU because I wanted to you know have a bit more of a voice and also just push high quality education so that we can
00:05:38
Speaker
really improve access and quality of information being disseminated so that we can help, not just the pets, but also, you know, obeyed some of that anxiety and some of that fear that people have around anesthesia, which is really commonplace. So that's a little bit about my journey.
00:05:54
Speaker
That's amazing. And today, I think I'm going to jump on what you said towards the end of your lovely diatribe about anesthesia being underappreciated, and maybe being a little bit of a topic that people are a little scared of, especially people who don't necessarily study anesthesia as much as you and I have. And so because of that, I think you and I have been around long enough to notice that there are some habits that individuals have picked up over the years that either something that was learned or something that people have kind of like fallen into because it feels safe for them are really going to be dispelling some urban myths around veterinary anesthesia. And I'm so glad that you can kind of join us today to dispel some of these little myths that have been put on. Attempt to dispel. I mean, some of this stuff is ingrained, like the lines on the palm of my hand, but
00:06:54
Speaker
You know, I do think it's important no matter where you are in your career or your career trajectory that, you know, we regroup and look at the evidence and I do that too as an anesthesiologist, you know, someone might question me and it might push me out of my comfort zone. And there's a lot to be said for operating within a comfort zone within anesthesia. I mean,
00:07:12
Speaker
it It actually makes you safer in certain capacities, but it doesn't necessarily mean that you're doing what's best for the patient. and like So trying to keep evolving and try to keep with what's current and moving past and understanding where some of these urban legends developed or evolved from is is really important.
00:07:28
Speaker
Yeah, so the first thing I think is very important for me anyway, it's not a shame people if they have fallen into these urban myths and legends. And so I think one of the ways I'm going to try to dispel any shame is to maybe ask you, is there something you were doing in your anesthetic practice kind of early on in your career, like you personally, that you now have learned maybe is not the best and you have changed the way you practice because of that?
00:07:55
Speaker
Bonnie, Bonnie, Bonnie, so much 100% of everything I've ever done, right? but Yeah, like I said, I'm a evolving project and I never expect to achieve perfection um because I don't think it's possible. But a really good example would for me would be fluid therapy.
00:08:12
Speaker
Right. So, and and we vacillate all the time in veterinary anesthesia about what's appropriate. What's efficacious? How do we measure whether or not fluid therapy is efficacious? And side note, nobody knows the answer to this. However, we do have some information for example, about how to drive fluid therapy. And I used to be like wicked a aggressive, right? Like let's get those crystalloids in. Let's go fast. Let's stop, you know, dancing around like the patient needs volume. I want to go to anesthesia.
00:08:42
Speaker
You know, the last couple of years, the evidence is really showing like rate of administration is not particularly, I mean, to a point, you know, the rate of administration, like really rapid aggressive crystalloids can actually be quite detrimental, particularly from the point of view of like vascular endothelium integrity. And the other thing too, is that overall, right? Like the difference between giving a bolus like, you know, at 999, like as fast as you can versus maybe putting it in over 15 minutes.
00:09:09
Speaker
You know, there is no evidence that suggests that like rapid infusion is beneficial. So over time, like I've totally, if you were my, you know, one of my techs 10 years ago and you're standing there and I'm slamming stuff in together with you, and then you came to practice with me now, I think you'd see a really big shift.
00:09:25
Speaker
And you know, I don't like I said, I don't aim to be perfect. And I do the best that I can with the information I have at the time. So I do allow myself that latitude for things to evolve. But fluid therapy is probably the latest and the greatest. Yeah, it's interesting because I have had an evolution in the way I administer fluids as well. who I know. So I was in academia for a few years. And I think when I was in academia, that was like the height of like people being scared of head of starch. Head of starch was a really big thing when I was an intern and I did my residency and then head of starch was bad all of a sudden because it could cause patients to go into renal failure or maybe have coagulopathies. And we were very, very conservative.
00:10:09
Speaker
for fluids for sure. And now I think I'm more liberal as far as giving fluids for anesthesia induced hypotension than I have been in the past. And again, I think it comes from a little bit of clinical intuition in that like there are patients who go to anesthesia at the end of the day and they've been fasted all day and all night. It's like it's 2 p.m. and they haven't had anything to drink since they got to the hospital. And I find those patients actually respond pretty nicely to like a ah good old fluid bolus. You know give them propofol and they get tachycardic and you're like, I'm just gonna give them some fluids. I'll give them like 10 mils per kilo and I do not slam it in. I'm like you Tasha, I don't do that.
00:10:55
Speaker
i more I don't I don't slam a man. I'll just be like, okay, let's give like a 10 mil per kilo fluid bolus over like 15 minutes. I also find that if you slam the fluids in at 999, the Catholic is gonna fall out.
00:11:10
Speaker
Sure enough. yeah Evidently. We're trying to push a lot of fluids through, you know, something with a small diameter that is probably also not that long. Catherine falls out and now you have to put a new Catherine and everyone is cursing and upset. And I don't like that. and don't I don't want anesthesia to make people more upset than they already are.
00:11:30
Speaker
I've been doing that a little bit more recently than I probably would have done like five or 10 years ago as far as giving fluids like pretty, liberal I wouldn't say liberally, but more liberally than I used to. Yeah.
00:11:42
Speaker
Yeah. Like I said, for me, it's more about the rate. Um, but I'm also like, you know, the whole like collage route, now collage are coming back in, you know, and I always sort of operate like if you have refractory hypotension on the table and I think that it's largely related to volume, there's only so far crystalloids are actually going to get you before you start to see things like hypocalcemia and you're going to lead to like intestinal edema and then they get diarrhea and they don't eat. And then everyone turns up the fentanyl and they never go home. And I'm a big believer in what we do on the table effects.
00:12:12
Speaker
you know, survival to discharge and also the quality of the welfare for the patient. hundred I mean, I was joking in the GDP edges earlier today, like I don't let things die from hypotension without the benefit of a colloid. This is a classic urban myth, right? Like colloids, colloids around.
00:12:27
Speaker
But in context, it's really the dose of colloid that's more the issue, right? You know, I i generally don't go above five mils per Kig, which side note totally an arbitrary number, but generally I don't go above that because that's the amount that I need to actually stabilize. I'm going to say perfusion instead of pressure, even though I can't actually quantify that, but I like to sound fancy. And so, you know, I give the colloid and, you know, to sort of slow down this read of like crystalloid, basically just moving into the interstitium and just be in a pain and like my calcium and my potassium just drop in and watching my, you know, and I don't want to get in an argument with criticalists about hemodilution because whatever. So we're not criticalists. No, we're not criticalists, but also when I'm watching my solids drop into the threes because you're not chocolates or crystalloids, what's the point? So I will switch over to a colloid and I keep my doses low and knock on wood. I have not yet had a problem and like I've had criticalists like an internist.
00:13:23
Speaker
like really clench their butt. And I, you know, I'm like, well, do you want it to have a collard or do you want it to be dead? So, you know, are often yeah, like, i like, you know, anesthesia, there is an RT anesthesia. It's not just the science. And I know that experiential, like knowledge is meant to be the lowest form, but sometimes in vet med, I struggle to base all of my practice off a paper on four healthy cats versus the 3000 septic abdomens that I've done in person.
00:13:51
Speaker
You know what I mean? So, yeah, there's there's there's a classic urban legend there,
Diagnostics: Necessary or Overused?
00:13:56
Speaker
colloids are bad. No, colloids will save your life if done appropriately. Yeah. Absolutely. All right. So let's move away from colloids are bad and let's let's go into pre anesthetic diagnostics. So is there anything related to like tests or screening tests that we run that maybe you think should be done more or are overdone? And this is a personal story, but I went to the doctor recently and I hadn't been done in a while.
00:14:25
Speaker
And I was talking to him about, you know, what kind of tests should I get? And i I literally said, so what are we going to run? Like CBC cam, lipids. And he's like, he's like, girl, this is not vet med. Like, no, we're just going to do like bare bones. Like you're healthy. You're fine. We're not doing all this crazy stuff. And I was like, man, because you saw where like my brain immediately was like, run every test.
00:14:50
Speaker
on me even though I'm healthy. But I'm curious what you think about at least you know back to vet med. Do you think we're doing appropriate screening? What is an appropriate screening for a healthy and unhealthy patient? I've asked other guests this so I'm curious what your response is.
00:15:05
Speaker
Fair enough. I mean, yeah, my doctor will only check my blood work at my annual physical every three years unless there's a major concern or or abnormality detected. So, um and like how many times have I been put under like so procedural sedation slash light anesthesia for endoscopy, for example, and they don't even ask my name half the time, right? So, and not that I'm advocating for that level of care, however. I mean, we do live longer than dogs, so like I get it, but. Yeah.
00:15:35
Speaker
Yeah. And like, you know, I have, I tend to put more value on my own life than I would, for example, no offense to the hamster lovers out there, but then a hamster. Okay. but So, you know, fair enough taken in context. I think if I had to go to a desert island for the rest of my life and, you know, the universe said I can only take one pre-inesthetic diagnostic with me. What would it be? Chest rats. For me, it's thoracic radiographs. I garner more information about cardiopulmonary stability from a thoracic radiograph than I do from pretty much everything other than a physical exam, right? I think blood work is grossly overdone, but I also appreciate that many clinicians are in a catch-22 with that. So for example,
00:16:21
Speaker
I'm going to share a personal story here. A few years ago, someone actually filed a complaint because a patient, we lost them under anesthesia. Patient was very geriatric, had multiple organ insufficiencies, but, you know, the patient did pass away and the others were not happy about it, fair enough. And they complained. So I went to my regulatory body and basically I was exonerated in every capacity, right? Like I had selected the correct breathing circuit and I had monitored all the patient and my record was, you know,
00:16:50
Speaker
perfection because I'm super type A. And the one thing they held me up on, so I i mean, it wasn't I didn't have like any sort of suspension, but I you know i got a written comment was that my pre-anesthetic blood work was three months old, and then I should have repeated it that day, which pissed me off.
00:17:08
Speaker
And the reason it did is because first of all, the regulatory body is not a board of anesthesiologists, right? So even though quote, I'm being judged by peers, those peers don't have the same level of training. And two, there was no insight given into why blood work, for example, would have changed the outcome. and And I say that a lot to you, like a lot of times for like healthy patients, do I need blood work? It depends on the procedure. So if we're going to do something quite straightforward and you're healthy, I'm not sure blood work helps.
00:17:38
Speaker
If you're quite healthy and we're going to do something like donate a kidney though, I'm probably going to grab a baseline of what your PCV is, right? You can be like low ASA and high anesthetic risk depending on the procedure, just like you can be high ASA and low anesthetic risk depending on the procedure.
00:17:55
Speaker
So, yeah, healthy patients going in for something really invasive where you have hemorrhagic potential. i'm Sure, I'll grab some baseline stuff. More unhealthy patients, though, I might be more inclined to check things like what's your metabolic status. I care a lot about pH and electrolytes because you cannot maintain normal tension if you're hypocalcemic, hypokalemic. What's your lactate? But, you know, in this particular complaint where I was given written advice, you know, they said you should have checked blood work because you don't know what platelet levels are. And I honest, Bonnie, I almost had a stroke.
00:18:25
Speaker
Because what is a platelet level really telling you? First of all, I have taken plenty of cases to the OR to be cut who have 20 or 30,000 platelets and you're going on that number because you got it. Maybe they're bleeding out, you know, hemangiosarcoma of the spleen and not everybody has platelet product.
00:18:47
Speaker
What's more pertinent to the patient though is platelets function, right? So you can have 160,000 platelets and if they're dysfunctional, patient's gonna bleed. And if you have 20,000 platelets and those platelets are functional, patient's gonna hold. So, you know, we throw so much weight behind these absolute diagnostics and unless you're interpreting in the face of what is clinically happening with that patient and it's pathophysiology, I don't think there should be a hard and fast rule. now That also comes with specialty training and the nuance of experience, right? And I understand why a GP is going to run that baseline, but like I get my hands tied a lot by the regulatory body. Cause I know that I don't need the blood work, but I'm going to run it for $250 because if I don't, my regulatory body is going to hang me from a lanyard, right? So, and that's unfortunate that that's the way we operate. Like we have to do futile and fear based perianesthetic work.
00:19:45
Speaker
But like if I had my druthers, I'd take a thoracic radiograph. like What do I care about monocytes? How is a basophil helping me choose my anesthetic protocol? Side note, it's not. so you know And then the same thing, like liver function, kidney function. By the time I think that your organ function is going to be a contributor to morbidity and mortality under anesthesia, you are clinical for that.
00:20:14
Speaker
You are clinical for that, right? So like by the time, like how many patients do we take to the table and mildly elevate an ALT, ALP? How do I modify my anesthetic protocol for that? Well, I don't, because it doesn't make a difference.
NSAIDs in Pain Management
00:20:28
Speaker
Yeah, really good. we're i mean We're going to talk about drugs in a minute. but ah So I run anesthesia at many different practices. And the big question I get asked a lot of times, and and people's opinions change on things like, how do you administer NSAIDs to patients with elevated liver values? And my response usually is like, we don't know how elevated liver values alters the function of how NSAIDs operate in the body and if it makes patients more vulnerable, less vulnerable to complications. What I could tell you is that many NSAIDs are primarily metabolized by the liver. That's it. And there's like a subset of animals that have can have an idiosyncratic reaction to NSAIDs that has nothing to do with their liver values or how their liver functions. Just some of them have worsening of liver function after we give them NSAIDs. We stop it.
00:21:21
Speaker
we may give them a little N-acetyl cysteine, they'll get better. But like I don't know what to tell you about elevated liver enzymes and using NSAIDs. We don't know. But what I can tell you is if you choose not to give an NSAID to this patient, that they are probably experiencing some level of degree of inflammatory pain.
00:21:41
Speaker
And we're not treating that by not giving NSAIDs. So my general recommendation, and this is not based on science unless you have smarter science or you're more knowledgeable than me, but I usually just say, let's just go with like the low end of the dose or short course of NSAIDs.
00:21:57
Speaker
Now, I mean, I always frame it in the context of patient welfare, right? So like like I said, like medicine, it's the whole point is that you're practicing the art of medicine. That's what it's called the art because there's a great gray area unknown. And you know what drives me is what do I think the likelihood is of causing an adverse patient outcome from a single dose of medican and a perioperative phase versus am I going to send them into long-term multi-systemic work and failure. This is so highly improbable and really I almost want it cruel. We're declining
00:22:34
Speaker
efficacious therapy in a patient with known pain because of the, like, itty-bitty chance that ALT might go up. I mean, it's really bizarre to me, you know, and I also get really ticked off about things like, you know, well, he threw up once on Medicare.
00:22:50
Speaker
And I'm like, well, I mean, he's a Labrador. He probably went outside and ate fox poo. But the other thing too is just because you puke on Medi-Cam doesn't mean that onsure is going to make you sick. But people like heart launch the NSAIDs. And at this point, like in terms of our like toolkit for acute pain,
00:23:08
Speaker
you know Are we benefiting the animal by behaving in this like fearful manner? And I don't think we are, right? So I'm like one shot of Medi-cam on the day of surgery for a cat who might've had mild hypotension. Give me a break, give the Medi-cam. Do the animal a favor. Because some people are like, well, I'm not going to give the NSAID, but I'm going to give the paracetamol. And I'm like also metabolized in the liver. like What are you doing? Yeah. Yeah.
00:23:35
Speaker
Yeah, agreed. So yeah, I just try to weigh this in like like it's a game of probability and you know some people are on different parts of the spectrum of courage and that's fine like I you know I like to think I have really big robust ovaries for this kind of stuff and I'm willing to take that liability hit too because I think I'm acting in the patient's best interest.
00:23:54
Speaker
Right. I mean to get you all hot and bothered about NSAIDs, but it is something that I think like people get very anxious or they have like one bad outcome, which is fair because it's a lot of probability as you will have sometimes like not, we're not going to have 100% perfect efficacy every time we give an NSAID to an animal, you know, that had mild hypotension or anesthesia. But like, I don't know. i It gets me hot and bothered too that you would poo poo like a ah whole group of drugs we know are extremely efficacious for acute pain, probably one of the most, I mean, besides like, and besides like opioids, but at least for oral therapy. Local regional, right? Like that's better than a local anesthetic. But yeah, I don't think like writing off every onset that we have, because the patient had a mild one time adverse effect. And I'm like, since when is correlation equal to causation?
00:24:44
Speaker
yeah you know And I'm just like, you know what it is? It's covering your bahooki and at the same time it's it's a punishment to that patient because how are you substituting something that is equally if not more efficacious than the NSAID?
00:24:57
Speaker
right so There's a culture of fear around NSAIDs that has gone to the extremists. Like I said, it's it's not helping our pets.
The Value of Pre-Anesthetic ECGs
00:25:05
Speaker
And so people just need to take a pause and like regroup on like the pharmacology of the different NSAIDs and like what are the probabilities of adverse outcomes before they make these like really black and white decisions. so Yeah, I wanted to ask you one more question about pre-acetic diagnostics. I have noticed that there has been an increase recently in some companies that run a lot of pre-acetic diagnostics that they have started including services where people can submit pre-operative ECGs.
00:25:38
Speaker
And I've been seeing this a lot recently, and I mean, I i think I have now reviewed at least over 100 ECGs before anesthesia because of this. And I'm curious what you feel about how much we're oftentimes making decisions based off of like a pre-anesthetic ECG as opposed to like doing cardiac screening as far as like maybe thoracic radiographs versus like BMPs or other types of hormones like that. Like what do you think, is there any benefit to doing these more advanced cardiac screenings?
00:26:14
Speaker
I just want to remind everybody listening that you can have a normal ECG and be dead. So, but like, throwing your whole full weight behind pre-anesthetic ECGs. I mean, there could be merit arguable and I would appreciate, you know, someone studying this if, for example, if you are any and a population cohort, so a typical breed or a typical age of a breed where you may be predisposed. But again, by the time you're going to have significant cardiovascular compromise, it is highly improbable that patient will be asymptomatic. So why are we wanting pre-anesthetic ECGs on healthy patients with no murmurs or dysrhythmias who have no clinical symptoms of cardiac insufficiency? Money grab?
00:27:01
Speaker
futile medicine, fear-based medicine, you know, I mean, would that change my anesthetic protocol? i You know, I always say to people, I'm like, the anesthetic drugs that a lot of the ones we use, methadone, for example, propofol and alphaxone for another one, midazolam, even ketamine, such an enormous safety margin. And at the end of the day, most of us are using those in cardiac insufficiency patients anyway, right?
00:27:28
Speaker
So, is it something we should do as a baseline? I don't think so. Do I think, you know, what is a three-lead, 14-second strip going to tell you about outcomes in that patient? What am I going to do differently with that information? Nothing. Nothing,
Anesthetic Drugs Myths
00:27:46
Speaker
right? Because if that patient is going to have a like such a ECG change that's going to cause me to jump in aesthetic protocols,
00:27:56
Speaker
i'm willing to bet i would have picked that up on physical exam or his history i'm going to jump now into urban legends associated with anesthetic drugs and i'm we' goingnna do there were many it's like an entire grims fairy tale but Well, I was gonna say I was gonna like shoot them out at you really fast. Oh my god. Yeah, do it. And we'll do like hot like really like rapid fire hot takes. Okay. Are you ready? Okay, I need code I'm willing to words for good or bad bet I though. would have Like, we'll say urban picked that up on a physical exam or history. legend and I think it should be dispelled. I'll say like bunk. And then like, if it's good, I'll be like rocket like something like that. What did they used to use on like, you remember the show Myth Busters? Yeah, yeah. Oh my god. Yeah, busted. But what did they say if it was like true? I don't remember.
00:28:41
Speaker
I'll say busted, but what if it's true? It'll be like ah corine like correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct. Correct.
00:29:01
Speaker
that's what i'm going to say when it's when the myth is not a myth Okay. Here we go. Rapid fire, anesthetic drug, urban myths. I'm a little nervous. I'm a little nervous right now, Bonnie. I think you're going to do, I think you're going to perform admirably. Thank you. Okay. So yeah, finger guns or busted. Okay. Okay. Ace, promazine and seizures. Busted.
00:29:27
Speaker
Why? bus did Okay, so first sure first, this original paper about ace promising and seizures came out in the 70s. There's a study on rats and they were doing clinical doses of a make per cake. You know what, if you give me a make per cake of ace promising, I'd probably have to have a moment too. So these are not clinically appropriate and I get a little bit hesitant about cross species extrapolation, right? And unfortunately we do rely on that, but you can't tell me that a study in rats is applicable to a cow.
00:29:56
Speaker
Right? Like that's what too wild. That's too wild for Tasha to handle. But furthermore, they've actually done specific studies looking at ace-promiseen in patients with seizures, both controlled and not so well controlled, actually, and improve their seizureing outcome. So I'm sorry, peeps, but busted. Okay, here's another one. Another ace-promiseen one. Ace-promiseen and boxers. Okay, so Tiny finger hearts slash my bus so So I don't have a 50-50. Okay, so acute death associated with ace-premiseen in boxers is very specific to a British lineage of boxers who are known to acutely drop dead. So if I were practicing, for example, in England and I was seeing a whole cohort of purebred like show boxers,
00:30:48
Speaker
Yep, I might want to run their lineage or be a little bit judicious. But if I'm on the other side of the world in Sri Lanka, and I've got like a boxer half breed, you know, ace promising is a reliable sedative is cheap and cheerful. It's predictive in its outcome. And, you know, I would be okay with that. So I think that's one of those that, you know, it's the nuance that matters.
00:31:09
Speaker
Yeah, I usually tell people I think our backyard Florida boxers are all ace-promisee deficient. Yeah. Yeah. I mean, I was like, yeah, like junkyard dogs are probably not going to do that, but like that specific lineage of these British boxers who are known to have like acute cardiac collapse. And that's because ace-promisee We talk a lot about hypotension, but it's not so much the alpha-block heat. it Is it a change in stroke index or cardiac index, right? So it's actually more primary cardiac than it is primary vascular. And you know, boxers do have a lot of thrilling cardiac diseases that we do deal with. So I mean, age would also probably be a consideration in that in that context too, but yeah. Half heart, half bust. Okay. I actually agree with that. Perfect. I know, right? Okay. Great minds think alike, as they say. Totally.
00:32:00
Speaker
All right, here's another one. Never give dexmedetomidine to animals with cardiac disease. Busted. Now, dexmedetomidine, I definitely feel like it has like its own stigma. There's like an aura around alpha-2 agonists.
00:32:19
Speaker
And we're getting to this point now, we're like looking at research where people are doing dexamethasone CRI's and septic patients in human medicine, right? And it's actually improving long-term mortality rates, right? Like they're coming off the ventilator doing better than ever. So, and I have a lot of clinical experience with dexamethatomidine, but yeah. Not all cardiac disease is the same, right? So you've got different categories of cardiac disease. It can be conduction system or electrical. It can be myocardial or actual muscular tissue. It can be pericardial. It can be valvular stenosis. It can be valvular insufficiency. It can be shunting, right? It is incredibly important within these categories of cardiac pathophysiology to understand the dynamics of how blood flow is occurring.
00:33:05
Speaker
In other words, you have to understand how the disease affects cardiac output before you can appropriately select your drugs, okay? And actually, in some cases, dexaminetomidine improves cardiac output and coronary perfusion. You know, through bradycardia, you're slowing down the heart's ability to, you know, engage an appropriate lucetropy, one of my favorite words, which is relaxation of the heart. And when you're in diastole and lucetropy,
00:33:33
Speaker
You're improving coronary perfusion, obviously, as long as you have appropriate like volume and hemoglobin. But yeah, not all cardiac disease is created equal. So it is not something to avoid. It really depends on the nature of the cardiac disease. It depends on the severity of cardiac disease. And it also depends on what doses you're rocking with your alpha-2s. So what we call sub-anesthetic, 0.2 to 0.5 micrograms per kilogram.
00:34:01
Speaker
You know, that may buy you a really stable anesthetic plane. And if you have like stage B1 mitral valve disease with no clinical symptoms of cardiac insufficiency when awake, you know like good exercise tolerance, no coughing, no choking when sleeping, doesn't turn blue. Why wouldn't I want to give you the benefit of that? you know it's It can be max sparing, although whoever's from Davis is going to lose their mind because they know that the the comparative between cardiac output, max sparing, and With DEX and and without DEX is is actually not as beneficial as we think, but it's analgesic, it's synergistic with opioids, it can be max varying, you know, it stabilizes your plane of anesthesia. You can cheat and fix your blood pressure. And like I said, slowing that heart rate down, for example, and restrictive cardiomyopathy. or hypertrophic cardiomyopathy, aortic or subaortic stenosis, you're actually you benefiting the patient because, you know, the gradient across that stenosed ejection is going to become higher with tachycardia and higher with hypotension, and dexaminetomine could actually do you a lot of favors in those cases.
00:35:09
Speaker
however If you're in GP, and you have a 15 year old poodle on the table with a grade four heart murmur and a dental, I'm not going to get on the phone and tell those people to wield dexametatomy. You know, I would say, I'm comfortable doing it, but I'm board certified. and like Again, it's the nuance of it. so It's a busted myth in IMO, but also it needs to be used judiciously in the hands of people who maybe don't understand the fine print. and Also, you know you have to have a little bit of courage when you first get going with this to actually give it to patients with cardiac insufficiency. But I have this wild story once where
00:35:48
Speaker
had a patient come in and it was you know in respiratory distress and you know you listen to its heart. Heart sounded okay, you know no murmur, mildly tachycardic, but it's in respiratory distress so that seems you know appropriate, strong synchronous pulses. I gave it dexametatomidine, it went to imaging. It was in such a state of dilated cardiomyopathy that the reason it no longer had a murmur was because there was no turbulence being afforded because the heart was barely beating and the blood was barely moving.
00:36:17
Speaker
And amazingly, that dog did not turn blue and die on me. So, you know, and I thought to myself, oh my God, that has got to be one of the dumbest things I've ever done. And I was waiting for that, you know, I'm like getting ready to reverse and I'm getting ready to intervene and I'm getting ready to do CPR. And he rocked his dexametatomidine and like all of my sphincters, you know, were quite tight that day. But over time, I've been like, my opinion about its safety margin is relaxing with experience.
00:36:46
Speaker
Yeah, that's fair. So what I'm hearing about dexametomidine and cardiac patients is like kind of like the ace, promazine, and boxer thing. It's like finger gun hearts slash busted because it depends on clinical nuance. What else is going on with that patient? And it depends on the type of cardiac disease that patient has. yeah The most important thing is you have to understand the type of cardiac disease. Like if you give a patient with paracridial effusion dexametatomy, probably going to turn blue. If you give a cat with nonclinical, no atrial enlargement, dexametatomy for anesthesia, it's going to do great in most cases.
00:37:26
Speaker
right? So yeah, it's the type and it's the degree and it's also dose dependent, right? Like a 0.2 mic per K of dexamutatominine is improbable that you're going to kill anything. But if you're going to hit them with like 20 mics per K IV, I wish you well and a healthy patient. Yeah.
00:37:42
Speaker
One of my soapbox things actually has to do with the fact that dexametomidine, when it originally came out, was dosed on body surface area. Oh yeah. I don't know if you remember that any more ago. Unfortunately. Now we kind of dose it off of like a microambrachilogram basis, which is fine. But one of my soapbox things that I really do think, especially with dexametomidine, that allometric scaling like is important.
00:38:11
Speaker
And I do not give like a mastiff like five mics per kilo of dexamatomidine. I mean, unless it's trying to kill me, but like I give them like one or two and I feel like I get excellent effects as opposed to like a Chihuahua or like a little Maltese or something that also, I mean, Maltese has never, I don't know if a Maltese has ever tried to take my fingers off, but definitely Chihuahua. And I feel like I'm going to give a Chihuahua like a heftier dose. And I do think allometric scaling is like something to think about, especially when it comes to like giant breed dogs, because I find people get very anxious when they've given a newfound Lin like,
00:38:54
Speaker
five mics per kilo of dexametomidine, which seems like a very appropriate dose of dexametomidine, but now they're in like raging second degree heart block with having escape beats. And that's not something I would see typically with five mics per kilo in a chihuahua.
00:39:11
Speaker
No, I totally agree. I mean, usually for anything that has like higher cardiac index rates of, you know, cardiac output, normalized body weight for everybody listening. Yeah. Like, I mean, you know, you would give a higher dose to a shrew than you would to an elephant because they're metabolic rate. Like their BMR is super high. So they burn through drugs. Like if you've ever anesthetized a dystocia who's in a hyper dynamic cardiovascular state, you got to use double of what, you know, you might use and like a calm older dog who's having a lipoma removal. So.
00:39:40
Speaker
Yeah, I think the higher like the caria or the cardiac index, the higher the basal metabolic rate, it is appropriate to go on the higher end of the dose for those guys. Oh yeah. And I'm with you, Tasha. I've totally given dogs dexametomidine, who then we later find out they have DCM. but I've been there 100%. Yeah. It really makes you think you should bring diapers to work. And like I was lucky that day. I think I was lucky. like I definitely think part of that, I was like, I think I could have caused irreparable harm. But again, like you know the culture of fear around drugs or like having a favourite drug is something that I try to coach people against because you know any drug that you understand well and that you use appropriately, across the board are safety margins on
Propofol 28 and Ketamine Safety
00:40:26
Speaker
a lot of these drugs. i mean Do you have any idea what a dose of ketamine you have to give to actually cause like irreparable harm? it's like weeks and weeks of like 50 migs per gig and then you know and in people it's like two years of that before anything happens with ketamine so you know it's not you know this is safer than this or this is better than this it's it's your knowledge and your comfort level and understanding the clinical context that's appropriate.
00:40:52
Speaker
We're going to go back to our myth busters on drugs now, specifically with ketamine since you brought it up. Tasha's like, don't have favorite drugs. And then like second favorite drug.
00:41:02
Speaker
yes
00:41:05
Speaker
Hey, ketamine, ketamine's not your favorite drug. I don't think I've met an anesthesiologist yet who ketamine wasn't like number one. Yeah, no. Well, for me, it's purple fall is number one because it's just smooth like butter. Love a little propofol. Wow. Yeah, I love propofol, but ketamine is definitely my second favorite. Okay. Well, now I'm going to ask you a MythBusters question about propofol then. Oh, okay. Okay. Propofol 28.
00:41:34
Speaker
Thank you. Which is the purple fall that can you open it last on the shelf for 28 days? No purple falls, 28 for cats.
00:41:43
Speaker
Yeah, the stars are hilarious. I'm laughing because I was locum in a few years back at a board certified dermatology and ophthalmology practice. And like I rocked up one day, you know, my lubricant scope and my cool shoes looking all, you know, anesthesia boss. And we were going to, you know, perform laser ablation on a cat and they handed me the purple fall 28, right? And I looked at them and I went,
00:42:08
Speaker
Is that all you guys, like do you want my purple foil 28 or do you have the regular, the regular purple foil nearly? No, no, but this is the only one we've had this one, you know, I'd only been at the clinic. This is my first time. So we've been using this for two years. And I went, oh, just, just, just. So, you know, it's not licensed for cats, right? chance is you That's kind of a no-no. And if you were to have some sort of, you know, pickle associated with the anesthesia, you know, this would be a point where if I, for example, anybody reviewing the record, they might, might get hung up on. And they're like, oh, sorry, God, we've never had a problem. And I thought to myself,
00:42:43
Speaker
That's very interesting. You got two years of data and I mean, they're doing like three, four procedures a day for two years, right? So averaging 20 to 30% feline population is a pretty good number. Never had a problem. Now there's no follow up to that too. So I have no idea what long-term outcomes were like. So that's highly anecdotal. But again, it was one of those things where I was like,
00:43:07
Speaker
You know, you're trained to think it's like such a big no-no and that you're going to have these terrible outcomes. And then someone tells you, you know, well, I've done 600 cats and I've never had an issue. And that always gives me moments pause. So would I do it if I had to? Yep. If I have another choice, will I probably pick something else? You know, and ah and this is totally, I'm just erring on the side of regulatory caution in that capacity. Yeah. I've given a probe of all 28 to Yeah, infinite number of cats. I mean, I don't know, i'm probably not infinite, but a lot. I have not had a problem. And I think there is a study in, I think, the journal of feline medicine. And the concern obviously being that the benzyl alcohol, which is the preservative in verbofol-28 that allows it to sit on the shelf for 28 days, cats don't metabolize that very well. So it could build up and cause liver toxicity.
00:43:58
Speaker
And I believe there is a study in the Journal of Eli Medicine where they unfortunately gave Proval28 to a few cats and then euthanized them, looked at their livers, and they were all hunky-dory. yeah No problems.
00:44:13
Speaker
So probably, I i actually- So you're feeling like you want me to say busted, because I forgot to be honest. I don't want you to say anything except for what you feel on your insides. Like I say, it's one of those things too. Sometimes we just have to have patience with long-term outcomes. like We bring drugs to market you know and with these hard and fast rules. And it's lab-based information. You've got to flush it out for 10 years.
00:44:38
Speaker
you know Oh yeah. I keep going to brunch is where everyone's talking about a Zen pick and I'm like, you might want to give it a minute to see what the long-term effects are. You know what I mean? Before you just start poking yourself with the Zen pick. So I'm one of those people, like I'm definitely on the more cowgirl side of practice for sure. Like I tend to be a little bit more aggressive in my decisions, but you know, at the same time, like I'm not the first person out of the post about stuff.
00:45:01
Speaker
I'm like a solid silver medalist. Like, I'll be there, but I want to see someone else go first to see what's really going to happen. So do I need to be a cowboy pro football 28? Probably not. Do I think it's problematic? Probably not. But I'm also going to bug my time like a spider in a web until see how it really flushes out in in larger clinical numbers. At least for the Ozempic, you'll look hot. while you're Depends on what your definition of hot is, Bonnie. Some of us live to be fat house cats. I mean, that that's fair. No fat shaming here on the Navas podcast. No, I'm like, yeah, absolutely not. I'm Canadian too. Like you need and a little extra cushioning up here where it won't make it through winter.
00:45:47
Speaker
ah Back to being a silver medalist, yeah because I'm going to ask you another like myth busters question. And i'm I'm on the silver medal side of this one, but recently I have been listening to some of my technicians who are coming back from recent meetings, like very top tier level meetings regarding anesthesia training.
00:46:12
Speaker
And there has been a lot more advocacy about using ketamine for cats with known hypertrophic cardiomyopathy at low dosages and not seeing a lot of adverse outcomes. And there has been a lot more advocacy for like sub-anesthetic doses of ketamine for cats even when if they have subclinical or clinical HDM.
00:46:36
Speaker
And I think there are some people who are advocating for that. And I am still like nervous about encouraging people to be using ketamine in this population. Question, ketamine has like a single injection or ketamine is a CRI. That is hard to say because I am not privy to this information. This is all things I'm getting from secondhand.
00:46:57
Speaker
So i I don't have an answer for you, but I'm curious what your opinion is about the use of ketamine in this particular population of cats, where traditionally, I think there has been a lot of people waving like flags and being like, you do not use ketamine for HTM cats. And now I think there is a little bit more nuance coming out of this conversation. And I'm curious, you have to say about ketamine and HCM. Yeah, I definitely, this is one of those things too, where like after X many years, I'm going back to start to
00:47:32
Speaker
review the literature, the current literature, not the like archaic literature, because that one's like that one i'm you know been reviewed. And trying to not have an absolute contraindications. I used to say that not a lot of things are absolute contraindications, but I'd probably say ketamine and HCM would be a good example. I'm sure many people have heard me say that in lectures before.
00:47:52
Speaker
but Again, like I said, is it a single injection? Is it a CRI? And again, it's it's the extent of the patient's compromise. In subclinical HCM, I'm probably not that fussed. However, if you had a subclinical cat who is like a textbook serial killer, right? So it comes to you in an extreme state of sympathetic tone. Am I gonna give it ketamine?
00:48:23
Speaker
Probably not because I think, you know, circulating catecholamines plus ketamine and a patient who has HCM could be a recipe for dysrhythmias. On the other hand, the vast majority of cats in the world, you know, all over the world, every continent, the exception of Antarctica are going to be getting something like DKT still. And they're not killing those cats.
00:48:53
Speaker
no And based on the you know percentage of cats that we know in the population who have subclinical HCM, right? Because I always say like you hear a cat murmur a lot of no idea what that means, right? But you know a lot of cats over decades and decades of time have been injected with ketamine and not just survived it, but really didn't have any like associated morbidity with it.
00:49:15
Speaker
So I'm starting to unclench a little bit. And again, it's case-based. It's the extent of the heart disease. It might be the extent of the patient's like temperament. right So how much do I think you're in a state of aggravated sympathetic tone? And then you know what's what's my dose? right And what's my route of administration? How am I administering? right So am I going to put something on like a subanesthetic CRI of ketamine with subclinical?
00:49:39
Speaker
HCM. Yeah, because for example, I don't reach for a light against your eye and a cat, you know, and maybe Sentinel and Dexman isn't cutting it and maybe the block didn't take well, you know, and it's like it's light on the table and can't see that awful thing where they're awake and hypotensive, you know, like systolic is 40 and it's trying to leave the table and you're like, I don't, I don't understand what's happening. I think I used to be one of those abject objectors, and now I'm you know i'm casually bonding my time in my silver medal position and letting those gold medalists cross the line first. but yeah I think this is one of those things I'm going to choose to revisit over time.
Advice for Veterinary Professionals
00:50:20
Speaker
I agree with you on that one. So I think we've gone through most of the urban legends that we wanted to cover, maybe not all of them, and I think we covered a pretty good chunk of them. So I think for me, what I would like to hear from you as somebody who is now representative of the North American veterinary anesthesia society. What is some like journal advice that you would give just people out there who maybe are listening to this podcast and they're really trying to do better with their anesthesia knowledge? Do you have any like parting words of wisdom for those people?
00:50:57
Speaker
Well, I have words, Bonnie. I'm not sure they come with wisdom, though. Yeah, I mean, I think my general opinion is that most of us, unless they you know choose specialty training, are under trained in veterinary anesthesia. And so a lot of people come to it with some degree of anxiety and fear. I mean,
00:51:17
Speaker
You know, every time I hire a new grad or I hire a new ER doctor, they'll be like, anesthesia is the one thing that scares me the most, you know? And so we do have a culture of fear. And the other thing is that a lot of people are trained and not necessarily by anesthesiologist, right? Like maybe it was a GP who taught classes in tech school, or maybe it was you've only ever worked with a surgeon, which just makes me die inside. But anyway, we're under trained.
00:51:43
Speaker
And I often tell people, like most of what I know is in a book, right? so' like there sounds like There's no secret club that we all join and pledge where I get information that isn't accessible with the exception of the clinical experience. So, you know, if you know that you're coming to a situation under trained, you do have to face your fear. And you have to go from being fearful to having a healthy, respect-free anesthesia, right? Because I mean, we're injecting controlled doses of controlled poison to induce a controlled state of shock.
00:52:11
Speaker
And you do that wrong and you cross the line and the patient will die. So it's very cool and it's necessary, but I understand why there's a lot of fear. And I also understand why there's a lot of these sort of urban legends about X, Y, and Z. But it's important that we continue to self-educate and revisit. And I would say to you, like if you're sitting in GP out there and you know you're not near an academic center,
00:52:36
Speaker
There is always like a phone or an email that you can reach an anesthesiologist or a VTS technician in anesthesia is gonna back up and you know we're out there too and like like I said we're not always optimized in our capacity to help people.
00:52:52
Speaker
And I really think too, like, you know, reach out and and have people come in and talk to your clinic and do the webinars and listen to the podcast and, and, you know, self-educate and just, you know, the more you anesthesia is one of those catch-22s. You got to do it to know it, you know, but doing it is terrifying.
00:53:08
Speaker
And especially in the early stages, like I remember the first time I ever did a horse call, I was like, don't tinkle in your pants, don't tinkle in your pants. And now I'm like, horse called, let's rock this. So, you know, you got to do it to be good at it, but you also sometimes have to, and this is a scary thing for a clinician to say, you got to experiment a little bit, right? Like if you're only ever using Torbin L. Faxolone and you're like, well, I'm, I'm scared of propofol or I'm scared of a Ptolema Dator. I've never done cat bowel. Unfortunately, you're never going to come out of that box of fear unless you actually do it.
00:53:38
Speaker
Yeah. Right. So it's, it's like real time experimentation to be able to improve your own skills and knowledge to gain that experience. But you know, if you're ever nervous and you want the backup, like phone in for a telemedicine consultation, get us to come to the clinics, like use this as that resource, because like a lot of us are up here in referral practices, like bored to death by TPLO anesthesia. And like, we want to help, like we want to teach, like we want to improve, we want to reach you guys. So yeah, I mean,
00:54:07
Speaker
I did GP for a long time and I know how isolating and like terrifying it can be, but use that resource that's there for you. And like every year we train more anesthesiologists and more nurse anesthetists and you know, technology is making it easier to get your paws on us, no pun intended. So I think people really need to optimize that opportunity. I couldn't agree more and I rarely plugged my own anesthesia consulting business into this podcast. Do it.
00:54:38
Speaker
But I have an anesthesia consulting business. So look me up. I would love to help you guys. I think many more anesthesiologists, I'm so happy that this is happening. But so many more anesthesiologists I know are actually forming their own consulting businesses as well because they want to get the word out on helping people with anesthesia from the ground up. There's so many GP practices and so many people are doing anesthesia on a day to day basis ah that do not involve the anesthesiologist yeah or specialty nurse and we want to be there to help you guys, I promise.
00:55:11
Speaker
Yeah, 100%. I mean, I have a full-time job, but like if you call me up you know and you say, could you come out on a Saturday to do this case, I'll use that opportunity to go out, do the case, and teach the whole clinical team. yeah And and you know I used to be, you know when you're a resident and like you're constantly exposed to such like high levels of research and and and practice where you know we're like we're doing valve replacements and there's a perfusionist and all this kind of stuff, and then you realize like out here in the real world, like 95% of the anesthesia getting done is getting done at a GP level, which is cool, with GP level staff, which is cool. And most of them hate it. And meanwhile, it's totally the coolest specialty and one of the most impactful too for welfare purposes. And so so, yeah, exactly. So I'm just like, I can warn now about like what we would call foundational teaching, like really getting the bare bones of physiology, pharmacology, the physics of the equipment, like,
00:56:07
Speaker
You know, things like, does a pulse ox work on a pigmented animal? For God's sake, you know? And so, like, I would rather do that now than talk about, like, what are the types of, you know, cardiac output measurement? And should we do lithium dilution? Like, who is that helping? You know? And it's not that it's not important to the science. And I respect the people out there who are doing it, because I know some of them are going to listen to this podcast. They'll be like Bartel.
00:56:32
Speaker
But, you know, that's not the bulk of what our community and what our pet population needs. And so, like, I would rather work, you know, with new tax and, and, and GPs than necessarily train residents because I've just figured out that that's more my calling because I just find it more
Closing & Resources
00:56:47
Speaker
impactful. So.
00:56:48
Speaker
Yeah, preach. I'm on your side. yep Well, thank you for all you do for NavS. And if you are not a member of the North American Veterinary Anesthesia Society, and you are listening to this podcast, what are you waiting for? Get on the train. It's like the most economical way to get the best CE on the market. And plus, you you know, you get access to the awesome podcasts and our blogs and our fireside chats and our symposium. So yes, he's the opportunity people like that's the message I'm trying to get across here.
00:57:18
Speaker
Yeah, absolutely. Well, thank you so much for your time today, dispelling some of these anesthesia faux pas. I appreciate it. Well, thank you, Bonnie, and thanks for organizing the podcast. I say that both as Madame Presidente, and I also say that to you just as another anesthesiologist, you know, the more we can, you know, optimize technology to get our messages out there, the better it is for clients, pets in our population.
00:57:50
Speaker
Thank you for joining us today. If you enjoy this episode, we invite you to explore the North American Veterinary Anesthesia Society and consider becoming a member. Membership with NAVAS provides incredible benefits, including access to anesthesia and pain management CE events, informative blog posts, fireside chats with board-certified anesthesiologists and specialty technicians, and much more.
00:58:15
Speaker
NAVAS members also enjoy VIN rounds, hour-long presentations on specific topics in veterinary anesthesia that offer valuable tips to use right away in your practice. If you're interested, visit www.mynavas.org to elevate your anesthesia journey today. If you've been enjoying our podcast, we'd love your support. Please consider liking, subscribing, writing a review, or sharing the podcast with friends and colleagues.
00:58:45
Speaker
Every bit of listener support helps us reach more veterinary professionals like you. For questions about this episode, or the podcast in general, or to suggest topics for future episodes, please feel free to reach out to us at education at mynavas.org.
00:59:03
Speaker
We'd love to hear from you. Special thanks to our sponsor, Decra, for making this podcast possible. To learn more about their veterinary anesthesia products, visit www.decra-us dot.com. And of course, a big thank you to our esteemed guest and Navas president, Dr. Tasha Bartel, for this insightful discussion on traditional practices in veterinary anesthesia.
00:59:28
Speaker
This episode was produced by Maria Bridges, edited by Chris Webster of Chris Webster Productions, with technical support from Saul Jimenez. Finally, thank you to all our gas pastors out there for spending time with us on the Navas podcast. Veterinary anesthesia is a lifelong journey of learning and growth, and we hope you'll join us next month as we continue exploring it together. I'm your host, Dr. Bonnie Gatson. Thanks for listening, and see you next time.