Are you ready to ride the modern wave of dynamic monitoring? In this episode of The CARES VetMed Podcast, Maryann, Travis, and Tracey break down why static numbers might be lying to you and how tools you already have in your clinic—like your trusty pulse ox—can revolutionize how you predict fluid responsiveness.

• Traditional Central Venous Pressure (CVP): A look at the classic static measurement of right ventricular preload (normal range: 2–6 mmHg). We discuss its historical popularity in critical care and liver lobectomies, and why it is no longer the gold standard due to its invasive nature and poor ability to predict fluid responsiveness.

• The Rise of Dynamic Predictors (PPV, SVV, PVI): Learn how modern monitoring uses heart-lung interactions to evaluate beat-by-beat blood flow. We define Pulse Pressure Variation (PPV), Stroke Volume Variation (SVV), and the non-invasive Pleth Variability Index (PVI), highlighting how a variation threshold of >12–13% indicates a patient will actively benefit from a volume bolus.

• The Ventilator Prerequisite: Why getting an accurate PPV or PVI reading requires a patient to be on a mechanical ventilator with consistent tidal volumes (10 to 15 mL/kg), and the challenges of trying to replicate this consistency via manual hand-bagging.

• Troubleshooting and Artifact Pitfalls: Practical advice on identifying errors. We cover how drug-induced vasoconstriction (like Dexmedetomidine) can make SPO2 waveforms disappear, and how line issues (air bubbles, kinked catheters, compliant tubing) dampen arterial line PPV readings.

• Perfusion as a Multimodal Picture: Why we must look beyond a single monitor number. We emphasize combining automated indices with physical tissue perfusion assessments (CRT, mucous membranes, peripheral temperature), especially when managing septic patients or utilizing vasopressors like norepinephrine.

#CARESaction: Too often, we find ourselves slumped over a gurney, monitor, or dental table. This week, we challenge you to keep an eye on your teammates' posture. If you see a coworker hunching over, step in and actively help them adjust the height of their table, gurney, or chair. Keep that blood flowing—for both you and your friends!

Veterinary History: We dive into historical texts with an excerpt from Animal Castration (1884) by Alexander Francois Augustine Liautard. Travis shares a graphic look at how 19th-century practitioners achieved "compliance" during large animal procedures. Liautard suggests that to distract an animal, one could try "pricking him with a pin on the lips or about the anus." As a brief afterthought, he notes similar results can be obtained by the "inhalation of a little ether or chloroform"—a wild testament to how far veterinary anesthesia has advanced!

We welcome your feedback, topic suggestions, or screenshots/videos showing before-and-after changes in your pulse oximeter's pleth index during a fluid bolus!

• Email: [email protected]

• Social Media: @caresvetmed

Links:

• Diagnostic accuracy of pulse pressure variation, stroke volume variation and plethysmography variability index for prediction of fluid responsiveness in anesthetized and mechanically ventilated dogs (Donati et al., 2026)

• Animal Castration (1884) by Alexander Liautard

• RECOVER

• ACVAA

Welcome to another episode of The CARES VetMed Podcast! This week, Maryann, Travis, and our host tackle the unique challenges of pediatric anesthesia monitoring. From neonates to young adults, these little patients present distinct physiological differences that require tailored approaches. Join us as we explore essential tips, tricks, and common pitfalls to ensure the safest possible anesthetic experience for our smallest patients.

This episode covers:

• Monitoring Equipment Adaptations: Practical advice for pulse oximetry in tiny patients, including using reflectance probes (rectal or shaved skin), relieving clamp pressure with needle caps or rubber bands, and the truth about "wetting the tongue." Discussion also covers adjusting the settings of an oscillometric blood pressure machine for small patients and the difficulties in obtaining accurate readings.

• Pediatric Physiological Parameters: Insights into managing temperature in rapidly cooling/warming pediatric patients, and the surprising lack of direct correlation between hypotension and acute kidney injury in human pediatrics. We discuss how very young patients rely heavily on heart rate to estimate blood pressure, and how to prioritize physical assessments such as mucous membrane color, CRT, and fluid status.

• Pharmacology & Protocols (Mini-Deep Dive): Brief discussion on using anticholinergics and ketamine in pediatric patients, especially for painful procedures, and the caution needed with propofol's cardiovascular effects. 

• Lung Compliance and Ventilation: The critical importance of monitoring peak inspiratory pressure in pediatric patients due to their compliant chest walls but less compliant pulmonary tissue, and the risk of pulmonary edema from over-inflation.

• Hypotension Intervention Strategies: A candid conversation about how to approach hypotension in pediatric patients, including when to intervene with multiple treatments simultaneously versus a stepwise approach, and the common use of pressors like dopamine.

• Glucose Monitoring: Guidelines for checking blood glucose in pediatric patients, particularly those under six months, and techniques for obtaining blood samples.

We welcome your feedback, suggestions for future topics, or any wild experiences you'd like to share from your careers. Please reach out to us at [email protected] or connect with us on social media at @caresvetmed.

Links:

• Veterinary Anesthetic and Monitoring Equipment

• Martins ARC, Ambrósio AM, Fantoni DT, Pinto ACBCF, Villamizar-Martinez LA, Soares JHN, Otsuki DA and Malbouisson LMS (2022) Computed Tomography Assessment of Tidal Lung Overinflation in Domestic Cats Undergoing Pressure-Controlled Mechanical Ventilation During General Anesthesia. Front. Vet. Sci. 9:842528. doi: 10.3389/fvets.2022.842528

• Moll X, Aguilar A, García F, Ferrer R, Andaluz A. Validity and reliability of Doppler ultrasonography and direct arterial blood pressure measurements in anaesthetized dogs weighing less than 5 kg. Vet Anaesth Analg. 2018 Mar;45(2):135-144. doi: 10.1016/j.vaa.2017.08.006. Epub 2017 Sep 15. PMID: 29246711. 

Ever feel like the busier your shift gets, the easier it is for your brain to go on autopilot right when it matters most? In this episode of The Cares VetMed Podcast, Maryann, Travis, and Tracey look at the hard science and surprising data behind why even the most seasoned veterinary experts rely on a simple piece of paper to save lives.

The math speaks for itself: a humble, one-page checklist can drop machine setup errors by 88% and cut airway complications by a staggering 97%. Getting human egos to step aside for the data isn't always easy, but from halving surgical complications to preventing catastrophic equipment mistakes, we explore how clinical checklists act as your team’s ultimate safety net against distraction. Tune in to find out why keeping it simple is your patient's best line of defense!

Key Topics Discussed

• The 2025 Equipment Setup Study: We break down a study by Love et al. that shows introducing a simple anesthesia machine checklist reduced student errors from 6.6% to 0.8%—an incredible 88% drop.

• The APL Valve & Airway Wins: How the same 2025 study proved that checklists reduced airway supply errors by 97.2% and cut the dangerous mistake of leaving the APL valve closed by 75%.

• The 2018 Surgical Safety Study: A look at data from Cray et al. showing that implementing a surgical safety checklist dropped overall perioperative and postoperative complication rates from 40.9% down to 29.3%.

• The Anatomy of Distraction: Why human error, lapses in judgment, and phone calls/questions in the middle of a setup are the biggest threats to patient safety—and how checklists catch you when you get pulled away.

• "Read-Do" vs. "Do-Confirm" Checklists: Breaking down the two distinct styles of checklists from Atul Gawande’s The Checklist Manifesto. Learn when to use a comprehensive instruction-style list (Read-Do) versus a quick, expert safety net (Do-Confirm).

• Fighting "Checklist Fatigue": How to get genuine buy-in from your team by keeping lists practical, concise (5 to 9 items max), and allowing room for local modifications.

• The Future of Tech: A discussion on how modern anesthetic monitors are beginning to integrate digital checklists and software that syncs directly into electronic medical records.

Questions to Think About While You Listen:

1. Are you letting ego get in the way of safety? Why admitting we are human and prone to distraction takes humility, but actively saves lives.

2. Does the layout of your paperwork cause mistakes? Why stacking multiple checklists on a single page might cause your team to accidentally skip vital blocks of information.

3. Is your team only as strong as your weakest player? How checklists level the playing field for new grads, novice assistants, and solo on-call staff.

Team Challenge: The Surgical Timeout Challenge

We are challenging every single listener to implement one practical, 3-point checklist in their clinic this week: The Surgical Timeout. Before the first incision is made, pause your team and confirm just three things:

1. Correct Patient

2. Correct Surgical Site

3. Verified Surgical Drugs & CPR Code

Links mentioned in the episode for reference:

• The use of a checklist reduces errors in equipment set-up by veterinary student anesthetists

• Effect of implementation of a surgical safety checklist on perioperative and postoperative complications at an academic institution in North America

• A Must Read!: The Checklist Manifesto by Atul Gawande.

• Clinical Templates: The World Health Organization (WHO) Surgical Safety Checklist.
  

Think the hard part is over once the last suture is tied? Think again. In this episode of The CARES VetMed Podcast, Travis, Maryann, and Tracey shine a light on the "Danger Zone"—that high-stakes window where even the most routine procedures can take a sudden, life-threatening turn.

We’re diving into the "why" behind post-op complications, sharing clinical experiences and exploring specific strategies to keep patients safe once the monitors come off.

In this episode, we explore:

• The Post-Op Statistic: Why do half of all anesthesia deaths happen after the surgery is finished? We talk about why "waking them up" is the most dangerous part of your day.

• The "Heavens to Betsy" Tray: We reveal what needs to be within arm’s reach when a recovery goes sideways—and why it isn't just about the breathing tube.

• The Science of "Flow-By": Why 100% oxygen isn't always the answer. We explain the "Nitrogen Skeleton" and how a simple Ambubag trick can help fix collapsed lungs.

• Pain vs. Panic: How can you tell if a patient is hurting or just confused? We look at the subtle physical cues that tell you exactly what your patient needs.

• Airway Brinkmanship: We discuss the high-wire act of recovering brachycephalic breeds and new tools that make it less stressful.

• Thermal Roadblocks: Why being "cold" is actually a form of sedation. We explore how temperature affects the body's ability to clear drugs, especially in exotic species.

Questions to Think About While You Listen:

1. Are you pulling the monitor off too early? We discuss the crucial "5-minute shift" that happens the moment you switch to room air.

2. Is the "quiet" patient the most dangerous? Why the patient sleeping peacefully might actually be the one in the most trouble.

3. Could your multitasking be a risk factor? We look at how 60% of techs who "double-task" might be missing the most important signs.

Links mentioned in the episode for reference:

• The Post-Op Hypoxemia Data:  C Piemontese et al. Noninvasive respiratory support in dogs Veterinary Anaesthesia and Analgesia 2026, 53, 101187

• High-Flow Nasal Oxygen: Jagodich TA, Bersenas AME, Bateman SW, Kerr CL. Preliminary evaluation of the use of high-flow nasal cannula oxygen therapy during recovery from general anesthesia in dogs with obstructive upper airway breathing. J Vet Emerg Crit Care. 2020;30:487–492.

• Mila/Cook Airway Tools: 

• Mila

• Cook

• The Feline Grimace Scale

A Note on Our Content: The views, opinions, and personal experiences shared by the hosts on this podcast are for educational and entertainment purposes only. While our hosts are Veterinary Technician Specialists (VTS) in Anesthesia & Analgesia, the protocols, techniques, and case management styles discussed on this show should never take the place of direct veterinarian approval or institutional oversight. Every patient is unique. Always consult with the attending veterinarian and review your specific clinic protocols before implementing any new anesthesia or analgesia plans.

As always, we sincerely thank all of you who took time out of your busy schedules to listen to this, as well as our other episodes. If you have any suggestions or feedback for us, we’d love to hear from you! You can send us a message on social media (@CARESVetMed) or email us at [email protected]. Let us know if you’d like to join us on a future episode!

Take care, friends!

Welcome to another episode of The CARES VetMed Podcast!

We're excited to be back with a deep dive into the updated 2025 American College of Veterinary Anesthesia and Analgesia (ACVAA) monitoring guidelines for small animals. Join Travis, Maryann, and Tracey as they discuss the significant changes since the 2009 version, focusing on the new minimum recommended monitoring standards and their implications for veterinary professionals.

In each episode, we hope to continue spreading kindness and positive impact through our #CARESaction Challenge!

NEW - Veterinary History Feature: Join us for a new recurring segment where we delve into historical veterinary texts! In this episode, we explore a quote from Leonard Conky's 1890 book, "Veterinary Medicine, Animal Castration Surgery, and Obstetrics Simplified." His intuitive observations on "natural pulse, temperature, and respirations" as keys to practice remain surprisingly relevant even in light of our modern advancements.

This episode is a must-listen for anyone involved in veterinary anesthesia, offering insights into best practices, new requirements, and the enduring importance of attentive, skilled monitoring.

Links mentioned in the episode for reference:

• ⁠⁠ACVAA Anesthesia Monitoring Guidelines (2025)⁠⁠

• Referenced studies on Doppler vs. Invasive Blood Pressure in Veterinary Medicine:

• ⁠⁠da Cunha, A.F. ∙ Saile, K. ∙ Beaufrère, H. Measuring level of agreement between values obtained by directly measured blood pressure and ultrasonic Doppler flow detector in cats J Vet Emerg Crit Care. 2014; 24:272-278⁠⁠

• ⁠⁠Kennedy, M.J. ∙ Barletta, M. Agreement between Doppler and invasive blood pressure monitoring in anesthetized dogs weighing <5 kg J Am Anim Hosp Assoc. 2015; 51:300-305⁠⁠

• ⁠⁠Skelding, A. ∙ Valverde, A. Review of non-invasive blood pressure measurement in animals: part 2 – evaluation of the performance of non-invasive devices Can Vet J. 2020; 61:481-498⁠⁠

• ⁠⁠Computed Tomography Assessment of Tidal Lung Overinflation in Domestic Cats Undergoing Pressure-Controlled Mechanical Ventilation During General Anesthesia⁠⁠

• ⁠⁠Masimo (for information on plethysmograph variability and dynamic indices)⁠⁠

• ⁠⁠Leonard Conky's "Veterinary Medicine, Animal Castration Surgery, and Obstetrics Simplified" (1890 text)⁠⁠

As always, we sincerely thank all of you who took the time out of your busy schedules to listen to this, as well as to our other episodes. If you have any suggestions or feedback for us, we’d love to hear from you! You can send us a message on social media (@CARESVetMed) or email us at [email protected]. Let us know if you’d like to join us on a future episode!

Take care, friends!

Join us for a fascinating discussion on brachycephalic breeds, featuring guest expert Elisa Mazzaferro, MS, DVM, PhD, DACVECC!

In this episode, we delve deep into the unique challenges faced by these beloved breeds, from breeding practices and standards to their complex and often underestimated perianesthetic risks.

Dr. Mazzaferro shares her expertise on:

• The current landscape of breeding testing and standards: Are we doing enough to ensure responsible breeding practices?

• Understanding the unique health concerns: From stenotic nares to elongated soft palates, we unpack the specific anatomical challenges that brachycephalic breeds face.

• Perianesthetic considerations: Why are brachycephalic breeds at a higher risk during anesthesia? What steps can veterinarians take to ensure their safety?

• The power of client education: Empowering pet owners with knowledge about their breed's potential health issues and the importance of preventative care.

• Implementing checklists into practice: A practical guide for veterinarians on improving patient safety and streamlining care for brachycephalic patients.

This episode is essential listening for veterinarians, veterinary technicians, and pet owners who want to understand the complexities of caring for these adorable but often vulnerable breeds.

Together, we can ensure a healthier future for brachycephalic dogs and #savethesmushies!

Welcome back to another episode of The CARES VetMed Podcast! Today, we're exploring the crucial role of mean arterial pressure (MAP) monitoring during general anesthesia.

We all know monitoring blood pressure is essential, but why is MAP so crucial? How do we calculate it? And what can it tell us about our patients' perfusion and how they're handling anesthesia?

In this episode, we'll cover:

• The importance of MAP monitoring: Why it's not just about a number, but a key indicator of organ perfusion and overall health.

• Calculating MAP: We'll review the factors that impact the MAP value.

• Anesthetic agents and their effects on MAP: Understanding how different anesthetic drugs can affect blood pressure and how to anticipate these changes.

• Common causes of hypotension during anesthesia: We'll discuss the most frequent culprits and how to identify them.

• Intervening in hypotension: From fluid therapy to medications, we'll explore the practical steps you can take to stabilize your patient's MAP.

This episode is packed with practical tips and real-world insights, designed to empower you with the knowledge and confidence to monitor and manage MAP during anesthesia like a pro. So buckle up, grab your stethoscope, and let's follow the MAP!

Hey there, fellow anesthetists! It's time to get up close and personal with our trusty sidekick – the anesthesia machine!

We rely on this machine to deliver safe and effective anesthesia to our patients, so understanding its ins and outs is crucial. In this episode, we're taking a look into:

This episode is geared specifically towards small animal anesthesia, so buckle up and prepare to advance your comprehension of the (anesthesia) machine!

We're all about caring for our furry patients, but who cares for you?! This episode is dedicated to your financial future - a topic that often gets swept under the rug, especially for those in our field.

If you put aside $24 a week, that would be $24,960 in 20 years, and in 40 years, it would be $49,920.

What if I told you that in 20 years it could instead be $61,400 and in 40 years it could be $348,000, would you do it?

Better yet, add in most companies' contributions, and that value will become $92,000 in 20 years and $522,000 in 40 years.

If you increase your weekly contribution by 5% each year, the value will become $131,000 in 20 years and reach $1 million in the 40th year!

This is the historical benefit of retirement planning and investing with the experts. Check out my conversation with Andy Samoiloff, where we discuss retirement planning and investing now to prepare ourselves for financial freedom in the future!

In this episode, we’re discussing a topic that can sometimes be overlooked but is critically important: thermoregulation!

We all know that our patients can get a bit chilly during surgery, but how much do we really understand about what's happening beneath the surface?

In this episode, we're diving into the fascinating world of body temperature, exploring:

Get ready to heat up your knowledge and become the ultimate temperature champions for your patients!