Playing It Safe

One of the most important pieces of equipment during anesthesia monitoring is the electrocardiogram (ECG or sometimes EKG).  With this tool we can not only keep track of the actual rate of the heart but also note electrical abnormalities in the heart, problems with rhythm, and issues with abnormal contraction patterns.  Not using an ECG during general anesthesia is taking a big and unnecessary risk. 

Today we had an issue with our ECG machine.  Remember that this is my first full week in the new location and I'm adjusting to the new staff and patterns.  Though I've worked with all of them before I don't know all of the ins-and-outs of the team yet.  We had induced our first procedure, a routine neuter, and had him under anesthesia.  As my assistant was connecting the monitoring equipment (ECG, blood pressure, and pulse oximeter) she noticed that the ECG wasn't reading at all.  It was strange because the graph wasn't coming up on the screen at all, yet the computer acknowledged that it had found and recognized the machine.  She tried to get it to work and went through various screens, turning it on and off, and finally rebooting the whole computer.  Nothing worked and the ECG still wouldn't read. 

Since the dog was already anesthetized and a neuter usually takes me less than seven minutes, I forged ahead and finished as quickly as I could.  We still had all of our other monitoring equipment so I wasn't without physiologic data.  The dog did fine and recovered normally.  But we still had three more anesthetic procedures, all dentals.  And we still couldn't figure out what was wrong with the ECG!  My assistant contacted tech support and they didn't know what was going on either.  They started to research it and said they'd call us back.

While waiting I made the decision not to proceed with the dental cleanings.  Those all would have taken longer than an neuter and I didn't want to take any risks of missing a serious cardiac abnormality.  So I called the owners, explained the situation, apologized for the inconvenience, and had them reschedule the cleanings.  I hated to do that as it potentially caused a problem for the client, as well as lost the revenue from the procedures.  However, my primary concern should always be to the health and safety of the pet, so I did what I thought was the right thing.  Thankfully the clients were very understanding of what happened.

In situations like this a vet should always remember that their first priority is the pet, not the client or even the business.  We shouldn't take risks that don't need to be taken, especially with anesthesia.  I've heard anesthesia described as the closest to the conditions of death we willingly take a patient.  So when we take this step we need to do it as safely as possible.  And if all of the equipment that keeps it safe isn't working as it should, we should think of the patient and consider canceling an elective procedure.

Later that afternoon we learned that a few days prior a different assistant had accidentally messed with some of the settings.  After looking into it further we discovered a setting that needed to be activated to allow the ECG pattern to display.  Somehow we had overlooked this when troubleshooting earlier, and if we had only noticed it we could have followed our original schedule.  I'm also very surprised that the tech support couldn't describe how to check that.  So our machine actually WAS working properly, but needed a single setting to be readjusted. I don't regret our decision to reschedule things, and I'm glad that everything will be in good working order for tomorrow.