Safe Harbor Veterinary Anesthesia Support, LLC

07/17/2023

I'm so excited about our newest episode of the NAVAS Podcast! If you have thought about obtaining a VTS in Anesthesia and Analgesia, then this episode is for you. Host Dr. Bonnie Gatson dives deep into the VTS application process in a round table discussion with a technician who is just beginning her VTS application journey, Vivienne Montony, and a technician who just recently obtained her VTS in Anesthesia, Melissa Vehouc-Clark. Together, the panel discusses the possible career benefits of obtaining a VTS in Anesthesia and Analgesia, what type of work environment will set you up for the best possible experience during the prequalification phase, and we will provide tips on how to maximize your efforts and avoid pitfalls during the later application and examination phases.

Available now where ever you get your podcasts!

www.mynavas.org/podcast

07/01/2023

Picking an anesthetic drug protocol for an individual patient is a foundational practice of veterinary anesthesia, but it can sometimes feel daunting. With so many anesthetic drugs to pick from, how can you be sure that you are choosing the right combination? In this episode, Dr. Gatson along with guest Dr. Alexander Thomson, a boarded veterinary anesthesiologist from City University of Hong Kong, will dip our toes in the sea of anesthetic induction agents. Together they discuss the importance of including an induction agent in your anesthetic plan, and they break down the good, the bad, and the interesting about each of the common anesthetic induction agents available on the market today. Also, if you stick around to the end of the episode, you will be rewarded with an intriguing conversation on the challenges of practicing veterinary anesthesia outside of North America.

Listen now on Spotify or iTunes!

www.mynavas.org/podcast

05/19/2023

On the NAVAS Podcast, we have been focusing our attention on new analgesic and sedative agents for dogs and cats. But what about horses? For this species, it seems like pain control is a mix between science and art, as robust pain management studies seem to lag behind smaller companion animals. Luckily, there are brilliant researchers out there helping to move the needle forward on pain management research that is desperately needed for this species. In this episode, host Dr. Bonnie Gatson is joined by fellow boarded veterinary anesthesiologist and Clinical Associate Professor at the University of Georgia, Dr. Rachel Reed, to discuss her research in utilizing different types of opioids in horses. Together they will discuss the challenges of utilizing full-mu agonist opioids, like hydromorphone, morphine, and meperidine, in horses and why, perhaps, you should consider adding this powerful group of analgesic agents to your balanced analgesia protocol for equine patients. And if you have no interest in horses as a species, stick around to learn more about opioids as a class of drugs, which can be applicable to any species that you typically work with!

This is a two part episode, so make sure to subscribe to the NAVAS Podcast so you don't miss this riveting discussion on perioperative pain management in horses.

mynavas.org/podcast

03/20/2023

Does this situation sound familiar to you? You’ve attended a great conference or CE event (maybe even listened to a brilliant podcast), and you learned something innovative regarding anesthesia or pain management. You feel invigorated to implement these changes in your practice and try something new that will help your patients. However, as time goes on, you never get a chance to try anything new. You get stuck in a loop of limitless barriers, and you just can’t seem to get anyone on board to make changes happen. If this frustrating situation sounds familiar, then this episode is for you!

Host Dr. Bonnie Gatson is joined by fellow veterinary anesthesiologist and Vice President of Education and Quality at United Veterinary Care, Dr. Kate Medl Bailey, to discuss strategies for change implementation in veterinary practice. Together they discuss how to navigate challenging conversations regarding change, implementing a culture of psychological safety, and how to best work as a team to ensure changes are implemented effectively with minimal emotional impact.

Listen at mynavas.org/podcast or where ever you choose to get your podcasts.

02/22/2023

We are excited to announce that episode 2 of the NAVAS podcast is now available where ever you get your podcasts!

How often do we get innovative new drugs in the veterinary anesthesia field these days? In this episode, host and veterinary anesthesiologist, Dr. Bonnie Gatson is joined by Dr. Heta Turunen, veterinarian and clinical researcher at Vetcare Oy, to discuss the newly developed and recently approved sedative agent, Zenalpha. Together, they discuss the clinical effects of alpha-2 adrenergic agents and just how different Zenalpha is compared to drugs in the same class such as medetomidine and dexmedetomidine. Learn how to utilize this new sedative drug effectively in your practice while brushing up on your general knowledge of alpha-2 adrenergic agents in small animal patients.

If you like what you hear, consider becoming a member of the North American Veterinary Anesthesia Society (NAVAS) for access to more anesthesia and analgesia educational and RACE-approved CE content.

01/18/2023

🎉🎉SPECIAL ANNOUNCEMENT!!! 🎉🎉

The inaugural episode of the NAVAS podcast is officially available where ever you choose to get your podcasts! The mission of this podcast is to help veterinary professionals and caregivers provide safe administration of anesthesia and analgesia to all animals, elevate our standard of care, and improve patient outcomes. In this episode, host and veterinary anesthesiologist, Dr. Bonnie Gatson, is joined by Dr. Jeff Wilson and Dr. Chelsie Estey from Elanco to discuss Zorbium, a novel transdermal formulation of buprenorphine that is approved for the treatment of pain related to surgical procedures in cats. Learn more about this fascinating new take on an old drug and how best to integrate this drug into your clinical practice.

https://www.mynavas.org/podcast

01/14/2023

Gastric dilation and volvulus (GDV) is a relatively common surgical emergency seen in dogs. The anesthetic management of these dogs can be challenging due to the emergent need for surgical intervention, but also because of the wide range of complex changes that can occur in dogs as a result of this pathology. Bonnie Gatson successfully managed not one, but TWO GDV cases this past week! Here are a small handful of tips and tricks on successful anesthetic management of these cases:

~Measure lactate values throughout the resuscitation period prior to anesthesia - if they begin to decline as the animal receives appropriate fluid therapy, then the chance of successful anesthetic management increases significantly! However, it is possible that lactate values may increase in the immediate post-operative period after stomach rotation and decompression, as less oxygenated tissues begin to receive adequate circulation.
~ Place two intravenous catheters and an arterial line (if possible) to measure direct blood pressure, as these animals can undergo sudden changes in their peripheral circulation throughout the surgical procedure.
~ Mechanical ventilation is preferred, as a large distended stomach can compromise appropriate ventilation. However, remember that mechanical ventilation can decrease preload, negatively effecting cardiac circulation. I tend to start patients on mechanical ventilation, but will switch to spontaneous ventilation if cardiac depression is significant following initiation of mechanical ventilation.
~ Any induction protocol will suffice, as long as it allows rapid intubation and inflation of the endotracheal tube to secure the airway!
~ Place ECG leads on the patient prior to anesthetic induction. I find that you are very unlikely to completely eliminate all cardiac arrhythmias prior to general anesthesia and this should not be a reason to delay cases. However, treatment of life-threatening arrhythmias, such as sustained high-rate ventricular tachycardia shown below, should be prioritized.
~Lidocaine constant-rate infusions during surgery and in the 24 hours following anesthetic recovery have been shown to decrease the rate of life-threatening cardiac arrhythmias and acute kidney injury in the post-operative period, allowing patients to be discharged from the hospital more quickly. (https://pubmed.ncbi.nlm.nih.gov/22805421/) The dose is a 2 mg/kg IV bolus followed by a constant rate infusion of 30 mcg/kg/min.

For more tips like these, remember that Safe Harbor Anesthesia provides training and CE for veterinarians and staff members. Contact us today if you need any refresher training on the anesthetic management of GDVs, or other common emergency patients.

01/03/2023

We're excited to hop into the New Year! Wishing you and your furry family members a Happy and Healthy New Year! We are excited to announce some new anesthesia services this year, including virtual consultations with an anesthesiologist, anesthesia training modules, client education documents, and drug calculators. We will be announcing those services as they become available. Dr. Gatson has also teamed up with the North American Veterinary Anesthesia Society to host a podcast centered around the practice of veterinary anesthesia and pain management. It has been an exciting start to the new year for us at Safe Harbor Anesthesia! If you are interested in starting your new year off on the right foot, reach out to us with any of your anesthesia-related needs including on-site anesthesia training and continuing education.🐾
https://safeharboranesthesia.com
https://www.mynavas.org/podcast

07/08/2022

Dr. Gatson was pleased to welcome Monica Calderon, a rising senior veterinary student at the University of Florida, to join her this week to practice the art of anesthesia at several specialty hospitals around the state of Florida. With Dr. Gatson's assistance, Monica was able to perform multiple forms of loco-regional anesthesia, learn to safely administer neuromuscular blocking agents, practice placing arterial catheters, and monitor anesthesia for dogs and cats for a wide variety of procedures. If you are a veterinary student looking to learn more about performing practical anesthesia, please consider reaching out to Safe Harbor Veterinary Anesthesia Support! As a former educator, Dr. Gatson loves to train motivated students eager to refine and grow their anesthesia skills!

06/13/2022

If you are located in the Sarasota/Bradenton region and are looking for some RACE-approved veterinary CE, here is an opportunity you shouldn't pass up! It's not too late to book!!!

https://www.eventbrite.com/e/continuing-education-for-florida-veterinarians-hosted-by-arc-registration-330588738817

Join us for dinner and 2 hours of continuing education presentations by Dr. Rose and Dr. Gatson of Veterinary Surgery Center of Sarasota

05/11/2022

One lung intubation is an uncommonly utilized technique that can be performed to isolate and collapse specific lung lobes and may be needed in certain situations. In this case, a lung tumor was being removed using thoroscopic surgical technique. Although there are several means to accomplish lung isolation, the most popular way is by placing a bronchial blocker into the lung l**e that needs to be collapsed using the guide of a bronchoscope. If this is a technique your practice wants to perform, feel free to contact us here at Safe Harbor Anesthesia, and we would be delighted to help your practice reach it's full potential!

04/18/2022

Wishing everyone out there a wonderful holiday weekend! And with the Easter Bunny visiting so many homes this Sunday, we here at Safe Harbor Anesthesia hope to remind our veterinary community that we offer anesthesia expertise to many species, not just to cats and dogs! Here is a wonderful throwback to Dr. Gatson performing an ultrasound guided transverse abdominis plane (TAP) block to a young rabbit undergoing an abdominal exploratory surgery for a gastrointestinal obstruction. This rabbit did amazing post-operatively, and began eating and drinking a few hours following surgery using a multi-modal analgesia approach. Along with the TAP block, this rabbit received an intra-operative fentanyl infusion followed by buprenorphine post-operatively. Just a friendly reminder that even exotic pets like rabbits can benefit from our extensive knowledge of locoregional techniques.

04/15/2022

Yes, you should always inflate your endotracheal tube cuffs before you use them. Yes, EVERY TIME! Even when it comes straight out of the package. Here is a great example of a BRAND NEW endotracheal tube that could have given us some major trouble if we used it without first checking the cuff.

If you are looking for a step-wise approach to check all your anesthesia equipment before use, we offer many custom checklists that can help streamline your anesthetic practice while improving patient safety. Connect with us to learn more!

04/01/2022

Dr. Gatson had the honor of being interviewed for Veterinary Human Factors Awareness Week, hosted by VetLed. This week will be filled with virtual sessions that you can access for free on Zoom, including Dr. Gatson's discussion on why anesthetists tend to understand the importance of human factors in veterinary medicine. VetLed has an inspiring mission to enhance the performance of veterinary teams and improve patient safety by emphasizing team building, refining communication skills, eliminating blame culture, and so much more. This is SO IMPORTANT as burnout is at an all time high across the veterinary profession. We encourage you to tune in and learn more about this amazing field in veterinary medicine!

03/19/2022

We enjoyed meeting with all kinds of visitors who stopped by our booth at the FVMA Conference this weekend!

03/18/2022

We would love for you to come by our booth at the FVMA Conference and learn about some of the wonderful services we have to offer!

03/11/2022

Attention one and all - we are once again hiring here at Safe Harbor! We are looking for a part time (up to 20 hours a week) assistant to help with a wide variety of tasks from office administration to content moderation and development. Work from anywhere remotely, but must have computer and high speed internet access. We are excited to have someone join our team as we continue to grow!

Want to know more about this position? Email Dr. Bonnie Gatson at [email protected].

03/04/2022

We are excited to announce that we will be heading to the FVMA conference in Orlando Florida from March 17-20! Come by booth 93 in the Exhibit Hall to learn more about all the amazing services Safe Harbor Veterinary Anesthesia Support, LLC has to offer, not to mention the raffles and giveaways that will also be available to visitors! Looking forward to meeting you all there!

03/03/2022

The 2022 AAHA Pain Management Guideline for Dogs and Cats is now live and available for free download! Don't have time to completely digest a densely packed 20 page document? You're not alone! Here are some of the highlights:

1) Pain management in small animals is a therapeutic continuum - it involves listening and engaging with owners about changes in their pet's behavior, training staff to recognize procedures and conditions associated with pain, instituting reliable pain assessment strategies in your practice, and a willingness to change therapy over time according to the needs of the patient.
2) Proactive, preemptive, multimodal therapy is best. Treat the pain before it starts! For chronic pain, it means educating owners of breeds with a high propensity of developing chronic pain disease (like osteoarthritis) what to look for when these diseases start to emerge. Teach owners what pain looks like in dogs and cats!
Excellent YouTube video on behavioral signs of OA in cats: https://www.youtube.com/watch?v=-7hnAFNFjW0
3) Use a standardized pain assessment strategy in your hospital that is included along with your history, physical exam, clinical observation, and palpation of the painful area. Don't forget to watch your patient in the exam room - watch how the animal sits, walks, or jumps. Encourage owners to share videos of their animals at home in various stages of activity. Here are some good examples of standardized pain assessment for acute/post-op pain:
Dogs: Colorado State Pain Scale (unvalidated, but easy to use), Glasgow Pain Scale (validated, relatively easy to use)
Cats: Same as for dogs, but the Feline Grimace Scale (https://www.felinegrimacescale.com/) is probably the best way to go.
There are several chronic pain scales, especially for pets with osteoarthritis that have been validated for dogs and cats. These rely heavily on owner assessment of behavior, despite possible knowledge gaps in owner recognition of painful behaviors.
Consider performing a pain assessment along with every TPR you order for your patient in hospital for animals undergoing therapy for acute pain.
4) Analgesics used for dogs and cats will depend on several factors including whether the pain is considered acute (physiologic response) or chronic (maladaptive) and whether or source of pain is known or unknown. AAHA created a pain treatment algorithm using a tiered approach (1st tier meaning an abundance of evidence exists to support its use vs 3rd tier meaning there is minimal evidence supporting its use in small animals). See the picture below. Remember that combining Tier 1 and Tier 2 treatments is acceptable and encouraged.
5) Here are some consensus statements and recent updates on different pain medications:
Simbadol - Although labeled for cats, it can be used in dogs for 24-hour acute pain relief, but off-label
Local anesthetics - Use them as much as possible for nerve blocks, and you can add either buprenorphine or dexmedetomidine to prolong the duration of action. Nocita (slow-releasing bupivacaine) can also be used off-label to provide 3 days of analgesia when used as an incisional block for anything other than a TPLO.
Tramadol - When given orally, it does not provide effective post-operative analgesia in dogs (IV tramadol may be a different story)
Gabapentin - Sorry to say, but this drug is not effective at providing post-operative analgesia despite it's recent widespread use. Also very limited data supporting its use in chronic pain states.
Maropitant - Has VERY VERY WEAK analgesic properties, but it's a great anti-emetic
Oral opioids with or without acetaminophen - Not a good option for providing analgesia in dogs and especially not a great option in the age of the opioid crisis
Long-term NSAID use - Definitely should be used at the lowest dose tolerated, as the rate of various organ toxicosis is quite low and efficacy is quite high in both dogs and cats. However, there is no NSAID approved for long-term use in cats at least within the USA, so this type of administration is off-label. Consider using NSAIDs even in arthritic cats with chronic renal insufficiency at low doses.
Anti-NGF monoclonal antibodies - A new class of drug with some promise as an effective therapy in cats with OA.
Amantadine - No new data has come out about it's use for chronic pain in dogs, but there is a study suggesting it should be used as twice daily dosing and can be used longer than 3 weeks.
Cannabinoids - Mixed results on its use for chronic pain conditions.
6) This paper goes into a lot of detail about non-pharmacologic treatment strategies (icing, acupuncture, laser, rehab, etc.), which should be integrated alongside pharmacologic treatment modalities to augment the overall analgesic experience. If you want to know more about these modalities, I encourage you to read this section in more detail.
7) There is some emphasis in the paper that, at least in humans, we know that positive emotional experiences decrease painful responses, while negative experiences have the opposite effect. Therefore, rough handling, bad-tasting medications, and other environmental factors should be taken into account when creating a treatment modality. Factors that possibly disrupt the human-animal bond should be weighed against any benefits that a treatment provides.

The AAHA Pain Management Guidelines can be found at this link: https://www.aaha.org/globalassets/02-guidelines/2022-pain-management/resources/2022-aaha-pain-management-guidelines-for-dog-and-cats.pdf?fbclid=IwAR3iuWViHuaR0uDW0AVY9NVT09d0WW1mYpQ-TqPLYG6omyKN0cut1Jf7gbg

02/24/2022

Great pateint care comes from great teamwork - where anesthesia and surgery, doctors and nurses, work together to save a life. There is nothing quite like having a cohesive team working efficiently in high stress situations, like this case, where a dog was bleeding internally from a ruptured mass on the spleen.

Give a shout out to your amazing team and tell them you appreciate their hard work and dedication when a job is done well👏

And as always, Safe Harbor Veterinary Anesthesia Support, LLC is always here to help your team blossom and grow 🌼 🌳 🌞

02/15/2022

Hemoglobin is red,
cyanosis is blue,
mucous membranes are pale,
so it's time to transfuse!

❤ Happy Valantine's Day from Safe Harbor Veterinary Anesthesia Support, LLC ❤

01/27/2022

Are you interested in joining a rapidly-expanding veterinary anesthesia support services practice? Does the idea of spending your work days providing a range of services such as direct anesthetic management of challenging cases, consultation, and on-site continuing education and staff training sound exciting to you? If so, then Safe Harbor Veterinary Anesthesia Support is the place for you!

Safe Harbor Veterinary Anesthesia Support is seeking board-certified or residency-trained anesthesiologists to join a team of independent contractors that provide a range of on-site anesthesia support services to veterinary practitioners around the state of Florida in accordance with our organizational mission: to provide high quality anesthesia services and elevate the standard of care of patients within the perioperative period.

Enjoy a flexible work schedule based on your life and needs in the beautiful sunshine state of Florida! Learn more by exploring our website: https://safeharboranesthesia.com

01/13/2022

Exciting new method of providing pain relief to cats with osteoarthritis was recently approved by the FDA! Check it out!

https://www.fda.gov/news-events/press-announcements/fda-approves-novel-treatment-control-pain-cats-osteoarthritis-first-monoclonal-antibody-drug-use-any?utm_medium=email&utm_source=govdelivery

FDA Approves Novel Treatment to Control Pain in Cats with Osteoarthritis, First Monoclonal Antibody Drug for Use in Any Animal Species

01/09/2022

Recently had a great case to accomplish Day 2 of our Pain Management Challenge! A young mixed breed dog was undergoing a tibial fracture repair after being found by Animal Services with a broken leg. On examination, the dog had severe wind up pain due to the chronicity of the fracture. Multi-modal analgesia is a pharmacologic strategy where combinations of analgesic agents are used for pain relief. This helps to break the cycle of pain along various stages of the pain pathway and allows practitioners to use moderate doses of individual drugs to avoid serious or debilitating side effects. Some people call it throwing the pharmacologic kitchen sink at a patient, but we call it a viable and effective pain management strategy!

For this dog, we administered Dexmedetomidine (0.003 mg/kg) and Hydromorphone (0.05 mg/kg) IV for premedication, followed by a combination of Propofol (2-3 mg/kg) and Ketamine (1 mg/kg) for anesthetic induction. Afterwards, we placed the dog on a Ketamine infusion (10 mcg/kg/min) and performed an ultrasound-guided sciatic and saphenous nerve block. Anesthesia was maintained with 0.75% isoflurane for the duration of the procedure! That evening, we were rewarded for our hard work with lots of puppy kisses, a wagging tail, and a dog that ate her entire dinner!

Here at SHAVAS we challenge you to think about how you will use a multi-modal analgesic strategy this week for your surgical patients!

01/06/2022

For Day 1 of our Pain Management Challenge, here at SHAVAS we encourage veterinary practitioners everywhere to include intra-testicular blocks along with their standard pain management protocol for neuters. In less than 1 minute of your time, you can augment analgesia for your patient with proven benefits that last into the post-operative period. 💪 For dogs and cats, inject your local anesthetic of choice into the center of the testicle, pull back on the syringe to ensure no blood flows into the needle hub, and inject until firm. For larger dogs, I tend to use 1mL of bupivacaine (0.5%) per testicle. For smaller dogs or cats, 0.5mL per testicle should do the trick. Will you use an intra-testicular block for your next neuter? I challenge you to it!

01/05/2022

We are bringing in the New Year at SHAVAS with a 5 day pain management challenge! Starting tomorrow, follow the anesthesiologists at SHAVAS as we highlight each step that will help you to create high quality peri-operative analgesia in your practice. Join us and challenge your approach to analgesia in your patients and help make 2022 the year where you up your pain management game! Are you up for the challenge?

11/12/2021

Dr. Gatson has the great honor to be selected as a guest speaker at Santa Fe Community College. She is excited to share her passion for veterinary medicine with students who are also animal enthusiasts!

09/22/2021

Continuing on with our ECG theme of the week, here is a great one! A 1 year old healthy Pit Bull under general anesthesia for a TPLO developed bradycardia and hypotension approximately 15 minutes following a lumbo-sacral epidural. Although not uncommon, we were ready to treat with a dose of atropine. Then look what happened! This type of conduction abnormality is very common following administration of anticholinergic such as atropine. My advice...don't panic! After 5 minutes, our healthy pup with back into a sinus rhythm and we were ready to start surgery. If you want more advice on how to troubleshoot these types of situations under anesthesia, consider reaching out to schedule a CE event or consultation with Dr. Gatson!