Monitoring anaesthesia when the team is small

A procedure in practice may involve three people: a surgeon, a veterinary nurse and an assistant. On paper, everyone knows their role. Then, mid-surgery, the surgeon needs something, the assistant is already busy, and the person monitoring is asked to help.

I see this in very different clinical settings. Whoever is monitoring the anaesthetic may also prepare the patient and set up the instrument table. They may open supplies and deal with whatever comes up. Sometimes jobs with no immediate link to the procedure pile on too: answering the phone, writing discharge instructions, checking stock, washing equipment.

Asking people to pay more attention misses the point: the same person is answering several demands at once. When they all look urgent, something gets left undone.

The record is the first thing to go

In my experience, documentation is often the first task to be interrupted. The person monitoring keeps trying to follow the patient and help the team, but they can no longer write things down regularly.

Two separate problems are hiding here, and they can occur together. One is losing information about what happened, and the other is missing a change as it happens.

An incomplete chart does not prove the patient went unobserved. Equally, a run of automatically saved values does not prove anyone interpreted them or responded when it was needed. Documenting, observing and being able to intervene are different things.

Who is responsible for the anaesthetic

The 2025 ACVAA guidelines include a professional dedicated to anaesthesia. They also stress the presence of trained, vigilant personnel in the perianaesthetic period ¹. That standard still stands when a small team finds it hard to meet.

Responsibility only works if the conditions to exercise it are there. The designated person may also be assisting with surgery, or doing jobs for other parts of the practice. Giving them the title leaves that conflict in place.

A professional category is only part of it: training, competence and supervision all count too. How duties are allocated has to comply with local rules. The AAHA guidelines put weight on team training ². This includes equipment, interpretation of monitoring information and preparation for emergencies.

Monitoring involves observing the patient, interpreting the data available and recognising when to act. AAHA recommends combining hands-on assessment with electronic monitors ³. That covers respiratory and cardiovascular function, anaesthetic depth and temperature. The equipment gives important information, but it does not do all of that work for the team. A number on the screen has to be read in the context of the patient and the procedure.

The surgeon can contribute to that assessment, but their attention is also tied up in the surgery. As I see it in practice, a monitor that several people can see does not replace explicit responsibility for the anaesthetic.

What can wait and what needs help now

Getting supplies and equipment ready before induction may cut down on predictable requests. Unexpected help may still be needed during the procedure, and preparation does not create a fourth person.

A list of good practice may assume someone is always free to take calls, open supplies or relieve the person monitoring. In a three-person team, everyone may already be busy, and then the list is of little use.

It is more useful to start from the work that actually happens. Which tasks pile up? Which can wait? Which need two people at the same time? The aim is to make the conflict visible, without blaming poor organisation or lack of commitment from the people in the room.

Interruptions come in different kinds. Opening supplies the procedure needs is different from updating a stock list. Seeing that difference helps the team spot requests that can be put off, even though the staff shortage remains.

As an organisational proposal for discussion, one review makes sense: which administrative or maintenance jobs are still given to the person monitoring? Sometimes nobody else is free to take them, and some will simply have to wait.

When the need arises during surgery, the conflict is harder: the team has to communicate it and weigh it against the clinical situation. A checklist can only work with the staff the practice actually has.

One question is worth asking before the procedure: what happens to monitoring if the person responsible has to assist the surgeon? The answer may show that the planned resources fall short of particular demands. If so, the organisation and the conditions for doing the procedure need discussing. Assuming one person will absorb everything is no answer.

If responsibility is handed over, I suggest the handover be explicit and accepted by the person taking it on. If there is no one to hand over to, we should not write a protocol as if there were. None of this is a universal clinical protocol, and each practice will need to adapt it to its own circumstances.

Recovery

The need for vigilance continues after surgery ends. AAHA recommends continued attention to the recovering patient ³. That means trained personnel and monitoring of relevant parameters.

In a small team, recovery can coincide with cleaning the theatre, getting the next case ready and other requests. So recovery belongs in the discussion about resources from the start. Who stays with the patient? How is information handed over?

Deciding who stays by the monitor during surgery achieves little if responsibility becomes unclear afterwards.

Where technology may help

Automatic capture may help preserve the data shown on the equipment and save some transcription work. A timeline may make the case easier to review.

How useful this is depends on the quality of the capture and on being able to check for errors and gaps. We should not assume that a digital system records everything, or that it always interprets its inputs correctly.

VetNoa is being developed to support data capture from existing monitors and the organisation of information over the course of a case. That support does not provide an extra person: nobody new is there to assess the patient, assist with surgery or carry out an intervention. Technology may ease specific tasks, but the team still needs the conditions to observe, interpret and act.

Questions for team discussion

Adapt these to your practice: they are not a protocol that guarantees safety.

• Who has explicit responsibility for the anaesthetic at each stage?
• Which simultaneous tasks are given to that person?
• Which of those tasks can be put off?
• What happens to monitoring when the surgeon needs help?
• Is there a real possibility of handing responsibility to someone with appropriate competence?
• Are the planned resources compatible with the demands of the case?
• Who monitors recovery and receives the handover?
• Does the record distinguish available data, gaps and interventions?