28/11/2014

Pain, protocols and future progression in anaesthesia – an exclusive interview with Matt Gurney, RCVS & European Specialist in Veterinary Anaesthesia & Analgesia.

matt gurneyMatt Gurney is renowned for his anaesthesia and analgesia expertise, not just in the UK but internationally. Having set up the anaesthesia service at North West Surgeons in 2006, he is now one of the directors of the referral center. His roles also include Chair of the Credentials and Education Committee of the European College of Veterinary Anaesthesia & Analgesia, where he sits on the Executive Committee.

In addition to his duties at North West, Matt regularly lectures to vets and nurses across Europe and contributes to veterinary journals and veterinary press. In this exclusive interview, Matt gives us an insight into the current state of play in veterinary anaesthesia, describes how the veterinary field compares to human anesthesia and gives his opinion on what’s in store for the profession in the future.

Can you give me an overview of your background and how you got to where you are now?

I graduated from Liverpool University where I was always in awe of the anaesthetists during our rotations – I never thought I’d be clever enough to become one myself though! However, doing a residency was always something which appealed to me as I wanted to master something specific rather than being a jack of all trades. After spending two years in mixed practice, I wasn’t ready to specialise in terms of species and anaesthesia seemed like the ideal discipline to apply across the board. It just so happened that a residency came up just at the right time and I’ve never looked back.

Which areas of anaesthesia and analgesia particularly interest you now?

I’m really keen on local anaesthetic techniques and managing acute and chronic pain. I think these are areas which can have a huge impact on the anaesthetic outcome and overall welfare of the patient. I also find the many associated challenges really interesting.

How has the field of anaesthesia changed since you’ve been practising?

It’s always rapidly evolving – mainly to try and keep pace with human medicine. However, we are always a little behind when you assess it from a morbidity and mortality point of view. Although, when you think that for humans there will always be a specially trained anaesthetist doctor overseeing the operation and compare this to veterinary patients where it is up to the vet nurses who have a million different roles, perhaps this isn’t surprising.

I think that this will always be the case but luckily nurses are more than capable. The key will be in practices recognising the need for specialist training for their nurses and listening to those that express their interest in learning more about anaesthesia – which in my experience, most do! Nurses are always attending the free CPD, but there needs to be more investment by practices in paid-for CPD. There’s definitely a lot more scope for development in this area.

What do you think might drive progression in the field?

Vets need to accept that there are some things that nurses should know more about than they do – anaesthesia being one of them. We are already seeing vet nurses becoming more empowered and their roles expanding. We will always be bound by legislation over what nurses can and can’t do but there’s nothing stopping vets from allowing nurses to take on anaesthesia as their domain and improving their expertise. Ultimately vets and nurses need to work together and a lot of it will come down to the relationship between the vet and nurse.

Tailored CPD for individual practices also works really well and I think there will be much more focus on bespoke CPD in the future. We already see groups of vets and nurses coming from the same practice to learn together, which is really effective. The nurse has to understand what the vet is doing to be able to perform a top class anaesthetic and this works both ways.

What change do you think has had the most impact on veterinary anaesthesia?

There’s definitely more of an interest in pain and recognition for the importance of effective analgesia. In fact, now we include analgesia as an equal part of anaesthesia. I also think we train our students really well now but when they get into practice they often feel pressured into using the protocols and practices of their mentor. I think sometimes the older generation get stuck in their ways and need to be open to trying new things and progressing in-line with our ever increasing knowledge.

What are the most exciting new developments?

I think (and hope) the next breakthrough development may be more options for longer term pain management in cats. Whenever a pharmaceutical company asks me what new drug would I most like to see developed, that’s always my answer.

Can you remember your first ever anaesthetic case?

I think it was probably a standard bitch spay at the small animal teaching hospital in Liverpool. As far as I remember all went well unless I have repressed another more traumatic memory!

Which cases do you find most challenging?

Cardiac patients and multi-trauma cats are often tricky. Cardiac patients are difficult because there are usually complex alterations in physiology to account for. Trauma patients can range from having the most satisfying to the most disappointing and upsetting outcome, which is often unpredictable.

You’ve obviously had involvement in overseeing and lecturing across countries through your involvement with the European College of Veterinary Anaesthesia & Analgesia. Are there any key differences in the approach of different countries to veterinary anaesthesia?

There are very varied numbers of anaesthetic specialists across the European countries. For example, France was slow to realise the key role of the specialist and currently there are hardly any Eastern European anaesthetists – but this is certainly changing. We’re seeing the playing field level across Europe, with a spread of specialists into Eastern Europe being the next frontier. In fact, the Association of Veterinary Anesthetists (AVA) annual congress will be held in Prague next year.

What is the one piece of equipment that you couldn’t live without?

It has to be the oesophageal stethoscope. It’s cheap and simple and gives you valuable information.

Do you think there is a particular piece of equipment that is underused by general practitioners?

Definitely the Doppler blood pressure monitor – it’s not just for the old hyperthyroid cat and should be used for every anaesthetic to increase familiarity, then when we really need it we understand the readings it is giving us.

What cases do you get referred to you the most at North West Surgeons?

About 40 % of our caseload are elective orthopaedic cases. I like them because they are amenable to most local anaesthetic techniques but pain management and dealing with post-operative complications can be challenging. The variety that comes with the soft tissue work adds to the excitement. The best part of the job is the fact that we are multidisciplinary and can really offer the best level of care to every patient.

What’s your one piece of advice for vets faced with developing a protocol for a really challenging case?

Don’t forget the basics – especially when it comes to monitoring. Whenever something happens that you’re unsure of, reassess the patient and adjust the depth until you feel happy that you’re in control again.

What are the hot topics in the anaesthetic world right now?

There’s an increasing interest in patient safety and development of checklists which mirrors development in human medicine. For example, the AVA has just developed an anaesthesia checklist for vets and nurses. It’s a really great initiative which details an easy to follow checklist of the machine aspects on the front and the patient aspects on the back. They are basically the kinds of things I go through in my head automatically but it is a really useful prompt to make us all stop and think logically. It’s such a simple process but, like any change, getting people to implement it will always be a challenge.

To find out more about Matt or North West Surgeons just visit http://nwsurgeons.co.uk/

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