Updated anesthesia-monitoring guidelines balance high-tech tools, practicality

The American College of Veterinary Anesthesia and Analgesia (ACVAA) has revised and expanded its guidelines for monitoring small animal patients during sedation and anesthesia, marking the first major update since 2009.

Developed in collaboration with the North American Veterinary Anesthesia Society and the Academy of Veterinary Technicians in Anesthesia and Analgesia, the 2025 guidelines go far beyond the previous edition. The document contains updated recommendations on monitoring cardiovascular function, oxygenation, ventilation, body temperature, neuromuscular blockade, and anesthetic depth in canine and feline patients.

Published online by the journal Veterinary Anaesthesia and Analgesia in March and appearing in print this May, the new guidelines also emphasize the importance of cognitive aids and team communication tools such as checklists to help veterinary professionals manage complex or high-stress situations more effectively.

Not to mention, protocols for monitoring sedated patients, a topic that went largely unaddressed in the previous edition, have been included this time around.

Dr. Lydia Love, lead author of the 2025 guidelines, emphasized the importance of monitoring anesthetized and sedated animal patients.

“All anesthetics are essentially toxins. They’re therapeutic because we control the dose, but they can compromise cardiovascular and respiratory function. That’s why robust monitoring isn’t optional, it’s lifesaving,” explained Dr. Love, an associate clinical professor who specializes in veterinary anesthesia and analgesia at North Carolina State University College of Veterinary Medicine.

What’s new

The veterinary profession has more monitoring tools available now than ever before, and using them properly can drastically improve patient outcomes, Dr. Love continued.

One such tool is capnography, a technique used for monitoring carbon dioxide levels in a patient’s exhaled breath. While commonly used to assess ventilation, capnography can reveal so much more, she said, including cardiac output, pulmonary perfusion, proper intubation, and equipment integrity. It can even help detect and differentiate the causes of hypoxemia.

“Capnography gives you so much insight into the patient’s physiology that people may not even realize. It’s underused and undervalued, and that needs to change,” Dr. Love said.

The guidelines also address neuromuscular blocking agents, a class of paralytic drugs that carry the risk of residual paralysis if not properly managed. Dr. Love pointed out that prior standards relied too heavily on subjective signs, such as spontaneous breathing. The updated guidelines push for objective neuromuscular blockade monitoring to ensure patients regain the ability to breathe and swallow independently before extubation.

The guidelines also provide specific recommendations on communication.

For one, direct and frequent communication of patient status should occur between the anesthetist and the veterinary team, including the surgeon.

Client communication is especially key because most pet owners focus on the surgical procedure when considering costs and often don’t realize the associated costs of advanced monitoring or its importance.

“It’s a hard sell, but anesthesia is where things can go wrong fast. It deserves as much attention as the surgery itself,” Dr. Love said.

What’s ahead

The authors say the 2025 guidelines were developed based on objective, evidence-based criteria, and a consensus of expert opinion and clinical experience.

Looking ahead, Dr. Love is clear: Another 16-year gap between updates isn’t acceptable. She recommends a review every eight years and a new edition by year 10.

She also sees enormous potential in big data and artificial intelligence (AI). Clinics using digital monitoring systems are already collecting vast amounts of data. In time, AI could help analyze that data and suggest tailored anesthetic protocols for individual patients.

“Imagine an AI tool that recommends a balanced, multimodal protocol based on real-time data from the patient in front of you,” Dr. Love said.

Until that day, the updated guidelines recommend using a surgical safety checklist tailored to the environment and used by anesthesia and surgical teams to ensure quality standards and assess perianesthetic communication. Such a tool can help reduce the mental load during high-stress situations and ensure critical steps aren’t overlooked.

“You want something that helps you think clearly when things start falling apart,” explained Dr. Love, who is now developing a digital app to support these checklists in veterinary settings.

For now, the guidelines note the choice of monitoring techniques and methods may vary depending on the spectrum of care and scope of practice.

Dr. Love acknowledged that many veterinary clinics cannot afford to implement all the recommendations outlined in the guidelines. Not every clinic can afford to have a board-certified veterinary anesthesiologist on staff or advanced monitoring equipment. To help overcome these challenges, the guidelines include minimum recommendations alongside advanced options.

“We worked hard to make this adaptable,” she said. “If a practice doesn’t have capnography, we suggest alternative methods that can still offer some insight. The goal is to set a realistic baseline for safe care without alienating clinics that have fewer resources.”

A version of this story appears in the June 2025 print issue of JAVMA