Anesthesia monitoring parameters and checklists for dogs and cats

Doses on this pageEvery dose below is quoted from the cited source. Verify against the current label/formulary and the patient's full clinical picture.

Sources and their limits

The full text of the 2025 ACVAA Small Animal Anesthesia and Sedation Monitoring Guidelines could not be obtained for this page. What appears here about the ACVAA document comes second-hand, from a 2025 interview with guideline co-author Dr. Lydia Love published by Today's Veterinary Practice [1]. That interview describes the guidelines' structure and main changes but does not reproduce their recommendation tables [1].

The numeric values come from two 2012 peer-reviewed articles in the same publication by Jeff Ko, a Diplomate ACVA, and Rebecca Krimins [2][3]. They reflect those authors' published ranges, and readers should not treat them as any college's current standard. The checklist implementation data come from one study at the University of Bern small animal teaching hospital [4].

Before induction

Love said the 2025 guidelines sort recommendations into three tiers [1]:

• minimum monitoring for any clinical setting
• alternatives for settings where the minimum is unavailable
• advanced monitoring for patients with coexisting disease, unstable conditions, or advanced interventions

She described the tiers as an attempt to address spectrum-of-care concerns across practices with different economic and ethical environments [1].

Items a practice could adapt, each attributed to the source that describes it:

• A standardized anesthesia checklist, including an equipment checklist, completed by the anesthetist before anesthesia begins, per Love's description of the guidelines [1].
• Emergency drug and reversal agent doses calculated before sedation or anesthesia and kept at hand, with a digital or printed spreadsheet suggested, according to Love [1].
• A dedicated anesthetist who stays with the patient throughout, which Love said the guidelines emphasize [1].
• A peripheral nerve stimulator whenever neuromuscular blockers are planned, because, as Love put it, normal neuromuscular function "cannot be determined by subjective means" [1].
• Confirmation of the animal's identity and the responsible veterinarian, the two "sign in" items chosen by the Bern expert panel [4].

Love cited her own study in which introducing an equipment checklist in a veterinary student live animal laboratory was followed by an 88% reduction in equipment set-up errors [1]. The interview does not give the study's design or sample size [1].

Love also said the guidelines now describe sedation as a continuum from conscious to anesthetized. They give separate monitoring recommendations for mild, moderate, and deep or profound sedation, because critical abnormalities can occur during sedation [1]. The interview does not list those sedation items, so they are not reproduced here.

Circulation monitoring

Ko and Krimins describe circulation monitoring as combining ECG, blood pressure, and hands-on patient assessment [2].

• ECG. Ko and Krimins advise continuous ECG through the perioperative period for heart rate and rhythm [2]. They caution that ECG shows electrical activity only. In electromechanical dissociation the tracing continues without a pulse, so ECG should not be the sole circulatory monitor [2].
• Invasive blood pressure. Ko and Krimins call an arterial catheter "the gold standard for BP measurement" [2]. It gives beat-to-beat values and access for arterial samples, at the cost of technical skill, equipment, and maintenance [2].
• Doppler ultrasound. Per the same authors, it measures systolic pressure only, must be read manually each time, and can be hard to obtain during vasoconstriction or hypotension [2].
• Oscillometric monitoring. The authors note it reports systolic, diastolic, and mean pressure and can run automatically [2]. It is motion-sensitive and less accurate, especially in cats and small dogs. They recommend a cuff width of 40% of limb circumference [2].

Ko and Krimins define a serious arrhythmia as one that changes rate or rhythm enough to affect blood pressure. They describe the balance between heart rate and blood pressure as a key consideration in deciding whether to treat [3].

For hypotension, they list these checks [3]:

• cuff size
• heart rate and rhythm
• anesthetic depth
• acid-base and electrolyte status

These are followed by some combination of reducing depth, fluids, and vasopressor or inotrope support, with ephedrine named among the options [3]. They suggest noninvasive readings every 1 to 2 minutes while titrating inotropes. They also warn that severe hypotension can make noninvasive readouts incorrect, so Doppler or invasive monitoring may be needed in critically ill patients [3].

Ventilation and oxygenation monitoring

• Capnography measures end-tidal CO2 (ETCO2, the CO2 level at the end of each exhaled breath). Ko and Krimins list its uses as detecting the following [2]:
• apnea
• hypoventilation
• disconnection
• obstruction
• cuff leaks
• exhausted CO2 absorbent
• faulty one-way valves
• esophageal intubation

Love added that capnography is essential for judging CPR effectiveness [1].

• Pulse oximetry measures hemoglobin oxygen saturation (SpO2). The authors note it can be disrupted by motion, ambient light, poor peripheral perfusion, electrocautery noise, abnormal hemoglobins, and dark pigmentation [2].
• Respirometry measures tidal and minute volume. Ko and Krimins describe it as most useful for sorting out whether rate or tidal volume is the problem when CO2 is high [2].
• Blood gas analysis gives PaCO2 and PaO2. The authors report that venous pH is an acceptable stand-in for arterial pH, but venous and arterial CO2 may not agree well enough to judge ventilation [2].

Ko and Krimins add that ETCO2 typically reads 5 to 10 mm Hg below PaCO2 under anesthesia because of increased alveolar dead space [2]. They list a sudden ETCO2 drop as a possible sign of low cardiac output, cardiac arrest, or pulmonary embolism. They list an ETCO2 typically below 7 mm Hg as suggesting esophageal intubation [3].

Reference values from the 2012 articles

The two articles differ on hypoxemia. The device article uses SpO2 of 90% or less [2]. The companion article pairs PaO2 below 60 mm Hg with a pulse oximetry reading below 92% [3]. Ko and Krimins also note that some textbooks set the systolic hypotension cutoff at 80 mm Hg rather than 90 [3].

Depth, temperature, and laboratory checks

• End-tidal inhalant concentration. MAC (minimum alveolar concentration) is the level preventing purposeful movement in 50% of animals at skin incision. Ko and Krimins describe a surgical plane as usually 1.3 to 1.5 times MAC, and maintenance above 1.5 to 2 times MAC as likely very deep [2]. They give isoflurane MAC as 1.28% for dogs and 1.63% for cats [2].
• Temperature every 5 to 10 minutes until the patient reaches sternal recumbency, per the same authors [2].
• Serial PCV and total protein to guide fluid and transfusion decisions in some surgical cases [2].
• Blood glucose, which the authors flag as especially relevant in pediatric, diabetic, and septic patients [2].
• Serial lactate as a trend for tissue perfusion [2].
• Urine output in patients with renal failure, severe dehydration, or acute hemorrhage [2].

Ko and Krimins cite a review of 1,281 anesthetized dogs in which 63% had hypoventilation, 38% had hypotension, and 16% had hypoxia [3]. The article does not describe that review's methods.

Responding to alarms

Ko and Krimins advise examining the patient first whenever any monitor alarms, to separate equipment faults from true physiologic problems [3]. Their bedside items:

• Eye position and palpebral or corneal reflexes [3]
• Toe pinch withdrawal [3]
• Pulse and heart rate [3]
• Mucous membrane color and capillary refill time [3]
• Chest excursion, plus heart and lung auscultation [3]

They list these common sources of false alarms [3]:

• loose ECG leads
• electrical noise
• motion
• misplaced pulse oximeter probes combined with vasoconstriction
• wrongly sized blood pressure cuffs

They also warn that frequent false alarms can erode the anesthetist's vigilance [3].

Team checklists through recovery

Love said the 2025 guidelines recommend surgical safety checklists tailored to each setting. They also recommend standardized handoff checklists when care is transferred, particularly in early recovery [1].

The Bern study modeled its checklist on the WHO surgical safety checklist [4]:

• Time out, before the procedure: introductions of everyone present, identity confirmation, anesthesia-surgery discussion of possible complications, and antimicrobial prophylaxis. This was later expanded to radiograph display, eye drops, and the number of swabs available [4].
• Sign out, at the end: postoperative plan, recovery organization, swab count, and bladder palpation and emptying [4].

Fifteen anesthesia specialists, residents, and doctoral students built the list in a Delphi process (structured rounds of expert ranking) [4]. Direct observation covered 69 cases after the first rollout and 64 after the second. Average time-out length was 25 seconds and then 16 seconds [4].

In a survey answered by 19 of 32 users [4]:

• 14 said communication improved
• 9 said the checklist prevented mistakes, all involving antimicrobial prophylaxis
• 10 found it time consuming

The authors noted three limitations: they had no baseline complication rates, the observer's presence may have influenced use, and some items were checked but not recorded [4].

Our read is that the study speaks more to implementation than to outcomes. The authors tied the weak first rollout to three problems: no responsible person, too few printed copies, and a surgical design applied to all anesthesia cases [4].

Before using any dose aboveVerify against the current label/formulary and the patient's full clinical picture.