CPE Anesthesia Station Breakdown: What’s New Starting July 2026

For many international veterinarians preparing for the Clinical Proficiency Examination (CPE), the anesthesia station can feel like one of the most intimidating parts of the exam. It requires more than knowing anesthetic drugs and protocols. Candidates must demonstrate organization, communication, patient safety, technical skill, and the ability to move through a detailed workflow under time pressure. With the newly published memorandum, there is even more uncertainty!

The CPE anesthesia station is designed to evaluate whether you can safely and confidently manage an anesthetized patient from protocol planning through surgical preparation and monitoring.

Here is a breakdown of what to expect, where candidates commonly lose points, as well as what has been changed:

Part 1: Removal of Drug Protocol and Calculation Station (Day Before)

The anesthesia process used to begin before you even met your patient.

During the drug protocol and calculation station, candidates were expected to:

• Select appropriate anesthetic drugs

• Design an anesthesia protocol

• Calculate concentrations and dosages based on the provided patient weight

• Justify the reasoning behind each selected medication

This section is now gone. This simplifies the process on the one hand, making it easier for less experienced candidates; however, experienced anesthetists will miss the lack of choice and autonomy.

Part 2: The Anesthesia Station

Candidates will work with one female dog per candidate, typically weighing 6–28 kg and with a body condition score of 2–4/5.

The station begins with requesting your patient from the staff.

Step 1: Pre-Anesthetic Evaluation (remains unchanged)

Before any medication is administered, perform a complete pre-anesthetic assessment, as previously required.

You will need to:

• Obtain a proper history

• Perform a physical exam including a distance exam

• Request and interpret blood work

• Assign an ASA classification

• Identify any risks that could affect anesthesia based on ASA

• Document all steps in the anesthesia sheet

Skipping important evaluation steps can result in major flaws because patient safety is the priority.

Remember: anesthesia is not just about putting a patient under. It is about recognizing risk and creating a safe plan.

Step 2: Premedication (This is new!)

Previously:

You would prepare medications in the syringe and then administer the premedication IM (drug choice, dosage, and injection location matter)

NEW:

• CPE site staff administers the premedication

• The candidate will be given in writing the premedication drugs used, the time, dose, and location/route of administration.

Step 3: Preparing the Anesthesia Machine (remains unchanged)

After premedication is administered, you should explain to the technician, just like before, what is to be expected as a consequence of the premed, give them easy-to-follow instructions (check every 5 minutes, don’t give any food or water, clean up vomit, bring the dog back in 20 minutes). Use your time wisely while your patient is away with the technician to allow for the premedication to take effect.

Organize your workspace and prepare:

• Breathing system

• Reservoir bag

• Anesthetic machine

• Endotracheal tubes

• Catheters

• Fluids

You should be ready to explain:

• Why you selected your breathing system (rebreathing versus non-rebreathing and why)

• How you selected tube and bag sizes (there is an empirical formula you must use); comparing to nostrils or eyeballing is inadequate

• Oxygen and gas flow rates

• How the anesthetic circuit functions

Candidates must also demonstrate a leak check of the anesthetic machine.

Be ready to discuss:

• Soda lime

• Scavenging systems

• Circuit safety

Step 4: IV Catheter Placement and Induction (remains unchanged)

When your patient returns, you will need to:

• Communicate clearly with your technician how they should assist you

• Place and secure an IV catheter using aseptic technique. 

  • A critical step:  Here is where most people get eliminated as they unknowingly contaminate the catheter.

• Confirm catheter placement and patency before induction

Another critical step:

Always call the examiner to check catheter placement before administering induction drugs.

After induction:

You should confirm the appropriate anesthetic depth before intubation.

Signs include:

• Relaxed jaw

• No blink reflex

• No tongue withdrawal

• Appropriate muscle relaxation

Then:

• Intubate the patient

• Confirm tube placement

• Check cuff inflation by performing the minimal occlusion method or hiss test

• Secure the tube

• Connect the patient to the anesthesia machine

• Turn on all the gases

• Open the pop-off valve after giving a few breaths

Critical Step: The five- and three-minute windows are to ensure that no more than five minutes pass between pushing the induction agent (e.g., propofol) and the gases correctly flowing to the patient, as well as no apnea going uncorrected for longer than 3 minutes after intubation.

Many candidates fail this step: Within 5 minutes of the start of administration of the induction agent, the candidate will intubate the patient, secure the endotracheal tube, appropriately inflate the cuff, and connect the endotracheal tube to the anesthetic machine with inhalant anesthetic and fresh gas flow rates set at appropriate levels to bring the patient to a surgical plane of anesthesia. Failure to complete all those tasks within the 5-minute limit will result in immediate dismissal of the candidate and a failing score for the Anesthesia Section.

Refer to Dr. Thompson’s demonstration to ensure your flawless performance during this difficult step. 

Step 5: Maintaining the Patient Under Anesthesia

Once the timer goes off, the examiner will step in and verify that the previously described three- and five-minute checkpoints are all correctly carried out. If you are permitted to continue, you can now hook up the fluids:

From here on out, candidates must demonstrate proper anesthesia management.

This includes:

• Setting oxygen flow to maintenance

• Managing the pop-off valve correctly when giving breaths

• Checking cuff inflation periodically

• Adjusting anesthetic gases

• Recording vital signs

• Monitoring analgesia and readministering pain medication if needed

One important safety point:

Never leave the pop-off valve closed after giving breaths. Improper management can create dangerous pressure changes, which would be an immediate fatal flaw.

Throughout the procedure, monitor and record every five minutes from the moment that the induction agent is given.

• Heart rate

• Respiratory rate

• Blood pressure

• Oxygenation

• End tidal CO₂

• Anesthetic depth

When the patient is stable and reduced to maintenance gas rates, and fluids are going, it is time to call the surgeon. Make sure you don’t forget this step. People have failed because of this.

Step 6: Assisting During Surgical Preparation - Clipping and Dirty Scrub (Some Changes)

Before surgery begins:

In the past, the surgical candidate would instruct the team to help them perform the clipping and scrubbing of the patient. In the new MOA of July 2026, the CPE site staff covers this step, including the transport to the surgical suite. You still will ensure safe anesthesia maintenance during this phase:

• Turn off gases temporarily so you don’t contaminate the room with anesthetic gases.

• Disconnect the patient from the hose, turning them into dorsal recumbency, and reconnecting the ET tube appropriately.

• Turn the gases back on, give a breath, and listen for correct cuff inflation again.

• Now the staff can clip and scrub the patient. 

• You will again turn off the gases, disconnect the patient, and jointly with the staff roll the prep table to the surgical suite. Like before, you will assist in lifting the patient from the dirty prep table to the clean surgical table. 

Once positioned, you will place monitoring equipment such as:

• Blood pressure cuff

• Pulse oximeter

• Capnograph

• ECG leads, though staff may help

• Verify that your fluids are still going

In the new version of the MOA in July 2026, ONLY NOW the surgical candidate will join; they may adjust the positioning if they wish, they will perform the second clean scrub, and then ready themselves for the surgery. 

Step 7: Intraoperative Monitoring (One big change)

During surgery, your role is active monitoring. You are expected to recognize and respond to changes.

Watch for:

• Tachycardia

• Tachypnea

• Increased blood pressure

• Hypotension

• Arrhythmias

• Hypercapnia

Pain management is also evaluated. A patient showing signs of inadequate analgesia requires an appropriate response.

Simply recording abnormal values without intervention can result in a major flaw.

BUT, the big change is that you are only expected to maintain the patient stable through the removal of the first ovary, and you can leave shortly after, when the examiner releases you. This removes the difficulty of managing a very long anesthesia that is otherwise influenced by surgeon skill level. 

Documentation and Communication Matter

The anesthesia record should be completed accurately throughout the station.

Examiners are evaluating more than technical skills. They are looking for a safe veterinary professional who can:

• Communicate with the team

• Explain decisions

• Handle patients appropriately

• Stay organized under pressure

Timing and Efficiency

The entire anesthesia process must be completed efficiently. Candidates should aim to have everything prepared within the required time frame. A disorganized approach can create unnecessary delays and increase the risk of mistakes.

The anesthesia station is not about memorizing a script. It is about demonstrating a consistent, safe, and logical approach every time. Practice the sequence, know your equipment, understand your drugs, and communicate every step clearly. That is what examiners are looking for.