Wednesday, August 17, 2011

551. Auditing Veterinary Spays at Toa Payoh Vets - Key Performance Indicators

KEY PERFORMANCE INDICATORS FOR SPAYING A HEALTHY AND YOUNG
FEMALE DOG AT TOA PAYOH VETS

Key Performance Indicators (KPI) should also be applied to veterinary surgeries as in any other businesses to improve the performance of a practitioner, to be operationally efficient and reduce wastage of veterinary materials used. A shorter surgery means lesser risk for pets undergoing anaesthesia.

From 2011, I will be monitoring the time it takes for a vet spaying of a female dog in Toa Payoh Vets and to do that, I have had recorded two spay cases done by me in 2011.

How long does it take to spay a female dog without complications? Two cases done by me are illustrated.

CASE 1.
Fox Terrier, Female, 1 year, 9.3 kg
Last heat 3.5 months ago. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. No IV drip set up.

CASE 1. SPAYING THE YOUNG FOX TERRIER
1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 2.29pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 2.35pm.
4. Time when the skin is stitched (C) = 3.01pm.
The following key performance indicators are as follows:
C - A should be less than 35 minutes.
In this case, C-A = 32 minutes.
C - B should be less than 30 minutes.
In this case, C-B = 26 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm


DOMITOR + KETAMINE IV WITHOUT NEEDING ISOFLURANE + O2 IN HEALTHY YOUNG DOGS
At 10kg bodyweight, Domitor = 0.4 ml. Ketamine = 0.5 ml. Total = 0.9 ml in one syringe. Give via IV.

If the above is given at 50% of the calculated dosage, isoflurane + O2 top up for less than 60 seconds, to effect (eyeball rolls ventrally and other signs) will be needed. Intubation is needed. Atropine IM is advised before surgery. Antisedan IM after surgery may be useful to get the dog to wake up within 2 minutes.

Fox Terrier, 1 year, Spayed. Rigid limbs after giving antisedan
to wake up the dog early. Atropine was given to resolve the problem.



MORE DETAILS OF THE FOX TERRIER ANAESTHESIA CLINICAL RESEARCH ARE AT:
http://www.kongyuensing.com/folder5/20110326injectable-anaesthesia-dogs-cats-rabbits-guinea-pigs-toapayohvets.htm

CASE 2.
Shih Tzu, Female, 9 months, 5.3 kg
lst day of heat. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. IV drip is given before injection of sedatives.

1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 3.15 pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 3.23 pm.
4. Time when the skin is stitched (C) = 3.41 pm.
The following key performance indicators are as follows:
C - A should be less than 30 minutes.
In this case, C-A = 26 minutes.
C - B should be less than 20 minutes.
In this case, C-B = 18 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm





4411 - 4416. Spaying a dog at her first day of bleeding







How long it takes to spay a female dog?
Injection of sedative to skin stitched up
Skin incision to skin stitched up
Case 1. The Fox Terrier, 9.3 kg. Isoflurane gas top up needed. Domitor 0.2 ml + Ketamine 0.3 ml IV. Approximately 50% of the calculated dose was given. Calculated dose should be Domitor 0.37 ml + Ketamine 0.47 ml IV would not need isoflurane gas top us
32
26
Case 2. The Shih Tzu, 5.3 kg. No need isoflurane gas top up as the calculated dose is given. Domitor 0.2 ml + Ketamine 0.25 ml IV.
26
18
If there is no need to top up with isoflurane + oxygen gas, the time taken from skin incision to skin stitched can be as fast as 18 minutes since there was no time wasted in topping up the anaesthesia and the hooking out of the ovary can be successfully done within 3 hooks.

Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy and young dogs and cats
Weight & Health Status
Domitor
Ketamine
10kg healthy, young female dog
0.4 ml IV
0.5 ml IV

Domitor 5-40ug/kg = 0.005mg/kg-0.04mg/kg
Ketamine 2-5mg/kg
Heart-diseased dogs - Do not use domitor + ketamine. Old dog - Use less domitor or 50% of the calculated dose. I will just use isoflurane + O2 gas solely if the dog is in poor health rather than taking risk with Domitor or Domitor + Ketamine IV.

Domitor and ketamine are synergistic and their combined use will be safer if injectable anaesthetics are required and no isoflurane gas is available. For healthy young dogs, use the calculated dosage given above. For heart-diseased dogs, use 50% of calculated dose and give isoflurane gas top up. Do NOT use domitor + ketamine is heart-diseased dogs.
I have around 30 years of small animal practice. I founded Toa Payoh Vets in 1980 and it is 2011 now. So practice makes perfect. The faster the surgery is done, the lesser the anaesthetic risk to the dog. So, I will be auditing veterinary surgery done by myself and vets at Toa Payoh Vets from 2011 onwards.


As I don't know how to lay tables properly at blogger.com, the proper layout and article is at:
http://www.sinpets.com/F5/20110816domitor-ketamine-spay-fox-terrier-26minutes_ToaPayohVets.htm


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