Sunday, December 18, 2011

780. Dr Sing's spay complications - report by Intern Kim

A COACHING SPAY SURGERY FOR MY ASSISTANT MR MIN AND INTERN KIM
- CORPUS LUTEUM

On Dec 18, 2011, a fine Sunday morning, I spayed a cat. There were 2 cats that came in for spaying. Normally my cat spays without complications take less than 15 minutues but this cat had some bleeding complications, being pregnant and has the corpus luteum.

Kim, the intern was able to see her first spay done by me. She sees practice on Sundays only whenever she is free. I asked her to write a report as writing can make her learn more. Here is her report (with my amendments in CAPITAL LETTERS):

Cat early pregnancy spay

3kg


Start time: 9.45am (SEDATION GIVEN IM. XYLAZINE 0.15 + KETAMINE 0.6 ML IM)
Start of surgery = SEDATION GIVEN

9.59am
Cut the skin (FIRST INCISION SKIN)

10.02am
Left ovary hooked out

10.07am
Scapel blade was used to cut off left ovary (CUT OFF LEFT OVARIAN LIGAMENTS AFTER LIGATION OF LIGAMENTS AND BV)

10.08am
Front paws were untied and body lifted up, cat started meowing (THE CAT WAS TILTED UPWARDS TO ASSESS THE RIGHT UTERINE HORN EASIER)

10.09am
Right ovary cut out

10.10am
Scapel blade was used to cut off Right ovary

10.13am
Extend incision bleeding (COPIOUS HAEMORRHAGE OBSERVED, USUALLY OMENTAL FAT BLEEDING)

10.16am
Slow breathing observed (I CAN'T FIGURE WHY INTERN KIM WROTE THIS AS CAT WAS UNDER INJECTABLE ANAESTHESIA)

10.17am
Ligate individual uterine twine (UTERINE HORNS)

10.18am
Check breathing again
Extend incision around 5mm
Clamp Uterine body
Check bleeding

10.20am
Bleeding controlled
Suspect torn uterine blood vessel

10.23am
Transfixing ligature uterine body to control bleeding

10.27am
(Cat on heat)
Bleeding again from ovarian fat


10.28am
Swab blood
Cut off uterine body

10.30am
Simple interrupted suture
Bleeding stop
Linear alba 3 stitches 3cm (LINEA ALBA 3 SIMPLE INTERRRUPTED SUTURES. 3 CM LONG)

10.32am
Check linear alba for hole
Stitch skin using horizontal mattress 2 stitches
Skin incision estimated to be around 3cm

10.33am
End of suture


Surgical time: First skin incision –> last stitch = 9:59- 10:33= 32mins
Operation time: Sedation-> Last stitch = 9:45- 10:33= 47mins
Suture used: 3/0 (ABSORBABLE PDS)
Amount used: 1 packet
Sedation dose: Isoflurorane gas 2% (NO ISOFLURANE GAS WAS GIVEN. XYLAZINE AND KETAMINE IM).

Conclusion by Dr Sing.
A good first draft written under time pressure. Vet interns are to write on their own first draft instead of being spoon-fed and then I will amend their report.

Corpus luteum yellow seen. Also small foetal lumps of 8 mm inside the uterine horns seen (Images taken). The cat owner was adamant that her cat Manja, 6 months old, had never been out or mated with another cat!

No comments:

Post a Comment