Friday, February 24, 2012

885. Veterinary Surgery Audit at Toa Payoh Vets by Dr Sing Kong Yuen

There is a need to be efficient and productive when vets operate at Toa Payoh Vets.
1. Name of file - 2012TPV Anaesthesia Record
TP Reference - 42373
Date of surgery - 24.2.12
Name of owner/representative: Mr ...

2. Patient
Name:
Age: 15 months
Weight: 5.8 kg
Temp: 38.6C
Microchip No.
3. Surgery
Procedure: Spay. Vet: Dr Sing Kong Yuen
Suture type: 2-0 Polysorb (Braided lactomer, Cutting 3/8 24 mm)
Suture packets used: One packet
Spay certificate No: 1675
4. Anaesthesia
Induction Drugs: Domitor + Ketamine IV
Dose calculation
Weight (kg)
Age
Dom
Ket
10
Young
0.4
0.5
5
Young
0.23
0.29
Given 50 %

0.1
0.15

One syringe with 0.25 ml. I added 0.15 ml normal saline = 0.4 ml IV
Top up
Isoflurane + O2 at 0.5-1
% for 21 minutes (C-B)
Isoflurane graph charting % at 5-minute intervals

Summary:
Isoflurane maintained at: 0.5 - 1.0% for 21 minutes
Route: IV
A. Time of injection of induction drug: 5.07pm
B. Time of isoflurane gas first given: 5.11pm
C. Time of isoflurane gas stopped: 5.32pm
D. Time of first skin incision: 5.17pm
E. Time of completion of skin stitching: 5.33pm
E-A = 26 minutes
E-D = 16 minutes
C-B = 21 minutes
MY AUDIT OF VETERINARY SURGERY IS BASED ON:
SURGICAL TIME TO SPAY A DOG IN THIS CASE

It took 16 minutes to spay this dog (E-D). I took 2 attempts to hook left the ovary out and had two ligatures (one transfixing and one normal) done on the uterine body. If I hook the ovary at the first attempt and ligate the uterine body once, the timing should be around 13 minutes. No bleeding seen in this case.

TIPS
The skin incision was around 1.8 cm long and the location was right, around 2 cm from the umbilical scar. The 4 legs were stretched very taut as I find this procedure much easier to hook out the left ovary. I used the scalpel to cut the ovarian ligament instead of fingers to snap it. Then I ligated the ovarian ligament area once. The dog's head was on my left. I raised the hydraulic table to suit my height as with too low the table height, I had to bend down and this would delay surgery. No swab was needed in this case. 2/0 absorbable suture x 1 packet was used. I seldom see the owner coming back for stitch removal as the stitches dissolve in 14-28 days. This saves the owner one trip and time.
5. OTHER MATTERS
Spay timing:

Skin incision: 5.17pm
Linea alba incision: 5.17pm
Left ovary hooked out: 5.19pm
Left ovarian ligament incised: 5.19pm
Left ovary clamped: 5.20pm
Left ovary ligated: 5.21pm.

Right ovary hooked out: 5.21pm
Right ovarian ligament incised: 5.22pm
Right ovary clamped: 5.22pm
Right ovary ligated: 5.23pm

Uterine body (UB) clamped: 5.24pm
UB transfixation ligature right side: 5.25pm
UB transfixation ligature left side: 5.26pm
UB 2nd ligation round UB: 5.27pm
UB incised: 5.29pm
UB checked for bleeding before putting into abdomen: 5.29pm

Linea alba stitched: 2 simple interrupted sutures: 5.29pm
Finger palpate linea alba (2 cm) for hole: 5.31pm.
Skin stitched: 5.31pm. First horizontal mattress
Isoflurane gas stopped: 5.32pm
Skin stiched: 5.32 pm. Second horizontal mattress
Uterus weight: 26 g. Owner said, not pregnant before
Spay certificate No. 1675

Dog's surgical wound bandaged, given baytril 0.6 ml and tolfedine 0.6 ml SC
E-collar. Home Baytril 50 mg x 2 (1/2 tab sid), Tolfedine 6 mg x 16 tab (4 tab sid)
6.30 pm phoned owner. Take dog home. Awake.


Website is at:
http://www.sinpets.com/F5/20120233SPAY-audit-surgical-anaesthetic-time-Singapore_ToaPayohVets.htm

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