Monday, August 13, 2012

1039. SOP - spaying a cat on heat

An example of the steps involved in spaying a young cat on heat (caterwauling was the reason for spaying) done by me is given as follows:

Record No. 155
Toa Payoh Vets Anaesthesia & Surgery Record
Patient's Name: Anja
TP Ref: 43711     Date: 13-8-12  Age: 10 m  Wt: 3.8kg*  Temp: 38.6*
Surgical procedure: Spay (on heat)
Type of suture: polysorb  Size:2/0   No. of packets used: One

DOCUMENTATION OF STEPS IN A SPAY OF AN AGGRESSIVE YOUNG CAT ON ESTRUS

1. Restraint. Owner to take the cat out of its carrier bag and put into the crate which has top and side doors. Do NOT put cat with its carrier bag inside the crate as in this case.
Use phone books to corner the cat or lasso if aggressive as it is not possible to sedate just by holding the cat, causing staff to be in danger of being scratched and cat escaping.

2. Sedation. For a 3.8 kg cat, I injected xylazine 0.15 ml + ketamine 0.6 ml combined IM left back msucles.

3. Pre-op clipping and cleaning was done 2 minutes later.
4. Surgery: A very bloody surgery as the ovaries and uterus were swollen with large blood vessels. More care in ligation is needed in such situations.

For younger vets, do make a larger skin incision of more than 2 cm long to get good exposure. In this case, I started the skin incision 1.5 cm from the umbilical scar, then made a 1.5 cm skin incision.

OVARIES. I hooked out the left ovary at the first attempt. I used 2 artery forceps to clamp the ovarian ligament and ligate cranial to the lower clamp. I ligate in one direction (5 throws of the knot) and then swung back to ligate in the opposite direction for the ovary. Then I used the scalpel to sever the ovarian ligament between the two forceps.

UTERINE BODY. I asked my assistant to loosen the front paws and in some cases to elevate the front half of the body (hand under the shoulders) to gain access to the uterine horn (right). Or I would extend my skin incision to 1.8 cm long to access the swollen and vascularised uterine body.

In this case, the uterine body was easily taken out after ligation of the right ovary. I clamped the uterine body with 2 artery forceps. Then I put the 2/0 suture below the lower forceps. I loosen the lower clamp to expose the grooved indentation. I slipped this suture into the groove and ligate 3 times. First in one direction, then in the other direction as for the ovarian ligament ligature. However, I ligate once more.

Normal cats not on heat. I ligate the ovaries and uterus twice only.

SPAY PROCEDURE TIMES
I asked Min to record:
Left ovary hooked out (first attempt)                   8.08pm
Right ovary taken out                                           8.15pm
Uterine body ligated started (with 3 ligatures)     8.21pm
Linea alba muscles stitched started                      8.26pm  (2 simple interrupted)




KPI
A: Injection of xylazine + ketamine 0.l5+0.6 ml IM     7.54pm
B: Isoflurane 5% given                                                   8.15pm
C: Isoflurane stopped                                                      8.17pm
D: lst skin incision                                                          8.06pm
E: Skin stitched up                                                          8.29pm (2 horizontal mattresses)

E-A = 35 minutes (whole spay procedure) excluding restraint of the aggressive cat.
E-D = 23 minutes (spay surgery)

As the cat was full of swollen blood vessels, extra care and time were needed to ensure that there would be no complications of bleeding to death. The left ovary was hooked out at the first attempt and the ovaries were unusually enlarged at around 8 mm x 8 mm x 6 mm (see images).

The above report serves as a benchmark for my associate vets. Elevate the op table to be comfortable doing surgery as each vet has his or her own height.


















*Cat aggressive. Lassoed and sedated inside crate. Rectal temp and weight were then recorded.

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