Monday, May 26, 2014

1370. Caesarean section of a Corgi using xyazine + ketamine + gas

May 26, 2014.

Corgi, F, 3 years was said to be 63 days pregnant, being mated on Mar 24, 2014 and had no obvious uterine contractions today May 26, 2014. The attending vet took 2 X-rays which showed 5 or 6 pups as one pup "could be deep inside the rib cage area".

Her ultrasound showed 2 or 3 pups with strong heart beats. But she had no manpower to perform the elective Caesarean section. Uterine inertia has happened and the overdue pups may die if the home breeder waits longer. Little milk seen when I expressed the nipples. Dog had abnormal sized nipples as if she had given birth before. "Six puppies likely," I said as the swollen belly was symmetrically enlarged.

ANAESTHESIA
1. Isoflurane + O2 gas only. I had performed over 200 C-sections using this method. The disadvantage is that some dams struggled a lot on inhaling the gas and it takes a much longer time. Some vets think that the dam will die of heart attack. I would take off the mask when such dams struggle and re-mask. All this takes a lot of time.

2. Xylazine + Ketamine at 1 ml + 0.5 ml IV induction for a 20-kg dog as a guideline and depending on the dog's health. 0.1-0.2 ml + 0.05-0.1 ml for a 2-3 kg Chihuahua. Just sufficient to intubate.

No struggling of the dam. I decided on this method in this Corgi.
For this Corgi, 14.1 kg, 38 deg C, normal heart and lungs, I gave Xylazine 0.3 ml + Ketamine 0.15 ml IV at 50% of the calculated dose. It was insufficient to intubate the dog. The dog vomited food after 5 minutes.

She was masked, intubated and given the isoflurane + O2 gas. Maintenance of gas was at 2% initially to 1% to 0% at the stitching of the linea alba and skin. The dog opened her eyes wide just after my last skin stitch of the skin as if from a deep sleep.

TRANSPLACENTAL EFECTS ON THE PUPS
According to a senior vet who practises the Xylazine + Ketamine IV sedation for many years, there is no transplacental transmission to make the pups sleepy. Even for pentobarbitone which he used many years ago, a minimal amount was used. He said pups would take some time to cry loudly but he had pups who cried immediately. His tip was to wait for the dam to have uterine contractions before Caesarean section. This would decrease lots of bleeding even the surgery was done before contractions. As the Corgi had no contractions at 63rd day, possibly uterine inertia, I had seen much more bleeding during the C-section when I extracted the placentas.    

SURGERY

Skin incised around 3 cm from umbilicus. Length of incision around 8 cm long. Vet textbooks advised much longer incision to exteriorise the whole uterus, probably needing 15 cm in this Corgi as the pups were large and long, the longest being around 15 cm.
I located the bifurcation of the two horns, incised at right angles to the bifurcation, around 8 cm long and manipulated the 6 pups into this opening. I could exteriorise the uterus after removal of the pups to ensure no more trapped pups. One pup was deep under the rib cage and it took some time to extract him out. 

Six puppies were delivered. They appeared "dead". I held each with both hands, stood with my legs apart and swung it 5-6 times in an arc vigorously, to expel any water in the lungs. My assistant would massage the top part of the neck with the head downwards and stimulate the hard palate and cleaned the mucus off the nostrils. It took over 5 minutes to get faint cries and some movement. At an average of 10 minutes, the C-section took a long time. It was around one hour before loud cries from two pups were heard. The surgery started around 7.30 pm and ended around 9 pm.

Two pups wee not crying and their noses were cyanotic in colour, after completion of stitching of the dam. But they had tongue movements.

"No hope for this biggest pup," I said as >45 minutes had passed with the pup still gasping. "Some pups do recover with prolonged neck massage." I swung this pup 5 times and dislodged some lung mucus.  Then I put the pup into my mouth and blew into his lungs. I could hear the lungs opening up. The husband continued massaging this pup after he had successfully revived the other pup. (see video). Incredibly, this large pup cried (see video). The owners brought the pups home.

MEDICATION
Oxytocin 2 ml SC, Baytril 1.5 ml SC and Tolfedine 1.5 ml SC. On reaching home, the dam had milk for the pups and so there was no need for bottle feeding. 4 males and 2 females.  Sire and dam were brown/white. Mating was once, on Mar 24, 2014 by bringing the dam to the sire who belonged to the friend.







CONCLUSION
The home-breeders were happy as 6 pups and the dam were alive. It is not a guarantee that such the vet will get successful outcomes. Know how to swing the pups and massage them. Blow air into their lungs may be needed although some vets may not like to do this. In this case, the largest pup had air blown to inflate his lungs and he did survive.  The C-section took me, with experience, 1.5 hours as each of the 6 pups needed swinging and revival. Assuming each pup takes 5 minutes of my time with the assistant, 30 minutes had been spent on this. Fortunately, the dam did not die and was well anaesthesized at 1% - 1.5% maintenance.



For vets with no experience in C-sections or capable assistants, it is best to avoid doing this surgery as owners are just not happy to receive dead dams or pups, blaming the vets. Read up on how to revive distressed pups.  The anaesthesia and surgery was $900 but the stresses on delivery of "dead" pups were tremendous.      

X-RAYS BY THE FIRST VET.  Two weeks earlier (could see only 5 pups on ventral dorsal view) and yesterday (on lateral view, 2 skeletons).  Ultrasound (2 pups with strong heart beats, one with weak beats).

FOLLOW UP ON MAY 27, 2014, 10 AM.  
The dam had milk on reaching home at around 10 pm. The pups are suckling and active. A whelping box prevents pups from wandering. Vaccination advised 6-8 weeks. 3 vaccinations. Weaning to puppy food at 4th week.

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