Wednesday, February 1, 2012

858. Anaesthesia old dog with heart murmurs - swollen r ear

This case illustrates the importance of being scientific in giving IV anaesthesia. If the vet simply gives Domitor 0.1 ml IV for small dogs regardless of size and age and top up with isoflurane gas + oxygen at all times, I will consider that this veterinary surgeon is not a good vet. In private practice, there is a need to keep veterinary costs low for the client, but the practice must earn a sustainable amount to survive.

If the vet uses Domitor 0.1 ml for small breeds and then top up with isoflurane gas due to insufficient analgesia to perform the surgery, there is a big waste of resources for the practice as isoflurane is not a cheap anaesthetic. Vets who don't have to pay for resources do not appreciate that the drugs are costly and that veterinary prices need to stay competitive. If this vet does not bother to be efficient and productive, he or she waste a lot of resources of isoflurane and prolong an operation since it takes more time to anaesthesize the dog with top up.

I have the following case to illustrate how a sound knowledge of the use of domitor + ketamine IV based on my formula and based on weight and age (in this case, 25% of the formula) enabled me to perform an aural haematoma surgery WITHOUT the need to top up.

Cross-bred terrier, 13 years old, 6.3kg, good condition, but machinery heart murmur. No coughing. Undescended testicle x 1. Bad teeth. Very high anaesthetic risk but surgery is the only option in this aural haematoma treatment.

This case - IV domitor and ketamine at 25%* of my calculated dosage was sufficient for an old dog not in good health for around 60 minutes of surgery. No blood test was done to screen the health to keep veterinary costs minimal.

Get all materials and plan early before giving the IV anaesthetic injection

Right ear swollen. Heart disease
Clip hairs

Wash ear well
S-shaped incision of sufficient length. Remove all clots inside
2/0 nylon horizontal mattress suture x 1 packet

Ear irrigation to flush out blood and debris. Dog howls.
Antisedan wakes up dog. Before going home, handing over inspection
Knots are on lateral side of ear pinna. Pain-killers and antibiotics. Home nursing advices.

I audit how long it takes me to do this surgery. The times of my surgery and procedures are as follows:
At 25%, D=0.07 ml K=0.09ml = 0.16 ml+ Hartmann to 0.9 ml given IV. Waited 5 minutes. Check blinking reflex which persisted throughout.

11.23 am

2/0 stitching ends.
11.24 am
Irrigate right ear to get rid of any dead ticks. The dog reacted by howling. This showed that the IV surgical anaesthesia lasted till from 10.35 am - 11.24 am. No need to use isoflurane for 48 minutes. This was a surprise to me as I was prepared for isoflurane gas top up.

In young healthy dogs, 25% will be insufficient. The dosage may be up to 100% for 48 minutes of analgesia without isoflurane gas top up.

However fast, I cut and stitched, the whole process was approximately 48 minutes for surgery without pain. At 11.35 am, I injected Antisedan 0.2 ml IM and the dog woke up fast as if he had an afternoon nap. The lady owner was quite happy and took the dog home.

POST-OP NURSING. I phoned the owner today Feb 8, 2012 about 5 days after surgery. The dog was trying to scratch its ears daily despite the e-collar being worn. I advised her to get a clean 10-20 ml syringe, fill it with lukewarm water and irrigate the ear canal which would have contained blood post-operation. This would reduce her costs.

I did not bandage the ear or plug the ear canal with cotton wool although in some cases I would do so. Usually the dog shakes off the bandage within 12 hours unless the whole ear is bandaged to the neck.

Some vets use X-ray plates to be stitched on the lateral and medial side of the ear to provide compression. I don't do it as the results of getting a normal ear back are not that good.

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