Wednesday, April 11, 2012

940. Veterinary anaesthesia to spay stray cats & multiple ovarian cysts

Yesterday, April 11, 2012, I visited a vet who had spayed thousands of stray cats. The young cat was laid on a metallic M-shaped holder (apparently commonly seen in Australian vet spays), without the need to tie up the legs. She tried to hook out the ovary but could not. She extended the skin incision to bigger than the width of her forefinger and could hook out the left uterine horn.

The cat had been pregnant and therefore the uterine horn was not easily hooked out. There seemed to be something stuck to the left ovary as she could not pull it out. I saw large veins from the uterine body to the ovary. "I have to refer to Vet 1", she said. Complicated surgical and medical cases are farmed out to Vet 1, as this is the policy.

"Just extend the skin incision by 1 to 2 cm more," I advised. "You will see what's been affecting the ovary." She used the scissors and cut further. It was a huge surprise. Around 3 big ovarian cysts of around 1 cm in diameter. had prevented the pulling out of the ovary till the incision was extended.

"I need to take a picture," I said as this type of medical condition is very rare. She had not seen it too despite many years of spaying stray cats. She said OK and I rushed to the car park to get my camera. When I returned, she had taken out the ovary but the cyst had ruptured. There was one cyst I managed to photograph for vet students to appreciate. We are taught about ovarian cysts but in the real world, they are uncommon. "Take another picture of the normal ovary to compare," she said as I had not thought of it. I got a few tips from her.

1. Suture muscle layer and linea alba with cat gut.
2. Subcutaneous suture, interrupted, at either ends of the fatty tissue with monofilament
3. Subcutaneous suture of the fatty tissues with continuous
4. Two horizontal mattress sutures of the skin, with one interrupted suture knot stitching out at one end. I can't figure this out as it is supposed to be buried.
No complaints of stitch breakdown with this method. The other knot at the other end was buried.

I just do Steps 1 and 4 in all cats and have no problems with stitch breakdown. Too many layers (Step 2) irritate the cat and dog during healing and also likely introduce pathogens. Keep spay simple is my policy.

Each vet has his own tested method and will not change his or her mindset when the method is successful. The important thing is the client's perception as many Singaporean clients appreciate excellent stitching (which may be a buried subcuticular suture, continuous i.e. Step 2 without Step 3.)

Well tested and proven to be effective and does not involve "ketamine."
I saw two cats well anaesthesized with this procedure. The dosage is as follows:

3kg young
Zoletil 100. 0.2ml. IM. Separate syringe.
Xylazine 20. 0.2ml. IM. Separate syringe.
duration >25min
Hartmann SC post op

Eg Jack Russell
Xyla 0.3 ml first.
Zoe 100. O.3 ml. Slow IV
To effect

Each vet has his or her own method. This method works very well and the vet sees no need to change. For me, in cats, I give a one-syringe Xylazine+ketamine combination IM. So, the cat gets one injection IM instead of 2. The less the better for our patients as injections may cause irritation. It is hard to change mindsets of most vets when they are used to a successful method of anaesthesia. Younger vets want to introduce propofol and althesin but these are expensive and add to the inventory. It is best that young vets adopt what is effective in the practice unless their method is more superior as for example, diazepam and xylazine is said to be safer than domitor and xylazine IV but I am used to the latter and find it effective. Diazepam is said to be safer than domitor in anaesthesia by not "affecting blood pressure or cardiac rate" according to one vet I spoke to.

But how much safer? So, I don't also go for another type as I find my present formula very effective and safe. In other words, there are many injectable anaesthestics and the vet must focus on one combination. Peferably one injection.

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