Prepubertal Spaying in cats - How?

Re: Prepubertal Spaying in cats - How?

Michael Woodhouse — Sat, 13 Sep 2014 20:26:07 GMT

[quote user="Nicola M"]Firstly, you can still normally (except if poorly placed/slips or if high airway resistance) assist or control ventilation with a properly placed LMA-therefore it is virtually the equivalent of an et tube in terms of airway safety. [/quote]

Yes if you want to vent, but many are managed with a simple bag-mask valve so the equivalent of your nurse closing the APL valve and squeezing the bag. The majority of the GAs are short procedures, apparently.

[quote user="Nicola M"]Secondly, during surgery in a human theatre there are numerous other staff members (normally more than one anaesthetist eg consultant/registrar with a junior, theatre assistants etc) so that if a LMA had to be repositioned if airway control lost, or if an et tube had to be placed instead you have more pairs of hands[/quote]

Agree, maybe not with the patient but many more bodies available.

[quote user="Nicola M"]Thirdly, as above but slightly different-your one veterinary nurse is monitoring GA, passing you suture materials, needles, finding bits of kit missed out of sets.....etc and usually with less monitoring equipment than a human anaesthetist....as opposed to there being one person (or more) whose sole job is monitoring the GA in a human theatre; therefore I would suspect that they spot a change in GA stability quicker[/quote]

Human anaesthetists read the paper. Honestly.

Re: Prepubertal Spaying in cats - How?

Nicola Cole — Sat, 13 Sep 2014 19:39:37 GMT

[quote user="Michael Woodhouse"]

Interesting discussion. Have any of you spoken to any human anaesthetists recently? They are intubating less patients and managing increasing numbers using laryngeal mask airways or just simple masks for shorter procedures. A number of UK ambulance services are removing ET tubes from kits and utilising LMAs and masks with OP or nasal airways. Placing an ET tube in every patient would be classed as old fashioned if you look at people. If it increased the morbidity or mortality even a tiny bit then every person would get a tube. There's loads of literature out there in the human sphere.

[/quote] A number of points on this (sorry no paragraphs as ipad): Firstly, you can still normally (except if poorly placed/slips or if high airway resistance) assist or control ventilation with a properly placed LMA-therefore it is virtually the equivalent of an et tube in terms of airway safety. Secondly, during surgery in a human theatre there are numerous other staff members (normally more than one anaesthetist eg consultant/registrar with a junior, theatre assistants etc) so that if a LMA had to be repositioned if airway control lost, or if an et tube had to be placed instead you have more pairs of hands (rather than just your one vet. nurse and a scrubbed and mid-procedure surgeon). Thirdly, as above but slightly different-your one veterinary nurse is monitoring GA, passing you suture materials, needles, finding bits of kit missed out of sets.....etc and usually with less monitoring equipment than a human anaesthetist....as opposed to there being one person (or more) whose sole job is monitoring the GA in a human theatre; therefore I would suspect that they spot a change in GA stability quicker (hmm-I may get some abuse for this last point!) So, even though GA problems during routine surgery are very rare, for the short time it takes to place an et tube so that, under your instruction, your nurse can take control of airway....personally I think it's worth it.

Re: Prepubertal Spaying in cats - How?

Evelyn Barbour-Hill — Sat, 13 Sep 2014 18:30:04 GMT

[quote user="robloxley"]

[quote user="Evelyn Barbour-Hill"] I used until recently to spay a lot of female cats around 6 months old and didn't often find that they were pregnant. What would you conclude from that?[/quote]

Something about the 'demographic' of your cat owners? And, by your statement, that more than zero were pregnant?

[/quote]

Professional and University people up that way, second biggest council estate in Wales round the corner that way....My point, if I have to spell it out, is that we can all decide for ourselves what spaying age is most advisable in our own particular situations, which may differ a good deal, and I rather resent being lectured in print and told that the problem resides in my "mindset" (whatever that is) and I've got to change it.

Re: Prepubertal Spaying in cats - How?

Neil Wheadon — Sat, 13 Sep 2014 16:42:41 GMT

Added to this when was the last time anyone saw a cat vomit for a routine neuter?

In 23 years - not one for me

Personally I use uncuffed tubes on cats and see little point in tubing a cat castrate figuring that I will do more harm trying to get a tube down than leave well alone.

One tip for anaesthesia, put a blanket under the shoulders not the neck as with the former you are tipping the larynx dowhill where in the later you create the perfect funnel should the animal vomits

Neil

Re: Prepubertal Spaying in cats - How?

Michael Woodhouse — Sat, 13 Sep 2014 14:38:01 GMT

Martin - I'm not sure the fact you tube all patients has anything to do with your mortality figures. Unless you are stupidly careless with modern drugs anaesthetic are actually very safe, and I suspect most general practitioners haven't lost more than 5 patients as a sole result of GA. There's a good study by David Broadbelt from the RVC that found half of dogs, and nearly 2/3 of cats that died, died in the post operative period.

http://www.ncbi.nlm.nih.gov/pubmed/18466167

As I student I saw practice at a number of small animal practices and none tubed cats routinely. All operated under triple combination - as did the first practices I worked at. In 10 years I never had to give supplemental iso, and would give oxygen if concerned by colour etc. In the last few years I have tended to place an uncuffed tube and give oxygen only. It concerns me that our assistant uses the same triple dose and usually has the iso on 1 or 1.5.

I almost never reverse the medetomidine. You remove its analgesic effects and get a cat tripping on ketamine. Keep them warm and monitored and they are fine.

The only death I know of from triple was a wild farm cat that was injected in a crush cage, unable to examine. Lifted out as it went to sleep and found to be in cardiac arrest. That was a colleague.

If a tube was essential every person would get one. I have no figures but I am told that depending on the anaesthetist well under half of human GA patients get one. Just because the lay staff 'think' a tube is a good idea, doesn't make it so. As we tend to mirror human medicine I suspect we may be tubing many fewer patients in 10 years time! I loathe the sanctimonious 'VDS say if you don't tube and it dies you will be struck off' and such similar rubbish.

Re: Prepubertal Spaying in cats - How?

Rob Loxley — Sat, 13 Sep 2014 10:28:19 GMT

[quote user="Evelyn Barbour-Hill"] I used until recently to spay a lot of female cats around 6 months old and didn't often find that they were pregnant. What would you conclude from that?[/quote]

Something about the 'demographic' of your cat owners? And, by your statement, that more than zero were pregnant?

Re: Prepubertal Spaying in cats - How?

ruths — Sat, 13 Sep 2014 09:13:06 GMT

Why not use uncuffed tubes in cats? You can get a bigger bore down and fit it snugly enough in the real littlies. Cuffs can be quite traumatic and restrict the airflow ( was it pouiselles law or something?)

Re: Prepubertal Spaying in cats - How?

Thomas Johnson — Fri, 12 Sep 2014 17:57:50 GMT

[quote user="Anthony Todd"]

The irony is clients and the charities always want males done too young [as if they are the real problem] and females too late ie 6 months, set in stone somewhere.

[/quote]

You've obviously not had much contact with the charities recently, the big push for neutering all cats at 3-4 months is coming from the Cats Protection and RSPCA.

Re: Prepubertal Spaying in cats - How?

Martin Atkinson — Fri, 12 Sep 2014 16:55:52 GMT

[quote user="Evelyn Barbour-Hill"]The point of the tube is to keep an open airway through which oxygen and other gases can be administered if so desired. The purpose of the cuff is to get a reasonable seal so that said administration of gases is reliable. The cuff is not there to prevent inhalation of water or anything else during a dental procedure: you have a proper throat pack to do that. [/quote]I recognised the omission of reliable administration of oxygen/gases as the most important reason for a cuffed tube but I did say prevention of aspiration was only half! Agreed on the throat pack but they are not 100% effective and you're not going to use a pack in a surgical procedure so they could still theoretically vomit and inhale that especially if they're on their back.

Let's not get pedantic, let's just agree that intubation with a correctly inflated cuff is a good idea.

Re: Prepubertal Spaying in cats - How?

Evelyn Barbour-Hill — Fri, 12 Sep 2014 14:35:46 GMT

[quote user="Martin Atkinson"][quote user="Anthony Todd"]Would you concede that the cuff doesn't need to be inflated, given that the only real problems are from overinflated cuffs?[/quote]Absolutely not. Half the point of the tube is to prevent aspiration of fluids namely vomit and saliva or water from dentals.[/quote]

I must take issue with that. The point of the tube is to keep an open airway through which oxygen and other gases can be administered if so desired. The purpose of the cuff is to get a reasonable seal so that said administration of gases is reliable. The cuff is not there to prevent inhalation of water or anything else during a dental procedure: you have a proper throat pack to do that.

Re: Prepubertal Spaying in cats - How?

Martin Atkinson — Fri, 12 Sep 2014 09:02:06 GMT

[quote user="Anthony Todd"]Would you concede that the cuff doesn't need to be inflated, given that the only real problems are from overinflated cuffs?[/quote]Absolutely not. Half the point of the tube is to prevent aspiration of fluids namely vomit and saliva or water from dentals. I concede only that some kittens are too small for a cuffed tube and need a 2 mm uncuffed tube but then its a compromise. I've never had a problem from an over-inflated cuff its all about technique and inexperience. If in doubt inflate the cuff as someone squeezes the re-breathing bag until there is just no more leakage. This takes all of another 30 secs and can be done while someone else is starting to prep to op site so no extra procedure time.

The only problem I've ever had with a tube was one cat many years ago where the trachea was torn by the tip of the tube but this was nothing to do with cuff inflation possibly the opposite. A nurse was performing a dental procedure and repeatedly turned the cat without disconnecting the tube. If anything the inflated cuff would prevent this as the tube would be more likely to turn with the cat! A review of technique mean't that this has never been repeated.

[quote user="Anthony Todd"]Talked to another dinovet today who said the trouble is so many vets have difficulty tubing cats, which I've seen and agree with.[/quote] What can I say? If you don't have the patience, hand eye co-ordination and motor skills or even are too geriatric to master the technique I can't help you!

Re: Prepubertal Spaying in cats - How?

John Flynn — Thu, 11 Sep 2014 20:55:18 GMT

[quote user="Evelyn Barbour-Hill"]1. I used until recently to spay a lot of female cats around 6 months old and didn't often find that they were pregnant. What would you conclude from that?[/quote]

That you have not been exerting an effective enough selection pressure in favour of earlier puberty in the local feline poplulation?

Re: Prepubertal Spaying in cats - How?

John Flynn — Thu, 11 Sep 2014 20:52:59 GMT

[quote user="robloxley"]As another aside - how long do people generally leave off giving atipamazole after the ketamine injection?[/quote]

depends whether ketamine was low-dose iv or higher dose IM.

If give all other 2/3 drugs IM, then wait 1minute and give ketamine iv (sweet spot when cat/kitten sleepier but prior to peripheral veins collapsing with alpha-2), then I reverse with atipmaezole immediately on finishing procedure. Otherwise I do tend to leave 45mins or whatever (not timed) wrapped up in a warm bed and unsupervised on recovery - hardly ideal, but I don't think thrashing around a kennel on a ketamine trip is ideal either.

I aprpeciate that there is a strong argument in favour of not giving atipamezole in such a situation, but only if continuous monitoring of the patient is to be undertaken.

Re: Prepubertal Spaying in cats - How?

Anthony Todd — Thu, 11 Sep 2014 19:59:48 GMT

[quote user="Martin Atkinson"]Incidentally, I've put the arguments re tubing or not past my staff and even the 20 year old auxilliary says there is no debate here - you tube everything! She further said she would never take her pets to vet who didn't . Once again shame on you who don't. [/quote]

Would you concede that the cuff doesn't need to be inflated, given that the only real problems are from overinflated cuffs?

All commentators and protagonists are assuming tubing is easy, trouble free and a given. Talked to another dinovet today who said the trouble is so many vets have difficulty tubing cats, which I've seen and agree with.

PS read this, particularly the sage advice re cuff pressure!

dental tracheal tear malpractice anesthesia claim warning

from

http://www.ebvet.com/forum/viewtopic.php?t=83

[ask the tuber how many mls they inflate the cuff with after you read the above, often it's only 0.2 or 0.3 ml if you have the correct size]

Re: Prepubertal Spaying in cats - How?

Anthony Todd — Thu, 11 Sep 2014 19:54:06 GMT

[quote user="Evelyn Barbour-Hill"]1. I used until recently to spay a lot of female cats around 6 months old and didn't often find that they were pregnant. What would you conclude from that?[/quote]

If they were, actually, six months old, not a day more and done going into winter then probably you were right but usually "six months" is more than that and often by the time the owner thinks about it they are much older than that!

Four months gives a "pfaff "period, decision, appointment, op, may involve another month?? ["Can't do next week, going on holiday etc. etc.]

[quote user="Evelyn Barbour-Hill"]2. Can anyone explain to me how early castration of male cats is going to make the slightest difference to the number of kittens conceived (disregarding the special case where the owners have one male and one female and the female doesn't get spayed)?[/quote]

Oh, so true! I read somewhere that the adult tom can ejaculate many times in one night....

The irony is clients and the charities always want males done too young [as if they are the real problem] and females too late ie 6 months, set in stone somewhere.

Re: Prepubertal Spaying in cats - How?

Martin Atkinson — Thu, 11 Sep 2014 16:11:04 GMT

[quote user="robloxley"] how long do people generally leave off giving atipamazole after the ketamine injection?[/quote]I normally wait about 5 minutes after they've come off the table to see if they'll cough their tubes voluntarily. By this time it will be 30-35 minutes since they were given the triple combo assuming 10 minutes before they are tubed, 5 mins prep time, 10-15 minutes surgery (we're not racing now) and the 5 minutes recovery.

I made concious note of the timing of the thyroidectomy I did this morning: premed torb/dom, after 10 minutes induced GA with propofol, intubated within 30 seconds of induction, 10 seconds total time actually opening the mouth and inserting the tube, didn't need any iso but lots of reassuring beeps coming from respiratory monitor, surgery time from start of prep to coming off anaesthetic machine 35 minutes, coughed tube 30 seconds later, awake and sitting up after a further 10 minutes. Perfect.

Incidentally, I've put the arguments re tubing or not past my staff and even the 20 year old auxilliary says there is no debate here - you tube everything! She further said she would never take her pets to vet who didn't . Once again shame on you who don't.

Re: Prepubertal Spaying in cats - How?

Evelyn Barbour-Hill — Thu, 11 Sep 2014 15:37:38 GMT

[quote user="bob lehner"]In contrast I do find with propofol there is often a considerable period of time after induction where the larynx remains tightly closed.[/quote]

Strange. Not my experience.

[quote user="Anthony Todd"] or do you prolong anaesthetic time by preping after tubing?[/quote]

Certainly.

Anyway, two points:

1. I used until recently to spay a lot of female cats around 6 months old and didn't often find that they were pregnant. What would you conclude from that?

2. Can anyone explain to me how early castration of male cats is going to make the slightest difference to the number of kittens conceived (disregarding the special case where the owners have one male and one female and the female doesn't get spayed)?

Re: Prepubertal Spaying in cats - How?

Rob Loxley — Thu, 11 Sep 2014 14:54:46 GMT

[quote user="emma_j"]Does anyone have a reference for the quadruple protocol? [/quote]

http://www.cats.org.uk/uploads/documents/Earlier_neutering_priciples-Dosage_Chart.pdf

https://itunes.apple.com/gb/app/kitten-quad/id455952335?mt=8

As another aside - how long do people generally leave off giving atipamazole after the ketamine injection?

Re: Prepubertal Spaying in cats - How?

Martin Atkinson — Thu, 11 Sep 2014 11:28:02 GMT

[quote user="Francisco Gomez"]I tend to agree with Martin (no need for insults). But then, I don't make the rules and these cats are spayed this way also because we do it for a charity. Now, if you're going to use a triple combination (IM)... When would you intubate the kitten? Just before you make your first incision? What about the time between the ketamine and that incision? Or will you keep probing that larynx until is relaxed enough? What's the perceived benefit of intubating for half of the GA?[/quote] I wasn't intending to be insulting more a gentle jibe.

Lets put it this way, every single animal that I GA is intubated if it is physically possible, no matter how small or how short the procedure, whether they've had triple combo or standard premed with torb/dom and induced with propofol or Alfaxan as soon as they are unconscious (OK I know that cannot always be precise with triple combo but it is just a matter of observation). The tube remains in situe until the animal has a gag reflex and is continually observed by a nurse until that point. My nurses would be the first to tell me off if it was done any other way.

Maybe this is why I can count the number of unexpected anaesthetic deaths in a whole career on one hand!

Re: Prepubertal Spaying in cats - How?

Marek Dycjan — Thu, 11 Sep 2014 10:31:48 GMT

Are there any informations about early spaying bitches? How early? What are the problems? How to sedate?

Re: Prepubertal Spaying in cats - How?

serena holmes — Thu, 11 Sep 2014 02:07:45 GMT

Over 1kg I use kitten quad/go flank/always intubate

Re: Prepubertal Spaying in cats - How?

ChrisBVSc — Wed, 10 Sep 2014 22:41:16 GMT

To continue the triple & tubing debate, what about the period post-op when you've still got half your 45min wait left before reversal (as per datasheet)? To be "gold standard" do people leave the cat intubated with a nurse monitoring until 45mins is up?

Re: Prepubertal Spaying in cats - How?

bob lehner — Wed, 10 Sep 2014 21:05:28 GMT

[quote user="Anthony Todd"]Of course, in skilled hands, tubing a cat is easy but I recall the Panorama program and the trouble seen tubing a cat, and for what[/quote]

One of the good things about triple combo - dom/torb/ket - aneasthesia is that once the cat is asleep (which is only a matter of a couple of minutes even after i.m. injection) the larynx is invariably totally relaxed and wide open. Absolutely easy to intubate.

In contrast I do find with propofol there is often a considerable period of time after induction where the larynx remains tightly closed.

Re: Prepubertal Spaying in cats - How?

Anthony Todd — Wed, 10 Sep 2014 20:43:05 GMT

PS, only on the condition that you all start preaching "spay no later than 4 months; castrate whenever you like, but preferably after sexual maturity".

Re: Prepubertal Spaying in cats - How?

Anthony Todd — Wed, 10 Sep 2014 20:40:15 GMT

Ok, Ok, I'll settle for a deflated endo tube as, I must admit, if it's done quickly and gently, it has theoretical advantages and no disadvantages but, my observations were that it is often none of these.