Teaching technique for cat spays

RE: Teaching technique for cat spays

Anthony Todd — Sat, 16 Jul 2016 09:57:23 GMT

[quote user="Richard Carter"]Interesting that almost all the USA, Australian and NZ schools will teach that NSAIDs perioperatively are contra-indicated and NSAID pain relief is to be reserved for fully conscious animals with good hydration, BP and liver function - apparently if your elderly labrador has liver disease, you are supposed to halve the dose or reduce to eod dosing.[/quote] (my italics and bold)

Glad I asked the question.....

RE: Teaching technique for cat spays

Michael Woodhouse — Fri, 15 Jul 2016 23:32:37 GMT

[quote user="Richard Carter"]at the time of ga opiods, ketamine, metomidine if not reversed are much safer than NSAIDs. Once the cat is up and running (and eating/ drinking) then nsaids.

[/quote]

It's a waste not taking advantage of the pre-emptive analgesia IMO.

RE: Teaching technique for cat spays

Richard Carter — Fri, 15 Jul 2016 23:30:51 GMT

[quote user="Anthony Todd"]are there any safer analgesics for cats [/quote]at the time of ga opiods, ketamine, metomidine if not reversed are much safer than NSAIDs. Once the cat is up and running (and eating/ drinking) then nsaids.

RE: Teaching technique for cat spays

Richard Carter — Fri, 15 Jul 2016 23:26:19 GMT

Was a good lecture last London Vet Show by Jill Maddison of RVC explaining how the different COX1 and 2 can change if you change species so while you may think you have a COX2, actually it may be non-selective suppressing prostaglandins. Dehydration, BP, pre-existing disease (liver, cardiac, GI and hepatic), concurrent use of ACEi, alpha2 agonists all play a role. Interesting that almost all the USA, Australian and NZ schools will teach that NSAIDs perioperatively are contra-indicated and NSAID pain relief is to be reserved for fully conscious animals with good hydration, BP and liver function - apparently if your elderly labrador has liver disease, you are supposed to halve the dose or reduce to eod dosing.

The take home message was nsaids are not sweets to treat the client, use them properly for conditions where they may be effective.

RE: Teaching technique for cat spays

Martin Atkinson — Thu, 14 Jul 2016 11:02:53 GMT

[quote user="Anthony Todd"]I ask again: are there any safer analgesics for cats when you need one?[/quote]Opioids?! Meloxicam is safe in 99% cats you've just got to be aware of the potential risks and potentiating factors. I tend to use Onsior more in older at risk cats as an NSAID as it should be more renal friendly.

RE: Teaching technique for cat spays

Anthony Todd — Thu, 14 Jul 2016 10:35:44 GMT

[quote user="Clive Ansell"]surgery carried out with skill and precision [/quote]

+1, and the exact example I was going to quote although mine were root canals......

What do you tell an owner when the C/S gets ARF.

I ask again: are there any safer analgesics for cats when you need one?

RE: Teaching technique for cat spays

Clive Ansell — Thu, 14 Jul 2016 09:45:26 GMT

[quote user="Martin Atkinson"][quote user="Anthony Todd"]So why use NSAIDs at all after routine atraumatic 5 minute surgery?[/quote]So you think having your uterus or balls ripped out is atruamatic? [/quote]

I would never advocate not giving adequate pain relief to surgical cases, but I often feel that in the debate about analgesia the quality of the surgery and skill of the surgeon gets left out a bit. A well planned and carefully, gently executed surgical procedure must be far less traumatic than a ripping out the uterus approach by a slash and grab merchant where the surgery could have been done with a chainsaw.

I do wonder how much, if any, analgesia a cat castrate really needs? I had an impacted wisdom tooth extracted about 2 years ago under local anaesthesia - I took no post op analgesics after the local wore off at all because I didn't need to - it was perfect piece of dental surgery carried out with skill and precision - i didn't even know he had got it out!

RE: Teaching technique for cat spays

Anthony Todd — Wed, 13 Jul 2016 23:02:06 GMT

[quote user="Martin Atkinson"]So you think having your uterus or balls ripped out is atruamatic? [/quote]

But ARF isn't all that pleasant either, and 5 minute atraumatic surgery is not particularly painful, or at least never appeared to be, which was my point. Are there not other, safer, analgesics for post-op pain?

RE: Teaching technique for cat spays

Michael Woodhouse — Wed, 13 Jul 2016 20:16:54 GMT

[quote user="Martin Atkinson"]In my practice no cats get NSAIDs until they are fully recovered from anaesthetic and had any fluid deficit corrected.[/quote]

I don't think I have ever touched an animal with a scalpel that didn't receive NSAIDs as part of the pre-med. With what we know about wind up etc I'm very surprised you don't give it pre op.

(Have put a number of animals with clinically evident renal failure on long term Metacam/Loxicom and all of them improved in renal parameters. I can accept the low BP theory and we currently don't routinely measure BP under GA (everything goes on the capnograph).

RE: Teaching technique for cat spays

Martin Atkinson — Wed, 13 Jul 2016 18:30:24 GMT

[quote user="Anthony Todd"]So why use NSAIDs at all after routine atraumatic 5 minute surgery?[/quote]So you think having your uterus or balls ripped out is atruamatic?

RE: Teaching technique for cat spays

Anthony Todd — Wed, 13 Jul 2016 18:12:41 GMT

[quote user="Martin Atkinson"]Fortunately they all recovered and gained normal renal function after intensive therapy.[/quote]

So why use NSAIDs at all after routine atraumatic 5 minute surgery?

RE: Teaching technique for cat spays

Robin Grimmer — Wed, 13 Jul 2016 18:00:16 GMT

The only case of ARF I recall was in an otherwise healthy 6 mo female kitten. This was in the bad old days and I gave ketofen injection post op. The litter sister had the same drugs and was fine. Since using metacam I have had no problems.

RE: Teaching technique for cat spays

Martin Atkinson — Wed, 13 Jul 2016 17:47:46 GMT

[quote user="Anthony Todd"]Any proof of the role of NSAIDs, you know in this era of EBM and not anecdote?[/quote]When Metacam oral for cats first came out of the first 6 cats I put on it. 3 developed ARF all had normal renal function as shown by blood tests before. It took a long time before I was confident to use it again.

I have subsequently had several healthy cats (I can clearly remember 3) which have developed ARF after a single injection of either carprophen or meloxicam after routine surgery and well managed anaesthetics. Fortunately they all recovered and gained normal renal function after intensive therapy.

RE: Teaching technique for cat spays

Anthony Todd — Wed, 13 Jul 2016 14:56:40 GMT

[quote user="Martin Atkinson"]Indeed I have several recorded cases of cats which went into ARF when I know their kidneys were fine before they were given NSAIDs because they were blood tested before. [/quote]

That may explain my challenge because I/we never saw post op complications that weren't surgical, and, I say again, never deaths.

Any proof of the role of NSAIDs, you know in this era of EBM and not anecdote?

RE: Teaching technique for cat spays

Martin Atkinson — Wed, 13 Jul 2016 12:43:27 GMT

[quote user="Anthony Todd"]

[quote user="Vet12345"]In the ARF cases that I came across in young healthy cats[/quote]

Be good if you could expand on this, 'cos I've never seen one or heard of any.

That is a normal young healthy cat that developed ARF after routine surgery.

Unless it turns out that, during the "routine surgery" there was a prolonged period of hypotension or hypoxia or surgery was grossly prolonged.

[/quote]In my experience Anthony it is due to administration of an NSAID on top of a a poorly managed anaesthetic/slightly dehydrated cat, +/- having an idiosyncratic reaction to said NSAID, which is not at all uncommon.

Indeed I have several recorded cases of cats which went into ARF when I know their kidneys were fine before they were given NSAIDs because they were blood tested before. I am consequently very cautious about using NSAIDs in cats, In my practice no cats get NSAIDs until they are fully recovered from anaesthetic and had any fluid deficit corrected.

I am concerned that some vets are encouraging owners to have unnecessary pre-surgical blood tests to make money rather than looking more carefully at anaesthetic monitoring/fluid therapy protocols. I'd routinely put animals on a drip before I spent their owner's money on blood tests even 40 ml saline sub cut is better than nothing.

RE: Teaching technique for cat spays

Anthony Todd — Wed, 13 Jul 2016 10:45:47 GMT

+1 Gillian [there's a first]...

Does anyone really think a consult discussion on the relative risks/benefits/dangers/rare events/ preexisting conditions/choice of drugs/blood values/history/congenital conditions/blood tests available etc. etc. is of much actual benefit to an owner who has absolutely no understanding of the complex issues and interactions and has a preformed prejudice from a bit out of an un-reviewed piece off Google which someone with an ax to grind has written??

In fact no scientific training at all, ['cos even on here we all can't agree!]

And is rushing to get her unruly, uncontrolled brats to pre-school!

[already expecting the rush of "all my clients understand everything I say perfectly"......]

RE: Teaching technique for cat spays

Neil Wheadon — Wed, 13 Jul 2016 10:40:28 GMT

[quote user="Hannah Wynne Richards"]Neil You're not the only one given a 1* for an illogical reason. Someone disagrees with me pointing out that mid-line wounds are more likely to get dirty than those on the flank, and that ferals are often malnourished, and then released into dirty environments.[/quote]

Thanks.

The 1 in 5 is an honest assessment. The 4 in 5 are small incision, forceps in, and up comes the uterus.

There are other readers on this forum, new grads for example and comments such as 'I never have issues' can make you feel quite inadequate. What it has done is pull up a few useful comments as to what to do if you have trouble, very helpful.

The in season cat and pregnant ones (you can't really feel very small enlargements can you?) are valid comments. I've seen ligatures rip away and forceps simply cut through uteruses in the past and hunting for that tissue from the flank is tough.

Neil

RE: Teaching technique for cat spays

Anthony Todd — Wed, 13 Jul 2016 10:33:23 GMT

[quote user="Vet12345"] We had about 4 cases of ARF in 'young healthy cats' following neutering procedures in a 12 month period[/quote]

This is, frankly, unbelievable IME. What were the outcomes ie was this diagnosed PM?

What was the rough total number of "young healthy" cats neutered in that 12 month period?

I don't think we had any post-op deaths following neutering ever [but cannot verify TBH, 'cos most of them are never seen again.]

All of our rare anaesthetic deaths were usually on induction, and, since triple combo [versus thiopentone] extremely rare.

Surgery deaths are something most vets remember....

RE: Teaching technique for cat spays

Gillian Mostyn — Wed, 13 Jul 2016 08:06:34 GMT

[quote user="Vet12345"]Ok maybe I am erring too much on the side of caution, I've seen BUN dipsticks used at a charity here in the UK. I'd imagine this would be a fairly cheap alternative to a bigger bill for the client but perhaps would give everyone a bit more piece of mind. [/quote]

1) do you think that pre-op bloods would have actually shown anything in the cats you had develop ARF post op?

2) using intra-op fluids actually carries its own risk of morbidity/mortality. Do you discuss these risks with the clients?

3) 'triple combo', whilst convenient and relatively cheap, is probably not the 'safest' anaesthetic choice. (I dont have a problem with it- I use it for young neuters- but wouldn't use it for older/ill cats). If you are giving the owners a choice for making the procedure as safe as possible, do you also discuss choice of anaesthetic with them, and let them choose their idea of the 'gold standard'?

RE: Teaching technique for cat spays

Vet12345 — Wed, 13 Jul 2016 01:58:30 GMT

I agree. I find that more clients want as much information as possible so they can get involved in decision making. I'm not hearing 'it's just a cat' as often anymore. (except when I work in more affluent areas)

RE: Teaching technique for cat spays

Vet12345 — Wed, 13 Jul 2016 01:36:47 GMT

Hi Anthony,

Sorry to have strayed off topic! I guess i'm being a bit of a hypocrite as I'm having trouble backing it up with papers. I am moving house so will have to look into this more at a later date. We had about 4 cases of ARF in 'young healthy cats' following neutering procedures in a 12 month period. Not aware of any before that when I was there and I moved to the UK after that. Admittedly I haven't seen any in UK. So I guess my preference towards recommendation is based a few cases and perhaps was down to other factors. I did not perform any the ops but was treating one of the cats, following an ARF post castration. He had a triple combo and meloxicam injection peri-operatively as did some of the other cases. No batch numbers were recorded so couldn't really link that as a potential cause. All procedures were done at different branches and I can't recall a mention of prolonged procedures.

Who knows, maybe someone gave the meloxicam twice as I have heard of this happening but usually the nurses will realise and tell someone. Neuters were normally done at about 5 months of age except for a few breeders that requested 12 week old neutering. We saw a lot of semi feral cats and a fair number of FIV positive cats. Often they have not been seen in a consult before being booked in over the phone for the surgery.

I also like to ideally do the admits to double check whether the owner withheld water overnight. The reception and nursing staff were told to inform people to ensure the pets had water overnight but still not everyone listens. Perhaps that was enough on a hot day to make the cat slightly dehydrated pre-op and more susceptible to kidney injury.

It was suggested that these cats could have had congenital kidney disorders that were not apparent pre-op. I thought this was a fairly interesting paper re congenital and inherited renal diseases (although no reference to ARF post neuter!). The authors mention that in the case of renal agenesis, where only one kidney is affected, the patient is usually not symptomatic. Primary renal neoplasms have also been described in puppies and kittens.

Greco, D S (2001) Congenital and inherited renal disease of small animals. The Veterinary clinics of North America. Small animal practice, March 2001, Vol.31(2), pp.393-9, viii

Ok maybe I am erring too much on the side of caution, I've seen BUN dipsticks used at a charity here in the UK. I'd imagine this would be a fairly cheap alternative to a bigger bill for the client but perhaps would give everyone a bit more piece of mind.

RE: Teaching technique for cat spays

Anthony Todd — Tue, 12 Jul 2016 23:40:55 GMT

[quote user="James Laidlaw"]Also, I'm not saying that EVERY patient MUST have bloods, but there's a point to discussing things with the client and letting them make an informed decision,[/quote]

But if you're informing an owner of risks it's important to be accurate and the example given exaggerated the risk and was not accurate!

The "2.5%" was in all dogs in for all surgery not young dogs in for a spay etc.........

As I said:

"Unless you can point to figures that say X% of cats [or dogs] under 2yo have potentially life threatening un-diagnosed conditions you've got a hard job to convince me."

then I will see "that side of the coin", in a routine op on a young fit animal and I think the human view is the same.

10yo yorkie in for a dental "been drinking a bit more than usual" discuss bloods with the owner for sure, but routine short ops in young "healthy" animals, not really.

Someone, somewhere, must have some data, even anecdotes, of "young healthy" animals in for routine ops and showing abnormal bloods which will cause surgical or anaesthetic risk with no history or signs.

Here's a paste from a UK vet's site which I would accept makes a case:

The full profile is recommended for the following categories of patient:

All animals over eight years of age
Younger animals that are unwell
Younger animals undergoing particularly long anaesthetics

RE: Teaching technique for cat spays

James Laidlaw — Tue, 12 Jul 2016 22:14:43 GMT

[quote user="Anthony Todd"]Crikey, talk about distorting figures to suit the finances.....[/quote]

Well, I've never been paid commission or owned a practice, so... There's that.

Also, I'm not saying that EVERY patient MUST have bloods, but there's a point to discussing things with the client and letting them make an informed decision, although I'm well aware of your opinions on this process and that you'll never see that side of the coin - just tell 'em what they need and she'll be right, right? For what it's worth, people in a lot of situations are educating themselves and better informed when they come to their vet - so in a lot of cases taking time to discuss things and help them understand not only leaves things clearer if there are complications, but I always felt added value and regularly got told by my clients in the UK that they were appreciative that someone was actually taking the time to explain things to them. It reduces their anxieties about leaving their pet at the clinic, and means they don't leave with unanswered questions - which is always a pitfall if the proverbial hits the fan.

RE: Teaching technique for cat spays

Anthony Todd — Tue, 12 Jul 2016 21:21:31 GMT

[quote user="James Laidlaw"]What if you can catch that 2.5% though - at least offer a "gold standard" approach to clients that may want to spend the extra money to cover that small percentage of higher risk patients, no?[/quote]

So you're going to push 97.5% of owners with pets for a GA to have "bloods" and justify it by saying that 2.5% have been shown to have an abnormality.....

These were all animals that came in for surgery, for all sorts of reasons, all sorts of ages a pretty low percentage I would have thought and a far cry from a population of young healthy animals in for a spay.

That's old dogs for dentals, gastric torsions, fractures an' all, so you're bound to get 2.5% with all sorts of diseases. [I would have thought it would be higher!]

Let's face it any animal having a significantly sinister blood value would have some signs an owner, let alone a vet, should notice!

Crikey, talk about distorting figures to suit the finances.....

RE: Teaching technique for cat spays

Iain Richards — Tue, 12 Jul 2016 20:46:54 GMT

Evening Martin, good to see a comprehensive profile! I'm evidently going off old knowledge!

Regarding the conflict - I was thinking in terms of the animal to whom it does no harm. As we are a customer service, I don't see too much of a problem in providing that service. Assuming of course the test is discussed and not just routine