tpvets_logo.jpg (2726 bytes)TOA PAYOH VETS
toapayohvets.com

Date:   18 August, 2011  
Focus: Small animals - dogs, cats, hamsters, guinea pigs, turtles &
rabbits
 
Key Performance Indicators - How long does it take to spay a healthy young female dog? 26 minutes or 18 minutes?
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS
Date:   18 August, 2011  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

KEY PERFORMANCE INDICATORS FOR SPAYING A HEALTHY AND YOUNG
FEMALE DOG AT TOA PAYOH VETS


Key Performance Indicators (KPI) should also be applied to veterinary surgeries as in any other businesses to improve the performance of a practitioner, to be operationally efficient and reduce wastage of veterinary materials used. A shorter surgery means lesser risk for pets undergoing anaesthesia. 

From 2011, I will be monitoring the time it takes for a vet spaying of a female dog in Toa Payoh Vets and to do that, I have had recorded two spay cases done by me in 2011.

How long does it take to spay a female dog without complications? Two cases done by me are illustrated.

CASE 1.
Fox Terrier, Female, 1 year, 9.3 kg
Last heat 3.5 months ago. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. No IV drip set up.
 
CASE 1. SPAYING THE YOUNG FOX TERRIER
1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 2.29pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 2.35pm.
4. Time when the skin is stitched (C) = 3.01pm.

The following key performance indicators are as follows:
31 minutes of surgery to spay a female Fox TerrierC - A should be less than 35 minutes.
In this case, C-A = 32 minutes
C - B should be less than 30 minutes.
In this case, C-B = 26 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm

DOMITOR + KETAMINE IV WITHOUT NEEDING ISOFLURANE + O2 IN HEALTHY YOUNG DOGS
At 10kg bodyweight, Domitor = 0.4 ml. Ketamine = 0.5 ml. Total = 0.9 ml in one syringe. Give via IV.

If the above is given at 50% of the calculated dosage, isoflurane + O2 top up for less than 60 seconds, to effect (eyeball rolls ventrally and other signs) will be needed. Intubation is needed. Atropine IM is advised before surgery. Antisedan IM after surgery may be useful to get the dog to wake up within 2 minutes.
 

Fox Terrier, 1 year, Spayed. Rigid limbs after giving antisedan
to wake up the dog early. Atropine was given to resolve the problem.
IV anaesthesia  domitor-ketamine one syringe dogs toapayohvets singapore Effect of ketamine after Antisedan is given. Fox terrier spay. toapayohvets  singapore Effect of ketamine after Atropine is given as limbs were rigid. Fox terrier spay. toapayohvets  singapore

MORE DETAILS OF THE FOX TERRIER ANAESTHESIA CLINICAL RESEARCH ARE AT:
http://www.kongyuensing.com/folder5/20110326injectable-anaesthesia-dogs-cats-rabbits-guinea-pigs-toapayohvets.htm
 


CASE 2.
Shih Tzu, Female, 9 months, 5.3 kg
lst day of heat. Skin incision 1.5 - 2.0 cm long. Spay hook is used. No subcuticular or subcutaneous sutures as they do irritate the dog. IV drip is given before injection of sedatives.
 

1. Time when the dog is given Domitor + Ketamine IV*. Atropine IM (A) = 3.15 pm.
2. Wait 5 minutes. Isoflurane + oxygen gas in mask. Intubate.
3. Time when the skin is incised (B) = 3.23 pm.
4. Time when the skin is stitched (C) = 3.41 pm.

The following key performance indicators are as follows:
shih tzu first vaginal bleeding at 9th month, the day of spayC - A should be less than 30 minutes.
In this case, C-A = 26 minutes
C - B should be less than 20 minutes.
In this case, C-B = 18 minutes.
No. of suture packets used - one packet 2/0 absorbable
No. of stitches to close the linea alba - 3 simple interrupted
No. of stitches to close the skin - 2 horizontal mattress
Skin incision 1.5 - 2.0 cm
 

tpvets_logo.jpg (2726 bytes)4411 - 4416.  Spaying a dog at her first day of bleeding
  shih tzu first vaginal bleeding at 9th month, the day of spayshih tzu first vaginal bleeding at 9th month, the day of spay shih tzu first vaginal bleeding at 9th month, the day of spay
shih tzu first vaginal bleeding at 9th month, the day of spay shih tzu first vaginal bleeding at 9th month, the day of spay shih tzu first vaginal bleeding at 9th month, the day of spay

 

How long it takes to spay a female dog? Injection of sedative to skin stitched up Skin incision to skin stitched up
Case 1. The Fox Terrier, 9.3 kg. Isoflurane gas top up needed.  Domitor 0.2 ml + Ketamine 0.3 ml IV.  Approximately 50% of the calculated dose was given. Calculated dose should be Domitor 0.37 ml + Ketamine 0.47 ml IV would not need isoflurane gas top us 32 26
Case 2. The Shih Tzu, 5.3 kg. No need isoflurane gas top up as the calculated dose is given. Domitor 0.2 ml + Ketamine 0.25 ml IV.   26 18
If there is no need to top up with isoflurane + oxygen gas, the time taken from skin incision to skin stitched can be as fast as 18 minutes since there was no time wasted in topping up the anaesthesia and the hooking out of the ovary can be successfully done within 3 hooks.
 

Injectable anaesthesia in the healthy dog and cat
in one syringe. Calculated dosage for healthy and young dogs and cats

Weight & Health Status Domitor Ketamine
10kg  healthy, young female dog 0.4 ml IV 0.5 ml IV
 
Domitor 5-40ug/kg = 0.005mg/kg-0.04mg/kg
Ketamine 2-5mg/kg
Heart-diseased dogs - Do not use domitor + ketamine. Old dog - Use less domitor or 50% of the calculated dose. I will  just use isoflurane + O2 gas solely if the dog is in poor health rather than taking risk with Domitor or Domitor + Ketamine IV. 
 
Domitor and ketamine are synergistic and their combined use will be safer if injectable anaesthetics are required and no isoflurane gas is available. For healthy young dogs, use the calculated dosage given above. For heart-diseased dogs, use 50% of calculated dose and give isoflurane gas top up. Do NOT use domitor + ketamine is heart-diseased dogs.

I have around 30 years of small animal practice. I founded Toa Payoh Vets in 1980 and it is 2011 now.  So practice makes perfect. The faster the surgery is done, the lesser the anaesthetic risk to the dog. So, I will be auditing veterinary surgery done by myself and vets at Toa Payoh Vets from 2011 onwards.

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