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

Date:   18 December, 2011  

Focus:
 Small animals - dogs, cats, hamsters, guinea pigs, turtles & rabbits
Productivity and Audit of Veterinary Surgeries for 2012
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

18 December, 2011  
toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129

As in any business, productivity is important. A longer time taken in veterinary surgery means a vet is less efficient and productive. I will be recording in greater detail,  the processes, proctocols and post-operation outcomes done by me and associates in 2012.

One of the various measurements is Duration. Starting time = when sedation is given. Ending time = last stitch.

Three of my cases are mentioned below.

Dec 14, 2011
CASE 1. Monorchid. One undescended testicle removal
Maltese, 4 years, 3 kg
A lady owner just wants undescended right testicle to be removed, but leave the normal one alone. She wiped tears off her eyes as she handed her dog to me. She was one of those educated owners who know about the anaesthetic death risk. Yet she knew that the undescended testicle may become cancerous in later life and still need to be removed. By then, an older dog would incur a higher anaesthetic risk of death. Her husband and I had to assure her that there was nothing to worry as the dog was in good health.

MY GUIDELINES: 10kg, young, healthy dog
Domitor (D) 0.4 ml Ketamine (K) 0.5 ml combined IV in one syringe. This is effective as an injectable anaesthesia lasting around 30 minutes and is sufficient for a dog spay without topping up with isoflurane + O2 gas. However, I usually use 50% of the guidelines for less than 5-minute operation and top up when required.

In this dog done by me, calculated D=0.172 ml, K=0.215 ml
At 50% of calculated dosage, I injected D=0.08, K=0.10. Total = 0.18 ml IV. Added Hartmann's 0. 12 ml to total 0.3 ml which was given IV. Intubated. Isoflurane + O2 top at 1%. PDS absorbable 3/0 suture, 2 horizontal mattress. Time start: 10.11 am Time end: 10.29 am Total = 18 minutes. Dog woke up within 10 minutes after end of surgery and went home soon. I did not tape up the wound and taught the owner to use a clean facial cotton with clean water to wipe off the blood the next day and check daily. No need to return for stitch removal as the stitches will dissolve in 14-28 days' time.
 
1/3 size of normal descended testicle - hard to locate, neuter, toapayohvets, singapore 1/3 size of normal descended testicle - hard to locate, neuter, toapayohvets, singapore
tpvets_logo.jpg (2726 bytes)4850. Only the undescended testicle is to be removed

Case 2. Tarsorrhapy (repeat)
Shih Tzu, 5.4kg. Had been warded for over 3 days. The dog looked weak but he was the quiet type. At 50% of calculated dosage, I injected D=0.108 ml , K=0.135 ml. Total = 0.25ml IV. Isoflurane + O2 top at 1%. PDS nylon 3/0 suture, 2 horizontal mattress. One suture is over tubing. Time start: 11.06 am Time end: 11.29 am. Total = 23 minutes
Dog was not waking up fast. Given dextrose saline SC and antisedan 0.2 ml IV. Dog woke up soon. OK as at 3 days post surgery. 

Case 3. Dec 9, 2011. Tarsorrhapy (lst time).
Shih Tzu, 3.9kg. The dog has been warded for the past 9 days without eye swelling or bleeding unlike Case 2 which was taken home against medical advice on Day 1. I will record the times later.

Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore
Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore Eye ulcer, distichia, ectopic cilia, young shih tzu, tarsorrhapy, toapayohvets singapore

Young Shih Tzu - ectopic cilia and corneal ulcer. Tarsorrhapy without problems of stitch breakdown

In conclusion, audit of veterinary surgeries is important in evaluating the standard of care and performance of veterinary surgeons.  Without an audit, vets may just waste materials, time and provide poor quality service. Some of the doctors and their nurses get distracted during surgeries by texting or making personal phone calls during surgeries as reported in one article I read recently. So, audit of veterinary surgeries by the Principal is important in ensuring a high standard of care and services. Doctors who don't perform well in the audit will have to leave the practice.

Marina Bay Residences condo, singapore, asiahomes, above 40th floor

Advertisement:   Asia USA Realty (Singapore)
asiahomes.com Pte Ltd  

VARIOUS UNITS ARE FOR RENT AT VARIOUS TIMES:
Tel: +65 9668 6468, Email: judy@asiahomes.com
Asia USA Realty

red eared slider eyes closed and puffy for last 2 weeks, now open after 4 days of treatment, toapayohvets, singaporeMore info at: Dogs or Cats. To make an appointment: e-mail judy@toapayohvets.com
tel: +65 6254-3326 or 9668-6469

Be kind to dwarf hamsters. Don't wait till tumour becomes large to ask your vet to excise it. Toa Payoh VetsHamster anaesthesia at Toa Payoh Vets

To make an appointment: e-mail judy@toapayohvets.com
tel: +65 9668-6469, 6254-3326

toapayohvets.com 
Be Kind To Pets
Veterinary Education
Project 2010-0129
tpvets_logo.jpg (2726 bytes)Toa Payoh Vets
Clinical Research
 

Copyright Asiahomes
All rights reserved. Revised: December 18, 2011

Toa Payoh Vets