Pyometra workshop

Question 1

what drugs should we avoid if the animal is compromised

Answer 1

NSAIDs
alpha 2 agonists
acepromazine

Question 2

What pre-med should we probably use when pre-med a pyometra

Answer 2

methadone- IM or slow IV

Question 3

what drugs do we use in co-induction- why do it

Answer 3

Propofol or alfaxalone then benzodiazepine then more propofol or alfaxalone

co-induction, theory is it might reduce total dose of propofol or alfaxalon

Question 4

what 2 questions should you ask yourself if SPO2% is dropping

Answer 4

Is respiratory system ok?
Is oxygen supply and delivery ok ?

Question 5

List 4 things that capnography can inform us of

Answer 5

ventilation
metabolism
cardiac output
equipment/ airway

Question 6

Define hypotension

Answer 6

BP values of systolic <80–90 mm Hg, mean <60–70 mm Hg, and diastolic <40 mm Hg

Question 7

Describe how to manage hypotension during anaesthesia

Answer 7

Switch down the volatile agent and consider PIVA – see if this works
Try an IV bolus of crystalloid (5-20ml/Kg) occasionally colloids are used – see if this works
If the animal is bradycardic too? Administer anticholinergic (atropine/glycopyrrolate)

Question 8

What does a slowly a dropping CO2 on a capnograph suggest

Answer 8

Dropping cardiac output

Question 9

What breeds are predisposed to pyometra

Answer 9

Labrador
Poodle
Doberman

Question 10

What are the clinical signs of a pyometra

Answer 10

open cervix –> mucopurulent vaginal discharge
closed cervix–> abdominal distention

Question 11

what is the most common bacteria involved in pyometras

Answer 11

E coli phylogroup B2

Question 12

What factors can increase the risk of pyometras

Answer 12

Diet containing E coli
Transmission of E coli from another dog
Administration of steroid hormones e.g. oestrogen
Hormonal effects amplified throughout life => higher risk in older dogs

Question 13

Some dogs with a pyometra present with PU/PD. What is the mechanism for this clinical sign?

Answer 13

Escherichia Coli endotoxin interfere with sodium reabsorption and damage ADH receptors and may result in an immune-complex glomerulonephritis and this causes the PU/PD

Question 14

A cockerpoo is admitted following suspicion of a pyometra by your colleagues in a branch practice and on presentation is in hypovolaemic shock. The dog weighs 12kg and you decide that it needs a bolus of fluids. You decide to give it a 10mL/kg bolus over 10 minutes. The giving set delivers 20 drops/mL.
What would the drip rate be?

Answer 14

4 drops a second

Question 15

How much methadone (10mg/ml) does the 12kg cockerpoo require if you choose a dose of 0.3mg/kg

Answer 15

0.36ml

Question 16

How much maropitant would you like to administer to a 12kg dog? Dose is 1mg/kg and the formulation is 10mg/ml

Answer 16

1.2 ml

Question 17

Consider the difference between cystic endometrial hyperplasia (CEH) and pyometra and decide which of the following statements is correct

Answer 17

Cystic endometrial hyperplasia is a thickening of the uterine tissue which then makes for an ideal environment for a pyometra to occur.

Question 18

If during anaesthesia a patients bradycardia is persistent, and the MAP is now also reducing, and the pulse oximeter reading is reducing from 98% to 92%. What do you do?

Answer 18

Administer atropine

Question 19

A patient is undergoing an OHE for a closed pyometra. The patient is ASA IV(E) What perioperative antibiotics, if any, would you prescribe?

Answer 19

Amoxicillin and clavulanic acid
Cefuroxime (Zinacef)