Reproductive anaesthesiaCase based seminar

Question 1

Case 1

Pebbles is a 10kg 4 year old pregnant CKCS (bred 66 days ago) straining unproductively, with no response to oxytocin, you elect to undertake a C section. Ultrasound confirms foetal heart beats. Pebbles is depressed, T 37.2C. Her HR is 138bpm, and RR is 48.

What is wrong?

Answer 1

• Needs C section
• Elevated HR
• IS puffing away

Question 2

How do you prepare Pebbles for anaesthesia?

IV access, where, how, what type of cannula?

Answer 2

20 guage (pink) needle for her cannula

From smallest to biggest cannulas go: yellow (24), blue (22), pink (20) , green (18)

(smaller lumen of guage bigger the needle. Think of it in terms of pressure a smaller needle like a yellow requires more pressure to empty contents therefore its guage is a higher number)

Question 3

How do you prepare Pebbles for anaesthesia?

–Fluid therapy, how much, what type?

Answer 3

• Hartmanns’s to counteract hypoperfusion that would be caused by anaesthetic drugs if she is trying to decompensate maybe give a bolus
• Colloids more efficacious in pregnant animals

Question 4

How do you prepare Pebbles for anaesthesia?

Oxygen?

Answer 4

Yes, flowby or mask.

It will increase the fractional inspired oxygen.

Question 5

How do you prepare Pebbles for anaesthesia?

–Analgesia, why, and how?

Answer 5

Yes, can have NSAID if not hypovolaemic. If worried about hypovolaemia give NSAID after fluid therapy.

Question 6

How do you prepare Pebbles for anaesthesia?

–Theatre preparation (monitoring for dam, and equipment for puppies)?

Answer 6

10kg gravid and may have lungs of an 8kg cavi and circle would be ok or T piece.

Question 7

•What premedication would be suitable for case 1?

Answer 7

If tractable etc. don’t need alpha 2s etc. could go straight for induction agent

But if use alfaxalone – and no premed, will have stormy recovery

Needs opioid

Can sedate animal, do epidural and C section

• In UK, GA and midline laparotomy
• Can put local anaesthetic in to help with nociception

Question 8

What breathing system would you like to use? (calculate FGF rates) see linked chart?

She is a 10kg dog

Answer 8

Lack not appropriate dogs over 10kg. T piece, Circle or Bain appropriate.

Question 9

Would we give case 1 nitrous oxide?

Answer 9

MAC is really high and would need lots to get an effect. On a non-rebreathing would have to give 70% nitrous oxide and 30% oxygen she needs more than this. May also cause diffusion hypoxia in young so don’t use it as anaesthetic agent in pregnancy.

Question 10

You successfully deliver 4 live puppies. They are not as vigorous as you anticipated. What instructions do you give to the resuscitation team, as you undertake an ovariohysterectomy and close the abdomen?

Answer 10

• Clear airway, give oxygen, vigorous rubbing. Give naloxone under tongue if you’ve given opiod.
• Most pups and kittens are dopey because of hypoxia.
• Doxapram is used in intensive care settings to stimulate the respiratory rate in patients with respiratory failure. It may be useful for treating respiratory depression in patients who have taken excessive doses of drugs such as buprenorphine or fentanyl analogues which may fail to respond adequately to treatment with naloxone.However Kate avoids it as it stimulates a big oxygen demand on the heart of animals already comprimised.

Question 11

What analgesia will you provide pebbles with?

Answer 11

Yes needs NSAID and opiod and local block before sutured up

Question 12

Case 2

• Ginger is an unvaccinated feral tom cat, that needs neutering. He is 6.8kg and uncooperative.
• Devise an anaesthetic plan.

Answer 12

Think IM combos.

Triples and quads.

Quite a large volume for a large tom. May resent large volume into muscle so consider this. Other route can be into mouth as they hiss at you (ketamine in mouth when they hiss at you/oral route)

Question 13

• Nanny G is a 4 year old Anglo-Nubian goat at a local petting farm. You visit and decide she requires a C section as she is straining unproductively, she is approximately 70kg in weight, and cooperative.
• Devise a suitable protocol.
• You deliver 2 kids. The owner asks you to disbud the kids. Make a plan.

Answer 13

• Landmarks for small ruminant c section. She will have prominent transvers process so easy to do paravertebral LA.
• Could cephalic catheter in ear probably get a pink catheter in the ear and then could give and induction agent like you would dogs and cats. Cascade comes in as nothing licensed in this species.
• NSAIDs important

Legal requirement: Only veterinary surgeons are permitted to carry out the disbudding procedure – which is considered veterinary surgery under the provisions of the Veterinary Surgeons Act 1966. There are no exemptions.

• In the interests of animal health and welfare BVA and GVS believe that:
• Veterinary surgeons carrying out disbudding should be proficient in undertaking the procedure
• Anaesthesia must be used, and analgesia should be used, for all disbudding procedures
• The principles of the Cascade should be applied when prescribing analgesics, and goat keepers advised of both the risks and benefits as part of the process of obtaining informed consent for the entire disbudding procedure
• This is usually carried out within the first seven days of life, as horn buds grow very rapidly. There are a number of issues associated with the disbudding of goat kids, including the need to achieve an effective block of four nerves to desensitise the bud (compared to only two nerves in calves). This places a real risk of a toxic local anaesthetic overdose in a high-risk neonatal kid. The skull is also very thin, and, in addition, many conventional calf disbudding irons do not have a large enough head to remove the bud and surrounding germinative soft tissue effectively1