This case illustrates
the importance of being scientific in giving IV
anaesthesia. If the vet simply gives Domitor 0.1 ml IV
for small dogs regardless of size and age and top up
with isoflurane gas + oxygen at all times, I will
consider that this veterinary surgeon is not a good vet.
In private practice, there is a need to keep veterinary
costs low for the client, but the practice must earn a
sustainable amount to survive.
If the vet uses Domitor 0.1 ml for small breeds and then
top up with isoflurane gas due to insufficient analgesia
to perform the surgery, there is a big waste of
resources for the practice as isoflurane is not a cheap
anaesthetic. Vets who don't have to pay for resources do
not appreciate that the drugs are costly and that
veterinary prices need to stay competitive. If this vet
does not bother to be efficient and productive, he or
she waste a lot of resources of isoflurane and prolong
an operation since it takes more time to anaesthesize
the dog with top up.
I have the following case to illustrate how a sound
knowledge of the use of domitor + ketamine IV based on
my formula and based on weight and age (in this case,
25% of the formula) enabled me to perform an aural
haematoma surgery WITHOUT the need to top up.
PATIENT
Cross-bred terrier, 13 years old, 6.3kg, good condition,
but machinery heart murmur. No coughing. Undescended
testicle x 1. Bad teeth. Very high anaesthetic risk but
surgery is the only option in this aural haematoma
treatment.
This case - IV domitor and ketamine at 25%* of my
calculated dosage was sufficient for an old dog not in
good health for around 60 minutes of surgery. No blood
test was done to screen the health to keep veterinary
costs minimal.
Get all materials and plan early before giving the IV
anaesthetic injection
Right ear swollen. Heart
disease
Clip hairs
Wash ear well
S-shaped incision of
sufficient length. Remove
all clots inside
2/0 nylon horizontal mattress suture x 1 packet
Ear irrigation to flush out
blood and debris. Dog howls.
Antisedan wakes up dog.
Before going home, handing
over inspection
Knots are on lateral side of ear pinna. Pain-killers and antibiotics. Home
nursing advices.
I audit how long it takes me to do this surgery. The
times of my surgery and procedures are as follows:
10.35am
At 25%, D=0.07
ml K=0.09ml = 0.16 ml+ Hartmann to 0.9 ml given
IV. Waited 5 minutes. Check blinking reflex which
persisted throughout.
11.23 am
2/0 stitching ends.
11.24 am
Irrigate right
ear to get rid of any dead ticks. The dog reacted
by howling. This showed that the IV surgical
anaesthesia lasted till from 10.35 am - 11.24 am.
No need to use isoflurane for 48 minutes. This was
a surprise to me as I was prepared for isoflurane
gas top up.
*NOTES In young healthy dogs, 25% will be
insufficient. The dosage may be up to 100% for 48
minutes of analgesia without isoflurane gas top
up.
However fast, I
cut and stitched, the whole process was
approximately 48 minutes for surgery without pain.
At 11.35 am, I injected Antisedan 0.2 ml IM and
the dog woke up fast as if he had an afternoon
nap. The lady owner was quite happy and took the
dog home.
POST-OP NURSING. I phoned the owner today Feb 8,
2012 about 5 days after surgery. The dog was
trying to scratch its ears daily despite the
e-collar being worn. I advised her to get a clean
10-20 ml syringe, fill it with lukewarm water and
irrigate the ear canal which would have contained
blood post-operation. This would reduce her costs.
I did not bandage the ear or plug the ear canal
with cotton wool although in some cases I would do
so. Usually the dog shakes off the bandage within
12 hours unless the whole ear is bandaged to the
neck.
Some vets use X-ray plates to be stitched on the
lateral and medial side of the ear to provide
compression. I don't do it as the results of
getting a normal ear back are not that good.
TOA
PAYOH VETS
