Those shelters that offer spay/neuter services may find themselves mulling over the ideal anesthetic protocol. What we’ve encountered is that there are a lot of variables to consider when developing a protocol tailored to your shelter’s needs. The constant variables remain the same among all clinics – adequate anesthesia, adequate analgesia, minimal stress and wide margin of safety. But what we often find through trial and error are variables that are associated with staffing, services offered, and resources available.
Number of surgeries
Most High Quality High Volume Spay Neuter (HQHVSN) clinics perform 30-50 surgeries per day. This not only dictates a minimum staff requirement, but may demand an IM cocktail over IV induction.
Staffing
As mentioned with HQHVSN, proper staffing is essential for keeping surgeons where they belong – in surgery. However staffing can also have a profound effect on what drugs are used and how they’re administered. Does the person running induction have an assistant to help with induction and to move the patient into surgery? If not, an IM protocol may be warranted for prep and intubation. What is the comfort level and skill of the induction staff? Can they intubate on their own? Can they perform IV induction? Is there someone designated to recover patients? If the same people are doing induction and recovery, patients will need to recover quickly.
Neuter vs Spay
What’s good for the girls may not be needed for the boys. Spays take longer and are more invasive requiring longer anesthesia and stronger analgesia.
Anesthetic Drugs
Sometimes accessibility to drugs will determine the anesthetic protocol chosen. Accessibility can include cost and proper licensing to order scheduled drugs. Drugs like dexmedetomidine are quite pricey and may be cost prohibitive if the majority of patients are large dogs. However, the volume of dexmedetomidine used can be greatly reduced when used in a combination protocol. This in turn can reduce cost. Although morphine is cheap and a terrific analgesic, it’s not always an option for many clinics because it’s a schedule II drug and requires special ordering and documentation.
Keeping in mind that every animal is an individual and will respond differently to any anesthetic protocol, there’s a lot to consider when deciding on an anesthetic protocol to fit your program. The following resources can assist in getting started:
http://sheltervet.org/wp-content/uploads/2012/08/VTFASN_JAVMA_Guidelines.pdf
http://veterinarynews.dvm360.com/dvm/data/articlestandard//dvm/332004/110470/article.pdf
http://www.aapma.com/resources/TTDex_injectable_chart-2012%5B1%5D%20%281%29.pdf
Asking other clinics about their experience with the protocols they use is extremely helpful. Here at Maddie’s Shelter Medicine Program, Cornell University, we are happy to discuss some of the protocols we have used and the effect they have had on our surgery day (sheltermedicine@cornell.edu).
