Pediatric Spay / Neuter Brenda Griffin, DVM Contents: Spaying and Neutering Puppies and Kittens Anesthetic Agents for Puppies and Kittens 6-16 Weeks Old Pediatric Spay/Neuter Notes Surgical Techniques Consent Forms Discharge Instructions for Puppies and Kittens Following Spay/Neuter Resources for Veterinarians Spaying and Neutering Puppies and Kittens Euthanasia of healthy unwanted cats and dogs remains the leading cause of death of these species. The Humane Society of the United States estimates that 4-6 million are euthanized annually in this country alone. This number has decreased markedly since the 1980's when an estimated 17 million cats and dogs were killed annually in the United States. Awareness of the magnitude of the problem, humane education and promotion of surgical sterilization are responsible for this dramatic decrease. The pet overpopulation problem, however, is far from being solved. In addition, the dynamics of the problem are changing, with cats currently outnumbering dogs entering many shelters in the U. S. Pet owner surveys reveal that the leading source of pets entering shelters are unwanted litters. Although virtually all animal shelters require adopted pets to be sterilized, the compliance rate of owners according to the American Humane Association is only approximately 50% on a national basis, despite implementation of spay/neuter contracts, coupons, other incentives and time-consuming follow-up. For these reasons, the American Veterinary Medical Association advises that all pets be neutered before adoption, including puppies and kittens as young as 8 weeks of age. The ideal age to spay/neuter dogs and cats is unknown. Currently, the most common age or the "traditional age" for recommending spaying/neutering is 6 months. This recommendation, however, is not based on research indicating that this is the ideal age to perform these procedures, but was probably chosen because anesthetic and surgical techniques were less advanced at the time and surgical success was more likely in a larger patient. Approximately 30 years ago, humane organizations began sterilizing young puppies and kittens. Understandably, many veterinarians expressed concerns and questions regarding the short- and long-term safety of sterilizing pediatric patients. In response to these concerns, numerous controlled prospective studies and retrospective cohort studies have been performed to verify the safety of early age spay/neuter. Based on these studies, we can now conclude that sterilizing young puppies and kittens is a medically-sound practice, and is not associated with any serious medical or behavioral risks. In addition, early age spay/neuter offers many advantages including well-established, safe anesthetic and surgical techniques, shorter surgical and recovery times, and avoidance of the stresses and costs associated with spaying while in heat, pregnant or with pyometra. There are also numerous long-term health benefits including virtual elimination of the risk of mammary and testicular tumors. Finally, in addition to benefiting the individual patient, early age spay/neuter helps veterinarians to fight the single largest killer of dogs and cats: overpopulation and euthanasia of unwanted, homeless pets. Anesthetic Agents for Puppies and Kittens 6-16 weeks old Brenda Griffin, DVM, MS Auburn University, 2002 A variety of anesthetic combinations can be used for pediatric patients. Each combination must provide complete anesthesia including immobilization, muscle relaxation and analgesia. Considerations in selection of anesthetic agents include cost and time when animals are owned by humane organizations where many surgeries are needed and funds are limited. For Puppies and Kittens: "Pediatric Cocktail" 10 ml Ketamine (100 mg/ml) 1.5 ml Xylazine (100 mg/ml* THE LARGE ANIMAL CONCENTRATION) 0.5 ml Acepromazine (10 mg/ml) Dose: 0.1 ml per pound body weight IM Reverse if needed with Yohimbine (2 mg/ml) 0.1 ml per 2 lbs body weight IM or IV Use for both ovariohysterectomies and castrations. Provide supplemental isoflurane by mask if needed. Torbugesic-Propofol-Isoflurane Preanesthetic: Torbugesic at a dosage of 0.2-0.4 mg/kg SQ Atropine at a dosage of 0.04 mg/kg SQ OR Glycopyrrolate at 0.011 mg/kg SQ Induction: Propofol at a dosage of 6-8 mg/kg IV to effect (via 25 ga butterfly catheter) *note: ketamine-valium may be used in place of propofol for induction [1:1 mixture of Ketamine (100 mg/ml) and Diazepam (5 mg/ml) at a dosage of 1 ml mixture per 20 lbs. body weight IV to effect] Maintenance: isoflurane (via uncuffed et tube or mask) For Puppies Only: Torbugesic-Pentothal-Isoflurane Preanesthetic: Torbugesic at a dosage of 0.2-0.4 mg/kg SQ Atropine at a dosage of 0.04 mg/kg SQ OR Glycopyrrolate at 0.011 mg/kg SQ Induction: Pentothal at 22 mg/kg IV to effect (dilute with sterile water if volume < 3 ml)(via 25 ga butterfly catheter) Maintenance: isoflurane (via uncuffed et tube or mask) For Kittens Only: KDT (Ketamine-Domitor Cocktail) l0 ml Ketamine (100 mg/ml) 1 ml medetomidine (Domitor, 1 mg/ml) 3 ml butorphanol (Torbugesic, 10 mg/ml) Dose: 0.1-0.15 ml per pound Reversal: antipamasol (Antisedan) (use alone for castrations or in conjunction with isoflurane inhalant anesthesia for ovariohysterectomies) Pediatric Spay/Neuter Notes Reasons to Perform Early Age S/N: No substantial medical reasons to wait Guaranteed compliance No "whoops litters" (pregnancies at <6 mos) Perioperative Concerns: Hypoglycemia Hypothermia Blood loss Infectious disease (incubating) Avoiding Hypoglycemia: Minimal stores of hepatic glycogen à risk for hypoglycemia Avoid prolonged fasting GI emptying time very fast in puppies and kittens (less risk for regurgitation/aspiration) Feed one-quarter normal ration 2-4 hours prior to surgery (maximum 6 hour fast pre-op) Take transport (car sickness) into consideration Feed 1-2 teaspoons 15 minutes after standing, then feed small meal a few hours later (puppies and kittens should be standing within 1-2 hours of surgery, or sooner depending on anesthetic protocol used) Keep Karo syrup on hand and give orally to any pups or kittens slow to recover (1 ml/kg) Avoiding Hypothermia: Use towels and supplemental heat Hot water blanket Hot water bottle or rice sock Shave hair conservatively Do not get hair coat wet during prep Never use alcohol Allow littermates to recover together Use shredded paper in recovery cages Physical Examination: Body weight and condition Minimum weight requirement = 2 lbs. Verify sex Males- check for cryptorchids; pup's might descend, kitten's usually do not Congenital defects Infectious disease Keep littermates together Shelter Medicine: Small animal herd health Balance humane, quality care and care of the masses Practical, time and cost-effective, while providing the best possible care Recommended Age to S/N: Shelter animals- neuter before adoption Client owned Following standard vaccinations Offer incentive for early S/N Price break Puppy/kitten classes Include permanent identification: microchip or tattoo Anesthetic Agents for Pediatric Patients: Small body weight- need accurate weight for drug dosage Many protocols safe (see attached) Special drugs and equipment not needed For gas anesthesia, use non-rebreathing system and uncuffed et tube or mask Surgical Techniques: Kitten Neuters: Scrotal incisions Closed technique Self ligatures No closure Puppy Neuters: Pre-scrotal incision Closed technique Self ligatures Close with tissue glue Puppy and Kitten Spays: Very little bleeding and fat Handle tissues gently Elastic (easy to elevate) Fragile Use snook hook ID by feel (springy) Cut suspensory ligament- kittens Strum suspensory ligament-puppies Ovaries appear disproportionately large compared to uterus Ventral midline incision Small (2 cm) Midway between umbilicus and pubis Slightly more cranial for puppies Expect abdominal fluid (normal, often substantial volume) Ligatures- Kittens Ovarian pedicles- self ligatures Uterine body- 3'0 absorbable suture Vicryl or surgeon's preference Ligatures- Puppies Ovarian pedicles and uterine body- 3'0 absorbable suture Vicryl or surgeon's preference Closure Linea alba- simple interrupted using same absorbable suture Subcutaneous Subcuticular Tissue glue if needed Tattoo ink Consent Forms An example consent form can be viewed here. Discharge Instructions for Puppies and Kittens Following S/N Puppies and kittens will be fed a very small meal (1-2 teaspoons canned food) following recovery from anesthesia prior to transport back to the shelter. Puppies and kittens should be kept warm and dry by providing ample bedding material, and litters should be kept together during transport. Some puppies and kittens may experience nausea and vomiting during transport (car sickness). This is to be expected and is not cause for concern. Once back at the shelter, litters should be bedded down together and once they are settled in, they may be fed approximately 1/3 their normal ration. Water should be provided. They may be fed normally the following morning. Incisions should be monitored daily to be sure they remain clean, dry and intact. Occasionally, a suture reaction or seroma may form within a few days of surgery. A suture reaction is a firm swelling along the incision. A seroma is a pocket of fluid at the incision. These will resolve in 1-2 weeks without treatment. If an incision opens (gaping wound) or if it appears red, painful or has a thick discharge, veterinary attention is warranted. Please report any problems to Dr. ________________________ at _____________________. Puppies and kittens rarely chew or lick or bother with their incisions in any way and should be playing and eating normally the day following surgery. If they are and if their incisions appear clean, dry and intact the day following surgery, they may be offered for adoption at any time. VERY IMPORTANT: Do NOT give Dr. ____________'s home phone number to adopters. Post surgical complications are very unusual and puppies and kittens should be expected to recover quickly. If puppies or kittens appear depressed, they should be evaluated for infectious diseases as these are unavoidably frequently encountered in the shelter setting. As always, all patients should be provided with extra TLC! Resources for veterinarians: Video- "The Case for Early Neutering" Available from the American Humane Association, ph #303-792-9900 Video- "Early Age Neutering: A Practical Guide for Veterinarians" Available from UC Davis/AVAR, ph#530-759-8106 Reprints: Griffin B. Spaying and Neutering Puppies and Kittens, Proceedings Auburn University College of Veterinary Medicine Annual Conference, 2002. (includes anesthetic and surgical protocols for puppies and kittens). Available on request from Dr. Brenda Griffin at griffb1@auburn.edu Association of Shelter Veterinarians- contact Dr. Julie Dinnage at sheltervet-owner@yahoogroups.com or jdddvm@attbi.com to join, excellent list serve for information for veterinarians.

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