Minnesota Veterinary Medical Association

(651)-645-7533

2007 State Fair Surgical Suite – Surgeon’s Information

Thank you for volunteering your time and skill at the Surgery Suite this year! A list of participating veterinarians will be posted at the Suite. There will be a paid technician, Shelley Cravens, in charge of the Suite and a veterinary student present to assist. Although it is not necessary, you may bring your own technician if you prefer additional or familiar assistance. Please read this over each year as changes are made on a regular basis.

1. Surgeries are scheduled for 10:00 AM and 12:00 noon for the morning surgeon, 2:00 PM and 4:00 PM for the afternoon surgeon. Please arrive one hour before your first scheduled surgery and be prepared to stay until the animals for which you have been surgeon are extubated and sternal. Please bring your own scrubs if you have them. (We will have some available if you do not.)

2. Humane societies will deliver all four patients for the day by 9:00 AM. The morning surgeon will be assisted by the technician in placing IV catheters in at least 2 patients, which will be covered with Vetwrap and kept heparinized until post-op. Please also do a pre-op physical and check to be sure these are intact females.

3. Please take a few minutes to talk to the moderator scheduled for your surgery time slots. Let them know what suture you are using, what the closure technique will be and if there is anything unique about the way in which you perform your spay surgeries. Also discuss coordinating how you might show a tissue on camera to the audience (e.g. an ovary, the linea alba) so that they might better orient themselves as to what the surgeon is doing. There is a speaker in the surgery suite now so that you can hear the moderator and better coordinate transmitting what is happening in surgery to the audience.

4. The technician and student will perform a blood count, a simple clot time & mini-screen chemistry panel on every patient. If there are abnormal values it will be your decision whether to proceed or try to get a replacement animal. Replacements are a lot of trouble, but worth it if you have real reservations about an animal's ability to survive surgery and anesthesia. All dogs/cats that don’t already have a subcutaneous ID chip will receive one that you can insert during pre-surgical prep.

5. See next page for drug protocol. The following anesthetic regime is the preferred one for dogs and cats. You may use a different regime if you feel strongly, however you are responsible for bringing your own drugs if you require other than what is mentioned below (except for acepromazine; there will be a bottle of this at the surgery suite). A pre-op sedative is to be given 15 minutes before induction time.

6. DRUG PROTOCOL

Quick Reference Guide & Common Drug Dosages
NOTE: Be sure to always confirm that the drug concentration matches with the one liste here.
Example: Morphine should be 15mg/mL
ALL DOSES ARE IN POUNDS (LBS)

ANESTHETIC/ANALGESIC DRUGS **Treat pain before it occurs**	ANALGESICS Post Op
Pre-Op: CATS Domitor (medetomidine)1.0mg/ml (0.01ml per pound) Atropine 0.54mg/ml (0.025 ml per pound) (optional) Buprinorphine 0.3 mg/ml (0.02 ml per pound) **Draw up Domitor 1^st. Mix above in same syringe and give IM	CATS: Buprinorphine 0.3 mg/ml Send home 0.02 ml per pound, give orally under tongue bid x 3 days
Pre-Op: DOGS Domitor (medetomidine)1.0mg/ml (0.01ml per pound) Atropine 0.54mg/ml (0.025 ml per pound) (optional) Morphine 15mg/ml (0.015 ml per pound) **Draw up Domitor 1^st. Mix above in same syringe and give IM Rimadyl Injectable 50mg/ml (0.04 ml per pound) **Give in separate syringe SQ	DOGS: Rimadyl Send home appropriate size per BW 4 day pack of oral Rimadyl
Induction: CATS and DOGS Mix equal amount in same syringe, Draw up Valium 1st . Valium 5mg/ml (0.02ml per pound) Ketamine 100mg/ml (0.02ml per pound) **Give IV SLOW TO EFFECT
Maintenance: Isoflurane or Sevoflurane 1.5-2.5%
Fluids: LRS (10 mg/kg/hr)+any deficit + 3x blood loss, if any
Antibiotics: Prophylactic durapen 30 minutes before surgery (0.1 ml per pound IM or SQ)
Monitoring Anesthetic Patient Jaw tone, Ocular position, CRT, Pulse HR: 50-160 bpm. RR 8-20 rpm Pulse Ox >96%, CVP: 3-8cm H20 Systolic BP: 90-160, Tidal Volume 10 ml/kg Temperature: forced-air warming blanket, warm bags and fluids.	[All doses to be adjusted based on circulatory status, age, disposition or co-existing disease]

6. Prepare Surgery Suite:

Enter the surgery only in proper attire (shoe covers, scrubs, cap and mask).

Familiarize yourself with the layout.

Adjust the surgery table to your preferred height and tilt, tell the technician the approximate position you prefer for lights. (The technician will focus the camera once the table is set.) Check to be sure the correct size of glove and gown are laid out for you and that your preferred sutures, blade, and gauze are chosen (see following equipment list for choices)

7. Anesthetic Induction:

Induction of the animal should be started promptly but not early, while the moderator runs the induction and prep DVD.

Administer IV to effect Ketamine:Valium (1:1)

Be conservative and take into account how sedated the dog is when administering the ketamine/valium. Dose only to effect.

Intubate. Hook up to Isoflurane/Oxygen. Attach IV fluids (LRS) that will run at a slow drip through surgery. If the animal does not already have a microchip, insert subcutaneous ID chip and record type and number (the technician has been doing this, just verify that it is done).

8. Animal Prep : (done by technician and student)

Bladder expressed; Large wide surgical clip, vacuum loose hair;

Surgical scrub in 3 cycles of Betadine and alcohol. Please let the technician know if you have a Betadine allergy; we do have chlorhexadine scrub available. Transport animal to surgery and tie on table. Attach EKG and Pulse Oximeter. Place Bair Hugger. Final camera adjustment and then one final scrub cycle; technician will stay with the patient and monitor anesthesia during surgery.

9. Surgeon Prep:

Put on scrubs, cap and mask. (Please bring your own scrubs if you have them as our supply is limited.) Remove all jewelry (the technician has a locked drawer if desired.)

Scrub with soap and brush for at least 5 minutes (time it!).

Dry with sterile towels. Put on sterile gown and gloves with assistance from student or technician.

Enter surgery only when all prep is completed.

Maintain sterility; do not hesitate to regown or reglove

10. Surgery: Let the moderator know in advance what suture patterns and layers of closure you will use. Do at least a 2-layer closure. Skin sutures are used at the veterinarian’s discretion (however the humane societies prefer SQ closure if you are comfortable with this). Ideally the surgery itself should be done methodically enough to last 30 minutes skin to skin - slow down if necessary.

11. Post-op: Remove drapes and transport animal to prep room for recovery. Please monitor the animal until extubated and recovering, before stopping fluids and moving it to a cage. Remain in the unit until the dog is sternal and doing well. Student and technician are responsible for subsequent clean-up.

Equipment Available

Emergency Supplies Ambu-bag; Oxygen on anes. Machine Diazepam 5 mg/ml

Atropine Epinephrine 1: I 000

Dexamethasone Sodium Phos. 4mg/ml Dopram

Dexamethasone 2 mg/ml

Lidocaine

If an animal has complications it is our policy to treat it to the best of our ability. Do bear in mind that we would prefer not to frighten or distress the audience but please weigh this against the fact that the animal deserves an attempt at resuscitation. If there is another emergency drug you want to have available, feel free to bring it with you.

Surgical Supplies

Suture : Swedged options = Chromic Gut in 1, 0, 2/0 and 3/0

Prolene in 2/0, 3/0 and 4/0

Vicryl in 1,0, 2/0 and 3/0

PDS II in 0, 2/0 and 3/0

Ethilon nylon in 2/0, 3/0 and 4/0

Flurofil in 2/0, 3/0, 4/0

Monosyn in 0, 2/0,3/0,4/0

Gauze:The pack will contain 4x4 Gauze (there is 2x2 available)

Blades:Number 10 and number 15 blades will be available.

Instrument Pack : 4 towel clamps, 1 Brown-Adson forceps, 1 thumb forceps,

4 straight Carmalts, 3 curved Carmalts, 4 Kellys, 4 mosquitoes, 1 knife handle, 1 Mayo scissors, l Metzenbaum, 1 needle holder with blades, 1 spay hook.

Needle holders without blades are available wrapped separately.

Extra small drapes and towel clamps are available for quarter-draping.

An abdominal retractor is available in case of problems.

If there is another instrument you like to use, feel free bring one for each surgery, wrapped and autoclaved (and remember to take them back with you). Mention the item to the technician as something to possibly obtain for future years.

If you have any comments or suggestions after participating in the surgery suite let us know. We try to improve the demonstration each year and really value input from the participants.

Thank you for volunteering!

SURGEONS: If you cannot participate at the last minute for any reason please find your replacement and notify the MVMA immediately.