Vet360 Vol 4 Issue 4 August 2017 Vet 360 | Page 17

CPD ACCREDITED ARTICLE
This study assessed puppy vigour and survival follow-
ing medetomidine, propofol and sevoflurane anaes-
thesia for elective CS.
Materials and Methods
This is a retrospective, descriptive study that included
292 CSs in 256 privately owned bitches which under-
went a CS and were selected from the general ob-
stetric population because of increased obstetric risk.
High-risk pregnancies in the current study were con-
sidered those occurring in bitches from breeds with a
high risk of complicated parturition 20 , with a history of
dystocia 21 , or with known very large litters 22 . All the
bitches were admitted 3 to 4d prior to the predicted
parturition date calculated as 57d following D0**.
**D1 was redefined as D0 because it chronically
caused the error of vets starting to count from the
old d1 and the next day d2 whereas it should be d1 =
0 and the next day is d1, this led to intervals between
cytological dioestrus and parturition being wrong (out
with 24 hours) which can be devastating in the bitch
when timing CS
During these days, the bitches were observed for
signs of impending parturition (panting, inappetence,
nesting behaviour, tenesmus) and by 6 hourly vagi-
nal speculum examinations to assess the cervix. The
decision on when to perform a CS was based upon
the first appearance of any degree of dilatation of the
cervix. Once the decision to perform a CS was made,
an ultrasound examination of the abdomen was per-
formed to establish if there were any dead foetuses
(absence of detectable heartbeat).
Starting at induction, fluid therapy commenced and
the PCV before and after CS determined as previous-
ly described 23 . All bitches weighed more than of 20
kg. The anaesthetic protocol used in the current study
included the alpha-2-adrenergic agonist medetomi-
dine hydrochloride (Domitor®, Zoetis Animal Health,
Sandton, South Africa) at 7 µg/kg iv as a premedicant,
followed one minute later by propofol (Fresenius
propoven®1%, Fresenius Kabi, Midrand, South Africa)
at 1 to 2 mg/kg iv as an induction agent. The propo-
fol was administered as follows, the calculated dose
of 2 mg/kg was drawn up in syringe and 1 mg/kg/iv
was administered as a bolus. The remaining propofol
was used as top-up if required. This was followed by
immediate intubation and inhalation of room air. Fol-
lowing surgical preparation (averaging 3 to 5 min), the
bitch was connected to a closed-circuit anaesthet-
ic machine with 2% sevoflurane (Sevoflo®, Safeline
Pharmaceuticals, North Cliff, South Africa) in oxygen
for maintenance of anaesthesia.
The CS was performed in standard fashion as de-
scribed 24 . Meloxicam (Metacam®, Boehringer Ingel-
heim, Randburg, SA) was administered iv (0.1 mg/kg)
intra-operatively, as previously proposed 25 , immedi-
ately after delivery of the last puppy. The processing
of puppies following delivery involved immediate
administration of atipamezole hydrochloride (Antise-
dan®, Zoetis Animal Health, Sandton, South Africa) at
the dose of 50 µg/puppy sc, tying off of the umbilicus
and applying 10% povidone iodine thereto, drying the
puppies, gently shaking fluids from their airways and
placing them in an air-heated incubator set at 35°C.
No oxygen support was offered to the puppies after
delivery.
Also, immediately after surgery, atipamezole hydro-
chloride at the dose of 20 µg/kg was administered iv
(extra label route of admin) to the bitch. The bitch was
observed until the coughing reflex returned and was
then extubated and observed until she was breathing
comfortably whilst in sternal recumbency, sitting up-
right or standing. It was recorded if the bitches were
fully ambulatory within 15 minutes following extuba-
tion. After delivery of the puppies the following re-
cords were made; total number of puppies delivered,
live puppies, dead puppies, deformed puppies and
puppies euthanased. The Apgar scores were assessed
starting with the first puppy 15 minutes after the last
puppy was delivered according to the methods pub-
lished 26 and later used by 27 . The bitch and puppies
were discharged usually 2 to 3/h following surgery.
The puppy survival rate was established immediately
after delivery, at 2 hours post CS and 7d post CS and
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