Surgery

Our skilled team of veterinarians are experienced in surgical techniques ranging from the most common elective procedures to abdominal, orthopedic, ophthalmic, and other disciplines.

General surgical procedures routinely performed include neuter and spay, growth removal; and exploratory, bladder, and soft-tissue surgeries.

All surgical procedures are performed with great care given to patient safety and attention to sterile protocol, guided by chosen mode of anesthesia and extensive Patient Monitoring throughout surgery and recovery, including pain management and follow-up care.

Patient Monitoring

Various patient vital signs are monitored throughout a surgical procedure, including:

  • Heart rate
  • Blood pressure
  • Respiratory rate
  • Temperature
  • Concentration of carbon dioxide in the blood (capnography)
    • Used to detect adverse respiratory event(s)
  • Oxygenation of hemoglobin in the blood (pulse oximetry) (SPO2)
    • Used to monitor changes in physiologic conditions
  • Electrical conduction of the heart (electrogardiography (ECG/EKG))
  • The relationship between blood flow (pulsatile) to static (non-pulsatile) blood in peripheral tissue (perfusion index (PI)), indicating pulse strength at the monitoring site
    • Used to monitor response to anesthesia and changes in physiologic conditions1
  • Fluid responsiveness, predicted by a measurement of respiratory variations in PI (Pleth Variability Index (PVI®))
    • Used to indicate if adjustment of fluid administration rate may be necessary,23 and/or if administration of an antihypotensive agent may be indicated

Surgical Prerequisites

  • Unless otherwise indicated, ensure your pet takes any prescribed medicines prior to surgery
  • Anesthetics should be administered on an empty stomach; therefore, do not give your pet any food after midnight (12:00 AM) the night before your pet’s surgery, although water may be offered
  • Exercise your pet prior to admittance to ensure he or she urinates and/or defecates if necessary
  • Drop-off for surgery is between 8:00 and 9:00 AM the morning of your pet’s surgery
  • Preanesthetic bloodwork may be required prior to surgery to rule out any preexisting conditions which could complicate anesthesia
  • It may be necessary for your pet to be hospitalized overnight following surgery; if applicable, one of our veterinarians will discuss such a requirement prior to your pet’s surgery

Call the hospital at 203-378-8276 if you have any questions.

Use of Antibiotics in Patients Undergoing Surgery

Prophylactic use of antibiotics refers to antibiotics administered prior to surgery in order to prevent the emergence of postoperative infections. Perioperative use of antibiotics refers to antibiotics administered before, during, and after a surgical procedure, with the aim of eliminating an established infection. In either case, such use is aimed at bacteria known or expected to be found at the surgical site. The following provides an overview of our policy toward the use of antibiotics in patients undergoing surgery.

Antibiotics in general should only be administered when they are required, because, as medications, antibiotics introduce the potential for side effects. Perhaps more importantly, however; over-use of antibiotics can contribute to the development of antibiotic-resistant bacteria.

The risk of antibiotic resistance is taken into serious consideration at our hospital; therefore, when indicated, our veterinarians will select an appropriate antibiotic with the narrowest spectrum possible, directed at the specific bacteria expected to be found at the surgical site, and based on current research in both the veterinary and human medical fields.

Generally, patients should receive antibiotics if they are:

  • undergoing surgery lasting longer than two (2) hours
  • receiving a major implant (e.g., metal plate, cemented hip joint or other joint replacement)

Occasionally, however; our veterinarians may elect to prescribe antibiotics in other instances, to patients with a preexisting infection at the surgical site or who may be particularly prone to infection; this includes patients that:

  • are geriatric
  • are immunocompromised or have a generalized skin infection
  • have a metabolic disease (e.g., diabetes)
  • have open wounds
  • are undergoing surgery to the gastrointestinal tract
  • are undergoing complicated fracture surgery and have extensive soft tissue trauma

While it may be surprising to learn your pet will not be receiving antibiotics prior to surgery, nor be sent home with antibiotics; there is overwhelming evidence that unnecessary antibiotic administration does not help prevent post-operative infections in most cases. Additionally, post-surgical infections can develop in patients who have received antibiotics. Moreover, routine use of antibiotics puts both you and your pet at risk for infections potentially resistant to all but the most potent antibiotics. Such excessive use of antibiotics contributes to the growing world-wide health crisis of antibiotic resistance.

If your pet is prescribed antibiotics, however; it is important they be administered specifically as directed by your veterinarian and printed on the prescription label. Please call us at 203-378-8276 if you have any questions regarding your pet’s prescription.

(Adapted from policies by Tufts University,4 and The General Assembly of the Swedish Veterinary Association).5

Post-Sedation Information

It is important that your pet be kept in an environment that is as quiet as possible for the first one (1) to two (2) hours at home (cats may be kept in their carrier and checked on periodically). During this time, water should be limited to small amounts. This can easily be accomplished by placing a couple ice cubes in an empty water bowl. Full availability of water can be provided after 12 hours.

Excitement and overfeeding can cause vomiting. Do not feed your pet for one (1) to two (2) hours after returning home (unless otherwise directed), and do not feed more than half the normal amount in the first 12 hours.

Shaking, shivering, and incoordination are common events of the first night at home. Please monitor your pet carefully and do not leave her or him unattended for long periods of time. A quiet place in the home away from noise and family activity is suggested. Any access to stairs must be avoided. Anesthesia/sedation will not be fully dissipated from your pet for 24 to 48 hours.

Call us at 203-378-8276 if you have any questions.

References

  1. ^ Clinical Applications of Perfusion Index. Irvine, CA: Masimo Corporation; 2007. http://masimo.com/pdf/whitepaper/LAB3410F.pdf.
  2. ^ Cannesson M., Desebbe O., Rosamel P., et al. Pleth variability index to monitor the respiratory variations in the pulse oximeter plethysmographic waveform amplitude and predict fluid responsiveness in the operating theatre. Br J Anaesth. 2008; 101(2): 200-206. doi:10.1093/bja/aen133.
  3. ^ Loupec T., Nanadoumgar H., Frasca D., et al. Pleth variability index predicts fluid responsiveness in critically ill patients. Critical Care Medicine. 2010;39(2):294–299. doi:10.1097/CCM.0b013e3181ffde1c.
  4. ^ Adapted from Use of Antibiotics in Dogs and Cats Having Surgery at the Foster Hospital for Small Animals. North Grafton, MA: Tufts University; 2013. http://vet.tufts.edu/fhsa/resources/fhsa_antibiotics.pdf.
  5. ^ Adapted from Lörstad SR, trans. Guidelines for the clinical use of antibiotics in the treatment of dogs and cats. Stockholm, SWE: The General Assembly of the Swedish Veterinary Association; 2010. http://svf.se/Documents/Sällskapet/Smådjurssektionen/Policy ab english 10b.pdf.