KNOWLEDGE SHARING

ON ABC PROTOCOL
TOPICS
• Preoperative physical exam
• Surgical asepsis
• Anesthesia & Analgesia
• Ovariohysterectomy
• Castration
Preoperative physical exam
• Temperature (100.2-103.8)
• Pulse
• Heart rate (70-120) & sound
• Respiratory rate (18-34) & sound
• Dehydration assessment
• Mucous membrane
ASEPSIS (INSRUMENTS)
• Autoclave surgical instruments, drapes and cotton
gauze, at 15 psi (121°C) for 15-20 minutes.
Asepsis (environment)
• The environment should be free from contamination (air is generally
contaminated by overcrowding).
• Surgical tables, floor etc. should be easy to clean, impervious
materials.
• Tables and floor disinfected at least once a day
• The air should not contain contagious organisms
• Only authorized personnel allowed
ASEPSIS (PATIENT PREPARATION)

- Minimizes animal own microbial

flora from surgical area
- Hair removal
- Scrub skin by antiseptic detergent
mixture such as savlon in a spiral
motion from center to periphery
until no visible dirt is observed in
swab.
- Empty bladder
- Clipped area sprayed with 70%
ethyl alcohol or 1% povidine iodine.
- Sterile drape is put over patient to
increase
- sterile area
ASEPSIS (SURGICAL PERSONNEL)
-Surgical head cover
-Face mask
- Scrubbing of Hands and arms and rinsing
- Alcohol spray in hands
- Gloving in proper way
ANAESTHESIA AND
ANALGESIA
 PREMEDICATION

SEDATIVE ANALGESIC ANTIBIOTIC MUSCLE RELAXANT

NSAID AMOXICILLIN DIAZEPAM

DIAZEPAM (MELOXICAM
0.2MG/KG)) 20MG/KG XYLAZINE

OPOID( MORPHINE
XYLAZINE (1MG/KG
FENTANYL,
IM)
BUPRENORPHINE)
ANAESTHESIA
• We will be using combination of DIAZEPAM AND KETAMINE as
anesthetic.
• INDUCTION:
1:1 mixture of Ketamine(50mg/ml) and diazepam (5mg/ml)
- Dose 1ml/10KG BW
• MAINTAINACE
1:2 mixture of diazepam and ketamine
-Dose 1ml/10kg BW
ANAESTHESIA MONITORING

MUCOUS MEMBRANE
JAW TONE PALPEBRAL REFLEX
COLOR

PEDAL REFLEX
 ANAESTHESIA MONITORING
Heart rate and respiratory rate should be continuously monitored every
5 minutes
 OVARIOHYSTERECTOMY
Instruments required
• Clamps
• Needle holder
• Blade
• Two curved artery forceps
• Two straight artery forceps
• 1 rat tooth forcep
• 1 thumb forcep
• 1 mayoscissor
• Catgut
• Suture materials
MIDLINE APPROACH
•Drape appropriately
• feel the last rib to confirm the
location of the umbilicus.
• Incision should be made 1-2
fingers from the umbilicus as
long as needed usually 4-5
inches.
• The exact starting point depends
upon the size of the dog
• You can start from the umbilicus
in pregnant dogs
• Incise the skin and subcutaneous tissue with
the blade.
• Dab subcutaneous bleeders if any with help
of mosquito forceps
• Incise the subcutaneous fat in order to
expose the linea alba.
Linea alba
OPENING ABDOMEN
• Tent the linea alba as caudal as
possible using rattooth forceps
and make a stab incision
through it blade pointing
upwards .
• Pull omental fat with thumb
forcep to ensure entry into
abdomen
• Extend the incision cranially
and caudally along the linea
alba using mayo scissors
Finding left ovary
• Slide finger against the abdominal wall below the bladder try to find
uterine horn or broad ligament between bladder and colon and gently
elevate it from the abdomen.
• Anatomically confirm the identification of the
uterine horn by following it to uterine bifurcation.
Suturing
• Suture muscle layer in simple continuous pattern using PGA 3-0 or 2-0
• Start and end at intact ( not incised part of muscle)
• Muscle should be lifted off with rattooth to avoid needle poking bladder.
Make sure to include fascia, make adequate tension or ABDOMINAL HERNIA
can occur.
-Surgeon’s knot at start and end of suture, secured by five more square knots
- Subcutaneous layer can sutured in in-out pattern, bury the end knot.
- Intradermal sutures in skin
- Bury the knot
suture patterns and knots
Castration ( Orchidectomy)
Suturing
• Similar to female
• No muscle incised so no suture required
• Subcut and skin sutured in similar way
Post operative care
• Attend and monitor dog till it recovers from anesthesia
• Check for temperature.
• Asses wound and pain score next day, give NSAID analgesic
•
SEDATIO
IV PREME BLADDE PATIENT
N(xylazi INDUCTI PROCED
CATHET DICATIO R PREPAR
ne ON URE
ER N EMPTY E
+opioid)
FLUIDS
• Isotonic crystalloid fluid is given at rate of
10ml/kg/hr.
- Less than 10 kg 1d/2sec
- 10-20 kg 1d/sec
- 20-30 kg 2d/sec
- Can be increased up to 90ml/kg/hr if hypovolemic
THE ‘ABCDE’ OF
BASIC CARDIAC
LIFE SUPPORT
• AIRWAY
• BREATHING
• CIRCULATION
• DRUGS ADMINISTRATION
• EVALUATION
 Commonly used emergency drugs
• Atropine : treatment for bradycardia and asystole ( 0.6mg/ml)
• Adrenaline : increases rate and force of cardiac contractions. Improved
blood pressure , coronary and cerebral blood flow (1mg/ml)
• Doxapram: Respiratory and CNS stimulant
Rapid onset
Wide safety margin
Counteracts effects of barbiturates
• Yohimbine or Atipamezole : reversal of xylazine (0.5ml/10kg)
• Lidocaine : treat ventricular fibrillation. (0.5ml/10kg)
• Naloxone : to treat opioid resulting respiratory depression.
HEART RATE ABNORMALITY
DECREASED (BELOW 50/MIN)
• Ketamine:diazepam 1:1 iv@ 0.2ml/10 kg dog ( in other protocols not
dusing K:D)
• If unresponsive, 0.01mg/kg IV atropine
• Diluted atipamezole or yohimbine to reverse the alpha-2- agonist
INCREASED (above 140/min)
Diluted xylazine (0.1ml + 2.9 sterile water) 0.1 ml/5kg
Respiratory abnormality
DECREASED RESPIRATORY RATE (less than 8)
•Decrease anesthetic dose
• Pinch the nasal septum, pull the
tongue out.
• Intubate and ventilate
• Doxapram (5-10mg/kg IV) (ONLY IF OXYGEN TANK AVAILABLE)
• Naloxone for opoid overdose
Hemorrhage
• INCREASE FLUID RATE UPTO 90ML/KG/HR for 1-2 hr IF PATIENT
SEVERELY HYPOVOLEMIC
• Find the bleeding stump ligate it
• If there is diffused bleeding, Whole abdomen can be packed with
swabs and apply pressure to form the clots.
HYPOTHERMIA
If temperature <94⁰F or
34.5⁰C
• If alpha 2 agonist was
used, reverse using
atipamezole or
yohimbine.
• Use warm water bottles
• Several layers of blankets
• Regularly check the
temperature
If the temperature is
Above 96 ⁰F
between 94-96 ⁰F
Cover with
• Cover the patients by blanket
blankets Warm bottles not
• Rub the patients with required
warm clothes
• Warm water bottles
can be considered