Lesson 35 - HQHV Spay and Neuter Surgical Techniques and Medical Protocols

What is high quality, high volume spay/neuter?

efficient surgical initiatives that meet or exceed veterinary medical standards of care in providing accessible, targeted sterilization of large numbers of dogs and cats in order to reduce their overpopulation and subsequent euthanasia

What are the regulatory and legal compliances that HQHVSN programs must comply with?

1. State Veterinary Practice Acts

2. Association of Shelter Veterinarian (ASV Guidelines)

3. Control Drug Regulations (DEA and state regulations)

4. Rabies Vaccination Laws

5. Animal Welfare, Biosecurity and Public Health Regulation

6. Local Regulations

What are the benefits of an efficient workflow?

1. maintaining patient safety, staff efficiency, biosecurity, and high-quality medical care while managing large numbers of surgical patients

2. reduces bottlenecks, minimizes patient stress, improves communication among team members, and allows the clinic to maximize surgical capacity without compromising standards of care

What is the importance of a strategic facility layout?

1. directly influences workflow efficiency

2. creates a one-way patient flow, reducing unnecessary movement and cross-contamination risks

3. improves staff productivity by minimizing travel distances between workstations and allowing continuous patient movement through the surgical process

Where can HQHVSN events be located?

1. Permanent spay/neuter clinics

2. Animal shelters

3. Mobile surgical units

4. MASH-style temporary facilities

5. Community outreach clinics

What important equipment must be available to run a HQHVSN event?

1. Surgery tables

2. Anesthesia machines

3. Monitoring equipment

4. Recovery cages

5. Surgical instrument packs

6. Oxygen supplies

What are the essential physical examination records that must be kept for a HQHVSN patient?

1. Patient ID, signalment, weight

2. Exam findings

3. Surgical clearance/risk assessment

What are the essential anesthesia records that must be kept for a HQHVSN patient?

1. Drug protocols, doses, and routes

2. Monitoring parameters

3. Anesthetic events/complications

What are the essential surgery report records that must be kept for a HQHVSN patient?

1. Procedure performed

2. Surgeon name

3. Intraoperative findings and complications

4. Permanent identification (tattoo, microchip, ear-tip) if applicable

What are the essential discharge instructions that must be sent home for a HQHVSN patient?

1. Postoperative care

2. Activity restrictions

3. Emergency contact information

4. Follow-up recommendations

What is the primary purpose of patient classification in an HQHVSN clinic?

to improve patient flow, safety, and resource allocation

Daily surgical capacity within an HQHVSN program is most strongly influenced by the operational bottleneck within the workflow. Which factor is most likely to create such a bottleneck?

availability of surgical packs and support staff

Who makes the final decision on patient selection?

veterinarian

What can affect patient selection?

1. Species; cats/ dogs

2. Patient Age: 4 months of age or older

3. Body weight

4. Breeds

5. Comorbidities

6. Staff Expertise

7. Availability of equipment

Who should perform the physical exam to qualify the animal as a surgical candidate?

veterinarian or a supervised veterinary student

What should the physical exam include?

1. Verification of patient and ID number

2. TPR and Thoracic auscultation

3. Body Temperature may or may not be measured at the discretion of the attending vet

4. Verification of sex

5. Reproductive status

6. Inspection for presence of ventral abdominal tattoos/ ear tips , or other indicators of previous sterilization

7. Microchip scanning can also be part of the PE

8. Preanesthetic diagnostic testing if indicated

Why does age matter in HQHVSN patients?

1. Determines eligibility for early-age spay/neuter

2. Incision site placement

3. Influences anesthetic protocols, drug dosing, thermoregulation, and recovery planning

4. Important for shelter, rescue, and community animals with unknown histories

When do permanent incisors erupt in kittens?

between 12-24 weeks

What do healthy kittens generally weigh?

~1lb per month of age

When do puppy deciduous teeth complete by?

approximately 8 weeks

When do puppies typically have adult dentition by?

7-8 months

What characteristics of adult dentition should be assessed?

tartar accumulation, tooth wear, staining, and periodontal disease to estimate age

Should water be withheld before surgery?

not necessary and not recommended

What is the appropriate period of time that food should be withheld from pediatric patients before surgery?

a small meal should be fed 2 to 4 hours before surgery, and food should not be withheld for > 4 hours before surgery

What is the appropriate period of time that food should be withheld from juvenile and adult patients before surgery?

1. food should be withheld for a minimum of 4 hours

2. overnight fasting is acceptable, but withholding food for longer than 6 hours is not necessary

When are exceptions to minimum fasting periods made?

feral cats in traps

What are the techniques for patient handling in HQHVSN clinics?

1. Fear-Free/Low-Stress Handling Techniques

2. Restraint tools and techniques

3. Trazadone/Gabapentin as oral premedication prn

4. Verify patient identity before administer of medications/procedures

5. Continuous monitoring

6. Standardized handling and anesthesia protocols for consistent care

What is housing like for HQHVSN clinics?

1. Cage-layout designed for efficiency of surgical flow

2. Clean, safe, secure, thermoregulated enclosures

3. Identification on all kennels

4. Individual cages

5. Keep litters together when possible

6. Separate species (dogs and cats)

7. Adequate kennel space for recovery

8. Monitor patients regularly for comfort, signs of distress, and recovery

9. Separate stressed, ill, and injured

10. Isolate animals with signs of infectious disease

What are the infectious disease control measures taken by HQHVSN clinics?

1. Good biosecurity practices

2. Train all staff and volunteers

3. Appropriate use of disinfectants for all surfaces and equipment

4. PPE and hand hygiene

5. Surgical order (Clean Dirty)

6. Dispose of waste, laundry, and contaminated materials

7. Screen for infectious diseases at intake

8. Separate/Isolate animals with signs of infectious disease

What are the HQHVSN clinic vaccination protocols?

1. Core vaccines based on species, age, and risk

2. Parasite prevention and deworming

3. Cost-effective wellness packages

What are the HQHVSN clinic additional services (when appropriate)?

1. Dewclaw removal (neonates)

2. Minor wound repair

3. Removal of small skin masses

4. Dental assessment and basic dental procedures

How do HQHVSN clinics improve access?

1. Offering bundled services and standardized protocols

2. Providing affordable preventive care during a single visit

What client communication is necessary before surgery?

1. Scheduling (appointments or walk-ins)

2. Pre-operative instructions

What client communication is necessary at discharge?

1. Written instructions, handouts (review verbally)

2. Home-care education

3. Videos or online resources

What client communication is necessary after surgery?

1. Clinic and emergency contact information

2. Referral resources

3. Financial assistance/payment options

What emergency protocols should be in place during initial patient assessment?

1. AFAST (portable ultrasound)

2. Abdominocentesis (tap) when indicated

3. PCV/TS to assess blood loss

What is the triage and decision making plan for a HQHVSN clinic?

1. Stabilize the patient

2. Determine treat vs. refer

3. Have a predefined referral plan

How should HQHVSN clinics manage a hemoperitoneum?

1. Exploratory laparotomy when indicated

2. Consider autotransfusion (filters, trained staff, equipment)

A high-quality, high-volume spay/neuter clinic performs surgery on a dog owned by a client with limited transportation and no established relationship with a primary care veterinarian. At discharge, the dog is stable, but the clinic will be closed overnight. What discharge plan is most likely to support patient safety and continuity of care while minimizing barriers to follow-up?

provide written instructions, review home care verbally, and include clinic, emergency, and referral contact information

An HQHV shelter clinic is considering adding vaccination, parasite control, and selected minor procedures to its spay/neuter program. Some team members are concerned that offering additional services will reduce efficiency and increase costs. Which strategy would best allow the clinic to expand services while maintaining the principles of HQHV medicine?

bundle commonly indicated services and use standardized protocols to improve efficiency and reduce unnecessary variation

An HQHV clinic receives a large group of shelter cats for sterilization. Several cats have unknown vaccination histories. The clinic manager reviews procedures for minimizing disease spread while maintaining surgical efficiency. What is the best population health strategy?

applying standardized intake screening and separating higher-risk patients from the general population

What are the unique anesthetic challenges of a HQHV setting?

1. Case Volume/Number of Anesthetized Patients at One Time

2. Patient Population

3. Pre-Operative Workup (+/-) (e.g. Bloodwork/PE)

4. Drug Protocols and Availability

5. Monitoring Equipment and Supplies

6. Trained Support Staff (+/-)

7. Recovery Time and Space

8. Discharge and Post-Operative Care Availability

What is the anesthetic goal of HQHV clinics?

maximize patient safety, welfare, efficiency, and control pet overpopulation

What is the priority of anesthesia drug protocols for HQHV clinics?

1. Multimodal analgesia

2. Reversible when indicated

3. Adapted to Skill Level (Vets, Techs, Volunteers)

4. Charts

5. Maintain surgery flow and efficiency

What are some other considerations of anesthesia drug protocols for HQHV clinics?

1. Patient Population

2. Behavior (Trazadone!!! and Gabapentin!!!)

3. Availability of options (Gas Anesthesia, TIVA/Injectable, IM Protocol)

4. Opioid Availability, Controlled Drugs, DEA Compliance, Safety and Security

5. Recovery Set-Up

6. Discharge Time/Pick-Up

7. Costs

What is the common drug protocol for HQHV clinics?

IM cocktail with reversal

How should patients be monitored?

1. Trained individual, assess q 5-10 mins, document

2. Parameters and anesthetic depth

What equipment is needed to monitor patients?

1. Heat support (all phases)

2. Pulse oximetry, BP, ECG, Thermometer

3. Oxygen source and Airway management (+/- ET Tubes)

4. ER Drugs, Crash cart, Resuscitation equipment

5. Fluid therapy (+/-)

6. Aesthesia Machines vs. Injectable

What are the anesthesia best practices?

1. Provide analgesia to every patient

2. Minimize stress

3. Use Pre-emptive analgesia

4. Employ multimodal analgesia

5. Incorporate local anesthetic techniques

6. Use NSAIDS appropriately

7. Tailor to patient and procedure needs

8. Monitor throughout recovery

9. +/-Discharge RX

What are the qualities of a good recovery space?

1. Warm, quiet, low-stress, clean

2. Well-equipped with supplies

3. Separate species

4. Separate FAS patients

5. "Recovery Beach"

How should patients be monitored during recovery?

1. Continuous monitoring, Prepared for Emergencies

2. Trained staff/supervision of volunteers (*Checklists)

3. Maintain body temperature and patent airway

4. Monitor vitals and incision

5. Rescue analgesia

6. Discharge readiness

What are the special patient considerations?

1. Pediatric anesthesia

2. Aggressive patients

3. Brachycephalics (BOAS)

4. Geriatrics

5. High-risk/comorbid patients (Heart Murmurs)

6. Additional Procedures besides Spay/Neuter

What are the pediatric anesthesia challenges?

1. Hypothermia

2. Hypoglycemia

3. Hypotension

4. Heart Rate

5. Disease Control

What are some techniques to avoid hypothermia in pediatric surgery patients?

heat support, smaller shave margins, warm prep solutions

What are some techniques to avoid hypoglycemia in pediatric surgery patients?

shorter fasting time (4-6 hours pre-op), feed within one hour of recovery

What are some techniques to avoid hypotension in pediatric surgery patients?

drug protocols, monitor cardiac output

What are some techniques to avoid low heart rate in pediatric surgery patients?

drug protocols, monitor cardiac output and heart rate

What are some techniques to control disease in pediatric surgery patients?

vaccinate, foster, SOPs for disease control

What is important for CPR preparedness?

1. Monitor patients closely and continuously

2. Recover Guidelines

3. Crash carts available (*Multiple Locations and Mobile)

4. Drug Protocols posted

5. Reversals

6. Mock code training drills

7. Know your team-Leader and Roles in Code

8. Equipment-Oxygen, Ventilation, EKG, Capnography

9. Challenges of Shelter/HQHV Setting

10. Most Common Emergencies

A dog undergoing castration receives an injectable general anesthetic protocol. The clinic has limited access to inhalant anesthetic and wants to reduce the amount of systemic anesthetic needed while improving perioperative analgesia. What is an appropriate anesthetic protocol strategy to address pain control in a low-resourced HQHV Clinic setting?

add an appropriate local anesthetic technique to the multimodal analgesic plan

An HQHV clinic reviews an anesthetic emergency in which emergency drugs were available, but staff were uncertain about their responsibilities during CPR. What is the most appropriate quality improvement measure for the team?

conduct regular team training with predefined CPR roles and emergency response protocols

What are the surgery principles for HQHV clinics?

1. Halstead Principles of asepsis

2. Mask, cap, gloves, scrub top (+/- gown)

3. High standards/ same standards

4. Efficient surgical practices (SOPs)

5. Protocols varies in resource availability

Where should the incision start in mature female dogs (>18 mo)?

caudal to umbilicus

Where should the incision start in young female dogs (6-18 mo) with minimal mammary development?

1 scalpel caudal to umbilicus from blunt end to end of the fenestration

Where should the incision start in pediatric female dogs (

incision 2x scalpel blades caudal to umbilicus (but never caudal to the midpoint between umbilicus and pubis)

Where should the incision start in female cats of all ages?

midpoint between cranial pubis and umbilicus

What are the practical applications of chemical castration?

1. Private Practice

2. Animal Shelters

3. Communities with Cultural Bias

4. Native American Reservations

5. Internationally in Underdeveloped Communities/ Limited Resourced Environments

6. Trained Veterinary Support Staff

What are the pros of chemical castration?

1. General anesthesia not required/decreased anesthetic risks

2. Overcome cultural barriers

3. Cosmetics

4. Time and efficiency

5. Minimal equipment and facility requirements

6. Increase number of surgeries performed

7. Decreased costs/affordability

8. Endocrine function of testicles preserved, ie still produces testosterone, Leydig Cells not damaged, 50 % reduction

9. Large Breed Dogs and Joint Disease

What are the cons of chemical castration?

1. Contraindications: Cryptorchids, TVTs, Scrotal Dermatitis,Testicular Disease

2. Identifying dogs as "Chemically Castrated"

3. Scrotal irritation, ulceration, abscess, infection, ablation (Technique)

4. Systemic reactions, such as vomiting, diarrhea, lethargy

5. Pain management recommended

6. Post-op recovery guidelines similar to surgical castration

7. Male dominant behaviors can still be present, such as roaming, marking, aggression, mounting (Testosterone still present)

8. Does not prevent diseases associated with male hormones, such as prostatic disease or testicular or perianal tumors

What are the pediatric surgery considerations?

1. Smaller incisions

2. Spay Hook Proficiency Important

3. Fair amount of clear abdominal fluid

4. Decreased proteins

5. Decreased fat surrounding ovaries

6. Technique: Ovarian pedicle tie (feline spay), Possibly one ligature on ovarian pedicles (felines/canines), Autoligation (feline/canine castration)

7. Routine Skin Closure or glue

What are special case (Pregnant, Lactating, Pyometra, Heat, Dystocia, Cryptorchids) considerations?

1. Common in shelter setting

2. Common with community cats (unknown history)

3. Do not turn away patients

4. Competent in techniques (entire team)

5. Established shelter policies and SOP's

6. Legalities /Owner's consent (including rescuers/trappers)

7. Ethical alignment for staff

What are some pre-op surgical complications (pre-existing conditions)?

1. Diaphragmatic hernia

2. Iatrogenic- anesthesia drugs

What are some intra-op surgical complications

1. Hemorrhage

2. Code

What are some post-op surgical complications

1. Lack of owner compliance

2. Dehiscence

3. Hemoabdomen

What should a HQHV surgical team do for a hemoabdomen?

1. Continuous post op monitoring of baseline values after more complicated procedures

2. AFAST scan

3. Active abdominal re-entry

4. Prepare Autotransfusion supplies

5. Team training