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Spay/Neuter:Targeting, Techniques, & Special ConsiderationsApril 4, 2013

Kathleen Makolinski, DVM(kathleen.makolinski@aspca.org)

University of WisconsinShelter Medicine Course

(Spring 2013)

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Where Will We Go?

Spay/Neuter• Benefits/detriments

• Medical guidelines

• Complications

• Program models

• Training opportunities

• Non-surgical sterilization

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Reasons to Spay/Neuter

Individual animal health benefits include:• Decreased risk of:

- Mammary gland tumors- Prostatic enlargement

• Eliminate risk of:- Ovarian/uterine cancer- Pyometra- Testicular cancer

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Reasons to Spay/Neuter

Neutered male cats have decreased:

• Roaming to find a mate• Fighting• Spraying/urine marking

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Benefits/Detriments ofSpay/Neuter

•Determining the optimal age

of gonadectomy of dogs and cats

Margaret Root Kustritz, DVM, PhD, DACT

www.avma.org/avmacollections/spay_neuter/www.avma.org/avmacollections/spay_neuter/

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Possible Detriments toSpay/Neuter

• Castrated dogs have ↑ risk prostatic neoplasms

• Spayed/neutered cats have ↑ risk diabetes mellitus

•. Spayed/neutered dogs have ↑ risk(…influenced by breed):- Cardiac and splenic hemangiosarcoma- Osteosarcoma

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Important to Note

When evaluating studies that compare risksfor certain conditions between

spayed/neutered animals and intact animals,it is important to look at the incidence ofsuch diseases in each animal population.

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Important to Note

Example:• In female dogs, the incidence of pyometra is:

- 15.2% by 4 years of age- 23% - 24% by 10 years of age

• Hemangiosarcoma is the most common cardiactumor in dogs, with reported incidence of 0.2%- Breed predilection exists- Spayed females reportedly have 5 times the risk

of cardiac hemangiosarcoma compared with therisk for sexually intact females

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Association of Shelter Veterinarians’Veterinary Task Force to

Advance Spay/Neuter

In December of 2006, 22 veterinarians met toaddress the need for increased capacity

and a consistent level of care withinspay/neuter programs.

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ASV’s Veterinary Task Forceto Advance Spay/Neuter

High-quality, high-volume spay/neuterprograms are efficient surgical initiativesthat meet or exceed veterinary medical

standards of care in providing accessible,targeted sterilization of large numbers of

dogs and cats in order to reduce theiroverpopulation and subsequent

euthanasia.

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Medical Guidelines forSpay/Neuter Programs

Goals

Instill confidence inpublic regarding

use of spay/neuterprograms

Promoteacceptance of thispractice area by

veterinaryprofession

Provide guidancefor veterinarians

involved inspay/neuterprograms

Allow fundingagencies todetermine ifspay/neuter

programs provideacceptable level of

animal care

Provide referencefor use by state

boards ofveterinarymedicine

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Medical Guidelines forSpay/Neuter Programs

JAVMA articleMaintain high standards of patient care

regardless of where spay/neuter is performed orwhich program model is utilized

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Medical Guidelines forSpay/Neuter programs

The Association of Shelter Veterinarianswww.sheltervet.orgTask Forces and CommitteesVeterinary Task Force to Advance Spay/NeuterMedical Care Guidelines

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HIGHvolume mustmean LOW

quality

HIGHvolume mustmean LOW

quality

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HIGH VOLUME HIGH QUALITY

HIGHvolume mustmean LOW

quality

HIGHvolume mustmean LOW

quality

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High Volume Leadsto High Quality

• Very efficient systems

• Protocols to maintain standards

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Medical Guidelines forSpay/Neuter Programs

Four sections ofguidelines document

• Preoperative care• Anesthesia• Surgery• Postoperative care

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Preoperative Care

• Withholding food prior to surgery- Pediatrics to be fed 2-4 hours prior to surgery- Other animals: Fast minimum of 4 hours

• Water not withheld prior to spay/neuter• Is animal receiving any medication?• Does animal have any health problems?• Client consent

– Acknowledging risk, authorizing surgery

• Establish medical record for each patient- To abide by DEA and state veterinary regulations

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Preoperative Care

Physical exam by veterinarian• Good medicine• Liability issuesFocus of exam• Mucous membrane color• Hydration status• Heart/lungs• Hernias• External parasites• Body condition score• Infectious disease?

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Preoperative Care

Physical examination

• Verify gender/reproductive status- Intact female- Spayed female- Intact male- Neutered male- Cryptorchid male

• Body weight- Verified close to surgery- May be estimated in feral/fractious patients- Used to guide drug dosing

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Preoperative Care

Example:Example:Presented with a2 year male cat withno palpable testicles.

Is he already neuteredor is he cryptorchid?

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Medical Guidelines forSpay/Neuter Programs

Preoperative careExample: You are a veterinarian in a mobilespay/neuter clinic that visits a rural animal shelteronce monthly. Today, a feline patient(DSH, 9 month old, ‘Love Bug’) presents to bespayed. She has the following clinical signs:- Sneezing small amount yellow mucus for 3 days- Mild clear ocular discharge- Appetite good- No fever- Very active 24

Medical Guidelines forSpay/Neuter Programs

Preoperative careExample: The shelter indicates that they willprovide care for the cat if spay/neuter is notpossible today. They do not have a formalized‘Foster Care Program.’ Once spayed, if she isadopted, she could leave the shelter withantibiotics to be administered at home if necessary.

WHAT TO DO ?

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What About Pre-Anesthetic Testing?

Is routine pre-anesthetic haematological andbiochemical screening justified in dogs?

Alef, M. et al., Veterinary Anaesthesia and Analgesia,Volume 35, Issue 2, pages 132–140, March 2008

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Anesthesia

Needs to achieve

• Pain control- Opioid- Non-steroidal antiinflammatory- Alpha2 agonist- Local anesthetic

• Stress reduction

• Muscle relaxation

• Unconsciousness

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Anesthesia

Pain control

• Multimodal analgesia

• Preemptive administration of analgesics

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Drug Dosing ChartFeline Drug Protocol

WeightWeight Drug #1Drug #1 Drug #2Drug #2 Drug #3Drug #3

Lbs. ml (IM) ml (IM) ml (IM)

2.0 0.01 0.05 0.03

2.5 0.02 0.06 0.04

3.0 0.02 0.07 0.04

3.5 0.02 0.08 0.05

4.0 0.03 0.09 0.06

4.5 0.03 0.10 0.07

5.0 0.03 0.11 0.07

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Anesthesia

Thermoregulation

• Reduce contact with cold surfaces

• Provide carefully protected contact with circulatingwarm water, heated containers, or use of forced hotair warming devices

• Avoid close contact with electric heating pads, blowdryers, heat lamps, drying cages

• Avoid excessive use of alcohol

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Preventing Hypothermia

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Preventing Hypothermia

Rice Sock

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Anesthesia

• Monitor for depth of anesthesia- Pulse quality, rate, rhythm- Respiratory rate and pattern- Jaw tone- Eye position and pupil size- Palpebral reflex

• Mask/chamber induction to be avoided- Highly stressful for patient- Bronchial irritation- Increased risk of aspiration of GI contents

• Be prepared for emergencies

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Surgery

• Separate, sterile instruments for each patient

• Surgeon: Properly performed handand arm scrub with appropriate agent

• Surgeon should wear cap,mask, and separate pairof sterile gloves for each surgery(sterile gown is optional)

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Surgery

• Ovariohysterectomy and ovariectomy are acceptable

• Both testes and ovaries need to be removed

• Prescrotal and scrotal approaches for neuterare acceptable

• Ventral midline, flank, and laparoscopic approachesfor ovariohysterectomy are acceptable

• Gentle tissue handling, meticulous hemostasis,aseptic technique

• Either interrupted or continuous suture pattern isacceptable for abdominal closure

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Surgery

What to do with fetusesWhat to do with fetuseswhen spaying a pregnant animal?when spaying a pregnant animal?

•• Open uterus and euthanize individual fetuses

• Intraperitoneal injection of euthanasia solutionthrough closed uterus

• Do not euthanize fetuses

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Surgery

Prevention of fetal suffering duringovariohysterectomy of pregnant animals

Sara White, DVMJAVMA, Vol 240, No. 10, May 15, 2012 (Commentary)

Prevention of fetal suffering duringovariohysterectomy of pregnant animals

Sara White, DVMJAVMA, Vol 240, No. 10, May 15, 2012 (Commentary)

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Surgery

Various surgical techniquesallow for safe and efficient

spay/neuter surgeries

Veterinary SeminarsIn Spay-Neuter Surgery: Pediatrics

www.humanealliance.org

Veterinary SeminarsIn Spay-Neuter Surgery: Pediatrics

www.humanealliance.org

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Surgery

Permanent identification of animalsas spayed/neutered

Choose a consistent means of identifyinganimals that have been neutered

TATTOOSTATTOOSEAR TIPS FOR FERAL CATSEAR TIPS FOR FERAL CATS

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Scoring Process for Tattoo

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Tattooed Animal

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Ear Tipped Cat

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Postoperative Care

Minimize risk of complication through vigilantobservation of animal in recovery period and

quick/appropriate response to abnormal findings

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Postoperative Care

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Postoperative Care

• Offer small amount water to all patientsas soon as ambulatory

• Offer small amount of food to pediatric,geriatric, frail patients as soon as possible

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Postoperative Care

Before release of patient• Patient should be ambulatory with no signs of distress• If possible, check surgical site

Review with animal’s caregiver• Oral and written

discharge instructions

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PostoperativeQuestions/Concerns

Spay/neuter programs must establish policies for handlingpostoperative questions, complications, and emergencieswithin at least 48 hour period following surgery

• Staff member carries cell phone that receives calls• Voice mail that is checked frequently• Establish relationship with local veterinarian or

emergency hospital who will see patients for recheck

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Morbidity/Mortality Data

In the event of patient death, necropsy should beperformed to establish cause

Program to identify

• Trends in deaths that occur during stay at spay/neuterprogram or following surgery

• Trends in post operative complications(Ex: Incision site infections, dehiscence, suture reaction)

Compare data collected from one year to the nextand to other similarly structured programs

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Prevention of Complications• Good surgical principles, aseptic technique

• Short anesthetic/surgical time

• Meticulous tissue handling

• Attention to hemostasis

• Careful placement of ligatures

• Adequate exposure

• Good post-op instructions/care

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Potential Complications

• Scrotal swelling/bruising• Incision site seroma/infection• Suture reaction• Hemorrhage• Urinary incontinence in female dogs• Ovarian remnant• Uterine stump pyometra• Inadvertent ligation of a ureter• Incision site dehiscence• Post operative vaginal bleeding

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ASV websitewww.sheltervet.org

contains supplemental informationto the Medical Guidelines

that were published in JAVMA

ASV websitewww.sheltervet.org

contains supplemental informationto the Medical Guidelines

that were published in JAVMA

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Mash Style Spay/Neuter Clinics

ADVANTAGESADVANTAGES

• Go to areas in need• Large geographic radius• Lower start-up cost• Quicker start-up time• Utilize core of volunteers•Work with & assist multiple

organizations

CHALLENGESCHALLENGES

•Wear & tear on equipment•Wear & tear on staff• Need for multiple volunteers• Need for home base

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Shelter Outreach Services(SOS)

• Provides MASH style spay/neuter program

• Established in June 2003

• Spay/neuter approximately 10,000 cats anddogs per year

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SOS Transport Vehicle

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SOS Program

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In-Shelter Spay/Neuter Clinic

ADVANTAGESADVANTAGES

• Spay/neuter prior toadoption• Transport not needed

for shelter animals• May be less expensive

than other options• May be able to use

facility for spay/neuterof public animals

CHALLENGESCHALLENGES

• May have limited accessfor public animals• Veterinary Education

Law in some states• Disease control and

housing for publicanimals

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Smoky’s Spay-Neuter Clinic

• Located within Richmond SPCA in Virginia• Opened in 2002• Clinic serves:

- Shelter animals- Public animals- Free roaming cats

• Animal control officers distributeeducational material in areastargeted for spay/neuter• Goal is 65 surgeries/day

- 2 veterinarians- Well trained medical staff 58

Mobile Spay/Neuter Clinic

ADVANTAGESADVANTAGES

• Travel to populationsin need

• Self contained• Could be multi-use vehicle• Presence in community

CHALLENGESCHALLENGES• Expensive to buy & maintain• +/- dedicated driver• Small space to work in• Find location to park• May need separate

recovery area• Cost of insurance, fuel• Difficult to manage remotely

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ASPCA’sMobile Spay/Neuter Clinics

• Five Mobile Spay/Neuter Clinics that providefree or very low cost spay/neuter to:- Shelters- Rescue groups- Feral cat caregivers- Animals whose owners are on public assistance

or in targeted geographic locations

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ASPCA’sMobile Spay/Neuter Clinic

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APSCA’sMobile Spay/Neuter Clinic

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ASPCA’sMobile Spay/Neuter Clinic

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ASPCA National Spay/Neuter Project

• Personalized training for small cities andrural areas to provide high quality,high volume spay/neuter services

• Helps community implement or enhance mostsuitable spay/neuter program model:- Mobile Clinic- MASH Program- In-Clinic Program

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Mobile Spay/Neuter Clinic withOff-Board Recovery

An off-board recovery spay/neuterprogram has been operating in

Oklahoma since 2004SPAY FIRST!

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StationarySpay/Neuter Clinic

ADVANTAGESADVANTAGES

• Can focus on performinglarge number spays/neuters• Self contained• Can cover large geographic

area with transport system• Visible presence in the

community

CHALLENGESCHALLENGES

• Start-up costs higher• Start-up time longer• Comply with building and

maintenance requirementsand zoning laws

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Humane Alliance(Asheville, North Carolina)

• Stationary spay/neuter clinic

• Established in 1994

• Serves Western North Carolina

• Sterilizes over 21,000 cats and dogs/year

• Uses extensive transport system

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Humane Alliance

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Humane Alliance

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Humane Alliance’sNational Spay/Neuter Response Team

Nationwide strategic placement of targeted,high-quality, high-volume, affordable

spay/neuter clinics

Assist with:• Floor plan• Budgeting• Surgical training• Selection of computer software• Anesthetic/analgesic protocols

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National Spay/Neuter Response Team

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Spay/NeuterTraining Opportunities

From Humane Alliance…• Externship for vet students, receive training in:

- Disease control- Patient assessment/selection- Patient preparation- Surgical technique- Record keeping- Anesthesia/pain management- Patient monitoring

Housing for students is provided at no cost72

Spay/NeuterExternship Opportunitiesfor Veterinary Students

• Association of Shelter Veterinarianswww.sheltervet.org

• The Humane Society Veterinary MedicalAssociation Field Services Programwww.ruralareavet.org

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Other Types Spay/Neuter Programs

• In veterinary practices- Voucher programs- Non-voucher programs

• In schools of veterinary medicine orveterinary technology

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Non-Surgical Sterilization

Alliance for Contraceptionin Cats and Dogswww.acc-d.org

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