Lecture 35

Question 1

What are the general characteristics of planned cesarean sections?

Answer 1

-planned surgeries are based on likelihood fetuses will be mature enough to survive
-typically done around 58-72 days after breeding or 63-66 days after LH surge/progesterone rise
-measure when progesterone drops to < 2 ng/mL or when temp. drops to < 100 deg.
-fetuses at term will have digits and teeth visible on rads and intestinal architecture and peristalsis visible on ultrasound
-fetal HR < 180 indicates stress

Question 2

What are the characteristics of emergency cesarean section?

Answer 2

-find out whether dams or pups are more important
-can do c-section, c-section + OVH, or en bloc OVH
-uterine obstruction or trauma is an emergency for the dam

Question 3

What are the pre-operative preparatory steps for a c-section?

Answer 3

*abdominal radiographs
-number of fetuses
-fetal maturity
-evidence of fetal death

*CBC/chem
-glucose
-lactate
-calcium
-PCV
-albumin
-WBC count and diff.

*IV catheter and fluids

*pre-anesthetic clip and prep

*antibiotics if indicated

Question 4

What are the characteristics of anesthesia for a c-section?

Answer 4

-all anesthetics cross the placenta
-gas anesthetics reduce uterine blood flow and cause neonatal depression
-avoid ketamine; increased fetal death
-prolonged induction and delayed delivery increase fetal hypoxia and depression
-post-op sedation may interfere with dam’s ability to provide maternal care

Question 5

What is an appropriate anesthetic protocol for a c-section?

Answer 5

-premed. with buprenorphine or dexmedetomidine
-pre-oxygenate by mask for 3 minutes
-give glyco. for maternal bradycardia
-give dam oxygen and fluids for fetal bradycardia
-lidocaine line or TAP block
-epidural can be done for elective c-section if quick
-induce in operating room with propofol or alfaxalone
-intubate and place on oxygen +/- gaseous anesthesia

Question 6

What are the steps for intraoperative care for a c-section?

Answer 6

-IV fluids to prevent hypotension and maintain fetal blood flow
-monitor blood pressure
-tilt table slightly to keep head elevated
-support ventilation
-c-section via standard approach or en bloc ovariohysterectomy

Question 7

What are the steps to a standard c-section?

Answer 7

-midline, long abdominal wall incision
-penetrate linea carefully to enter abdomen
-gently extract uterus or one horn from abdomen
-isolate uterus to reduce abdominal contamination
-incise uterine body or both uterine horns on midline
-remove neonate and pull placenta off face
-clamp cord 3 to 5 cm from neonate’s abdominal wall
-remove placenta with gentle traction if possible
-continue removing fetuses
-remove any left behind placentas if possible
-palpate uterus before and after closure to ensure all fetuses are removed

Question 8

What are the characteristics of uterine closure?

Answer 8

-use 3-0 or 4-0 rapidly absorbable monofilament
-close with simple continuous or Cushing pattern

Question 9

What are the characteristics of abdominal closure after a c-section?

Answer 9

-lavage and suction out any contaminants
-routine closure of linea and subQ tissues
-intradermal pattern to close skin; do not do skin sutures or staples

Question 10

What are the characteristics of en bloc ovariohysterectomy?

Answer 10

-fast OVH followed by fetal extraction
-does not affect lactation
-comparable fetal survival rates to typical c-section
-not recommended for fetal bradycardia or hypoxia
-minimize time from clamping uterine artery to neonatal extraction to reduce fetal hypoxia and maximize survival

Question 11

What are the steps to an en bloc OVH?

Answer 11

-pull uterus and ovaries onto drape
-isolate ovarian pedicles and uterine body; break ligaments as needed
-double or triple clamp ovarian vessels and transect between clamps
-double clamp uterine body and transect between clamps
-drop everything into a sterile pan
-complete fetal extraction
-ligate pedicles and uterine body
-close routinely

Question 12

What is the post-op care following a c-section?

Answer 12

-clean soap/prep solution off of dam’s abdomen
-check dam for colostrum
-provide blocks, buprenorphine, and single dose of NSAID to dam as needed for pain
-place neonates with dam under observation during recovery
-early release of mother and neonates to owner

Question 13

what are the steps to normal neonatal care following c-section?

Answer 13

-vigorously rub with soft, clean, warm, dry towel to stimulate breathing
-rub until crying or regular, deep breathing
-provide oxygen as needed
-suction mouth gently with bulb syringe or mucus trap
-ligate or tie umbilical cord
-examine for congenital defects
-place in warm incubator until dam is available

Question 14

What can be done if a neonate is not breathing?

Answer 14

-keep rubbing
-apply tight fitting mask and ventilate
-reverse mu opioids with naloxone
-acupuncture at nasal philtrum
-intubation in larger puppies
-doxapram under tongue with oxygen as last resort