As in any business, productivity is important. A longer
time taken in veterinary surgery means a vet is less
efficient and productive. I will be recording in greater
detail, the processes, proctocols and
post-operation outcomes done by me and associates in
2012.
One of the various measurements is Duration. Starting
time = when sedation is given. Ending time = last
stitch.
Three of my cases are mentioned below.
Dec 14, 2011 CASE 1. Monorchid. One undescended testicle removal
Maltese, 4 years, 3 kg
A lady owner just wants undescended right testicle to be
removed, but leave the normal one alone. She wiped tears
off her eyes as she handed her dog to me. She was one of
those educated owners who know about the anaesthetic
death risk. Yet she knew that the undescended testicle
may become cancerous in later life and still need to be
removed. By then, an older dog would incur a higher
anaesthetic risk of death. Her husband and I had to
assure her that there was nothing to worry as the dog
was in good health.
MY GUIDELINES: 10kg, young, healthy dog
Domitor (D) 0.4 ml Ketamine (K) 0.5 ml combined IV in
one syringe. This is effective as an injectable
anaesthesia lasting around 30 minutes and is sufficient
for a dog spay without topping up with isoflurane + O2
gas. However, I usually use 50% of the guidelines for
less than 5-minute operation and top up when required.
In this dog done by me, calculated D=0.172 ml, K=0.215
ml
At 50% of calculated dosage, I injected D=0.08, K=0.10.
Total = 0.18 ml IV. Added Hartmann's 0. 12 ml to total
0.3 ml which was given IV. Intubated. Isoflurane + O2
top at 1%. PDS absorbable 3/0 suture, 2 horizontal
mattress. Time start: 10.11 am Time end: 10.29 am Total
= 18 minutes. Dog woke up within 10 minutes after
end of surgery and went home soon. I did not tape up the
wound and taught the owner to use a clean facial cotton
with clean water to wipe off the blood the next day and
check daily. No need to return for stitch removal as the
stitches will dissolve in 14-28 days' time.
Case 2.
Tarsorrhapy (repeat)
Shih Tzu, 5.4kg. Had been warded for over 3 days. The
dog looked weak but he was the quiet type. At 50% of
calculated dosage, I injected D=0.108 ml , K=0.135 ml.
Total = 0.25ml IV. Isoflurane + O2 top at 1%. PDS nylon
3/0 suture, 2 horizontal mattress. One suture is over
tubing. Time start: 11.06 am Time end: 11.29 am. Total =
23 minutes
Dog was not waking up fast. Given dextrose saline SC and
antisedan 0.2 ml IV. Dog woke up soon. OK as at 3 days
post surgery.
Case 3. Dec 9,
2011. Tarsorrhapy (lst time).
Shih Tzu, 3.9kg. The dog has been warded for the past 9
days without eye swelling or bleeding unlike Case 2
which was taken home against medical advice on Day 1. I
will record the times later.
In conclusion, audit
of veterinary surgeries is important in evaluating the
standard of care and performance of veterinary surgeons.
Without an audit, vets may just waste materials, time
and provide poor quality service. Some of the doctors
and their nurses get distracted during surgeries by
texting or making personal phone calls during surgeries
as reported in one article I read recently. So, audit of
veterinary surgeries by the Principal is important in
ensuring a high standard of care and services. Doctors
who don't perform well in the audit will have to leave
the practice.
TOA
PAYOH VETS
