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What types of questions should we ask a client when they bring their dog in due to a difficult birth?
- when did signs of first stage labor start?
- have any fetal membranes or puppies been visualized at the vulva?
- have any puppies been delivered? if so, in what condition (dead, alive)?
- what was the time interval between the puppies that have been delievered?
- what is the previous pregnancy and whelping history?
Should we still use a balanced anesthesia approach when we are doing a c-section?
What is the heart rate of a healthy fetus? At what heart rate should we be worried?
- healthy heart rate: 150 - 200 bpm
- unhealthy: 100 - 150 bpm (could indicate fetal stress)
What are the benefits to premeding the dam before a c-section?
premeds reduce anxiety, especially if the dam has already started parturition, has had a prolonged second-stage labor, has delivered puppies or has uterin inertia
Which premeds are okay to give a dam prior to a c-section?
- metoclopramide or cimetidine
Which opioids are best to use for a c-section and why?
- torb because it has a short duration (1-2 hours) so by the time we get the puppies out the torb has worn off of the puppies and then we can give the mama another pain medicine of whatever we would like because we won't have to worry about the puppies getting it too
- if we give another opioid besides torb we should give the puppies a reverser (naloxone) after they are born so they won't have the adverse side effects of the opioids
How do we administer Naloxone (reverser for opioids) to puppies?
put a drop under their tongue
Which anticholinergic is preferred for a c-section and why?
- atropine because it crosses the placental barrier and counteracts fetal bradycardia and has a shorter onset and duration than glyco
- glyco does not cross the placenta barrier due to the size of its molecules
What is metoclopramide and cimetidine and why are they important to use for a c-section?
- metoclopramide is an antiemetic
- cimetidine is an acid blocker
- decreases the risk of esophageal reflux and regurgitation due to the fact that most c-section patients have not been fasted
Which premeds should we avoid using for a c-section?
- alpha 2 agonists
Why should we avoid using benzodiazepines for a c-section?
can cause hypotension and requires a lot of liver metabolism which is not good for the babies
Why should we avoid using phenothiazines for c-sections?
- can cause hypotension
- there is no reversal agent so this drug can have lasting effects for hours
- can cause respiratory depression in puppies
Why should we avoid using alpha 2 agonists for c-sections?
- can cause profound bradycardia
- decreases cardiovascular funtion
Should we administer fluids during a c-section? Why or why not?
- yes due to the mama losing a lot of fluid during the surgery
- start with a standard rate of 10ml/kg/hr but can double it if we need to
Which type of fluid should we give during a c-section?
Should we preoxygenate the dam before doing a c-section? Why or why not?
- yes, to prevent hypoxemia in the dam and puppies
- 100% oxygen by face mask for 5 minutes before and during induction
What is the ideal drugs for induction and maintence of general anesthesia for a c-section? Why?
induce using propofol and maintain on inhalants due to both being very short acting
Do all induction agents cross the placenta?
Can we skip using propofol and mask the patient down?
yes, but the patient will go through the excitement phase so if the patient is not cooperating or is very large (will take a long time) then propofol is preferred
Can we use ketamine for a c-section?
- we should avoid this since part of ketamine is combinede with benzodiazepine
- we should also avoid using ketamine because it lasts longer
Why should we avoid hyperventilating our patient during a c-section?
hyperventilation leads to hypocapnia which then decreases blood flow to the uterus and umbilical cord this in turn leads to decreased oxygen being delieverd to the puppies
MAC (minimum alveolar concentration) of inhalation anesthetics is decreased during pregnancy by _____ for halothane and _____ for isoflurane.
Should we use an epidural for a c-section? Why or why not?
- we can use on but its not necessary
- using an epideral helps lower anesthesia needed for the patient due to less surgical stimulation
How do we correct hypotension?
decrease inhalant, increase fluids
What should we do once the puppies are delivered?
- rub them vigorously to stimulate them to breathe
- suck fluid out of their nose and laryngeal
- naloxone under tongue if they need to have opioid reverses
- doprame under tongue to stimulate respiration
Should we "sling" the puppies after their born?
- some vets will have us sling them
- this helps get the fluid out
- but can hurt their brains
- be careful not to drop puppy
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