Another Point of View

ANOTHER POINT OF VIEW

BY MICHAEL GUY, R.N.

I suspect I am in the minority with my viewpoint regarding C‑sections anesthetic. I shall relay it to you for your consideration. If nothing else it may illustrate how differently things can be done with similar results. At best it may offer an alternative to present methods.

I have experienced several methods for anesthetizing a bitch during a C‑section. From days gone by when drugs were okay for the bitch, but not the puppies, to when Halothane was the only option, to the more modem methods used today.

I have used Isoflorine inhalation. Granted the puppies and bitches recover quickly, but I found maiden bitches overexcited initially, almost hyper, and milk flow rather reduced increasing 2‑3 days later. I recently heard of a brood bitch I had sold being given Valium initially, then Isoflorine, she was very difficult to get under, fighting the intubation; consequently, the whole litter was lost.

I have used Propofol or Rapinovet on three sections ‑ all bitches seemed to take too long to respond, the intubation tube could not be removed as quickly as expected, the bitch did not fight the tube as expected when the anesthetic had stopped. They did not come around as fast as expected following the procedure. The puppies however seemed responsive. The vet had used this method on both French Bulldogs and Pomeranians and had wonderful responses; he was very surprised at the poor response of three different, unrelated bitches. One of my bitches seemed to have either internal bleeding or a sudden drop in blood pressure post operatively and required a blood transfusion. A breeder of Pugs had his bitch suffer cardiac arrest several hours following a C‑section using Propofol; all had seemed well immediately following surgery. (They did not do a post mortem so we do not know if there was another cause for the arrest.) Consequently however we do not use this method any longer. I hypothesize that possibly there is a metabolic difference, in the breeds of oriental decent. Having bred Chow Chows, I know that they do not metabolize salt as readily as other breeds, we also had several idiopathic responses to various anesthetics in the Chows; possibly there is an undiscovered genetic connection.

The following combination is what I have used for over 40 sections. I have not lost a bitch. I have lost two puppies only out of approximately 120. Both of these occasions were due to a failed natural delivery where the bitch initially had contractions and labor arrested; on examination the placenta had detached. On both occasions there were live viable puppies behind the dead one that responded normally. These two separate losses cannot be attributed to the anesthetic used. The cocktail used is as follows:

0.02 mg/kg Atropine (To dry secretion in the airway.)

0.05 mg/kg Acepromazine (sedation)

0.2 mg/kg Oxynumorphan (a pain killer, do not exceed 4.5 mg total dose)

INTRAVENOUS, Maintain a patent line with normal saline, TKVO

CALCULATED ON THE BITCHES NONPREGNANT WEIGHT.

LOCAL FREEZING ALONG THE INCISION LINE, we like to do the local freeze before the IV if the bitch is cooperative.

The bitch is sedated only, she is aware of my presence, and I talk to her throughout the procedure. They often respond with a slight twitch of the tail, or a "knowing"‑ blink of their eyes. They do not require intubation and breathe on their own; the rate is reduced from 30 to 20 breaths per minute. Her milk flow is normal to heavy, and puppies generally nurse before leaving the vets or at least 23 hours later. The bitch remains sedated for 4‑6 hours just resting, coming around slowly. Maiden bitches are introduced to their "kids" slowly, first hearing the crying, then feeling them nurse, enjoying the feeling the Oxytocin release gives them, and eventually fully accepting their babies.

I know many people will feel vulnerable without an intubation tube in the bitch. Many will question if the bitch feels any pain. Vets may disregard the use of Acepromazine as it can cause a drop in blood pressure. All that I can relate is my own experience and success with this method ‑ over 40 litters without complications is validation enough for this method. I would be very pleased to hear of other experiences people may have had, or simply your opinion on the methods.

THE ORIENT Express / APRIL 1997