The Infamous Snip

In this episode Dogtor S is going to focus on some of the most commonly performed surgical procedures on dogs and cats in general practice: the spay or neuter. Read, or listen, on to find out more about the procedures themselves and what your pet goes through on the day they get these done.

Hello to all and welcome to Episode Four of this podcast series where I, Dogtor S, guide us through the various procedures, illnesses, and treatments that our favorite four legged friends usually go through. This episode is going to focus on spays and neuters. The infamous snip, the fixing, surgical sterilization, etc. These procedures are likely the most commonly performed surgical procedure in the United States in veterinary medicine, but what does the procedure entail and what does my pet go through during their visit to the veterinarian? These are the questions that I will answer today, so sit back, paws and press play. This podcast does contain fairly in depth descriptions of certain surgical procedures, so anyone that may get faint or squeamish as well as my younger listeners may wish to skip to the next episode.

So… you find yourself in the following predicament; it is time to spay or neuter your dog or cat. You’re terrified, you’re worried about the anesthesia, and you’re worried about what will happen to your pet when you drop them off, you’re worried about the price, and you’re worried that it will change them. These are all very valid concerns and ones that we come to terms with since spaying and neutering became such widespread practices. Now, there is a mass of a research that is fairly new surrounding this topic, so the timing for the procedures and the various potential health impacts will be covered in later podcasts. For now, let’s focus on what the procedures are and what your dog or cat goes through when they get dropped off.

Let’s start with the spay as it is a bit more technically challenging than a neuter. There are a few different techniques for spaying, but predominantly it boils down to between an ovariectomy and an ovariohysterectomy. There is no difference so long as you get all the ovarian tissue out between the techniques so it frequently ends up being the preference of your veterinarian. When your pup or kitten gets dropped off to be spayed they will usually be checked in by a technician. They will ensure she has been doing well for the last several days, that she has not eaten in about 12 hours, and that you have no concerns with her for today. The reason behind the fast, or withholding food is to help minimize the risk of aspiration of GI contents when the gag and swallow reflexes are lost under anesthesia. If all things look good she will likely be set up in a kennel and await her turn for surgery. It is usually during this period that your veterinarian will come in and do a physical exam. They are making sure that there is nothing that stands out from previous exams that would indicate that the procedure may not be safe. If your pet has gone into heat it may be recommended to wait for the procedure. The heat cycle is not necessarily bad; however, it does make the procedure more risky because there is a lot more blood flow, and a higher risk to your girl. Spays can still be done during heat, so if there is a pregnancy concern etc it may still be recommended, just be sure to have a conversation with your veterinarian. If all things check out then your pet will receive a premedication injection. This is usually an opioid alone or in combination with other drugs either to help provide additional sedation, pain relief, or to help control side effects of the primary medications.

At this point typically an intravenous catheter will be placed usually into your pup’s or kitty’s frontlimb. This allows quick access to the vein to administer drugs, fluids, or to intervene in the unlikely event that something goes wrong. From there it is time to induce anesthesia. Nowadays this is largely done with a drug called Propofol which is incredibly safe when used at appropriate doses. This causes anesthesia and allows the veterinary technician to place an endotracheal tube. This is a tube that goes into the trachea of a dog or cat and protects their airway during any procedure requiring general anesthesia. Once under anesthesia, animals lose their ability to swallow, so this is an important protective feature done for most spays and neuters at veterinary hospitals. Finally once intubated your pet will be started on isofluorane or occasionally Sevofluorane. These are the two most widely used inhalant anesthetics in animals.

During anesthesia a veterinary technician will be monitoring the blood pressure, heart rate, respiratory rate, and the patient’s ability to provide enough Oxygen to their body using a value called an SPO2. If there are any concerns they notify the veterinarian performing the surgery, or a separate anesthesia monitoring veterinarian, immediately so that they can be addressed.

At this time I will describe the procedure to be done to spay a dog or cat using an ovariohysterectomy technique.

During the induction and prep for anesthesia, the abdomen is shaved of fur until only skin is visible. This area is scrubbed and aseptically prepared for surgery. This serves to disinfect the surgical site and reduce the risk of infections. An incision (or cut) is made down the midline of the abdomen and the abdominal cavity is entered. First, using a spay hook, literally a smooth hook shaped instrument that is designed to grab a hold of the uterus and not traumatize other important tissues, the uterus is identified and the ovary is isolated. Using pressure with the surgeon’s fingers a ligament called the suspensory ligament will be broken down to release the ovary from its attachment to the body wall. Once that is done a clamp is placed around the blood vessels that supply the ovary and these are ligated or tied off so that they no longer flow. Now if doing an ovariectomy rather than an ovariohysterectomy at this time the opposite side of the ovary called the proper ligament will be clamped off. This ligament attaches the ovary to the uterine horn of the same side. The blood vessels will again be tied off and assessed for bleeding. Following this in an ovariohysterectomy, the pedicle (or what remains of the ovary’s attachment to the body wall) will be cut and assessed closely for any bleeding that needs to be addressed, if there is none then the surgeon will break down the broad ligament which is a large piece of tissue that spans along the length of the uterine horns. If the animal is young, or a cat, this will be broken manually, if the animal is older or very large it too will be ligated and cut to ensure there is no excess bleeding. Once this is done, it will be repeated for the opposite ovary. Finally, the bifurcation of the uterus (or where it splits into two separate horns) will be exteriorized and again ligated to tie off the large uterine arteries. The uterine stump will be excised and assessed closely for bleeding, if none is seen it too will be released to the abdomen. Now, it is time to close the initial incision. The body wall will be closed first, followed by the subcutaneous tissues and then the skin. In cats, frequently the subcutaneous tissues are not closed, so it is just the body wall and then the skin. Finally, a line block will be administered around the incision. This is a combination of local anesthetics that will provide pain relief immediately post operatively and sometimes much longer depending on the drug available.

Now if your pet was getting neutered rather than spayed then much of the preparation would be exactly the same. This procedure tends to be quicker and is usually not an abdominal surgery and so is a little less invasive. If both of the testicles are in the scrotum then there are two techniques used. One is called a prescrotal castration the other is called a scrotal castration. The only difference between these two is where the incision is made, i.e. just above the scrotum or in the scrotum itself. Now, I tend to prefer a prescrotal castration so I will describe that one here, they are very similar techniques. A side note quickly, if your pet has a testicle that has not fully descended into the scrotum than he will be what is known as a cryptorchid, or literally hidden testicle. Depending on where the testicle is, the surgery may be a lot more difficult. Testicles that are within the abdomen can be extremely difficult to find; this procedure will be a lot more similar to a spay. If the testicle is in the groin or inguinal area, then it will be about the same as a normal neuter, just different incision.

Now back to a standard neuter, an incision is made over the top of one of the testicles and the testicle is exteriorized. Just like with the ovaries, the major blood vessels supplying these are tied with suture and then when the testicle is cut they are closely assessed for bleeding, if there is any bleeding from these vessels then another suture will be placed. Once this has been done for both testicles the subcutaneous tissues will be closed and then the skin. Just like with a spay a local anesthetic will be injected around the surgery site and then they will be woken up from anesthesia. A side note is that in cats almost exclusively they are neutered via scrotal incisions, which is essentially the same procedure that I described; however, the incision is made directly over the testicle within the scrotum.

For spays and neuters the recovery period is pretty standard, sometimes the veterinarian may want the incision iced or wrapped depending on how much pain or swelling there is. This can also depend on the size of the patient, as larger patients seem to have a bit more significant bruising after the procedure. The recovery from anesthesia typically takes about 15-20 minutes in the hospital; however, your pet will likely seem drowsy or a little disoriented for about 24 hours after the surgery. Most of the time patients are ready to be sent home the same afternoon of the procedure.

Once you’ve gotten your loved one home they will likely be pretty sedate and sleepy for the night. They may or may not want to eat. Some animals will be what’s called dysphoric which is a side effect from the medications that they receive around the procedure. This causes them to be more vocal or whiny. They also may act restless and walk around the house. Rarely are there concerns that develop after these procedures that require emergency attention, but there are some, so be sure to read and listen to the instructions by your veterinarian on the day of the procedure. More often than not by the next day any effects of the drugs for anesthesia will have worn off, and usually by day two or three your puppy or kitten will be acting basically back to normal. Older animals may take a little longer to recover, but again frequently they will follow this same time course. Your pet will almost always be sent home with some pain medications, it is important to give those as instructed. We know that procedures cause pain post operatively and it is very important to manage it so that your animal feels as little discomfort as possible. One thing that I’ve encountered frequently is that people are inclined to stop the medications because they don’t perceive that their pet is in pain because they are acting normal. Dogs, and especially cats, will almost never show overt or obvious signs of pain, so I always recommend giving the full course of pain medications that your veterinarian prescribes.

I hope that this walk through of the day at the veterinary clinic for your pet is helpful, and hopefully eases the mind a little when you drop them off. I also hope that it helps to educate a little around the various procedures for sterilization that we do. Furthermore, there is much new research around spaying and neutering that has come to light over the years and future podcasts will address the pros and cons of spaying and neutering based on the strongest research that we have available now. Thank you for listening, this has been dogtor S with paws press play.

Useful Resources: These are videos of the procedures described, do not watch if squeamish!
Canine Spay:
https://www.youtube.com/watch?v=rEyZQyeFJFc
https://www.youtube.com/watch?v=97Knt23bO1o
Canine Neuter:
https://www.youtube.com/watch?v=UjfNbu0zxfk
Feline Spay:
https://www.youtube.com/watch?v=UjfNbu0zxfk
Feline Neuter:
https://www.youtube.com/watch?v=P11e2LmR6K8

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