Metacam - pre, post or during op?

Re: Metacam - pre, post or during op?

Nick Shackleton — Sun, 19 Dec 2010 20:02:52 GMT

[quote user="shelly jefferies"]

We give all most patients metacam on nurse checks as soon as admitted, the only ones that don't are old animals waiting pre-op blood results. if ok then given metacam straight away.

this means most patients have had their metacam 30-45 minutes minimum before premed and GA.

[/quote]

Surely your patients should have an exam prior to medications being administered. All our patients (where I worked full time) were TPR'd and had chest auscultation (by a vet) before any medications are injected. Even those that have been hospitalised the night before or seen in the previous week.

With regards to metacam/other NSAIDs. provided they are required dogs got them IV during prep for procedure as well as IV antibiotics. Cats receive IV ABs and then NASIDs at vets choice and the majority got them at the end of surgery during recovery.

We had other forms of analgesia available for the kitties such as local anaesthetics, ketamine, opiates, nitrous..... (these were also available for the troublesome canine patients too)

Re: Metacam - pre, post or during op?

shelly jefferies — Sun, 19 Dec 2010 19:04:48 GMT

We give all most patients metacam on nurse checks as soon as admitted, the only ones that don't are old animals waiting pre-op blood results. if ok then given metacam straight away.

this means most patients have had their metacam 30-45 minutes minimum before premed and GA.

Re: Metacam - pre, post or during op?

Emma Townson VN Cert IV MBVNA — Sat, 18 Dec 2010 17:56:35 GMT

Our protocol is:

Vet/Ace pre med, Prop and Iso GA and Metacam on extubation (along with possibly post op AB's - they are covered with analgesia form the vetergesic which last 8 hrs (if im not mistaken?!) and then NSAIDs post op for prolonged analgesia when they are discharged.

Re: Metacam - pre, post or during op?

BengalcatRVN — Fri, 26 Nov 2010 20:43:23 GMT

[quote user="Phrin SVN"]

PS - I dislike triple too, for that very reason - 45mins! And unfortunatley they are not monitored during that time either, as the vet want's to get on with something else... so the cat spends 35mins in a kennel unattended, witing for ketamine to wear off, before it can be reversed!

I'm not sure if it is better or worse for the patient, but one of our vets always wants to reverse the medetomidine () as soon as the castrate is over..... so far he has given in to the nurses protests, and waited the 45 mins, but what does everyone else think?

[/quote]

Am a hater too, poor cats tripping, even after 45 mins. Said before, don't use it in rabbits anymore either. 28d rules seen to that! I'm glad, seriously, the big eyes and thrashing freaked me out! I'm rubbish with generic names as my spelling is awful

Re: Metacam - pre, post or during op?

Phrin Vernon RVN — Fri, 26 Nov 2010 20:28:24 GMT

Re: Metacam - pre, post or during op?

Phrin Vernon RVN — Fri, 26 Nov 2010 20:23:07 GMT

[quote user="Celine"]

Ah I'm so glad we're talking about this subject! I was wondering about this myself when I was locuming for while where all cat spay / castrates got triple combo. (HATE!! I see no good reason why a cat castrate should be unconcious for 45 mins for a 2 min operation.)

Correct me if I'm wrong but I always thought you should give your opiods before your NSAIDS as the NSAIDS block some (?)receptors that the opiods could otherwise latch onto, and then if you give the opiod it can't have as good an effect as it should, resulting in an overall lower level of analgesia. (Correct me here if needed guys, I'm sure I remember this lecture at uni but then it could have taken place during one of those dreams where I realise I'm in my PJs in the lecture hall *ahem* )

So, if this is correct, then we should give meloxicam or your NSAID of choice, after giving the butorphanol time to work. However, I read quite recently that the analgesic benefits of butorphanol vary massively between individuals, some as short a time as 30 mins! So my worry would be that if we're waiting for recovery to give the NSAID we may well have a period where there is no analgesia on board... ouchy.

Agree / disagree? Also, can I be pedantic and suggest we use the drug names instead of trade names? It makes us soooooooooooooo much more professional, which is what we are paying the beloved RCVS to foster after all

[/quote]

I've never heard of that Celine, but it could make sense ... very interesting, & I'd love to learn more as anaesthesia and analgesia are my favourite topic! I have a LOT to learn however

Don't NSAIDs bind to prostoglandin receptors? I can't remember, or have never been taught where the various opiods bond.... All I can remember from that lecture is diazepam & GABA receptors lol!

Re: Metacam - pre, post or during op?

Celine — Fri, 26 Nov 2010 20:10:43 GMT

Re: Metacam - pre, post or during op?

Claire Cameron — Fri, 26 Nov 2010 19:45:15 GMT

[quote user="dinkyd"]We give ours IV after induction[/quote]

Do you give Metacam IV to kitties?

Re: Metacam - pre, post or during op?

Claire Cameron — Fri, 26 Nov 2010 19:42:54 GMT

[quote user="*Steph *"]

[quote user="Vicky SVN"]

[quote user="SmegSlayer"]

[quote user="Cat Woman"]

If used once the op is underway (& I mean for cat spays/castrates) then by the time it has an effect on the body, the cat is waking up & therefore its blood pressure will be getting back to normal. [/quote]

How long do you're spays and castrates take??? S/C injection takes at least 15 mins to work and all our cat neuters are waking up at this point maybe our main vet is just super quick but he can do a cat spay from intubation to off iso in under 10 mins. and our slower vets are generally 20-25mins max so there is a high chance of the animal waking up before the NSAID has taken effect

[/quote]

10 minutes??? Does that including scrubbing time? Cos it seems very quick to me...i've worked with fast vets, but never seen a cat spay done in 10 min.

[/quote]

Our vet does them in 10mins also.. he's super quick and the incision is TINY! the cat castrates.. well.. you only got to blink and you've missed it! lol

[/quote]

I worry, as I personally think 10mins is too fast, there's a difference between efficiency and speed. I wouldn't be happy if my cat was spayed in 10minutes

Re: Metacam - pre, post or during op?

Vicky RVN — Fri, 26 Nov 2010 19:12:18 GMT

I've never known pain relief not to be given to castrates...ouch poor things! Buprenorphine and metacam all the way.

[quote user="BengalcatRVN"]

And I agree on the 10 mins, my vets pretty fast, unless someone else is knocking the cat out while the vet scrubs, but even then, surely checking everything is "as it should be" is more important than the race to the end.

[/quote]

That's how i feel...if it were my animal i'd rather it be under ga for another 10 min personally, in order for thorough scrubbing of patient/vet and time spent checking.

Re: Metacam - pre, post or during op?

BengalcatRVN — Fri, 26 Nov 2010 17:58:45 GMT

No pain relief to castrates? Why is it people think they don't feel pain?! Is it just because they are cats? All my cats get buprecare and metacam, doesn't matter if they are a spay or a castrate. Of cause taking into account health, on advise of the vet.

Re: Metacam - pre, post or during op?

Steph Phillips — Fri, 26 Nov 2010 17:46:41 GMT

[quote user="Vicky SVN"]

[quote user="SmegSlayer"]

[quote user="Cat Woman"]

[/quote]

10 minutes??? Does that including scrubbing time? Cos it seems very quick to me...i've worked with fast vets, but never seen a cat spay done in 10 min.

[/quote]

Our vet does them in 10mins also.. he's super quick and the incision is TINY! the cat castrates.. well.. you only got to blink and you've missed it! lol

Re: Metacam - pre, post or during op?

Vicky RVN — Fri, 26 Nov 2010 16:32:18 GMT

[quote user="SmegSlayer"]

[quote user="Cat Woman"]

[/quote]

10 minutes??? Does that including scrubbing time? Cos it seems very quick to me...i've worked with fast vets, but never seen a cat spay done in 10 min.

Re: Metacam - pre, post or during op?

Linzi Mac — Wed, 24 Nov 2010 13:35:29 GMT

All our patients get sedated and their metacam at the same time as their pre med, We do consider each animal and if metacam is appropriate to each case, We havent had any problems and our patients seem less painful when waking.

Re: Metacam - pre, post or during op?

Leanne Tyreman-Guest — Wed, 24 Nov 2010 13:02:07 GMT

One of my vets has been to an American CPD recently and they said it was a problem giving the Metacam INTRA op, pre or post op is fine, like others have said due to the perfusion issues with hypotension.

Obviously thats just their take on it via the studies etc over there but thought it may help the discussion!

We give ours with P/M or right at the start of the op, makes you wonder whats right and whats not! interesting stuff!

Re: Metacam - pre, post or during op?

Claire Cameron — Wed, 24 Nov 2010 11:25:12 GMT

[quote user="SmegSlayer"]

depends on whether or not the vet can be bothered to wait the full amount of pre med time or possibly if delayed the pre med wears off

[/quote]

So very relieved I do not work with vets like this.

Re: Metacam - pre, post or during op?

SmegSlayer — Wed, 24 Nov 2010 07:45:38 GMT

depends on whether or not the vet can be bothered to wait the full amount of pre med time or possibly if delayed the pre med wears off

Re: Metacam - pre, post or during op?

Cat Woman — Wed, 24 Nov 2010 07:26:47 GMT

But they have had analgesia in the pre-med too (& I have noticed that alot of people on here don't give metacam at all to castrates?). If metacam is given at induction, then in most cases, it would be taking effect as the cat wakes up - no?

Re: Metacam - pre, post or during op?

SmegSlayer — Wed, 24 Nov 2010 07:11:00 GMT

[quote user="Cat Woman"]

Re: Metacam - pre, post or during op?

Cat Woman — Tue, 23 Nov 2010 22:00:00 GMT

[quote user="MrsP"]Have been told about not giving it intra-op due to possible reduced tissue perfusion to kidneys due to higher potential of low BP. If there's any doubt about renal issues, we don't use it at all.[/quote]

Thats exactly the reason I have been told not to use it pre-op!! If used once the op is underway (& I mean for cat spays/castrates) then by the time it has an effect on the body, the cat is waking up & therefore its blood pressure will be getting back to normal. As I said in the original post, I understand the importance of analgesia, but I wanted to find out the "gold standard" for giving the NSAID. I appreciate that the risk to the kidneys may be small, but if there is a risk then shouldn't we do the utmost to minimise it?

Wish I could find the article!!

Re: Metacam - pre, post or during op?

MrsP — Tue, 23 Nov 2010 20:46:45 GMT

We give ours in the pre-med as preemptive analgesia.

Have been told about not giving it intra-op due to possible reduced tissue perfusion to kidneys due to higher potential of low BP. If there's any doubt about renal issues, we don't use it at all.

Also we are now using the licensed cat metacam inj and oral.

Re: Metacam - pre, post or during op?

dinkyd — Tue, 23 Nov 2010 20:38:37 GMT

We give ours IV after induction- most of our patients are on some sort of NSAID when coming in anyway.All our routine patients are given IVFT from induction and until extubated.NSAIDS can have an increased risk of clotting issues (think nsaids are similar/same group as aspirin - this is used to thin the blood in some conditions)However im sure i have read that the doses we give for animals are unlikely to cause this - think this is more for carprofen and meloxicam though - im unsure of the older nsaids kicking about!

Re: Metacam - pre, post or during op?

Phrin Vernon RVN — Tue, 23 Nov 2010 19:58:02 GMT

This is an ongoing debate at work, and the partners are hoping to get a talk by an anaesthatist for us, to clear up any worries, and so that we can have a set practice protocal - at the moment is very much down to each individual vet.

Personally I feel that the pre-emptive benefits are worth it in elective neuters, in young healthy animals, and that anything else should be supported with IVFT, and NSAIDS given either part way through surgery, or on extubation.

We use buprenorphine in our premeds, which should have analgesia properties for 6hrs I believe, which should cover those old cat dentals on the brink of renal failure! It's usually no more than 3hrs tops from pre-med to recovery.

Just my opinion though - I'd love to read some papers on it! Hope you can find your link Steph

Re: Metacam - pre, post or during op?

SmegSlayer — Tue, 23 Nov 2010 19:45:29 GMT

we generally give metacam with premed. we don't give D/T/K to many animals, occasionally cat castrates but they have acp and vet with proprofol most of the time. if we do give D/T/K we wait till the atipam is given.

Any animal we are worried about regarding renal function gets onsior injection instead of metacam

Re: Metacam - pre, post or during op?

Kim Buckley — Tue, 23 Nov 2010 10:57:13 GMT

[quote user="Sal (the 1st) Holesworth VN CMH Chyp (M)PNLP"]

some vets prefer post op because of possible clotting problems during surgery - I dont recall ever having a case which has had clotting problems as a result of metacam but I have heard it from more than one vet in different practices so maybe there is information on this as well out there?

[/quote]

Yeah we don't give it if there is a high risk of blood loss for this reason. They get it once they are awake and we just give them lots of opiods so they don't feel painful.