C-sections

RE: C-sections

James Colver Cert. Ed, RVN — Tue, 05 Sep 2017 17:06:35 GMT

Thanks for taking the trouble :) Mixed information on the subject abounds!

RE: C-sections

Samantha Flavell — Mon, 04 Sep 2017 21:23:47 GMT

Hi, I hope these help a little (this is not exhaustive, just a quick link to some sources:

Norkus -veterinary technicians manual for emergency and critical care , pg 92

States 4 separate sources as to why doxapram can worsen outcomes.

J vet intern med 2008; 22:9-25

Cardiopulmonary resuscitation in small animal medicine an update (Plunkett McMichael) - states that doxapram administration is contraindicated for the reasons discussed before/on the forum.

Matthews - veterinary manual of emergency and critical care states on pg 754 - however, doxapram has not shown to be of benefit.

Your statement from BSAVA manual does seem to support doxapram as not of benefit also due to hypoxaemia.

I know not being of benefit is different to contraindication, however with the other sources suggesting harmful effects I would not be wanting to use it personally. It is a complex drug and even with human medicine there seems to be a lot of times when it should not be used (sorry, not got time to list these sources). With human medicine they often know the medical condition of their new borns more-so than us, so it is easier for them to know if contraindicated due the physical illness/condition of the patient than us at present. (That is personal opinion).

Maybe with advances in the future we will have a better understanding of if and when it can help.

I hope this is of interest. It is good to have healthy discussion on these matters :)

RE: C-sections

James Colver Cert. Ed, RVN — Mon, 04 Sep 2017 19:08:02 GMT

Does anybody actually have a reference to support the statement that Dopram drops are contraindicated in resuscitating neonates?

2016 (apologies I thought it was 2017 but still very recent) BSAVA Congress proceedings recommend their use where necessary and in conjunction with oxygen therapy (Lara Dempsey) as does the 9th edition of the Formulary. The BSAVA Manual of Anaesthesia and Analgesia simply states that "..it is difficult to recommend the routine use of doxapram" as it is "not effective during hypoxaemia, and is unlikely to result in a positive response when administered to a neonate that is hypoxaemic due to hypoventilation."

This suggests to me that it is not contraindicated per se, and may in fact be useful in certain circumstances...

RE: C-sections

Samantha Flavell — Sat, 02 Sep 2017 12:21:22 GMT

Dopram is no longer recommended, in fact it is contraindicated as it decreases cerebral blood flow and increases cerebral oxygen demand. I have not used it in many years and still have had successful pup/kitten rescusitations! Also, I do not swing since researching a while ago and use 1ml syringe or little baby suction devises to clear the airway, lots of rubbing and keeping head slightly lower.

Also, mom is most important so don't forget her. Anaesthesia may change once the pressure of the gravid uterus has been dealt with, and also reaction to analgesia given.

RE: C-sections

James Colver Cert. Ed, RVN — Thu, 31 Aug 2017 21:39:36 GMT

Some considerations -

- decrease in functional residual capacity (air left in lungs after expiration) so pre-oxygenate the dam

- Higher oxygen requirement

- Delayed gastric emptying and decreased oesophageal sphincter tone, so watch carefully for reflux

- May require less GA (progesterone decreases requirement)

- Analgesia remains controversial, most vets seem to wait until the puppies are out, but it's an important part of the GA protocol and good analgesia will likely lead to a better recovery of the dam / better ability to look after her offspring

- Care with positioning as gravid uterus puts pressure on diaphragm, vena cava and aorta (but again, be prepared for reflux)

I THINK that dopram drops are still indicated for pups (just the injectable dopram is out of favour) - according to 2017 Congress notes anyway. Note that dopram drops will only work when used in conjunction with oxygen supplementation.

As others have said, a list of things to have to hand would include plenty of swabs, towels, haemostats, oxygen for puppies, a source of warmth, somewhere to put the puppies..

RE: C-sections

k.91 — Thu, 31 Aug 2017 21:04:16 GMT

[quote user="F1chick"]

I was recently told not to use dopram any more as it is no longer deemed good for the babies. I can't remember who told me this or why it's not to be used. Anyone????!

[/quote]I was thinking that as well, we no longer stock it because it's contraindicated. I want to say it's because of the benzyl alcohol toxicity you see in human neonates causing CNS damage, profound hypotension and metabolic acidosis (flatmate is a midwife, not my own knowledge) but there may be another reason in veterinary medicine.

RE: C-sections

Jacqueline Gallacher — Thu, 31 Aug 2017 00:05:51 GMT

I clip mum up before induction, get someone to hold her front paws up and clip her and do initial scrub, it means less time under GA and pups recover much quicker. also tilt her to her left when she is on her back as this takes the pressure off the vena cava.
As others have said be prepared, have a basket with heat pad, plenty towels. dopram and all you need ready before you start. Its a bit full on but you will probably enjoy it.

Ask around too as there are always other nurses or vet students or volunteers who would love to be involved in a C section and you could call on them to help when you know one is coming in.

Re: C-sections

Honeybadger — Thu, 10 May 2012 20:43:01 GMT

I found plastic pipettes handy for sucking out any oral secretions.

Re: C-sections

NuttyNu — Thu, 10 May 2012 15:44:06 GMT

We get them come in occasionally... Not usually in night time if I am honest.

The other main thing I would say is to have as much "noisey" monitoring equipment on as possible so that even if you cannot look at the bitch at the time, you have some noise which is beeping for breaths, beeping for heart beats etc so that you can hear increases, decreases (and hopefully not but also stopping). Deal with the bitch like a normal anaesthetic which hasn't had a pre-med and then just tackle the pups as they come.

But staying calm is the most important thing as if you panic, your body forgets to use common sence!!!

Re: C-sections

F1chick — Tue, 08 May 2012 19:57:04 GMT

I was recently told not to use dopram any more as it is no longer deemed good for the babies. I can't remember who told me this or why it's not to be used. Anyone????!

Re: C-sections

Nicola Smith — Tue, 08 May 2012 13:25:11 GMT

If you have any slow to get going get some sugar and fluids into them and keep them very warm. If we have slow ones we put them on a bair hugger, give fluids and also give them some sugar orally - either the glucogel things you can get for diabetics or if youve not got any just mix a bit of sugar into water, or honey on the gums - these tinies can go hypoglycaemic very quickly. We have had some seem almost dead butwith this combination have got thme going and they have gone on to do well.

Re: C-sections

rettur — Tue, 08 May 2012 08:48:48 GMT

Re: C-sections

Charmaloo88 — Mon, 07 May 2012 21:27:09 GMT

I hadn't seen one for 3 years...then had 3 in a fortnight!

My top tip: 1ml syringes and cotton buds. Find these are great for clearing airways effectively and thanks to these I've never had a swing a pup/kit (controversial technique, I know!) as well as a clean streak of survivors since my first c-section 3 years ago!

Re: C-sections

nin86 — Thu, 03 May 2012 14:11:43 GMT

You arent alone! I have been in practice for 7 years and never seen a bitch c section! Have seen 2 cat c sections but waiting for the bitch to see!

Just have to try and keep calm, make a line of puppies and have a little production line going. Keep rubbing them 1 by 1 and move along the line. Just make sure you have everything put ready to save you time so you dont need to go far to get anything. :)

Re: C-sections

bongo — Wed, 02 May 2012 10:18:11 GMT

dont think that all c sections happen at night. I have dealt with about 4 and all in the daytime. I think if there is something that is likely to need one they will cut it when there is a full team around. Dont get me wrong, they do also come about when there is only one nurse and one vet aswell. Some of ours were actually scheduled in, Bulldogs- need I say more!

Re: C-sections

Ju_xx — Wed, 02 May 2012 08:43:52 GMT

You will Be surprised how well you cope when there is just one vet and one nurse on! Ive had to do it before with 1 eye on mum, running around for vet, anaesthetic and 8 pups! Its worth the running around and panic though!

Re: C-sections

mrsthoros — Tue, 01 May 2012 23:16:14 GMT

One other thing- Do not forget mum!!! It's so eay to get fixated on the babies but their chances are much higher if mum makes it too. Be prepared for one or 2 abnormal pups- not always but it can happen and isn't very nice. Also sorry if this is basic but you don't need to go over the top with swinging them everywhere to get rid of fluid from there lungs- often head down and plenty of rubbing and stimulation and clearing mouths/airways should do it.

Re: C-sections

littleblue — Tue, 01 May 2012 21:27:54 GMT

Thanks so much for all the tips everyone! Theres a couple of things I hadn't thought about, which people covered :)
I'm sure my mind will refer back to these suggestions when I finally do see one, hehe :)
One thing I'm nervous about is our lack of staff if we have a lot of pups - theres usually only one vet and one nurse here at night! We don't have a dedicated receptionist here either, and I don't think it'd be a good idea to have the bitch's owner in theater.

Re: C-sections

bongo — Tue, 01 May 2012 13:26:58 GMT

Its like most things as a VN, you panic when you think about them but when you are involved in the situation you get your nurse head on and everything just seems to happen. C sections are fantastic and definately a good experience when they go well. We once had so many puppies we had to haul receptionists in to help us! T peice and o2 masks, dopram drops, lots of towels, artery forceps, catgut for the umbilicus, heat pads, we normally tilt the bitch to get weight off diapragm. As soon as the pups are out the anaesthesia is sooooo much better and you can get some better pain releif on board. I always found them a good team work exercise!

Re: C-sections

Selena Carnell — Mon, 30 Apr 2012 18:33:50 GMT

Lol don't forget phone tucked in to shoulder answering emergency phone too.

Re: C-sections

Caro Laithwaite VN — Mon, 30 Apr 2012 05:04:31 GMT

Warm bed box to dump babies in with one hand as rubbing 3 others like mad with other hard an waving foot round trying to grab suture material with toes and sorting gas flow with teeth... easy really we are nurses...

Re: C-sections

Cloudy Weather — Sun, 29 Apr 2012 22:03:34 GMT

You will also need some scissors and tie (i.e cat gut) for the umbilical cord, dopram drops if required. Plenty of towels and people available to rub the puppies is important - dont let the number of pups/kittens catch you off guard :) Its quite amazing and although I was shaking like mad in my first one you kind of just naturally react to the situation as instinct takes over. I am sure you will do great, however whats crucial is that if you are doing the anesthetic rather than delivery the puppies you must stay focused on the mothers vital signs.

Re: C-sections

Amy Homer. RVN. NCert A&CC — Sun, 29 Apr 2012 20:35:32 GMT

i agree with all the other comments re equiptment etc,

also bear in mind the anaesthesia side of it. they dont usually have a premed (as it can cause sleepy pups) so will often be puffy and may require more volatile agent and induction agent. only put into dorsal recumbancy at the last moment as the uterus will put pressure on major blood vessels which can cause issues with bp etc. (try to clip the dog before anaesthetising) . once in theatre, put into dorsal recum, but try to raise head end and slightly rotate the dog to the left to eleviate this pressure and remove extra strain from the diapragm.

once the pups are safely out, you can administer pain releif (under vet instruction). we usually give buprenorphine and an nsaid at this point.

other things just to be awaree of is pregnancy can cause acid reflux so i would use a cuffed tube in dogs if possible. once surgery done i usually wipe over the tummy with water to remove any excess hibi and spirit from around the teats as i have found the pups dont like it . keep mum and pups warm, and once mum is awake and ok i would introduce pups, supervise this though as i have had mums that will attatck their own pups in this period.

hope this helps x

Re: C-sections

Ozzie Kate — Sun, 29 Apr 2012 19:46:53 GMT

Yep! Always told you could never have too much

Towels
Hot water bottles
Lap Sponges
Warm flush
Forceps
Spare pairs of hands!

Re: C-sections

Stuart McQueen RVN MBVNA — Sun, 29 Apr 2012 19:30:11 GMT

Put the bitch on IVFT!!!

Towels, artery forceps

Heat pads.

Get the owner to spay at the same time - this is a bit controversial!! But I worked with the PDSA where it was common practice!

Don't panic! Although 2 puppies and monitoring mum is a lot easier than 8 puppies!!