Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
Mouse is a 7 month old, female, domestic short hair cat. She was presented to the
hospital because she has entered her first heat cycle and her owners do not want her to become
impregnated. Mouse is an indoor cat who is allowed out into the owner’s fenced yard and the
owners have seen and heard evidence of suitors. At home Mouse is a friendly cat, not shy about
seeking attention, and is of a normal activity level for her age. Her urination and defecation are
reported to be normal, and there has been no vomiting or diarrhea. She has a good appetite. Her
owners feed her Natural Choice Kitten dry free choice, with ¼ can of canned Kitten food twice
daily.
Mouse is up to date on her vaccinations, and is in otherwise good health. Even though
performing an ovariohysterectomy while Mouse is in estrus will be more complicated, her
owners feel that it is in her and their best interests to do the surgery now. The risks of the
increased vascularity of the uterus and ovaries is explained thoroughly and they are willing to
take the increased risk. Mouse will be hospitalized overnight, because she has eaten this
morning, and the surgery will take place the following day.
A physical examination reveals that Mouse is in good body condition with a BCS of 3/5.
Temperature: 102.1 F
Heart rate: 180 bpm
Respiratory rate: 36
Weight: 4 kg
Mucous membranes: pink
Capillary refill time: <2 seconds
The veterinarian orders pre-anesthetic blood work. A CBC, serum chemistry panel, and a
coagulation panel. The veterinarian wants to be sure that Mouse’s clotting factors are normal
before undertaking an in-heat spay.
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
The CBC and coagulation panel are normal
WBC: 6.2
Neutrophils: 78%
RBC: 9.6
Lymphocytes: 20%
HCT: 38%
Monocytes: 2%
PLT: 378
Blood smear: morphologically normal
Prothrombin Time: 17 seconds
The serum chemistry panel is also normal, although it does show a mild hyperglycemia
which is attributed to the stress of handling.
BUN: 16 mg/dL
CREAT: 0.8 mg/dL
PHOS: 3.2 mg/dL
GLU: 200 g/dL
TP: 5.9 g/dL
ALB: 2.8 g/L
T Bili: 0.3 mg/dL
ALT: 25 u/L
K: 3.6 mmol/L
Na: 160 mmol/L
Cl: 118 mmol/L
Mouse is fasted overnight and a physical exam is done the following morning before
surgery. Her physical parameters remain essentially unchanged.
Resting temperature: 102 F
Heart rate: 160 bpm
Respiration rate: 36 bpm
Weight: 4 kg
Mucous membranes: pink
Capillary refill time: <2 seconds
Her glucose is checked again and with gentle handling and a sneaky ear prick instead of a
jugular puncture it is a much more normal 116 g/dL.
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
The veterinarian assigns Mouse to Risk Class P1 and requests that Mouse be
premedicated with “kitty magic” which is a combination of ketamine 2.2 mg/kg, butorphanol
0.22 mg/kg and dexmedetomidine 0.11 mg/kg. Each drug is drawn up individually and then
combined into a single syringe to be given as an intramuscular injection. The advantages of
using “kitty magic” in young, healthy, P1 cats is that it provides good pre-surgical and
intraoperative analgesia for short procedures, and that in many cases the cat may be able to be
intubated and placed on gas anesthesia with the minimal use of an induction agent. “Kitty
magic” is a combination of an opioid analgesic (butorphanol), a dissociative anesthetic
(ketamine) which also provides analgesia, and an alpha-2-agonist (dexmedetomidine) that
provides sedation, muscle relaxation and analgesia. This combination of drugs works
synergistically, thus reducing the required dose of each individual drug required, and provides
several different types of analgesia that block different types of pain pathways. An antiinflammatory agent will be provided post-operatively giving Mouse complete multi-modal pain
control, and hopefully keeping her at a 0 on the Feline Acute Pain Scale throughout her
procedure and recovery.
Mouse is given her premedication injection and then is allowed to sit quietly in a cage in
the prep room for 15 – 20 minutes while the medications take effect. After 17 minutes, Mouse is
heavily sedated. A 22 g catheter is placed in her right cephalic vein, and warmed LRS is started
at 3 ml/kg/hr (12 ml/hr). Her jaw tone is tested, and intubation appears possible without the use
of further drugs. A small amount of lidocaine 20% injection (0.1 ml) is squirted on her laryngeal
folds and after 60 seconds a lubricated 3.5 mm endotracheal tube is passed. The cuff is carefully
inflated and Mouse is placed on isoflurane 2.5% and oxygen via an anesthetic machine.
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
Mouse’s abdomen is shaved from her xiphoid process to her pubic bone and a surgical
scrub is completed before she is moved into the surgical suite. The anesthetic technician attaches
the surgical monitor to measure her ECG, heart rate, respirations, C02 & SP02 levels, blood
pressure and temperature. An esophageal stethoscope is inserted to manually monitor her heart
rate, and her upper body is covered in a hot air warming blanket.
The veterinarian makes a midline incision that is slightly longer than that of a typical
non-estrus spay. Mouse will need 3 or 4 skin sutures, rather than the usual subcuticular closure
with a drop of skin glue. The uterus and ovaries are located, ligated and removed. Fortunately
for Mouse, the surgery goes well and without any complications. From first incision to the final
suture the entire operation is completed within 27 minutes.
After completion of the last suture the veterinarian takes diluted bupivacaine (0.125%)
and injects the area around the incision site to provide local analgesia. At this point, the
isoflurane gas is turned off, but Mouse is provided with oxygen for an additional 5 minutes.
Once Mouse is able to swallow she is extubated and her post-operative temperature is recorded
at 100 F. Mouse is taken to the recovery area where her vital signs will be checked and recorded
every 15 minutes for the next hour and the warmed intravenous fluids will be continued at a
maintenance rate of 70 x (weight in kg)0.75 or 8 ml/hr until she is completely recovered.
Mouse will be given a single postoperative injection of meloxicam SC at 0.1 mg/kg.
Meloxicam is a non-steroidal anti-inflammatory drug that with a single pre or post-operative
injection has been shown to provide analgesia for 24 hours.
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
Mouse will be hospitalized overnight following surgery and will be released to her
owners the next morning. The veterinarian and his technician do a brief physical exam before
releasing her and notes that her vital signs are as follows:
Rectal temperature: 101.8 F
Heart rate: 160 bpm
Respiratory rate: 36 bpm
Weight: 3.99 kg
Mucous membranes: pink
Capillary refill time <2 sec
Incision is clean and dry. Suture line is intact.
Feline acute pain score: 0
Food is offered and Mouse is very interested. By the time the technician returns to check
on her again, all of the offered meal has been consumed. Mouse is friendly and solicits attention
from her caretaker. The veterinarian verbally gives the owners the following instructions, and
also provides them in a handout format.
POST-SURGICAL HOME CARE

Mouse may be cranky, quiet or sensitive for 24-48 hours after surgery. These
personality changes are due to the anesthesia and pain medications and will not
continue for long.

Take a look at the surgery site several times daily, it should be clean and dry with
a minimal amount of puffiness. If there is swelling, redness or any missing
sutures contact the vet immediately. The sutures will need to be removed in 10
days.

Do not allow Mouse to lick the suture site. A soft e-collar has been sent home.
Please put the “cone of shame” on Mouse if you must leave her alone for an
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
extended period of time (such as going to work). She can eat, drink and attend to
necessary bodily functions while wearing this collar.

Monitor Mouse’s litterbox habits. She should be urinating and defecating
normally within 24 hours after surgery.

Keep your cat inside at least until the sutures are removed and the vet clears your
cat to go outside. Keep physical activity to a minimum, no stressful play session.

Your cat was given Metacam to manage pain following surgery. Metacam is an
anti-inflammatory pain medication that works for 24 hours. If you take your cat
to another vet in the next 30 days, please bring your dated post-surgical handout
with you. Metacam can interact with other medications and it is important that
any vet treating your cat knows when it was administered.

Do not use any pain medications that were not prescribed by the vet. Most human
pain killers are toxic to cats. If you feel that Mouse is painful, please call us and
we will prescribe an oral pain medication (such as buprenorphine) that is safe for
use in cats that will not interact with the Metacam.
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Sarra Borne Lord UID 000493586
Week 13 Assignment: Case Study
VETE 4325 CA Anesthesia and Surgical Nursing
November 21, 2014
References
Bryant, S. (Ed.). (2010). Anesthesia for veterinary technicians. Ames, Iowa: Blackwell
Publications.
Busch, S. (2006). Small animal surgical nursing: Skills and concepts. St. Louis,
Missouri: Mosby.
Davis, H., Jensen, T., Johnson, A., Knowles, P., Meyer, R., Rucinsky, R., & Shafford, H.
(2013). 2013 AAHA/AAFP fluid therapy guidelines for dogs and cats. Journal of
the American Animal Hospital Association, 49(3), 149-159.
Hines, R. (2013). Normal feline & canine blood chemistry values. Retrieved from
http://www.2ndchance.info/normaldogandcatbloodvalues.htm
Plumb, D. (2011). Plumb's Veterinary Drug Handbook (Vol. 7). Ames, Iowa: WileyBlackwell.
Thomas, J., & Lerche, P. (2011). Anesthesia and Analgesia for Veterinary Technicians
(4 ed.). St. Louis, Missouri: Mosby Elsiver.
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