PART I. Sharing Knowledge with Veterinarians Anaesthetic Procedures in NANAS Sunday, Apr 27, 2008 I visited NANAS (Noah's Ark and Natural Animal Sanctuary), an animal sanctuary in  Johor on a fine cloudy humid Saturday afternoon of April 26, 2008 to know more about animal shelter medicine.  I had the opportunity to study the effects of Zoletil combination being used. To share knowledge with others working in shelter medicine in other countries via the world wide vet, I have recorded below the following effective anaesthetic regime in NANAS. It is an alternative to gas anaesthesia and the dosage is as follows: 1. Zoletil 50 (Virbac) white powder is present in a bottle. Tiletamine 125mg, Zolazepam 125 mg. 2. Xyalzine 100mg/ml in a bottle.  Put 2 ml of this into the Zoletil bottle. 3. Ketamine 100mg/ml in a bottle. Put 8 ml of this into the Zoletil bottle. 4.  The bottle now contains a clear solution of 10 ml.  This combination is used as shown below: FOR CAT SPAYS 1-2 kg.  0.15 - 0.18 ml IM Bigger cats  0.2 ml IM. I noted that the duration of surgical anaesthesia was more than 30 minutes in cats 1-2 kg being spayed. The tongue is pulled out as a routine to prevent food being vomited during surgery. Such food  gets into the lungs and cause death by inhalation pneumonia.  Surgical incision is midway between umbilical scar and pelvic brim in the young cats being spayed.   FOR DOG SURGERY In a dog of around 15kg , a 0.8 ml IM permitted surgical anaesthesia of around 30 minutes in one case of conjunctival growths being removed. As the dog showed signs of waking up (eye reflex and mouth clamping), a 0.6 ml IM was injected. The dog was under surgical anaesthesia within 1 minute.  Topping up may be required at Animal Shelters. POST-OPERATION In NANAS, the following were given for cats and dogs. 1. Tolfedine 4% (tolfenamique 4g) at 0.5 ml IM or SC for cats after spay and neuter. A pain-killer. 2. Amoxicillin (Longamox) at 0.5 ml SC for cats after spay. An antibiotic.        An incredibly beautifully designed cat house in NANAS. Waterfront views and wooden floor boards. An open area permitted cats to get out and enjoy the views and sun. A 2nd-year vet student who loves cats visited NANAS. Would she set up a cats only practice in Singapore? Would such a practice be feasible?

PART II. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in TOA PAYOH VETS

Recently, some owners asked me why there were no antibiotics given after sterilisation of their male cats. 

Generally, no pain-killers or antibiotics are given to your male and female cats post-operation from Toa Payoh Vets for cases operated by Dr Sing as experience indicates that they are not necessary. Many owners find it hard to give oral medication to cats. 

In big dogs, non-steroidal anti-inflammatory pain-killer and antibiotics may be prescribed after spay.   Typical anaesthetic regimes for cats living and born in Singapore are shared with fellow veterinarians by Dr Sing Kong Yuen.  Some vets may seek such  internet information.  They are as follows as at Feb 1, 2009:

For Dr Sing's cases at Toa Payoh Vets, the anaesthetic regime is usually:

Xylazine & Ketamine injectable anaesthesia are used for cats. Dosage is xylazine 20 mg/100 ml at 0.2 ml mixed with ketamine 100 mg/ml 0.8 ml in 1 syringe, IM injection. This dosage is most effective for a cat around 2-4 kg. Onset of anaesthesia is 2 minutes after IM injection in most cases. Duration of surgical anaesthesia is at least 30 minutes.

For fat cats or young ones less than 2 kg, half the above dose is sufficient but surgical anaesthesia is less than 10 minutes compared to 30 minutes in above full dose. If necessary, isoflurane anaesthetic gas at 5% is given by mask for one minute to effect to complete the surgery.
 
Xylazine & gas anaesthesia or gas anaesthesia alone are usually used for dogs by me as I find them to be most effective.

Please note that the xylazine solution I used is 5X less potent than that used for the Zoletil combination at NANAS. It is 20 mg/100 ml xylazine, not 100 mg/ml.

Toa Payoh Vets do use Domitor, Antisedan, Zoletil anaesthetic protocols as well. There is presently insufficient data to write about the experiences 

INCISION SITE.
In NANAS, I observed that the incision begins at the middle 1/3 area between the umbilical scar and the pelvic brim. Cats I observed were around 6 months of age. The cat's tongue was pulled out to one side of the mouth to prevent vomitus from being swallowed. Bladder was expressed so that the bladder would not be nicked. 

At Toa Payoh Vets, I incise at the cranial 1/3 area, at 1 cm from the umbilical scar in dogs and cats. This position enables me to easily access and ligate the swollen "on-heat" ovaries easily, especially in dogs. Palpate for the full bladder and express it free from urine before spaying. Be careful not to nick the full bladder. Seldom do I encounter a full bladder at this location but there needs to be care in incising the linear alba in case the bladder is just below. Palpate the abdomen first to check for the bladder and express the urine.

---

PART III. Sharing Knowledge with Veterinarians
Anaesthetic Procedures in one Singapore veterinary practice

I have insufficient experience with the following anaesthetic regimes but am recording the procedures based on information provided to me by one vet with considerable experience in the following anaesthetic protocol without the need to use gaseous anaesthesia as at Feb 2009.

1. Xyalzine 20 & Ketamine 100.
1.1  For example in a Jack Russell, 5 kg dog.  1-5 years old.
Xyalzine 20 at 0.4 ml IV, Ketamine 100 at 0.1 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary

1.2  For example in a Jack Russell, 6 kg dog.  1-5 years old.
Xyalzine 20 at 0.4 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary

1.3  For example in a Jack Russell, 10 kg dog.  1-5 years old.
Xyalzine 20 at 0.8 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary

1.4  For example in a Jack Russell, 15 kg dog.  1-5 years old.
Xyalzine 20 at 1.3 ml IV, Ketamine 100 at 0.2 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary

1.5  For example in a Jack Russell, 20 kg dog.  1-5 years old.
Xyalzine 20 at 1.6 ml IV, Ketamine 100 at 0.4 ml IV.
Separate syringes. Then top up with Zoletil IM injection if necessary

1.6  For example in a Jack Russell, 2.5 kg dog.  10 years old.
Xyalzine 20 at 0.2 ml IV, Ketamine 100 at 0.05 ml IV.
Separate syringes. Then top up with Zoletil IM or IV injection if necessary

2.  TOPPING UP WITH ZOLETIL when the animal shows signs of movement and recovering from surgical anaesthesia from the xylazine/ketamine combination.
Zoletil 100 powder. Add 10 ml diluent. The solution is equivalent to Zoletil 50 now.
Use 0.1ml Zoletil 50 IM for small breeds
Use 0.2 ml Zoletil 50 IM for big breeds (20 kg) 

Topping up with Zoletil IM in the above protocols is effective. The above is useful for vet surgeries without gas anaesthesia or in field work. It is much more expensive to install gas anaesthesia in certain situations and I hope the above information will be of use for practitioners. Obviously, the older dogs and cats will need half the dose and there is a need to be very careful with injectable anaesthetics. It may be best to refer to other vets with gas anaesthesia facilities, in the best interest of the animal.

CASES IN MAY 2009 AT TOA PAYOH VETS
RABBIT INJECTABLE ANAESTHESIA
1.3 kg. Around  4-5 months old. Neuter.
0.1ml Zoletil 50 IM. Wait 5 minutes. Give 0.05ml Domitor IV ear vein, 27G needle.  Effective general anaesthesia. Rabbit takes >1 hour to wake up. No problem. No need for Antisedan. 

CATS INJECTABLE ANAESTHESIA
2 kg. Around 8 months
0.1ml Ketamine 100 and 0.05ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay.

2.5 kg. Around 1 year
0.1ml Ketamine 100 and 0.1ml Xylazine 20 IV in one syringe gave general anaesthesia >60 minutes for spay. Femoral vein used. 

---