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pediatric patient can be safe, provided that appropriate attention is paid to basic principles. Pediatric cats and dog have lower body fat percentages and a larger surface-area-to-volume ratio than their adult counter parts. Their ability to shiver may also be reduced. Therefore, measures should be taken to assist pediatric patients retain body heat to avoid hypothermia. A comprehensive preoperative physical examination should be performed on all patients.
According to the Association of Shelter Veterinarians guidelines for spay/neuter programs:
“Warmth is best preserved by reducing contact with cold surfaces, limiting body cavity exposure, and providing carefully protected contact with circulating warm water or heated containers, such as carefully monitored
water bottles or rice bags. Forced hot air or convective warming can also be an effective means of maintaining body temperature perioperatively (1)”
Alternative anesthetic protocols can help mitigate the risk involved with anesthetizing pediatric patients. It is the veterinarian’s discretion whether or not to perform diagnostics including packed cell volume, total solids, and blood glucose measurement. For most high-volume spay/neuter programs and animal shelters, such tests are cost-prohibitive.
There are various anesthetic protocols that have been designed for pediatric patients. The use of barbituates should be avoided due to limited body fat in pediatric patients (2). The authors of several pediatric spay/neuter guidelines recommend the use of a dexmedetomidine, ketamine, butorphanol combination administered intramuscularly. These drugs may or may not be available in all international settings. In places where dexmedetomidine is available, atipamizole can be administered immediately after surgery to reverse the effects of the dexmedetomidine. Perioperative analgesia should be provided in the form or a nonsteroidal anti- in ammatory such as meloxicam prior to the start of surgery (3).
Also cited as a common concern is the risk of stunting of normal growth, increased risk of obesity, behavioral problems, and greater incidence of cystitis later in life. Numerous controlled studies have been performed to address these concerns. Studies have found that there is no signi cant weight difference between dogs and cats sterilized between 6 and 14 weeks of age and those sterilized later in life (4). In one study, researchers found that the limbs of animals sterilized at a young age tended to grow for a longer period of time which results in slightly taller heights (5). The clinical signi cance of this is unknown.
Special care must be taken to address pediatric patient’s susceptibility to hypothermia and hypoglycemia and small volume of blood. Minimizing fasting periods to 2 to
An Urban Experience
4 hours prior to surgery and feeding small amounts of food immediately upon anesthetic recovery can reduce such risks (6).
Bene ts
Performing pediatric spay/neuter procedures is a safer procedure and research suggests that there are no adverse physiologic effects from spaying/neutering animals prior to sexual maturity. Anecdotally, veterinarians report that pediatric spay/neuter procedures take less time to perform and have a lower risk of hemorrhage. Pediatric surgical spay/neuter techniques are similar
to those for adult animals. Pediatric patients also
recover much quickly from anesthesia than their adult counterparts. The surgical procedure is easier, faster, and less expensive. Shorter surgery times also means shorter anesthetic periods, leading to reduced perioperative complications (7,8). The cost of pediatric spay/neuter procedures is also less than traditional surgery performed on adult patients due to the limited materials necessary.
In a shelter environment, it is recommended to spay and neuter animals as young as 6 weeks of age. In a private practice environment, veterinarians should encourage owners to schedule an additional appointment at the end of the puppy or kitten vaccination series. This way, the animal is successfully sterilized prior to 5 months of age, or sexual maturity.
References
1. Looney AL, Bohling MW, Bushby PA. The association of shelter veterinarians veterinary medical care guidelines for spay neuter programs. American Veterinary Medical Association. 2008;233(l):74-86.
2. Cistola AM, Golder FJ, Levy JK, et al. Comparison of two injectable anesthetic regimes in feral cats at a large-volume spay clinic. Veterinary Anaesthesia and Analgesia. 2003;30(2):101-102.
3. Grif n B, DiGangi B, Bohling M. A review of neutering cats. In: August JR, ed. Consultations in feline internal medicine. 6th ed. St. Louis, Mo: Elsevier Saunders, 2009776-790.
4. Little S. A Winn Foundation report on early spay/neuter in the cat [Internet]. The Winn Feline Foundation. [cited 1 May 2017]. Available from: http://nbcrtx.org/ articles/catlinks_early-spay-neuter.pdf.
5. Tremayne J. Early spay/neuter procedure: bene ts must outweigh risks, DVMs say [Internet]. DVM Newsmagazine. [Cited 26 April 2017]. Available from: http://veterinarynews.dvm360.com/early-spayneuter-procedure-bene ts-must- outweigh-risks-dvms-say.
6. Howe LM. Prepubertal gonadectomy in dogs and cats-part I. Compendium on Continuing Education for the Practising Veterinarian. 1999;21(2):103-111.
7. Howe LM. Short-term results and complications of prepubertal gonadectomy in cats and dogs. Journal of the American Veterinary Medical Association 1997;211(l):57-62.
8. Bohling MW, Rigdon-Brestle YK, Bushby PA, et al. Veterinary seminars in spay-neuter surgeries: pediatrics [video]. Humane Alliance. [cited 1 May 2017]. Available from: https://www.youtube.com/watch?v=uvmp AQXRJg0.
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