Surgery Notes — Desexing

Vets or nurses fill in the Surgery Booking Template Excel sheet the day before surgery (use the "⬇ Download booking template" button on the Shift List tab if you need a blank copy). Upload the completed sheet the next day to register every booked animal in one go — ID, type, species, location, age, procedure, tasks and notes all come across automatically.

One device should follow the same animal the whole way through — pre-exam, assist, surgery, and recovery — rather than being handed between different stations for different animals. That keeps every stage of that animal's record in one continuous note.

Pressing "+ Register medication chart" (under Paperwork) also puts the post-op buprenorphine (if Required is ticked in Recovery — one dose about 4 hours post-op, S8 sign-out flagged) and the oral meloxicam course (if toggled) onto the animal's chart, even if you haven't typed anything in the box. Oral meloxicam and gabapentin also keep their own chart lines up to date automatically. The Post-op medications — complete list table shows every post-op drug with its dose, the weight used and whether it is on the chart. For any other genuinely new medication that needs its own printable 14-day chart, use "+ Register medication chart" under Paperwork: type the instruction, check the parsed drug/dose/frequency/route/days before saving. Every chart registered today (from this tool, Processing, or Sick & Injured) collects in one place — open Medication Charts from the Shift Tools hub to select and export them as one Excel workbook, one real 14-day sheet per animal. Ask a nurse or the admission AA to print these and collect medications — print on the Cranadopt printer, drawer 2 (yellow paper).

After the uterus is removed the animal weighs less, so pregnant spey (Stage 1, 2 and 3) shows a Post-spey weight box in the surgery section. Weigh the animal after surgery and enter it: buprenorphine, meloxicam (SC and oral), gabapentin and the medication chart weight then calculate from it. The premed and atipamezole always stay on the pre-op weight. Leave the box blank and the pre-op weight is used. The shift list, exam list, completed list, note and Excel export show the post-spey weight once entered.

Drug	SC / IM	IV
Methadone (10mg/mL)	0.4mg/kg	0.4mg/kg
Midazolam (5mg/mL)	0.2mg/kg	0.1mg/kg
Medetomidine (1mg/mL)	7mcg/kg	4mcg/kg

Pick the route under Premed used and the dose card, premed tick, note and atipamezole (half the medetomidine volume) all follow it. Every premed also has an "actual amount given" box — fill it in only if you gave something different from the calculated amount (atipamezole then follows the amount given); leave it blank and the calculated amount goes in the note.

Export all notes at the end of the day and send them to the surgery nurses (assist, recovery, and surgery) so they can complete all notes, update ShelterMate statuses, and action medication requests.

HQHVSN = High-Quality, High-Volume Spay-Neuter, defined by the Association of Shelter Veterinarians' 2016 Veterinary Medical Care Guidelines for Spay-Neuter Programs. The "quality" isn't traded off for the "volume": the same standard of individual patient care applies, but a dedicated team doing nothing but desexing — standardized weight-based drug protocols, refined technique, minimal individualized pre-op workup in healthy young adults — lets an experienced HQHVSN vet safely do 30-60+ desexings in a day versus a handful in general practice. The outcome data below is the actual proof this isn't a lower standard of care.

Feline intubation isn't benign — it carries a real risk of tracheal trauma (including the rare but serious tracheal-tear/stricture complication), and CEPSAF identifies it as a specific feline anaesthetic risk factor. For short, routine desexings under ZMD (a total injectable protocol, not inhalant gas), omitting intubation is acceptable as long as backup airway equipment and someone trained to use it are immediately at hand. We still intubate — or keep a much lower threshold to — for anything outside routine: brachycephalics, pyometra, prolonged/complicated procedures, regurgitation/vomiting risk, or any patient not maintaining a clear airway on its own.

Per ASV guidance, routine IV fluids are reserved for patients with an actual indication — pregnant, pyometra, substantial blood loss, or prolonged surgery — plus warmed fluids for pediatric, small, frail, or ill patients. A healthy ASA I-II patient having a short, low-blood-loss elective desexing doesn't show a benefit from routine IV fluids; SC fluids can be given for comfort instead. It's a judgement call based on the individual patient, not a blanket rule — if anything about the case raises risk, place a line.

Age	Fasting
6-16 weeks	Small meal 2-4h pre-op; do not withhold food >4h — hypoglycaemia risk
>16 weeks	Withhold a minimum of 4h; overnight is acceptable; >6h is unnecessary

Water is never withheld in either group. (ASV 2016 guidelines)

Zoletil is tiletamine (a dissociative, same family as ketamine) combined with zolazepam (a benzodiazepine). In cats, zolazepam's elimination half-life (up to ~5h) outlasts tiletamine's (~2-4h) — as the dissociative tiletamine clears first, the cat is left in a phase where the benzodiazepine's tranquilisation exceeds any remaining anaesthetic effect. Clinically this shows up as prolonged sedation, ataxia, and a rough, disoriented recovery rather than a clean wake-up. This is expected pharmacology for ZMD in cats — a slow, dysphoric recovery on its own isn't evidence of a dosing error or poor technique; even a correctly-dosed, correctly-given premed will still show this pattern.

There's no single hard cutoff — it depends on dose, whether the cat needed a top-up, and individual metabolism — but as a working guide: most cats are through the disoriented/ataxic phase within 6-8h, and full return to normal behaviour can take up to 24h, especially after multiple injections. Don't expect "back to normal within an hour or two," and don't mistake ongoing zolazepam-driven grogginess for a complication needing reversal — atipamezole only reverses the medetomidine component of ZMD, not the Zoletil.

Levy et al. (2017, The Veterinary Journal 224:11-15) followed 71,557 cats and 42,349 dogs desexed at a single high-volume clinic (Humane Society of Tampa Bay) from 2010-2016, and found an overall perioperative mortality of 3.3 per 10,000 surgeries (0.03%) — 5/10,000 in cats (0.05%), 0.9/10,000 in dogs (0.009%). That's in the range reported for elective human surgery.

Population	Dogs	Cats
HQHVSN (Levy 2017)	0.009%	0.05%
GP, healthy elective ASA I-II (CEPSAF)	0.05%	0.11%
GP, all cases (CEPSAF)	0.17%	0.24%

Levy's discussion places the HQHVSN result at roughly a tenth of the rate reported for healthy-animal anaesthesia in low-volume general practice (Brodbelt et al.'s CEPSAF data). The streamlined, single-procedure HQHVSN model isn't a lower standard of care — the data says it's measurably safer than traditional general practice for this specific procedure type.