Many people are under the impression that a desexing operation is a simple procedure because it’s one that’s commonly performed. Nothing could be further from the truth. Desexing a female dog, for example, is major abdominal surgery. A surgeon who is competent in all the techniques involved and in coping with all the potential intra-operative complications has pretty well mastered the art of surgery involving any soft tissue organ. This has ever been the case. However, the “nuts and bolts” of what actually happens when your dog is desexed has changed markedly in recent decades.
Loathe though I am to admit it, I walked out of the gilded doors of the Sydney University Veterinary Faculty, freshly-printed degree clutched in hand, 32 years ago. The practice where I had my first job had a pretty good standard, and I had already been working there on weekends as a student for three years. A female dog being desexed in those days would be admitted to hospital in the morning. Her heart would be listened to with a stethoscope, she would be anaesthetised with an intravenous barbiturate drug, she would have a tube inserted into her windpipe and she would be kept asleep with a gaseous anaesthetic which was delivered with oxygen. The hair would be clipped from her abdomen and the skin would be surgically prepared, the operation would be performed using sterilised instruments and with the surgeon scrubbed and wearing sterile gloves; ligature material was made out of catgut (a product actually made out of sheep intestine), and suture materials came out of multi-use reels containing surgical spirit. The patient would then be allowed to wake up, and she would be discharged that night, sometimes still a little groggy from the anaesthetic. That was it. As I said, I was working in a high quality practice; there were many veterinary practices whose standards were very significantly inferior to those I was accustomed to.
What a difference to how the same dog would be treated if she were to come in for a desexing operation at GVH today. She would still be admitted on the morning of the operation, but her owner would be given the option of running some pre-anaesthetic blood tests to check that there was no problem with her kidneys, liver, red blood cells or blood electrolytes. In the vast majority of cases these tests are all normal in the young dogs who come in for desexing, but occasionally we discover an abnormality which leads us to delay the surgery, and sometimes to go on to diagnose a significant medical problem- an early diagnosis which substantially improves the prognosis. Thirty to sixty minutes before she was due to be anaesthetised, the vet would listen to her heart and lungs with a stethoscope, and she would be given a pre-medication induction: a combination of a mild tranquiliser and a narcotic (methadone). The administration of the narcotic prior to the surgery has been proven to significantly reduce the severity of post-operative discomfort. She would then have an intravenous catheter placed into a vein in her front leg and she would be anaesthetised with an intravenous drug which is newer and much safer than the barbiturate she would have been given 30 years ago. A tube would be inserted down her windpipe, but now the gaseous anaesthetic with which her anaesthetic is maintained is also much newer and much safer than the one previously used. She would be placed on intravenous fluids for the duration of her anaesthetic. She would be placed on a heating pad to prevent hypothermia. Before she was clipped and prepared for surgery, she would be hooked up to a variety of instruments to monitor her heart rate, ECG, respiration and blood pressure. A trained veterinary nurse would continuously monitor her anaesthetic right up until the time she was awake enough to go back into her recovery cage- a cage in the main part of the hospital in full view of the staff. The operation itself would be performed under strict sterile conditions, and the material used for ligatures and sutures would now come out of sterile, single-use packets. Catgut is very much a thing of the past; the synthetic suture materials we now use are both stronger and less irritant. After the operation, when she was able to sit up she would be given an injection of a non-steroidal anti-inflammatory drug, which helps with pain relief and also reduces the development of inflammation associated with the surgical wound. The methadone injection she received for her pre-medication will have worn off within four hours, so she would then be given another methadone injection for continued pain relief. Four hours later she would be given an injection of a longer-lasting narcotic drug, which would be effective all through the night. When she was checked at hospital rounds the following morning, she would be given further anti-inflammatory treatment, and she would be discharged with a few days of anti-inflammatory tablets for continued pain relief. Assuming that there was no problem post-operatively, we would then see her back after 10 to 14 days to have her skin sutures removed.
In reality, a “simple” desexing operation was never simple. The improvements that have gradually come into play over several years mean that the way that it is now performed at GVH it is a major undertaking, utilising the very best, state-of-the-art materials, with the very safest techniques and monitoring methods, and with minimal or no discomfort to the animal. When I look back now at how I was doing the same operation 30 years ago, I feel like I used to walk with dinosaurs. I should also point out that at GVH we have incorporated all of these improvements as a matter of policy, because it the very best thing to do for our patients. A desexing operation is already heavily subsidised by the veterinary practice performing it- even without utilising the advanced techniques I’ve described, there’s no way that costs are covered by the fee charged. The only additional charge in the procedures I have described as we perform the operation now at GVH is for the optional pre-anaesthetic blood tests. All other advances have been incorporated into the already heavily discounted fee, at absolutely no cost to the client. We do it because we want to do the best job possible, with as little discomfort to the animal as possible.
It’s a delight to see these patients waking up from their operations completely relaxed, in excellent physiological condition, and with absolutely no pain.