C-Sections

• when did signs of first stage labor start?
• have any fetal membranes or puppies been visualized at the vulva?
• have any puppies been delivered?  if so, in what condition (dead, alive)?
• what was the time interval between the puppies that have been delievered?
• what is the previous pregnancy and whelping history?

yes

• healthy heart rate:  150 - 200 bpm
• unhealthy:  100 - 150 bpm (could indicate fetal stress)

premeds reduce anxiety, especially if the dam has already started parturition, has had a prolonged second-stage labor, has delivered puppies or has uterin inertia

• opioids
• anticholinergics
• metoclopramide or cimetidine

• torb because it has a short duration (1-2 hours) so by the time we get the puppies out the torb has worn off of the puppies and then we can give the mama another pain medicine of whatever we would like because we won't have to worry about the puppies getting it too
• if we give another opioid besides torb we should give the puppies a reverser (naloxone) after they are born so they won't have the adverse side effects of the opioids

put a drop under their tongue

• atropine because it crosses the placental barrier and counteracts fetal bradycardia and has a shorter onset and duration than glyco
• glyco does not cross the placenta barrier due to the size of its molecules

• metoclopramide is an antiemetic
• cimetidine is an acid blocker
• decreases the risk of esophageal reflux and regurgitation due to the fact that most c-section patients have not been fasted

• benzodiazepines
• phenothiazines
• alpha 2 agonists

can cause hypotension and requires a lot of liver metabolism which is not good for the babies

• can cause hypotension
• there is no reversal agent so this drug can have lasting effects for hours
• can cause respiratory depression in puppies

• can cause profound bradycardia
• decreases cardiovascular funtion

• yes due to the mama losing a lot of fluid during the surgery
• start with a standard rate of 10ml/kg/hr but can double it if we need to

LRS

• yes, to prevent hypoxemia in the dam and puppies
• 100% oxygen by face mask for 5 minutes before and during induction 

induce using propofol and maintain on inhalants due to both being very short acting

yes

yes, but the patient will go through the excitement phase so if the patient is not cooperating or is very large (will take a long time) then propofol is preferred

• we should avoid this since part of ketamine is combinede with benzodiazepine 
• we should also avoid using ketamine because it lasts longer

hyperventilation leads to hypocapnia which then decreases blood flow to the uterus and umbilical cord this in turn leads to decreased oxygen being delieverd to the puppies

• 25%
• 28 - 40%

• we can use on but its not necessary
• using an epideral helps lower anesthesia needed for the patient due to less surgical stimulation

decrease inhalant, increase fluids

• rub them vigorously to stimulate them to breathe
• suck fluid out of their nose and laryngeal
• naloxone under tongue if they need to have opioid reverses
• doprame under tongue to stimulate respiration

• some vets will have us sling them
• this helps get the fluid out
• but can hurt their brains
• be careful not to drop puppy