1. The document provides guidelines for international spay/neuter field clinics, covering topics such as pre-operative planning, supplies, surgical protocols, anesthesia, post-operative care, and recovery monitoring. 2. Proper sterilization of instruments and maintaining aseptic technique during surgery are emphasized as critical for reducing post-operative complications. 3. Thermoregulation of patients is identified as a major concern, as hypothermia is a common post-operative complication; keeping patients warm and dry during and after surgery is advised.

2. Planning

3. Community organization

4. Local veterinary community

5. Community outreach

6. Cultural sensitivity

7. Language skills available throughout clinic

8. Permit acquisition

9. Clinic location

10. Caseload

11. How caseload is acquired/decided

12. Identification and records

13. Transport

14. Clinic housing

15. Volunteers

16. Adequate numbers and expertise to ensure standard of care and safety

17. Veterinarians

18. Veterinary Technicians and/or assistants

19. Others

20. Medical supplies

21. Budget constraints

22. Manifest

23. What needs to be imported

24. What can be acquired locally

25. Methods of sterilizing

26. Prior to clinic

27. drapes, instruments, etc

28. Throughout clinic

29. Sterilizing machines

30. autoclave or pressure cooker

31. Kills all viable organisms including spores using pressure

32. Instruments must be open for adequate sterilization

33. Pressure cooker is relatively cheap and easy to maintain

34. Autoclave

35. Expensive pressure cooker

36. Expensive to operate and maintain

37. Ease of use if available and working correctly

38. Dry oven

39. Requires the use of steribags for appropriate sterilization

40. Cloth wrapped instruments and drapes will burn if sterilized at the appropriate temperature for the appropriate amount of time

41. Requires specific indicator strips for dry ovens to assure adequate sterilization

42. Sterilizing solutions

43. Kills most microorganisms except spores when done correctly

44. Requires minimal time in solution for adequate sterilization. Minimum of 15 minutes. Instruments must be open for adequate surface contact.

45. Instruments need to be clean prior to immersion in sterilizing liquid

46. Examples Benz-all, Dermacrit

47. Miscellaneous supplies

48. Laundry, biohazard materials, cleaning supplies, trash collection and disposal, cages

49. Preoperative considerations

50. Disease awareness

51. Rabies

52. Local incidence

53. How to address bite cases that may occur during clinic

54. Infectious diseases

55. Incidence of tick borne diseases such as Erlichia and Babesia

56. Common pathogens, distemper, parvo etc.

57. Available vaccines

58. Clinic detail checklist

59. Equipment list

60. Medical supply list

61. Clinic flow

62. Clinical details

63. Records

64. Minimal data

65. Owner name, address, contact information, surgical release

66. Owner communication to assure understanding of procedures to be performed

67. Patient information

68. Name, species, breed, age, weight, physical exam

69. Medications administered

70. Anesthesia record

71. Surgical record

72. Recovery notes

73. Post operative instructions

74. Physical exam

75. Temperature, pulse rate and quality, respiration rate and lung sounds

76. CRT and mucous membrane color and texture

77. Exam of all other systems for clinically relevant findings

78. Reproductive tract

79. Verify sex

80. Males – Cryptorchid

81. Females – vaginal swelling or discharge, pregnant, in heat.

82. Presence of transmissible venereal tumors

83. Analgesia

84. Anesthetic protocols include analgesics. Every surgical case should receive analgesics.

85. Recognition of ability to acquire

86. Cost

87. Availablity

88. Premeptive analgesia

89. Mulitmodal analgesia

90. Common analgesics

91. Anesthesia

92. Minimally acceptable standards will vary based on the use of gas or injectable anesthesia and what analgesics and anesthetics are available.

93. Needs to be adequate and humane. A surgical plane of anesthesia must be maintained throughout procedure.

94. Primary reason analgesia and anesthesia are inadequate are:

95. Drugs used

96. Insufficient, inadequate, inappropriate

97. Surgical skill

98. Affects surgical time

99. Affects tissue handling. Rough tissue handling induces more post-operative pain.

100. What analgesics and anesthetics are available

101. Monitoring equipment and personnel

102. Anesthesia should be monitored to anticipate if/when more or less anesthesia may be required and to assist in identifying intra-op complications.

103. Must be prepared and have the ability to address rapid changes in the depth of anesthesia. “Top off” does and method of delivery should be determined prior to inducing anesthesia.

104. Adjuncts

105. Intubation

106. Ambu bag for injectable anesthesia

107. Catheters

108. Fluid therapy

109. Thermoregulation

110. Protocols

111. Adequate analgesia and anesthesia do not require the latest or most expensive analgesics, sedatives or anesthetics.

112. Protocols will vary based on what is available and affordable.

113. Cost

114. Ease of acquisition

115. Knowledge of drugs

116. Injectable vs. gas anesthesia

117. Must be able to address complications that may arise

118. Emergency drugs and procedures

119. Catheters

120. Fluid therapy

121. Additional analgesia and anesthesia

122. Thermoregulation

123. Emergence delirium

124. Consequences of non-sterile technique

125. Specific protocols

126. Surgery

127. Location of surgery area

128. Location will vary depending on the logistics of the clinic site. Ideally it is a room or an area dedicated to surgery, covered and protected.

129. Asepsis

130. Fundamental to safe surgery and decreased post-op complications.

131. Always established and maintained throughout surgical procedure

132. The cost of establishing and maintaining are far cheaper and more humane than the lack of sterile technique and the consequences.

133. If sterile technique is broken, needs to be addressed, not ignored.

134. Consequences of non-sterile technique may not be visible, such as slow rate of healing or is in more pain.

135. Serious consequences of non-sterile technique may not be visible for a few days. Therefore post-op complications may go unaddressed unless post-op care is very good.

136. Surgical prep

137. Adequate surface for patient and equipment

138. Equipment necessary

139. Sterile gloves, drape, suture, blade, instruments, gauze

140. Cap and mask preferred but not always available

141. Method of sterilizing instruments

142. Autoclave

143. Cold sterile

144. Drape material

145. Adequate size to maintain asepsis

146. Should be resist ant to fluids in normal surgical conditions

147. Suture material

148. Approved for medical use

149. Pre-operative preparation

150. Clipping hair and hair removal

151. Patient prep

152. Solution and scrub technique

153. Surgeon prep

154. Recommended techniques

155. Adult dog or cat

156. Ventral midline or flank approach

157. Complete ovariohysterectomy

158. Closure

159. Body wall must include rectus fascia

160. simple interrupted, cruciate or continuous

161. Subcutaneous

162. Subcuticular

163. Adult male dog

164. Prescrotal approach

165. Complete removal of both testes

166. Closure

167. Subcuticular +/- subcutaneous

168. Cryptorchid

169. Must remove both testes

170. Approach and closure determined by location of testes.

171. Adult male cat

172. Scrotal approach

173. Complete removal of both testes

174. Incision left open to heal by second intention

175. Pediatric female dog or cat

176. As described above for adult dog and cat

177. Pediatric male dog or cat

178. Scrotal approach

179. Closure glued (dog) left open (cat)

180. Pediatric surgery

181. Hemostasis

182. Must be addressed throughout procedure

183. The common occurrence of tick borne diseases and their effects can contribute to pre, intra or post-op complications

184. Must be familiar with the diseases and how to address possible complications.

185. Thermoregulation

186. Produces significant and often avoidable complications, delays recovery

187. Temperatures should be monitored intro op if procedure is long, prolonged, complicated or one is operating in extreme environmental conditions.

188. Warm ambient temperatures are not conveyed to a table surface. Heat loss form an animal to the table surface can be significant. Always have something between anima and table surface such as a dry towel, bubble wrap, newspaper.

189. Keep patients dry and warm. Fluid soaked animals are much more prone to hypothermia as they lose heat on a surface colder than they are.

190. Keep heat sources such as socks filled with rice, warm water bottles, etc. available. Never put a heat source directly against an animal’s skin.

191. Minimize the use of water/cold prep solutions. Excess prep liquid should not be squeezed onto the surgical surface of the animal. Alcohol greatly and rapidly lowers body temperature.

192. If working in extremely hot environment with minimal to no ventilation, employ methods to keep body temperatures within normal parameters

193. Fans, cool floors, IV fluids, cool water bottles

194. Recovery

195. Needs to be monitored. Important to have experienced people so as to be able to identify normal vs. abnormal recovery and parameters.

196. Experienced personnel increase the ability to recognize and address possible complications as soon as possible.

197. Reference of normal recovery parameters available to assist volunteers

198. Any questions on parameters should be addressed by a veterinarian or experienced veterinary technician.

199. Most common area of the clinic where volunteers are bitten

200. Thermoregulation is the most common post-op complication.

201. Keep patients dry and warm. Fluid soaked animals are much more prone to hypothermia as they lose heat on a surface colder than they are.

202. Keep heat sources such as socks filled with rice, warm water bottles, etc. available. Never put a heat source directly against an animal’s skin.

203. Pediatrics

204. Are prone to hypothermia and hypoglycemia. Have heat sources as well as a concentrated glucose source such as honey, karo syrup available.

205. Post –op care and instructions

206. Must be provided and explained in a language the owner understands.

207. Must provide contact information for possible post-op issues or questions.