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Pain Management

by Ron
(Pennsylvania)

Hello Dr. Neely,

I am about to have my 4.5 month old kitten spayed. The doctor wants to give her a pre-surgical injection of Metacam. The internet seems to be filled with horror stories concerning this drug.

Would you choose this medication or is there a safer alternative for post-sugical pain management?


Thanks,
Ron


Hi, Ron

I do not use Metacam in cats. I use Torbugesic and have been happy with that and it is safe. I would not use Metacam in cats.

I hate to "open up a can of worms", but I'm here to represent the cats of the world, right? ....so....I would be more concerned about the type of anesthetic that is used.

Anesthesia for cats is something I really need to write an article about, but until I do, if you would just like to ask your vet how they induce and maintain anesthesia in cats, I would be happy to give you an opinion about it. Anesthesia can be very safe or it can be risky. Recovery can be smooth for the cat or it can be quite rocky.

Thanks, Dr. Neely

Comments for
Pain Management

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Aug 28, 2008
 follow up
by: Anonymous

Hello Dr. Neely,

Just wanted to let you know that my kitten was spayed on Tuesday with all of your suggestions (sevo/torbugesic injection, pre-anesthesia bloodwork, anesthesia monitoring, ecg monitoring, IV fluid therapy, etc.) and she came through it very well with no complications.

Again, thanks so very much for your professional advise.

Sincerely,
Ron

Hi, Ron

I'm thrilled to hear that! That's the only way to do it. I hope you'll spread the word to any other cat owners you know!

Thanks for letting me know,
Best,
Dr. Neely
Aug 13, 2008
 Follow-up
by: Ron

Hello Dr. Neely,

Thanks for the great information. Unfortunately,
Dr. Bebko's office staff informed me that the clinic does not do spayings or neuterings. Why, I don't know, no explanation was offered.

I will be persuing your recommendations with the two clinics that agree to use the gas.

Again, thanks for all your help...

Ron



Aug 12, 2008
 PAIN RELIEF AND ANESTHESIA FOR A CAT
by: Anonymous

strong>Hi, Ron,

You know at times like this, I wish I could teleport myself to other places. It would be easier than explaining and easier than worrying about the cats I hear about.

Ok, for starters, your breeder is a smart lady.
Her idea of anesthesia is the best not only for Ragdolls, but for all cats.

Cats should not receive injectible anesthetics. I'll save the reasons for another time. Gas-only anesthesia is the way to go. Both iso and sevo are very good agents. I have used both. Sevo is newer and supposedly has some advantages, but after trying it, I went back to iso. However, that is not to say Sevo is not perfectly acceptable.

The cat should be induced with gas only, either by being in a chamber or in our case, we wrap the kitty in a towel and hold her and administer the iso via mask until she is asleep enough to intubate. I'm sure anyone who is wiling to do gas only and is using a chamber is certainly going to intubate to maintain anesthesia for the surgery. They will pass an endotracheal tube into her trachea and connect her to oxygen/iso or oxygen/sevo mix until the surgery is over. You should inquire if they have monitors for respiratory rate, heart rate, pulse oximetry, ECG, etc. and if everytime a surgeon performs surgery, there is a dedicated technician there to monitor the patient and control the anesthetic/oxygen gas flow.

One great thing about using gas-only is that when it is turned off, they wake right up. That's a good thing, unless, of course, they are in pain and then waking up can be rocky.

That's where the pain relief comes in. I definitely suggest Torb over Metacam. I am not familiar with the Torb/vitamin mix your breeder suggests. I imagine she is talking about oral Torb mixed in a vitamin mix to make it taste better. We give an IM Torb injection at the beginning of the surgery because IM acts more quickly and so will be at its peak when the kitty wakes up. We also follow up after surgery with a 2nd Torb injection given subcutaneously because it will last longer given that route. That is often all that is required. Every once in awhile, a cat seems painful the next day as well and we would give Torb SQ again.

I actually may have a name for you in Pittsburg. I knew someone there very well. I'm just not sure she's still there. I will do a little research this evening and get back to you if I have a recommendation. However, it sounds like you may be able to work things out with one of the vets you're already talking to. Iso or Sevo with Torb for pain is the way to go.

Write back, of course, with further questions.

Thanks,
Dr. Neely

Aug 12, 2008
 Follow-up
by: Ron

Ron,

(412) 681-1122

Dr. Bob Bebko (one of the best in the country!)
Cat Clinic and Hospital

Pittsburgh, PA 15224

located in the Bloomfield – Shadyside area of Pittsburgh on Liberty Avenue. This location is only two buildings from the Bloomfield Post Office and on the same side of the street. The nearest intersection is Baum Blvd. and Liberty Avenue, only a few hundred feet from the Cat Clinic and Hospital. Phone hours start at 9:30 a.m. every day.

Hello Dr. Neely,

Thanks so much for your time. I am about ready to drive to Philadelphia (from Pittsburgh) to have my little one spayed.

Let me explain, I adopted my Ragdoll kitten from an out-of-state breeder. She gave me strict instructions on her medical care. As for her spaying, she wants only a gas anesthetic agent used, no injectables. She states that Ragdolls are very sensitive to most anesthetic agents particularly the injectables. For pain relief she also suggests Torbugesic mixed into Hi-Vite drops. I have been to five different practices trying to do what the breeder suggests, and I am having no luck finding one that suits all the breeder's concerns.

Two of them agree to use only gas agents. The one who wants to use the Metacam would use isoflurane. They induce the gas via a 10 gallon aquarium used as a chamber.

The other practice would use Sevoflurane. Is one of these agents better that than other?

I don't have the particulars on how the gas is maintained, but if you would give me some general guidelines for the safest approach to feline anesthesia I would appreciate it very much. Better yet, do you know of any practices in the Pittsburgh area that could safely accommodate the breeder's suggestions? (just kidding)

Thanks,
Ron


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