Schedule Surgery

Attending Veterinarian Scheduling Checklist

What is required from an attending veterinarian prior to scheduling surgery?

This document is a brief overview of what the attending veterinarian must evaluate during their patient’s presentation and physical exam.
This checklist should be completed within one month of your patient’s requested surgery date.
Please see your Service Agreement for more complete requirements.

1) Confirming that your patient and owner are there for the problem you are proposing to correct through surgical intervention – Patient history and client consultation:

Owner is presenting the patient for a lameness that is observed daily/consistently and believes that this is affecting the patient’s daily activity and quality of life.

Owner has confirmed the affected limb IN PERSON by pointing to the limb

2) Confirming that your exam findings are consistent with the problem you are proposing to correct through
surgical intervention and that no additional concerns are noted – Physical examination:

Patient has a lameness on gait evaluation and has clinical findings on musculoskeletal exam consistent with the reported diagnosis

Postural (paw placement) reactions are normal on all four limbs and there is no pain on neck ROM and spinal palpation

Patient has a normal cardiorespiratory auscultation, there is no mass effect within the abdomen and they have a normal rectal exam

3) Confirming that our expanded profile of diagnostics reveal no findings that warrant a more thorough investigation prior to undergoing general anesthesia and surgery – Diagnostics:

ECG trace should be observed by the attending veterinarian for 1-2 minutes.

o If there is concern for an abnormal ECG trace, then a veterinary cardiologist should be consulted Radiographs performed, most commonly under sedation, and sent to a veterinary radiologist for review:

o Lateral thorax (3-view if there is any concerns)

o Lateral abdomen, which includes the lumbosacral space (3-view if there are any concerns)

o VD pelvis (include lateral if any concerns)

o Orthogonal (mediolateral and craniocaudal) views of the limb with the surgical diagnosis Hematology and chemistry blood panel, as well as urinalysis.

o If there are abnormal findings on this minimal database, then further investigation is required and may include a consultation with an internal medicine specialist and/or an abdominal ultrasound

4) Ensuring that we educate our owners thoroughly so they know what to expect – Owner education and preparation:

Owner has been guided to review their Surgery Day Expectations and has been directed to read the Resources in Pet Owner Resources to prepare themselves and their pet for surgery.

For patients that are scheduled for a TPLO procedure, this website is an excellent resource https://tploinfo.com/

Patient has been prescribed NSAID/analgesics, as well as anxiolytics (e.g. trazodone)

o Many patients benefit from receiving trazodone + gabapentin the evening prior to and the morning of their procedure. This helps to limit patient stress and to reduce anesthetic drug requirements on the day of their surgery.

5) Now you are ready to schedule your patient’s procedure:

If you have case-related questions that you want to ask me before scheduling, then submit your question
through the website or by emailing me directly at Albert@DrAlbertLynch.com

Safety is always the top priority

If you have a patient that does not permit the pre-operative screening diagnostics to be performed, and they are not able to be sedated, then here are some options that may help:

1) If the patient presentation, diagnosis and all other findings are routine (e.g. torn cranial cruciate ligament in an otherwise healthy young adult dog) and the patient is behaving nervous (not aggressive):

a. You may send them home (using your discretion and professional approval) with gabapentin (20-30mg/kg lean bodyweight) + trazodone (5-10 mg/kg lean bodyweight) to be given the evening before and the morning of their next attempted pre-operative approval visit

b. You may perform a limited panel of diagnostics and schedule their surgery, as long as you communicate the purpose of these diagnostics to the owner and document this in the patient chart

c. You may have the patient sent to a referral center for the evaluation and diagnostics

2) If the patient is behaving with aggression, then it should be strongly considered whether or not it is appropriate/safe for that patient to have their surgical procedure performed at your hospital

Special circumstance – Fractures

The question frequently comes up, “when can the fracture be scheduled?”.

• In the event of a patient with a fracture, the same checklist and documentation is necessary, except for
urinalysis.

There are two broad patient groups to consider here:

1) Low-energy trauma fractures: This may be scheduled as soon as the above pre-operative approval visit/diagnostics is complete (including same day if radiographs are sent for immediate radiologist review).

o Example patient with a low-energy fracture is a toy-breed dog that jumped out of their owner’s arms and presents with a radius and ulna fracture

2) High-energy trauma fractures: This may be scheduled after the patient has been monitored for 72 hours, in your practice or at a referral/emergency facility, due to the risk for intrathoracic and/or abdominal trauma that may not be immediately evident, such as urinary tract trauma.

o Example patient with a high-energy fracture being any patient with a hit by car type trauma, or
any patient with multiple fragment (comminuted) fracture from unknown origin.

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