Pyometra

• Fluid resuscitation prior to anaesthesia

  Careful goal directed anaesthesia.

  • Assess patient and where possible commence IVFT to improve Haemodynamic status.
• Premedication or sedation - ASA III-V

  As animals become more compromised avoid:

  • NSAIDs
  • Alpha 2 agonists
  • Acepromazine

  Communicate the risks to the owner

  Oxygen and IV access.

  Analgesia

  IV fluid resuscitation/challenges
• What pre-meds to use for pyometra patients?

  Opioids:

  • Methadone (IM or slow IV)
  • OR
  • Fentanyl (slow IV)
  • AND
  • Consider lidocaine bolus then CRI
• Induction of anaesthesia in compromised animal

  As animals become more compromised always continue to administer oxygen during induction.

  Administer drugs slowly as ‘vein to brain’ time has increased with low cardiac outputs.
• Options for induction in the compromised patient

  Propofol or Alfaxalone (low end of the dose range).

  Propofol or Alfaxalone then benzodiazepine then more propofol or Alfaxalone

  Ketamine and benzodiazepine.
• Maintenance of the compromised patient


  Measure ET tubes, reduce dead space, inflate cuff with care, secure well and tie to patient.

  Use lowest % of sevoflurane or isoflurane

  Supplement with CRI.

  Use local anaesthesia where possible.

  Aim to reduce MAC of volatile
• Monitoring and responding to the pyometra patient

  Watch and count respiratory rate and note effort, observe mucous membrane colour, CRT and reflexes, record it.

  Make sure you know what to do if the rate is to fast or too slow.

  If SPO2 value start to drop, move probe and check its real (spring compresses tissue).

  Some pulse oximeters also indicate signal tissue perfusion.
• Monitoring and responding to capnograph changes

  Capnograph informs you about:

  • Ventilation (RR)
  • Metabolism
  • Cardiac output
  • Equipment/ airway
  • Measured in mmHg (35-45mmHg)
• Monitoring and responding to blood pressure changes

  Blood pressure (BP) and perfusion are often altered inc compromised animals (but blood pressure is not the same as perfusion).

  You mist know how to measure blood pressure