August 2012 by Kathleen Makolinski, DVM

Audience: Executive Leadership, Foster Caregivers, Public, Shelter/Rescue Staff & Volunteers, Veterinary Team

Q. What are currently considered "best practices" for high-quality, high-volume spay/neuter for community/feral/unsocial cats?

A. Free-roaming cats have a variety of temperaments and those who are feral need special consideration when performing anesthesia and spay/neuter. It is important to minimize the cat's stress and maximize safety for the humans who are providing medical care. The following will review "best practices" for the spay/neuter of cats who need to be trapped in order for surgery to occur:

• In order to minimize the cat's stress during transport to a spay/neuter program, humane box traps are covered with a cloth. This reduces visual stimulation and calms the cat. It is best to use a light-weight cloth in warm weather and a heavier cloth when it is cold.
• Upon admission to the spay/neuter program, each cat is visually assessed to determine if any clinical signs of illness are present. Although spay/neuter may still be performed on cats who display minimal signs of disease (example: ocular discharge/sneezing from upper respiratory tract infection), the cat should be isolated from other cats and placed appropriately within the day's surgical schedule.
• It is best to utilize a pre-medication and anesthetic induction protocol that allows for injection of the cat while still in the humane box trap. A trap divider or "catacomb" is often utilized to isolate the cat in one part of the trap while the injection is given. The cat is monitored closely after anesthetic induction and is removed from the trap only after sedated.
• While there are many safe and effective anesthetic/analgesic protocols for spay/neuter of feral cats, an important component of all such protocols is the provision of multimodal pre-emptive analgesia. This involves the use of more than one pain control agent and the administration of an analgesic drug prior to the initial incision. These measures help to provide optimal pain management.
• After anesthesia but prior to spay/neuter, a veterinarian examines the cat. This allows for identification of any medical conditions that will need treatment (examples: umbilical hernia, fleas, abscess, ear mites, dehydration, etc.) or warrant postponement or cancellation of the surgery (examples: clinical signs of major illness such as jaundice, severe stomatitis, etc.).
• Regarding testing each cat for feline leukemia and feline immunodeficiency virus, it has been hypothesized that fewer cases of feline leukemia will ultimately result when financial resources are used to provide as many spays/neuters as feasible rather than testing for feline leukemia and removing those cats who test positive. Therefore, it is generally recommended that retrovirus testing NOT be performed on every healthy cat.
• For female cats, both ventral midline and flank incisions are considered to be acceptable. In order to avoid nicking a mammary gland, flank incisions may be particularly beneficial in those females who are lactating.
• Since cats will not have skin sutures removed at a later date, it is important that absorbable sutures be utilized. Suture material is used on one cat only and NOT soaked in antiseptic solution for use in subsequent cats.
• Unilateral "ear-tipping" has become the universally accepted standard for identifying free-roaming cats as spayed/neutered. Therefore, it is recommended that the distal tip of one pinna be surgically removed following spay/neuter. This can be seen from a distance and can save a cat from a return trip to the spay/neuter program.
• Rabies vaccines should be administered as mandated by state regulations. The 2006 American Association of Feline Practitioners Feline Vaccine Advisory Panel Report makes recommendations regarding administration of other feline vaccines in trap-neuter-return programs.
• It is important that all cats be vigilantly monitored in the immediate post-operative period. In order to minimize stress, once the cat is awake, with head up, and in sternal recumbency, his or her trap is partially covered with a cloth, so that monitoring of the cat can continue.
• It is important that caregivers receive written and verbal information regarding the care and feeding of cats in the days following surgery as well as a telephone number to call in case questions or concerns arise regarding the cat's recovery.
• Free-roaming cats are returned to the site of trapping as soon as they are fully recovered from anesthesia and it is determined that they are not showing any signs of post-operative complications (example: bleeding from the incision). For male cats this may be as soon as the day following surgery. Non-pregnant female cats may be ready for release 1 - 2 days following surgery. Cats who were pregnant at the time of surgery may need a bit more time to fully recover from the surgery and anesthesia.
• Morbidity and mortality statistics for community/feral cats who undergo spay/neuter are tracked in an effort to determine if any changes in medical protocols are warranted. It is ideal if a necropsy can be performed on any cat that dies during anesthesia, surgery, or in the immediate post-operative period.

Q. Do you feel these best practices are being widely utilized, or can we do better?

A. Generally, programs that spay and neuter community/feral cats serve as a valuable resource in their community. They strive to educate people about the humane management of this population of cats and provide an alternative to euthanasia. Many programs implement "best practices." It is ideal for all such organizations to continually seek out new information and implement progressive protocols that will benefit the cats that they serve.

Q. How do you think the cats are impacted by non-use of intubation, difficulty monitoring during procedure, no follow-up beyond the day of surgery, and any other practices that are common to surgery on feral populations?

A. Intubation requires training, practice, and patience and if not performed properly, can be harmful to the patient. Although some organizations prefer to intubate cats in order to maintain a patent airway, many spay/neuter programs operate successfully without routinely intubating cats during anesthesia. If feline patients are not routinely intubated, staff should be prepared to efficiently intubate a cat in an emergency situation.

Community/feral cats can be monitored under anesthesia in ways similar to pet cats - their pulse quality/rate/rhythm, as well as respiratory rate/pattern, jaw tone, and eye position can be assessed throughout anesthesia. Various monitors can assist in gathering this important information.

Community/feral cat caregivers are instructed to contact the spay/neuter program or an emergency veterinary hospital with any questions or concerns about the cat in the post-operative period. If a cat has any medical issues after release from a trap, an attempt to re-trap the cat is made so that he or she can receive proper medical care.

The bottom line is that high-quality spay/neuter provides a means for the humane population management of community/feral cats. Any risks to the individual cat are generally far outweighed by the benefits provided to the population as a whole.

Q. What are the procedures you'd most like to see implemented in all such programs, and what are the obstacles to that happening?

A. It is essential that all spay/neuter programs provide adequate pain control for their patients. Providing analgesia is safe and beneficial for the patient as well as cost effective. It can be challenging for people (many of whom are volunteers) to concurrently coordinate spay/neuter programs for community/feral cats and obtain information related to "best practices." However, easily accessible webinars, regional conferences, and workshops allow people to obtain additional information and gain the confidence necessary to implement changes in their program.

Related Resources:

• Post-mortem findings in 54 cases of anesthetic associated death in cats from two spay/neuter programs in New York State, Gerdin, J., et. Al. Journal of Feline Medicine and Surgery, Vol. 13, Issue 12, December 2011, pp 959-966.
• Response of feral cats to vaccination at the time of neutering, Fischer, S., et al, Journal of American Veterinary Medical Association, Vol. 230, No. 1, January 1, 2007.
• The Association of Shelter Veterinarians veterinary medical care guidelines for spay/neuter programs, Looney, A., et al, Journal of American Veterinary Medical Association, Vol. 233, No. 1, July 1, 2008.