or IOs and is an ineffective route for administration of emergency drugs. A single dose of 10 ml/kg SC of 4% dextrose has been recommended for short procedures in healthy small exotic mammals (Redrobe 2002). Fluids administered subcutaneously or intraperitoneally are slowly absorbed and not appropriate for treatment of severely ill, dehydrated, or shocky patients.
Maintain vascular access in the postoperative period if at all possible. Continue to administer fluid at least at a maintenance rate until the patient has completely recovered and is eating and drinking well.
Perioperative Antibiotic Therapy
The aim in administering perioperative antibiotics is that the blood level of antibiotic will be effective in preventing incision site infection from target organisms. In most cases, the target organisms are normal skin flora that cannot be completely eliminated during patient skin preparation. The antibiotic should be administered prior to making an incision, which is when the first exposure occurs and should continue until the surgery is complete so any blood clots that form will have therapeutic levels of antibiotic. If the patient is already receiving antibiotics for treatment of an infection and has therapeutic circulating levels of antibiotics effective against the target organisms, additional IV perioperative antibiotic is not needed. If the therapeutic antibiotic is not expected to be effective against the surgical target organisms, perioperative antibiotic administration of an antibiotic expected to be effective against the surgical target organisms should be administered perioperatively. For example, if a patient is receiving cephalexin for a skin infection, but the surgery is in the perineal area where fecal contamination is a concern, adding a perioperative antibiotic against which fecal flora are likely to be sensitive is appropriate. There is no evidence that continuing to administer a perioperative antibiotic for a brief period of time postoperatively is beneficial for preventing surgical site infections (SSIs) and may select for resistant organisms.
Surgeon Aseptic Preparation
The goal of surgeon aseptic preparation is to reduce the incidence of SSI. In human medicine, SSI has been shown to delay wound healing, increase antibiotic use, increase hospital stay, and increase costs, and can result in fatal consequences. Minimizing the risk of SSI in exotic animals is essential for many reasons. Surgeons should wear a cap, mask, gloves, surgical gown, and shoe covers for all surgical procedures (Figure 1.1). Procedures should be done in the cleanest environment possible. A dedicated operating room is ideal, but avoid doing surgery in rooms where abscesses are treated, dirty procedures are performed, or there is fecal contamination.
In one study, glove perforation occurred in 67% of surgeries underscoring the need for hand antisepsis to reduce skin flora before gloving (Verwilghen et al. 2011). Scrubbing is not recommended because it removes protective mechanisms on the skin surface and exposes more potentially pathogenic bacteria. Additionally, it causes small abrasions and excoriations damaging the surgeon's skin and increasing the risk of colonization by pathogenic organisms.
Alcohol‐based hand rubs are recommended because they have rapid action, are faster to use, and cause less skin damage compared with antiseptic soaps. Alcohol‐based hand rubs do not require water. It has been estimated that on average 20 l of water are used per hand when using antiseptic soaps. Additionally, many water faucets and municipal water sources are contaminated with Pseudomonas sp. and other Gram negative organisms that can recontaminate the hands. There is no reason to do a one‐minute hand wash with a neutral soap before applying the hand treatment, and it has been shown that omitting hand washing prior to applying Sterilium® (Medline Industries, www.medline.com) increases its efficacy (Verwilghen et al. 2011). The World Health Organization recommends alcohol‐based hand rubs over antiseptic soaps because of their superior efficacy both in vitro and in vivo, better skin tolerance, lower environmental impact, and no risk of recontamination from rinsing with contaminated water.
Patient Preparation
Regardless of the patient size or species, standard aseptic technique is essential for reducing the risk of SSI. Commonly, exotic animals are more likely to develop SSI than domestic animals because their housing often require them to be in proximity to their urine and feces. Prepare an appropriate area around the proposed surgical incision. Some species like chinchillas and rabbits have fragile skin that can easily be damaged during clipping for surgery. For most mammals, a No. 40 clipper blade is used; however, in patients with very fine fur a No. 50 clipper blade (Oster Professional Products, McMinnville, TN) is better suited. The teeth of the No. 50 blade are closer together than those of the No. 40, making it more difficult for the patient's skin to get caught between the teeth and be cut. Move slowly over the skin and keep the skin in front of the clipper blade flattened. Clean and lubricate the blade frequently to help decrease the risk of damaging the skin.
Figure 1.1 The surgeon must adhere to proper aseptic technique wearing clean scrubs (a). A cap, mask, and shoe covers, and sterile gown and gloves are proper attire regardless of the size and species of the patient (b).
In birds, it is best to pluck feathers which then regrow rapidly; however, it is best not to pluck primary flight and tail feathers as this can damage the follicle resulting in abnormal feather growth. Some birds, such as penguins, have very small dense feathers that are very difficult to pluck. Use a No. 10 clipper blade for these birds. The No. 10 blade teeth are farther apart and clip the feathers at the base. Cut or clipped feathers will not be replaced until the shaft is molted and replaced naturally.
For many years, it has been suggested that alcohol be avoided for skin preparation of small patients because evaporative cooling might cause clinically important hypothermia. A study in mice compared the effect of skin preparation on hypothermia (Skorupski et al. 2017). They compared alcohol alone, povidone iodine alone, povidone iodine alternating with alcohol or saline or warmed saline. Alcohol alone or alternating with povidone iodine caused a dramatic drop in surface and core temperatures, but it rebounded quickly. When alcohol was used alone, the these temperatures returned to nearly the level of the control animals within minutes; however, when alternating with povidone iodine, this was not observed to occur. The authors theorized that the alcohol evaporates very quickly and the cooling stops, whereas povidone iodine and saline evaporate over a longer period of time resulting in more profound hypothermia. Using warmed saline did not modify this effect. The coldest core temperatures were observed in all povidone iodine treatment groups, and this hypothermia persisted. The authors suggested the povidone iodine takes longer to evaporate than saline, resulting in these low body temperatures. The authors concluded that using alcohol for rodent aseptic preparation causes less hypothermia and should be encouraged.
In that study, three applications alternating povidone iodine with either saline or alcohol was used. In veterinary, surgery tradition has been to apply alternating patient skin preparation solutions such as povidone iodine or chlorhexidine alternating with alcohol or saline. The author has been unable to find any scientific evidence for this protocol. It is not applied to humans where a single application of a skin preparation solution is applied prior to making an incision. In fact, the instructions for use on the stock bottle of chlorhexidine indicate to apply the solution and allow it to remain in place for two minutes, then wipe it off and be done.
In another study, an alcohol‐based skin preparation was compared to chlorhexidine for reducing skin surface bacteria (Maxwell et al.
