Presenters: Caroline Allen MA VetMB CertSAM MRCVS London Veterinary Director at RSPCA, and David Yates, Hospital Director RSPCA Greater Manchester Animal Hospital
I have always seen pre-pubertal neutering as a procedure confined to rescue centres purely as a method of population control. It is a something I have never really considered for use in general practice as I have always considered the size of a kitten a limiting factor. However, last week’s webinar led by RSPCA hospital directors Caroline Allen and David Yates demonstrated that prepubertal neutering can be advantageous to the growth of a veterinary business as well as playing a crucial role in cat welfare by helping to control an already ‘out of control’ cat population.
My general concerns with prepubertal neutering (rightly or wrongly) are firstly, that anaesthesia poses a greater risk for the smaller patient, and secondly, that neutering too early could detrimentally affect the development of a very young cat. Contrary to my first belief, it was explained the morbidity of cats being neutered is related to both their age and mass, with larger cats usually having a prolonged surgical time which can lead to greater complications. Prepubertal cats, on the other hand, would have minimal fat, allowing for better exposure and more straightforward haemostasis. They can also be rapidly induced using the quad method of anaesthesia which will be discussed later within this blog, and most prepubertal cats tend to heal and recover quicker. They also demonstrate less affective pain on recovery and are much less likely to have complicating surgical factors such as pregnancy or an ‘in season’ uterus.
Of course, another key advantage to prepubertal neutering is that surgery is performed at the optimum time for population control. Caroline also explained there is little evidence demonstrating the difference in the development of cats between prepubertal neutering and neutering at five to six months old. However, as an example, it has been considered that a prepubertal neutered male cat may be more likely to suffer from FLUTD due to less developed reproductive organs such as the penis and urethra. Studies have however shown that there is no difference between the urethral diameter and function in a cat which has been castrated at prepuberty and one which has been castrated at six to seven months.
The kitten quad is the anaesthetic regime of choice suggested by Caroline and David for prepubertal kittens and can be downloaded as an app to aid in calculating doses based on body surface area. The four agents used in this regime include medetomidine, ketamine, midazolam and either buprenorphine or methadone as the opiate. David advised either opiate can be used in the hospital setting but buprenorphine is advisable if intubation is not possible as it offers 20-30 minutes of surgical time. Midazolam is an important addition to the more familiar triple approach as it allows for a lower dose of medetomidine to be used, the patient can be reversed early without encountering too much excitement induced by ketamine and it helps to stimulate appetite in the recovered patient. In humans, it also acts as an amnesic so may be of benefit in kittens which have encountered stress whilst hospitalised for the procedure. The use of the kitten quad can be given intramuscularly which should help avoid the restraint required to administer an intravenous injection.
David and Caroline also explained the potential benefits delivered to general veterinary practices which take up prepubertal neutering. There can be quite a gap between vaccination and neutering in our standard approach to kitten care which can allow clients to drift off perhaps to another ‘cheaper’ practice. Some clients may even forget altogether to get their cat neutered and before you know it you are having to spay a heavily pregnant cat or, even worse, sweating over a cat caesarean in the middle of the night. Adopting the prepubertal approach allows for a smooth transition from vaccination to neutering helping to keep clients ‘on board’ and also stops staff becoming demoralised when having to spay pregnant cats on a regular basis.
Prepubertal neutering also allows litter mates to be neutered at the same time which helps to save space when hospitalised as they should all be placed in the same cage to help minimise stress. It is also an excellent way of differentiating yourself from other practices with clients and staff considering your practice a trailblazer for new and innovative approaches.
Caroline and David went on to deliver ten top tips for performing feline neutering techniques with both speakers championing the midline spay for its improved exposure and also as an ideal approach if, for any reason, problems were to be encountered.
This was a thought provoking webinar which will undoubtedly inspire many of us to step out of our comfort zone and consider introducing prepubertal neutering into practice. In fact the final push came when renowned and highly respected owner of the Oxford Cat Clinic, Martha Cannon, entered into the discussion and strongly advocated pre pubertal neutering, and as far as I’m concerned if Martha says we should be doing it, it has to be an approach we all take into serious consideration.
The Stethoscope (MRCVS)