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Surgery by the Book

by David Handel, DVM

When you hear the words “veterinary surgery,” what do you think of? Most of us conjure up images of spays, neuters, and exploratories. However, when the Maryland State Board of Veterinary Medical Examiners (SBVME) thinks of veterinary surgery, several other issues also come to mind. There are several regulations that specifically address the facilities that we, as veterinarians, use when performing surgery. Our state regulations require that, “If surgery is performed, appropriate facilities and equipment shall be provided and the operating area shall be run in accordance with accepted surgical practice.” On a day-to-day basis, this means that surgery should be conducted with care and attention to detail.

Perhaps one of the most important things to remember before performing surgery is that it is the veterinarian’s responsibility to conduct a physical examination prior to administering an anesthetic, injectable sedative, or injectable tranquilizing agent. Even if you have seen your patient before the date of surgery, you are required to conduct a physical examination within twelve (12) hours of anesthesia. This examination must be conducted and properly documented in the medical records. By way of example, you examined a puppy at his last vaccine visit. It is now three months later and he is presented for his neutering surgery. While a valid veterinarian-client-patient relationship exists, it is still your responsibility to conduct a physical exam on the day of, and before surgery. If the puppy is found to be coughing or sneezing, or to have a new health issue, it is then your decision as to whether surgery is still appropriate on that date. Without the exam on the date of surgery, you risk sedating an unhealthy patient, which could result in an undesirable outcome. Documentation of the physical must include the exam, the treatment provided to the animal and, if medication is given, the amount (including concentration), frequency, and route of administration. It is also your responsibility to document the progress and disposition of the case, and record your surgery and anesthesia in logs housed at your facility.

Following surgery, it is prudent to check on your patient while he is still in your care, and to document this. Also, contacting the owner for an update the day after surgery is ideal. The rationale behind this is that your surgery may have gone well, but recovery may not always be routine. If you take appropriate measures to monitor recovery and make adjustments as necessary, you may be able to avoid problems. Again, all of this should be documented in the patient’s medical record. All of this information is outlined in Code of Maryland Regulations (COMAR) 15.14.01.10.

It is in your best interest, as a Maryland-licensed veterinarian, to be cognizant of changing rules and regulations. The rules that each of us is required to follow are fluid and not set in stone. Standards of care are continually evolving, and the SBVME routinely reviews its regulations to ensure they are appropriate. A recent proposal discussed by the SBVME is that veterinarians will be required to have supplemental oxygen available in lieu of simply an ambu-bag. As veterinarians, it is our responsibility to stay current on the COMAR from which the standards of care are derived. A complete list of the SBVME’s regulations can be viewed at: http://www.mda.state.md.us/vetboard/regulations/index.php .

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Important Links from this article

View the SBVME Regulations