A warm (90° F) incubator, hemostats, suture material, suction bulb syringes, emergency drugs, and an adequate supply of soft
dry towels should be prepared beforehand. As each neonate is handed off, the umbilical cord should be clamped and ligated
1-2 cm from the umbilicus. Fetal fluids and amnion should be removed by rubbing briskly with a soft, clean towel. The oral
cavity and nares may be suctioned with a bulb syringe. The old practice of "swinging" puppies to clear their airways is best
avoided because of the potential for cerebral hemorrhage due to concussive injury. If vigorous rubbing is not successful at
stimulating respiration, positive pressure ventilation may be initiated with a snug fitting mask, keeping the neonates head
and neck extended to ensure adequate inflation of the lungs. Alternately, intubation may be accomplished using a catheter
or small, uncuffed endotracheal tube. Because isoflurane is minimally metabolized, ventilation is the primary route of elimination.
Thus, its depressant effects can not be reversed until the neonate breathes. Cardiac massage may be instituted if a heart
beat can not be detected once warming and ventilation measures have been instituted. Epinephrine (0.1 mg/kg) may be given
intratracheally, intraosseously, or intravenously if cardiac massage is unsuccessful. Naloxone (0.1 mg/kg) should be considered
if the dam received opioid analgesics as part of the anesthetic regimen. Although doxapram (dopram) is routinely administered
in many practices as a respiratory stimulant, it is not used for this purpose in the resuscitation of human neonates and there
is no evidence to support its use in veterinary patients.
The prognosis for medical management of dystocia is guarded, with success rates of 20-40% in the veterinary literature. Additionally,
stillbirth rates have been shown to rise when dystocia is allowed to continue for greater than 4.5-6 hours from the time of
onset of second stage labor in the dog. For these reasons, the decision to proceed to caesarian section should not be delayed
if response to medical management is poor or unlikely to result in successful delivery. In recent studies, neonatal survival
rates following surgical treatment of dystocia have been reported at 92% at birth, with 80% still alive at 7 days post c-section.
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