CPD ACCREDITED ARTICLE tality rate was 1 % 62 . Our results show that medetomidine appeared not to have affected puppy survival rate and maternal survival rate .
In a study involving 37 CSs performed on English Bulldogs , 14.9 % of the puppies were stillborn , 8.2 % of the puppies alive , were deformed ; mainly cleft palate ( palatoschisis ) and anasarca , and 10 % of the puppies died before the age of weaning 20 . This is similar to the 6.9 % birth defects and 15.91 %, 24h mortality that Batista et al . ( 2014 ) reported for elective CS in English bulldogs . The results from the current study in English bulldogs were similar with respect to the number of deformed puppies ( 5.59 %) but better for percent live birth ( 96.67 %). In 193 puppies from 42 litters , 65 born by spontaneous delivery , 66 by assisted delivery and 62 by caesarean section , the percentage of stillbirths were 14 %, 20 % and 8 % respectively 26 .
Puppy survival rates at birth and at 2h after birth supposedly reflect the effects of perioperative conditions more specifically than at 7d after delivery 12 . This is because deaths within the first week are often associated with factors relating to maternal care , agalactia , undetected birth defects and infectious causes 54 .
It is important to establish prior to a treatment or procedure whether all the foetuses are alive and well prior to the intervention 63 to avoid a false overestimation of the effect of the intervention on puppy mortality . Pre-operative ultrasound
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enterprises . up . ac . za / vet-science-courses enables one to account for at least some foetuses that died before and therefore those stillbirths may be considered independent of the intervention . The current study identified 45.6 % ( 36 / 79 ) of stillborn puppies on ultrasound examination immediately before the CS was performed .
Because the aim of the current study was to evaluate the effect of our anaesthetic protocol on puppy survival rates , puppy vigour and maternal survival rates , attempts were made to exclude confounders which may have affected outcome not related to anaesthetic protocol . These were foetuses detected dead on ultrasound examination prior to administering any drugs included in the anaesthetic protocol and puppies euthanased because they were deformed . This correction is particularly useful when comparing puppy survival rates of the English bulldog breed to those of others . English Bulldog puppies not only have poorer survival rates at 2h and at weaning age but also an increased risk of being stillborn or being born with defects requiring euthanasia 20 , 64 .
The maternal survival rate in this study was good as all but one of the 292 bitches anaesthetised were alive at 7d post CS . A single Boerboel bitch died from gastric dilatation and volvulus two days after discharge . Gastric dilatation and volvulus is a well-recognized cause of sudden death in large breeds 65 . Therefore , our results support the finding by another worker that premedication with medetomidine was not identified as an increased risk factor for anaesthesia in the dog 17 . In contrast , xylazine has safety concerns for both dam and neonate when used for CS in the bitch 12-16 . The demonstrated safety recorded in the current study may in part be explained by ; improved alpha 1 : alpha 2 specificity exhibited by medetomidine compared to xylazine , greater awareness of the physiologic effects of alpha2-adrenergic agonists 17 and the use of a relative low dose ( 7 µ g / kg ) of medetomidine . Although dexmedetomidine and medetomidine induced similar clinical effects 66 , there are theoretical pharmacological advantages of the non-racemic alpha2-adrenergic agonist , dexmedetomidine , over medetomidine 67 . The primary author observed no differences in clinical effects when medetomidine is replaced by dexmedetomidine .
Apgar scores have been shown to be influenced by anaesthetic agents . Alfaxalone ( 1 to 2 mg / kg ) has been shown to be slightly superior to propofol ( 2 to 6 mg / kg ) in this respect 27 , 68 . Overall , the Apgar scores achieved in the current study were higher than those reported in other studies irrespective of method of delivery or anaesthetic protocol used 26 , 27 , 68 , 69 . The time at which Apgar scores are measured after birth is important . Although in early studies in man , a score at one minute was used 70 , it was later demonstrated that the score at five minutes is more predictive of survival 71 . Similarly , in puppies , evaluations performed at five minutes after birth were less predictive than those
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