5/2/2018

DVM Intake Exam Estimated age:3 years Microchip noted on Intake?neg Microchip Number (If Applicable): History : Subjective:BAR Observed Behavior -growls, lunges when approached; good appetite; sedated with 0.2 ml torb/0.2 ml dexdomitor IM for exam Evidence of Cruelty seen -n Evidence of Trauma seen -n Objective BCS 5/9 EENT: Eyes clear, AU-mild waxy discharge, no nasal or ocular discharge noted Oral Exam:mm pk, moist; mild tartar/staining PLN: No enlargements noted H/L: eupnic, clear lung sounds, no murmurs/arrhythmias ABD: Non painful, no masses palpated U/G: male intact MSI: Ambulatory x 4, skin free of parasites, no masses noted, healthy hair coat CNS: Mentation appropriate - no signs of neurologic abnormalities Rectal:grossly normal Assessment 1. Healthy Prognosis:good Plan: -monitor overall health while in care center SURGERY: Okay for surgery

5/5/2018

Presurgical exam and sx notes: *limited to visual exam prior to sedation due to aggressive/fractious behavior** BAR BCS 7/9 - slight sneeze observed - amb x 4 - mentation appropriate – no signs of neurologic abnormalities Under sedation: - hydrated EENT: clean/clear Oral Exam: nsf PLN: No enlargements noted H/L: NSR, NMA, Lungs clear, eupneic; nsf ABD: soft abdomen, no masses palpated U/G: intact male MSI: skin free of parasites, small spot of alopecia on medial left thigh with small abrasion, no masses noted, no obvious signs of injury/trauma Rectal: externally normal A: ok for surgery Sx notes: Routine Neuter => Testes exteriorized on R and L sides by scrotal incision over each testicle; each spermatic cord was auto-ligated and each testicle was excised distal to the ligature; scrotal incisions are left open to drain and heal by second intention; a green-ink tattoo was placed at the caudal abdomen/inguinal region lateral to midline and covered with tissue adhesive

5/5/2018

Anesthesia Summary: Feline Neuter Pre Medication/Induction: Ketamine 100mg/mL injectable, __0.6___mL IM Dexdomitor 0.5mg/mL injectable, _0.12___mL IM Butorphanol 10mg/mL injectable, _0.06__mL, IM Anesthesia Notes: (Add any ET tube size, type of breathing circuit and breathing bag size here as well as notes about intraoperative emergency drugs/why you gave them, or other notable items here) Pet did not require intubation or IV catheter for procedure. NSAID: Robenacoxib 20mg/mL injectable, __0.6_mL, SQ, once, for post-operative pain relief. Given post operatively. Other: (State all additional medications during the pet’s peri-operative period) Simbadol 1.8mg/mL injectable, __0.8_mL SQ, once, for post-operative pain relief, given post-operatively. Recovery Status (Note “Uneventful” or “Other” and describe): Uneventful Anesthetist/Surgical Monitor (P#’s): __0811____/___1154___