Protocols: Surgery

Spay and neuter surgery for feral cats requires slightly different protocols that reflect their unique circumstances. The following are some protocols you should consider implementing when treating feral cats.

  • Require that feral and stray cats come into the clinic in traps. A policy that requires cats to be brought to the clinic in a trap ensures the safety of the staff, veterinarian, and cats and makes it easier to treat the cats.

  • Health evaluations should be a part of the pre-surgical process. Feral cats are not often at a veterinarian office or clinic. Prior to surgery, a quick visual examination will ensure the cat is healthy enough for anesthesia. A veterinarian should make the final decision as to whether the cat is accepted for surgery. Veterinarians must weigh the risks and benefits of neutering a cat with mild infections or noninfectious conditions. It is likely the benefits of neutering outweigh these risks when considering feral cats in a spay and neuter program, because the opportunity to neuter any individual cat may not present itself again. Once the cat is under anesthesia, use this opportunity to perform a full physical examination while determining the sex of the cat.  

  • Anesthesia protocol should involve an anesthesia cocktail called TKX (telazol, ketamine, and xylazine). Using an isolator “comb,” push the cat into one side of its cage to restrict her movements so that you can inject the TKX directly into the muscle.

    According to Brenda Griffin, DVM, MS, DACVIM, prepare TKX by reconstituting one vial of Telazol (500 mg) with 4 ml ketamine (100 mg/ml) and 1 ml xylazine (100 mg/ml). Note: this is the concentration of xylazine marketed for use in large animals, not the 20 mg/ml small animal product.

    The dosage of TKX is 0.25 ml per cat IM. Do not exceed 0.3 ml per cat. For very small kittens, use 0.15-0.2 ml. This provides approximately 30 minutes of anesthetic time. If additional time is required, isoflurane should be used.

    For feral cat spay and neuter programs, where an accurate weight cannot be determined before anesthesia drugs are administered, use readily and safely reversible agents and refrain from the use of drugs that result in marked cardio-respiratory depression.

    Reversal (if needed) is achieved with yohimbine (2 mg/ml; 0.5 ml/cat IM or IV). An additional dose of yohimbine may be given after 30 minutes if results are inadequate. The cat should be returned to the trap immediately after reversal.

    After TKX has been administered, leave the cat in her trap until she is fully unconscious, with trained observers monitoring her continually. Conscious feral cats should never be taken out of traps for the safety of the cat and the clinic personnel.

  • Dissolvable sutures must be used to eliminate the need for a follow-up visit to remove stitches. Sutures requiring additional follow-up put the cat at risk in her outdoor environment; additionally, a second trapping to have sutures removed is a stressful endeavor that should be avoided. Use high-volume, low-cost, high-quality surgical techniques that can reduce the number of sutures required and reduce the size of the incision to eliminate the need for internal sutures, which have the propensity to become infected. For more detailed surgical information, visit the Feral Cat Project ( and Humane Alliance (

  • Learn more about high-volume surgical approaches. Feral cat spay and neuter surgery can be quicker, allowing one surgeon to neuter more cats if high-volume techniques are employed. These techniques include using stations to perform different services for cats and making smaller surgical incisions. View our Feral Cat Clinic Procedure video to see a high-volume technique called the Modified Miller’s Knot at

  • Practice standard procedures for controlling potential infectious diseases. All equipment that has direct patient contact should be thoroughly cleaned and disinfected between cats. Use cleansers known to destroy common veterinary pathogens. Staff, volunteers, and veterinarians should wash and sanitize their hands between patients or gloves should be worn by all. Veterinarians spaying female cats should perform proper hand and arm scrubs with appropriate cleaning agents before performing surgical procedures. Single-use surgical gloves should be used when performing surgery.

  • Learn safe techniques to spay pregnant or lactating females that can mitigate the risk of complications. Because it is difficult to retrap a cat, Alley Cat Allies believes that the benefits outweigh the risks when spaying pregnant or lactating females. After spaying a pregnant female, administer 150 ml subcutaneous fluids before returning her to her trap. Be sure to keep her warm while recovering. If the kittens are near-term, euthanasia solution should be injected into the uterus after it has been removed. While the decision to spay a pregnant female is a difficult one, remember that the goal of a spay and neuter program is to reduce the number of kittens.

  • Establish emergency readiness and clinical policies and incorporate them into your consent forms. Consent forms should be used for all patients and clearly explain the risks of infectious disease exposure, anesthesia, and surgery. Consent forms should also give authorization for surgery and capture client contact information, including an emergency phone number. Create a policy that clearly states how your clinic handles the euthanasia of very ill cats and how pregnant and nursing females are treated. Make certain that all clients are aware of your policies by posting them in a visible location or including them with the intake paperwork and requiring a signature. 

  • Consider the weather and seasons when treating feral cats. Because feral cats live outdoors, their treatment in particularly hot and cold weather must be taken into account. For example, in cold weather groomers should shave less fur for surgery preparation. Learn more about what feral cat caregivers must consider when working with a veterinarian by reading our Colony Care Guide at

  • In the event of a cat dying, the caregiver should be notified and a necropsy should be performed by a third party to establish the cause of death.

For more information on surgery preparation, anesthesia protocols, spaying and neutering feral cats, watch Alley Cat Allies’ Feral Cat Clinic Procedure Video at Also visit the Feral Cat Project (http://www.feralcatproject) and Humane Alliance (

  © 2012 Alley Cat Allies