C Section Ruminant

Question 1

What are the 2 Paravertebral Nerve blocks?

Answer 1

1) Proximal

2) Distal

Question 2

How can you block the paralumbar fossa in cattle?

Answer 2

1) infiltration anesthesia
- Line block
- inverted L block

2) Paravertebral Nerve block
- Proximal
- Distal* (what we did in lab)

Question 3

What are the 2 infiltration anestheia blocks used to block the paralumbar fossa?

Answer 3

1) inverted L

2) line block

Question 4

Why is infiltration anesthesia more risky than para vertebral, in ruminants?

Answer 4

Because you will be approaching the lidocaine toxic dose.

5mg/kg
-goats more sensitive dilute to 1%

Question 5

What is the toxic dose of lidocaine for ruminants?

Answer 5

5mg/kg

-goats more sensitive dilute to 1%

Question 6

Describe the parameters for line block/ inverted L

Answer 6

• 1cm deep (SQ)
• 2-7cm deep (Muscle
• 1-2 Mls per site

Question 7

How do you do the inverted L block

Answer 7

• Parallel to the last rib
• under the transverse process of the lumbar vertebrae
• all the way to the tuber coaxe

Question 8

What are the advantages of infiltration anesthesia?

Answer 8

EASY to perform

Question 9

What are the disadvantages of infiltration anesthesia?

Answer 9

• large amounts of lidocaine required (easy to reach toxic dose)
• anesthesia may be inadequate
• more block required to enlarge incision
• Lidocaine in incision site (delays healing)

Question 10

What are the parameters of the Proximal paravertebral nerve block

Answer 10

Blocks: T13, L1, L2

-dorsal and ventral roots

Question 11

What nerves provide sensation to the paralumbar fossa?

Answer 11

T13, L1,L2

-dorsal and ventral roots

Question 12

What are the advantages of the Proximal paravertebral block

Answer 12

1) less lidocaine than infiltration
2) excellent anesthesia of ENTIRE FLANK
3) No lidocaine in incision

Question 13

What are the disadvantages of Proximal paravertebral block?

Answer 13

1) more difficult to perform
2) scoliosis to side of block
3) Ataxia ( if migration of lidocaine to L3)
4) Risk of penetrating major vessels/ spinal chord

Question 14

What Nerves does the distal paravertebral nerve block block?

Answer 14

Same nerves

Question 15

What are the advantages of performing the DISTAL paravertebral nerve block over the proximal?

Answer 15

1) easier to perform/ regular size needle
2) no scoliosis
3) less risk of ataxia
4) less risk of damaging vessels/ spinal chord

Question 16

What are the disadvantages of the Distal paravertebral nerve block?

Answer 16

*variable position of the nerves = potential failure

Question 17

What are the indications for performing a C section?

Answer 17

To relieve or prevent dystocia :

1) maternal indication:
- small pelvis
- abnormal pelvic conformation
- uterine inertia/torision/rupture
- hydrops (amnion, Allantosis)
- Vaginal constriction

2) fetal indication:
- oversized fetus
- fetal malposition
- fetal monsters/emphysematous fetuses

Question 18

What does a reproductive examination for dystocia involve?

Answer 18

1) vaginal examination
- cervix dilation
- calf Presentation, Postion, Posture
- Dead/Alive, monster/emphysematous

2) Transrectal palpation

Question 19

When performing a C section from which side do you approach?

Answer 19

LEFT
-easier to manipulate rumen than SI

• Standing = most common

Question 20

What is the standard approach to C section in cattle?

Answer 20

Standing PL fossa celiotomy (LEFT side)

Question 21

Where do you make the incision for C section in cattle?

Answer 21

Caudal 1/3 of the left paralumbar fossa

• 10cm ventral to the transverse process
• extend incision ventrally (40cm)

Question 22

What are the muscle layers that are cut during a C-section?

Answer 22

• Skin
• EAO
• IAO
• transverse abdominal
• Peritoneum

Question 23

Why make the C-section incision in the caudal 1/3 of the PL fossa?

Answer 23

Ease exteriorization of uterus

Question 24

T/F: you should attempt lifting the uterus out during a C- Section in cattle?

Answer 24

FASE
-Do not attempt lifting uterus

*grasp limb (MT3/MC3) and rock uterus towards incision

Question 25

How would you close the uterus following C-section in a cow?

Answer 25

1) Single layer - ONLY if live calf and no IU contamination (closed cervix—> elective C-section) - continuous inverting - avoid mucosal penetration Or 2) Double layer -simple continuous + and inverting sutuer: ——>Lemberg ——>Utrecht ——>Cushing (DO not penetrate the mucosa)

Question 26

The closure of the uterus following C-section is dependent on What?

Answer 26

- calf alive or not | - IU contamination

Question 27

WHat suture pattern has been associated with better fertility following C-section?

Answer 27

Utrecht suture patter

Question 28

Other than the standing PL celiotomy (standard) what approach can be used for C-section?

Answer 28

Left oblique Celiotomy 1) gravity horn readily exteriorized - lesss strength needed to exteriorize uterus - large calves - minimized abdominal contamination 2) anesthesia of ventral body wall may occur 3) Incision 10 cm cranial and 10 cm ventral to cranial aspect to TC - extended cranioventrally @ 45 degrees - end 3 cm caudal to last rib - grid technique

Question 29

When should you use the Ventral midline celiotomy approach?

Answer 29

1) fractious cattle not amendable for standing Sx 2) Recumbent cows 40 cm incision starting just cranial to udder -extend cranially More risk of vessel damage -mainly in diary cattle

Question 30

What vien runs just cranial to the udder?

Answer 30

MAjor Transverse vein

Question 31

What is the best approach for a recumbent cow that requires Celiotomy?

Answer 31

Ventrolateral

Question 32

What C-section approach is recommended when you have an EMphysematous calf and why?

Answer 32

Ventrolateral Celiotomy - minimalists abdominal contaimination - want to be able to bring the uterus out of the abdomen before incising

Question 33

Describe Ventrolateral celiotomy (C-section)

Answer 33

1) incision parallel to superficial mammary vien - mark vien when cow is standing (more prominent) - Axial to vein 2) time consuming 3) large incision - wound care - wound closure

Question 34

Why is the Paramedian celiotomy approach a poor surgical approach for C-section?

Answer 34

1) dorsal recumbancy —> CV compromise 2) Poor holding layer for closure 3) hemorrhage 4) No additional advantages—> NOT recommended

Question 35

What are the complications of C-section?

Answer 35

1) Peritonitis, Metritis (ET), Adhesions 2) wound infections - 25% more with emphysematous fetus 3) 15% decline in fertility vs vaginal delivery 4) calf survival rate 60% - shorter duration of Sx 5) Cow survival rate 80% - uterus exteriorization upon Sx - removal of blood clots upon Sx - no retained placenta

Question 36

What is the survival rate of the calf during C-section?

Answer 36

60%

Question 37

What is the survival rate of the Cow during C-section?

Answer 37

80% Decreased mortality due to: 1) uterus exteriorization 2) removal of blood clots 3) no retained placenta

Question 38

What percent decline in fertility do you have with c-section compared with vaginal delivery?

Answer 38

15%

Question 39

What is another indication for C-section in SMALL Ruminants ?

Answer 39

Pregnancy ketosis

Question 40

What are the most commonly used approaches for C-section in SMALL ruminants?

Answer 40

1) PL fossa Celiotomy (STANDARD) 2) Ventrolateral approach 3) ventral midline Celiotomy