Equine Respiratory Surgery Flashcards Preview

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Flashcards in Equine Respiratory Surgery Deck (75)
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1
Q

what system in the horse is often a limiting factor in performance?

A

respiratory system

2
Q

what type of pathology is common in horses?

A

upper respiratory

3
Q

what has evolved to maximise air flow in horses with upper airway issues?

A

surgical techniques to allow maximal air flow in these horses

4
Q

how is a diagnosis of upper respiratory tract pathology in horses made?

A

dynamic endoscopy

5
Q

what is a key benefit of dynamic endoscopy?

A

larynx and pharynx can be examined during fast work which is where performance is likely to be sub optimal

6
Q

what are the 2 main types of dynamic endoscopy?

A

overground

treadmill

7
Q

what are the main elective surgical procedures of the equine URT?

A
ventriculocordectomy
aryepiglottic fold resection
prosthetic larygoplasty
laryngeal advancement
soft palate cautery
epiglottic entrapment release
arytenoid chondritis excision
sinus surgery
tracheotomy
8
Q

what are the main emergency surgical procedures of the equine URT?

A

emergency tracheostomy
occlusion of artery for gutteral pouch mycosis
trauma
thoracic drain placement

9
Q

what sort of animals are often in hospital for URT surgery?

A

elite athlete - will likely be fit and highly strung

10
Q

what should be assessed during the clinical exam of a URT patient?

A

whole horse but respiratory tract especially

11
Q

how long should horses be starved before GA or sedation?

A

2 hours

12
Q

what is involved in pre-op planning for URT surgery?

A
procedure and kit required
position - standing or lateral/dorsal
contingency plans if things go wrong
recovery plan
what will be needed post op
13
Q

what are the advantages of standing sedation for URT procedures?

A

reduces GA risks
may reduce costs
anatomical advantages
less facilities and experts required

14
Q

what are the anatomical advantages of surgery under standing sedation?

A
access/position
reduced haemorrhage (especially sinuses)
15
Q

what are the disadvantages of standing sedation for URT surgery?

A

not all horses have suitable temperament
less control of situation if complications arise
need to control the environment (especially movement and noise)
duration is limited so speed is crucial
may still need a GA if there are complications

16
Q

where is standing surgery often performed?

A

in stcoks

17
Q

what premed may be given to horses before sedation?

A

ACP

18
Q

what drugs may be given as a loading dose for standing sedation in horses?

A

alpha 2 agonists (xylazine, detomidine)

opioids (butorphanol, methadone)

19
Q

what drugs may be used as a CRI for standing surgery?

A

alpha 2 agonist only

20
Q

what must be considered when placing fluid lines and CRI?

A

location - will it interfere with surgery and is it accessible
avoid causing paralysis of nerves on both sides

21
Q

what will be given alongside sedation for standing procedures?

A

LA - nerve blocks, local infiltration

22
Q

what is one of the most challenging aspects of standing surgery?

A

multiple pieces of equipment required
fluids and CRI
lots of cables/wires etc
visualisation and access needed

23
Q

when should equipment be set up for standing sedation?

A

before the horse arrives

24
Q

what area of the horse should be prepared for a tie back procedure?

A

ventral neck and caudal mandible

25
Q

what is a sinus flap used to treat?

A

sinus empyema
sinus cysts
ethmoid haematoma
maxillary tooth repulsion

26
Q

what surgery involves a large amount of haemorrhage?

A

maxillary tooth repulsion

27
Q

how is a sinus flap performed?

A

reflect skin
remove bone
gross viewing or endoscope

28
Q

what are the advantages of general anaesthesia?

A
more control of the horse (safer with fractious patients)
generally good access and visualisation 
less time pressure but will take longer
less movement/noise sensitive
oxygen is available
29
Q

what are the disadvantages of GA for horses?

A

cost, expertise, time, facilities
risk of death under GA is 1% in healthy horses
airway supervision required at all times
duration

30
Q

what elective procedures may be performed under standing sedation?

A
ventriculocordectomy
aryepiglottic fold resection
prosthetic larygoplasty
epiglottic entrapment release
arytenoid chondritis excision
sinus surgery
tracheotomy
31
Q

what surgical procedures can be performed under GA?

A
ventriculocordectomy
aryepiglottic fold resection
prosthetic larygoplasty
epiglottic entrapment release
arytenoid chondritis excisionlaryngeal advancement
soft palate cautery
32
Q

what surgical procedures are usually only performed under standing sedation?

A

sinus surgery

tracheotomy

33
Q

what emergency surgical procedures are usually only performed under standing sedation?

A

emergency tracheostomy
trauma
thoracic drain placement

34
Q

what emergency surgical procedures are usually only performed under GA?

A

occlusion of artery for gutteral pouch mycosis

35
Q

where is laser surgery performed?

A

transendoscopically

36
Q

what must be worn when involved with laser surgery?

A

PPE is vital - goggles

37
Q

what safety feature do all lasers have?

A

key for locking mechanism which should be stored separate to laser

38
Q

why should lazers not be used with nitrous oxide?

A

fire hazard

39
Q

why is suction needed in laser surgery?

A

toxic gases are produced including xylene and toluene

40
Q

what surgical procedures can be performed by laser?

A

ventriculocordectomy
aryepiglottic fold resection
sinus surgery

41
Q

what is happening during epiglottic entrapment?

A

epiglottis trapped in fold of mucosa over the soft palate

42
Q

what is often seen following laser epiglottic entrapment surgery?

A

abscessation

43
Q

what are the main patient considerations intra-operatively?

A

patent airway is essential
protect from aspiration
obstructions may compromise airway

44
Q

how can the airway be protected from aspiration?

A

cuffed ET tube
suction available
use swabs
drainage

45
Q

what are the issues with soft palette cautery?

A

welfare issue
consists of burning the soft palate
leads to considerable pain and patient is unable to eat

46
Q

what is the aim of soft palate cautery surgery?

A

creates scarring to tighten the soft palate to prevent dorsal displacement

47
Q

what is the key health and safety risk with soft palate cautery?

A

no nitrous oxide to be used as is a fire risk

48
Q

what are the main post operative considerations following respiratory surgery?

A

swellings may compromise airway

inhalation pneumonia is a risk

49
Q

what must always be available near the stable of a respiratory surgery patient?

A

emergency tracheostomy kit

50
Q

what should all respiratory surgery patients be fed?

A

moist/soaked hay or haylege for all

51
Q

where should food be positioned for horses following respiratory surgery?

A

high for tie forward

lowered (off the floor) for all others

52
Q

why does food need to be fed from high up in tie forwards patients?

A

avoids pressure on the sutures

53
Q

why does food need to be fed from the floor for all other respiratory surgery patients?

A

allows airway drainage

54
Q

what analgesia is usually used for pain management following respiratory surgery?

A

NSAIDs

topical throat spray

55
Q

what is found within topical throat spray?

A

glycerin
dimethyl sulfoxide
dexamethasone

56
Q

what happens to the wound made in the larynx post surgery?

A

left open to drain as surgery is classed as contaminated

57
Q

what is often placed at the end of laryngeal surgery for recovery and left overnight?

A

laryngostomy tube

58
Q

what is the purpose of a post op laryngostomy tube?

A

avoids laryngospasm and provide O2

59
Q

why must larygostomy tubes be occulded before they are removed?

A

to ensure that the patient can breathe without the tube in place

60
Q

under what conditions must a chest drain be placed?

A

surgical

61
Q

what is the position of chest drains?

A

ventral if fluid
dorsal if gas
uni or bi lateral

62
Q

how can level of fluid or gas in the patient be monitored?

A

marker pen or clipper marks on patients side

63
Q

what is thoracoscopy used for?

A

investigate and treat pleural/pulmonic disease (e.g. pleuropneaumonia exudate, neoplasia, haemothorax, pyothorax)

64
Q

what conditions is thoracoscopy performed under?

A

standing sedation

65
Q

what procedure should thoracoscopy be set up as?

A

laparoscopy

66
Q

what 2 pieces of equipment are essential for thoracoscopy?

A

suction

oxygen

67
Q

what is a tracheotomy?

A

temporary emergency placement of tube in trachea

68
Q

what type of tube is used for a tracheotomy?

A

plastic

69
Q

what is a tracheostomy?

A

long standing use for tube/opening in trachea

70
Q

what is a tracheostomy formed from?

A

stoma or metal tube

71
Q

when is an emergency tracheotomy needed?

A

tor provide a functional airway

72
Q

what may affect the airway and cause need for tracheotomy?

A

direct obstruction of airway

external obstruction

73
Q

what disorders of the URT can cause direct obstruction of the airway?

A

laryngeal obstruction, paralysis, spasm
oedema
tracheal collapse

74
Q

what can cause external obstruction of the airway?

A

abscesses (e.g. strangles affecting retropharyngeal lymph nodes)
oedema following trauma

75
Q

what equipment is required for an emergency tracheotomy?

A
tracheostomy tube
clippers 
sterile gloves
LA
gauze swabs soaked in 4% CHG scrub
gauze swabs soaked in SS
no 10 scalpel blade
suture material

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