Equine Respiratory Surgery

Question 1

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

Answer 1

respiratory system

Question 2

what type of pathology is common in horses?

Answer 2

upper respiratory

Question 3

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

Answer 3

surgical techniques to allow maximal air flow in these horses

Question 4

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

Answer 4

dynamic endoscopy

Question 5

what is a key benefit of dynamic endoscopy?

Answer 5

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

Question 6

what are the 2 main types of dynamic endoscopy?

Answer 6

overground

treadmill

Question 7

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

Answer 7

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

Question 8

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

Answer 8

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

Question 9

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

Answer 9

elite athlete - will likely be fit and highly strung

Question 10

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

Answer 10

whole horse but respiratory tract especially

Question 11

how long should horses be starved before GA or sedation?

Answer 11

2 hours

Question 12

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

Answer 12

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

Question 13

what are the advantages of standing sedation for URT procedures?

Answer 13

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

Question 14

what are the anatomical advantages of surgery under standing sedation?

Answer 14

access/position
reduced haemorrhage (especially sinuses)

Question 15

what are the disadvantages of standing sedation for URT surgery?

Answer 15

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

Question 16

where is standing surgery often performed?

Answer 16

in stcoks

Question 17

what premed may be given to horses before sedation?

Answer 17

ACP

Question 18

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

Answer 18

alpha 2 agonists (xylazine, detomidine)

opioids (butorphanol, methadone)

Question 19

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

Answer 19

alpha 2 agonist only

Question 20

what must be considered when placing fluid lines and CRI?

Answer 20

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

Question 21

what will be given alongside sedation for standing procedures?

Answer 21

LA - nerve blocks, local infiltration

Question 22

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

Answer 22

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

Question 23

when should equipment be set up for standing sedation?

Answer 23

before the horse arrives

Question 24

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

Answer 24

ventral neck and caudal mandible

Question 25

what is a sinus flap used to treat?

Answer 25

sinus empyema sinus cysts ethmoid haematoma maxillary tooth repulsion

Question 26

what surgery involves a large amount of haemorrhage?

Answer 26

maxillary tooth repulsion

Question 27

how is a sinus flap performed?

Answer 27

reflect skin remove bone gross viewing or endoscope

Question 28

what are the advantages of general anaesthesia?

Answer 28

``` 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 ```

Question 29

what are the disadvantages of GA for horses?

Answer 29

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

Question 30

what elective procedures may be performed under standing sedation?

Answer 30

``` ventriculocordectomy aryepiglottic fold resection prosthetic larygoplasty epiglottic entrapment release arytenoid chondritis excision sinus surgery tracheotomy ```

Question 31

what surgical procedures can be performed under GA?

Answer 31

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

Question 32

what surgical procedures are usually only performed under standing sedation?

Answer 32

sinus surgery | tracheotomy

Question 33

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

Answer 33

emergency tracheostomy trauma thoracic drain placement

Question 34

what emergency surgical procedures are usually only performed under GA?

Answer 34

occlusion of artery for gutteral pouch mycosis

Question 35

where is laser surgery performed?

Answer 35

transendoscopically

Question 36

what must be worn when involved with laser surgery?

Answer 36

PPE is vital - goggles

Question 37

what safety feature do all lasers have?

Answer 37

key for locking mechanism which should be stored separate to laser

Question 38

why should lazers not be used with nitrous oxide?

Answer 38

fire hazard

Question 39

why is suction needed in laser surgery?

Answer 39

toxic gases are produced including xylene and toluene

Question 40

what surgical procedures can be performed by laser?

Answer 40

ventriculocordectomy aryepiglottic fold resection sinus surgery

Question 41

what is happening during epiglottic entrapment?

Answer 41

epiglottis trapped in fold of mucosa over the soft palate

Question 42

what is often seen following laser epiglottic entrapment surgery?

Answer 42

abscessation

Question 43

what are the main patient considerations intra-operatively?

Answer 43

patent airway is essential protect from aspiration obstructions may compromise airway

Question 44

how can the airway be protected from aspiration?

Answer 44

cuffed ET tube suction available use swabs drainage

Question 45

what are the issues with soft palette cautery?

Answer 45

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

Question 46

what is the aim of soft palate cautery surgery?

Answer 46

creates scarring to tighten the soft palate to prevent dorsal displacement

Question 47

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

Answer 47

no nitrous oxide to be used as is a fire risk

Question 48

what are the main post operative considerations following respiratory surgery?

Answer 48

swellings may compromise airway | inhalation pneumonia is a risk

Question 49

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

Answer 49

emergency tracheostomy kit

Question 50

what should all respiratory surgery patients be fed?

Answer 50

moist/soaked hay or haylege for all

Question 51

where should food be positioned for horses following respiratory surgery?

Answer 51

high for tie forward | lowered (off the floor) for all others

Question 52

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

Answer 52

avoids pressure on the sutures

Question 53

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

Answer 53

allows airway drainage

Question 54

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

Answer 54

NSAIDs | topical throat spray

Question 55

what is found within topical throat spray?

Answer 55

glycerin dimethyl sulfoxide dexamethasone

Question 56

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

Answer 56

left open to drain as surgery is classed as contaminated

Question 57

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

Answer 57

laryngostomy tube

Question 58

what is the purpose of a post op laryngostomy tube?

Answer 58

avoids laryngospasm and provide O2

Question 59

why must larygostomy tubes be occulded before they are removed?

Answer 59

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

Question 60

under what conditions must a chest drain be placed?

Answer 60

surgical

Question 61

what is the position of chest drains?

Answer 61

ventral if fluid dorsal if gas uni or bi lateral

Question 62

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

Answer 62

marker pen or clipper marks on patients side

Question 63

what is thoracoscopy used for?

Answer 63

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

Question 64

what conditions is thoracoscopy performed under?

Answer 64

standing sedation

Question 65

what procedure should thoracoscopy be set up as?

Answer 65

laparoscopy

Question 66

what 2 pieces of equipment are essential for thoracoscopy?

Answer 66

suction | oxygen

Question 67

what is a tracheotomy?

Answer 67

temporary emergency placement of tube in trachea

Question 68

what type of tube is used for a tracheotomy?

Answer 68

plastic

Question 69

what is a tracheostomy?

Answer 69

long standing use for tube/opening in trachea

Question 70

what is a tracheostomy formed from?

Answer 70

stoma or metal tube

Question 71

when is an emergency tracheotomy needed?

Answer 71

tor provide a functional airway

Question 72

what may affect the airway and cause need for tracheotomy?

Answer 72

direct obstruction of airway | external obstruction

Question 73

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

Answer 73

laryngeal obstruction, paralysis, spasm oedema tracheal collapse

Question 74

what can cause external obstruction of the airway?

Answer 74

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

Question 75

what equipment is required for an emergency tracheotomy?

Answer 75

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