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2025 Exam Block 7 > Exam 3: Lecture 22 - Principles of Thoracic Surgery > Flashcards

Exam 3: Lecture 22 - Principles of Thoracic Surgery Flashcards

1
Q

what does thoracotomy mean

A

surgical incision of the chest wall

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2
Q

what does pulmonary lobectomy mean

A

removal of a lung lobe or portion of a lung lobe

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3
Q

what does pneumonectomy mean

A

removal of all lung tissue on one side of the thoracic cavity

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4
Q

where is intercostal/lateral thoracotomy performed

A

by incising between ribs

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5
Q

where is median sternotomy performed

A

by splitting the sternum

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6
Q

what is a complete lobectomy

A

removal of a lung lobe or a portion of a lung lobe

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7
Q

what is a partial lobectomy

A

removal of a portion of a lung lobe

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8
Q

what are the indications for thoracic sx

A
  1. diagnostic biopsy
  2. cardiovascular sx
  3. pulmonary lobectomy
  4. tracheal sx
  5. esophageal sx
  6. mediastinal neoplasia
  7. thoracic duct ligation
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9
Q

what are the 5 conditions we do cardiovascular sx for

A
  1. patent duct arteriosus
  2. vascular ring anomalies
  3. open heart procedures
  4. neoplasia
  5. pericardiectomy
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10
Q

what conditions require emergency stabilization prior to thoracic sx

A

trauma that impairs respiration or acute respiratory impairment

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11
Q

what are some techniques for emergency stabilization prior to thoracic sx

A
  1. stabilization of rib segments
  2. thoracocentesis
  3. O2 therapy
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12
Q

T/F: the thorax is one of the most common regions injured by blunt trauma

A

TRUE!!

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13
Q

__1___ of animals having blunt trauma have thoracic injuries and __2__ have concurrent abdominal and thoracic injuries

A
  1. about 3/4
  2. about 1/2
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14
Q

T/F: equipment for thoracocentesis and thoracostomy tube placement should be readily available and we (as vets) should be familiar with these techniques

A

true

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15
Q

carefully auscultate the _____ of all trauma patients

A

the thorax!

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16
Q

what should we do for large neoplastic lesions in the chest

A

position animal in sternal or lateral recumbency with affected side down and supplemental O2

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17
Q

What can we use to detect and define the severity of respiratory impairment

A

blood gas analysis and pulse oximetry

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18
Q

why should we investigate unexplained abnormalities

A

because ventilatory impairment caused by nonsurgical correctable diseases is sometimes identified

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19
Q

T/F: we don’t need to correct anemia prior to chest sx

A

false, we should correct the anemia

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20
Q

what premed drugs should we avoid for thoracic sx

A

drugs that cause hypoventilation

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21
Q

what should the anesthesia provider always be prepared for with thoracic sx

A
  1. airway diseases
  2. anesthesia machine
  3. monitors
  4. induction drugs
  5. emergency drugs
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22
Q

how long should we preoxygenate patients prior to induction

A

3-5 mins

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23
Q

how can we confirm that we did not intubate a bronchus

A

by auscultating both sides of the chest, ET tube can be palpated in the thoracic inlet, and confirm with EtCO2

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24
Q

animals with open chest cavities require what for anesthesia

A

intermittent positive pressure ventilation

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25
once we complete chest sx, what is important to remember about anesthesia
1. extubation should not be rushed 2. patient awake and not overly sedated 3. respiration is adequate 4. patient is comfy prior to extubation
26
T/F: animals with underlying pulmonary disease or trauma are at an increased risk of developing pulmonary infections
true, should give prophylactic abx at induction
27
what do appropriate prophylactic abx depend on
1. length of sx 2. type of sx 3. immune status 4. underlying disease process
28
T/F: debilitated animals undergoing thoracotomy for removal of large neoplastic lesions dont benefit much from prophylactic abx use
false, they are likely to benefit
29
what are the 2 common surgical approaches to the thorax
1. lateral (intercostal) approach - left or right 2. median sternotomy
30
where should the skin be incised for an intercostal thoracotomy
extend from just below vertebral bodies to near the sternum
31
what retractor should we use for an intercostal thoracotomy
finochietto retractors
32
what is this and why do we need to use caution when using
finochietto retractor....can break the ribs if we put too much pressure
33
what should we do when we close an intercostal thoracotomy
place a thoracostomy tube through an intercostal space 1-2 spaces caudal to the incision prior to closing
34
what is this picture demonstrating
closing an intercostal thoracotomy with stay sutures
35
T/F: we must remove residual air from the thoracic cavity using the preplaced thoracostomy tube or an over the needle catheter
TRUEEEE bc must take out air to return chest to negative pressure
36
What thoracic procedure is especially painful on recovery
median sternotomy
37
what are the benefits of a median sternotomy
1. gives exposure to both sides of thoracic cavity 2. bilat partial lobectomy is easily performed 3. can isolate caudal vena cava, main pulmonary artery, and both sides of pericardial sac
38
what are the indications for a median sternotomy
1. mediastinal tumors 2. pericardiectomy 3. spontaneous pneumothorax 4. trauma 5. exploratory thoracotomy 6. cranial lung lobe tumors
39
what procedure is shown here
median sternotomy
40
what should we consider when doing a median sternotomy
2 or 3 sternebrae should be left intact cranially or caudally to reduce post op pain and prevent delayed healing caused by sternebral shifting
41
if exposure of the lungs or heart is needed, where should our median sternotomy incision go
extend from xiphoid cartilage cranially to the second or third sternebra
42
if exposure of the cranial mediastinum is needed, where should our median sternotomy incision go
the sternotomy should extend from the manubrium caudally to the 6th or 7th sternebra
43
what is this
sternal saw for performing median sternotomy
44
what is this and why should we use caution when using
oscillating orthopedic saw....must use caution because it doesnt have a guard like the sternal saw does
45
what are the steps of a median sternotomy
1. place dog in dorsal recumbency, incise skin on midline 2. expose sternum by combo of sharp and blunt dissection 3. transfect sternebrae on midline via sternal saw, bone saw, chisel and osteotome, or scissors in young animals 4. once xiphoid is split, place malleable retractor 5. place moistened lap sponges
46
what are 2 important things to remember about median sternotomy procedures
1. if a thoracostomy tube is to be placed, do it PRIOR to closing sternotomy 2. do not exit tube from between the sternebrae....exit through between the ribs or diaphragm
47
how can we close median sternotomies
1. with wires in dogs that are larger than approx 15 kg 2. heavy suture for cats and dogs smaller than 15 kg
48
how do we place wire when closing a median sternotomy with it
around the sternebrae in a figure 8 pattern
49
T/F: in large dog, sternotomies closed with wire may be more stable as healing is associated with chondral or osteochondral bridging
true!!
50
what type of wire should be AVOIDED to close a median sternotomy
double loop cerclage wire due to high failure
51
what is the top and bottom showing
top - simple twist cerclage wire bottom - single twist figure 8 pattern
52
what is this image showing
median sternotomy closure with wire
53
how should we close the subcutaneous tissue for a median sternotomy
in a simple continuous pattern with absorbable suture
54
T/F: residual air should be removed from the thoracic cavity and we should close the skin routinely after median sternotomy
TRUE
55
how can a partial pulmonary lobectomy be performed
via intercostal thoracotomy or median sternotomy
56
what procedure is shown here
partial pulmonary lobectomy
57
what procedure is this
partial pulmonary lobectomy using a TA stapler (thoracoabdominal stapler)
58
what instrument is on the top and what is on the bottom
top - right angle forceps bottom - satinsky clamp
59
when doing a complete pulmonary lobectomy, it is important to ligate and transect what
the vasculature to the affected lobe!
60
what procedure is being shown here
complete pulmonary lobectomy
61
what should we do post op for thoracic sx cases
1. monitor respiration closely 2. if respiration is inadequate, eval the thorax to verify we got all the residual air 3. take rads to eval for pneumothorax if needed
62
why are blood gas analysis important post-op thoracic sx
they help to eval adequacy of ventilation
63
what should we do for hypoxic animals post op
receive O2 by nasal insufflation or O2 cage
64
can inadequate ventilation be caused due to pain??
yes!! median sternotomies are very painful and may cause decreased ventilation compared to intercostal thoracotomy
65
multimodal _____ is needed in ALL patients undergoing thoracotomy procedures
analgesia
66
what can post op rads R/O if there is hyperventilation after thoracic sx
1. pneumothorax 2. hemothorax 3. pulmonary edema
67
Is hypothermia common with thoracic procedures
Yes!! even with large dogs!!!
68
how can we rewarm patients undergoing thoracic sx
1. warm water bottles 2. circulating warm water blankets 3. warm air blankets
69
post op complications are reported in __1___% of thoracic sx cases consisting mostly of __2_ and __3__
1. 39% 2. wound complications 3. problems with thoracic drain
70
incidence of what after thoracic sx is found to be 6.5% with a MORTALITY RATE OF 67%
pyothorax!!!
71
where can subcuanteous fluid accumulate post thoracotomy
at the ventral aspect of the thoracotomy incision
72
what is/are a major complication of a partial or complete lobectomy
air leakage or hemorrhage or both
73
how can we prevent delayed healing and nonunion of sternebrae in a median sternotomy
by using adequate closure and leaving several sternebrae intact
74
why can we see post op lameness after thoracic sx
because of pain with severing the latissimus dorsi muscle
75
what are the 3 things we need to monitor very closely for post op thoracic sx
1. pneumothorax 2. hemothorax 3. BOTH
76
what is the abnormality seen in these thoracic rads
well circumscribed mass on left side of chest
77
what procedure is being performed here and by what approach
lung lobectomy via intercostal approach

2025 Exam Block 7 (28 decks)

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