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Surgery > Resp/Thoracic SX SA > Flashcards

Resp/Thoracic SX SA Flashcards

1
Q

Why can’t cuffed tracheostomy tubes be used long term?

A

interferes with the mucociliary mechanisms of the trachea and result in accumulation of mucus and debris at the end of the tracheostomy tube

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2
Q

What are the components of brachycephalic syndrome?

Which cannot be addressed surgically (bolded)?

A
  1. stenotic nares
  2. elongated soft palate
  3. redundant pharyngeal mucosa
  4. eversion of laryngeal saccules
  5. laryngeal collapse
  6. hypoplastic trachea
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3
Q

Where is the normal location of the soft palate?

A

separates the nasopharynx from the oropharynx

soft palate should extend to touch or lie on the very tip of the epiglottis

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4
Q

Describe the folded flap palatioplasty procedure.

A

Using electrocoagulation, 50-60% of the palatine muscle is resected and the caudal edge of the mucosa is then folded forward and sutured to the cranial portion of the open wound.

This not only shortens the palate but also places the suture line rostral to the tip of the epiglottis.

The remaining palate is thinner and therefore nasopharyngeal obstruction is reduced allowing better airflow through the nose and reduced snoring by the animals during sleep.

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5
Q

What are the indications for folded flap palatioplasty procedure?

A

thickened elongated soft palate

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6
Q

Which drug is recommended to administer pre/post-op for soft palate SX?

A

corticosteroids

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7
Q

What are the options for fixing an elongated soft palate?

A

partially excising the long palate

CO2 laser or Ligasure electrosealing device (reduce hemorrhage & swelling)

Folded Flap Palatioplasty (thickened elongated SP)

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8
Q

What are the three stages of laryngeal collapse?

A
  1. laryngeal saccule eversion
  2. corniculate cartilage collapse
  3. cuniform process crosses over
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9
Q

Is a collapsing trachea apart of the brachycephalic syndrome?

A

NO! (hypoplastic trachea)

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10
Q

Before performing a corrective SX for brachycephalic syndrome where you will be working in the pharynx & edema formation is common, what are two pre-SX considerations?

A

corticosteroids

tracheostomy

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11
Q

What is the technique used to open the stenotic nares?

A

caudal wedge technique (lifts and lateralizes)

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12
Q

What does the elongated palate resection entail?

A
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13
Q

What is the benefit of performing a CO2 laser soft palate resection vs. using a scalpel blade & suture?

A

less bleeding**

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14
Q

What are the indications for a folding flap palatoplasty?

A
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15
Q

How much of the palatine muscle is removed with folding flap palatoplasty?

How is this beneficial?

A

50-60%

keep suture line away from the tip of the epiglottis (avoids irritation)

increase the diameter of nasopharynx & reduces snoring

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16
Q

What is the main concern with saccule resection?

A

The main concern is scarring and stricture formation if the saccules are trimmed too far ventrally.

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17
Q

What is the most common form of laryngeal paralysis?

Which breeds are most affected?

What age?

A

Idiopathic acquired laryngeal paralysis

large breed dogs (Labrador retriever, Saint Bernard, golden retriever, and Siberian huskie)

>9 years

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18
Q

Laryngeal paralysis is secondary to denervation atrophy of the muscle resulting in failure of the arytenoid cartilages and vocal cords to abduct during inspiration.

A

cricoarytenoideus dorsalis

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19
Q

What are the C.S. for laryngeal paralysis?

A

voice change, stridor, respiratory distress, coughing, and exercise intolerance

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20
Q

Where is the suture passed to and from during a unilateral arytenoid lateralization?

A

Monofilament nonabsorbable suture (prolene) is passed from the cricoid or thyroid cartilage to the muscular process of the arytenoid cartilage.

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21
Q

What is the general approach for a tracheostomy?

What important structures need to be avoided?

A

ventral betw/ 3rd and 4th tracheal rings

recurrent laryngeal nerves, the vagosympathetic trunks and the carotid arteries.

22
Q

In which breeds is collapsing trachea most common?

Age?

A

miniature or toy breeds

(Pomeranian, miniature and toy poodle, Yorkshire terrier, Chihuahuas, pug)

all ages (avg. = 7yrs)

23
Q

Unlike in the horse, laryngeal paralysis is (unilateral/bilateral)?

A

bilateral

24
Q

What are the post-op complications of laryngeal tie-back SX?

A

aspiration pneumonia (10-25%)

suture pullout/fracture of cartilage

25
Q

When is placing a tracheostomy tube indicated?

A
26
Q

What is the classic sign of a collapsing trachea?

A

goose honking cough

27
Q

Although the etiology for collapsing trachea is unknown, what are the associated histo signs?

A

hypocellular tracheal cartilage rings and lacking in glycoprotein/GAG content

28
Q

What is the grading system for a collapsing trachea?

A
29
Q

When does the trachea collapse w/ abnormal rings located in the cervical vs. thoracic regions?

A

cervical= inspiration

thoracic= expiration (results in increased resistance→chronic hypoxia→increase workload for R-side heart→R-sided hypertrophy)

30
Q

What does medical management for tracheal collapse entail?

A

symptomatic therapy using antitussive medication, corticosteroids, bronchodilators, sedatives, and weight loss

31
Q

What are the common methods used to diagnose collapsing trachea?

A

rads & fluoroscopy

endoscopy & tracheoscopy (evaluate laryngeal fxn for paralysis)

32
Q

What are the two main approached to SX fix collapsing trachea? Associated CI?

A

external rings (C-shaped rings (Hobson technique) (5-8 mm wide) or a continuous spiral prosthesis (Fingland technique)): intrathoracic collapse

intraluminal stents: affects mucociliary clearance & often develop complications w/ a couple of years

33
Q

What is the main complication with SX for collapsing trachea?

A

damage to the recurrent laryngeal n.

34
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A
35
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36
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37
Q
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38
Q

Maintenance of the latissimus dorsi muscle offers three advantages:

A

(1) the surgical closure is much more rapid;
(2) there is less intraoperative bleeding and less postoperative pain when the muscle is not sectioned
(3) this broad, flat muscle helps to form a better seal after the ribs are approximated.

39
Q

Where should the thoracostomy tube be placed when closing from a thoracic SX?

A

minimum of two intercostal spaces caudal to the thoracotomy incision

40
Q

How would the placement of the thoracostomy tube change based on if fluid vs. air had accumulated in the thorax?

A

If pneumothorax = dorsal placement of the tube ​

fluid collection in the hemithorax = ventral placement is

more ideal

41
Q

What are the main disadvantages associated with a median sternotomy approach?

A

Pain

pulmonary lobectomy is often more difficult particularly in very deep chested dogs

42
Q

What pain management is important for thoracic SX?

A

Parenteral administration of narcotics such as morphine is beneficial, and intercostal nerve blocks using bupivacaine are also helpful.

43
Q

what is the #1 need for thoracic SX?

A

ventilation

44
Q

What suture material is used for thoracic SX?

specifically: tieback, rib approx, vessel ligation

A

tieback: prolene

rib approx: PDS & maxon

vessel ligation: silk

45
Q

What are these and when can they be used?

A
46
Q

what would be the approach to the following areas?

A
47
Q

When performing a lateral thoracotomy, what structures can be used as landmarks for the procedure?

A

want to go caudal to 4th rib- 1st mammary gland or scalenus muscle

48
Q

What is the closure procedure for a sternotomy technique?

A
49
Q

Where do you place the thoracotomy tube in the skin and through which ICS do you puncture the tube into the pleural space?

A

11th into skin

8/9th into pleural cavity

50
Q

For a lung lobectomy, what do you use to ligate the pulm a./v. vs. bronchus?

A
51
Q
A

Surgery (8 decks)

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