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Equine Surgery and Medicine > Surgery 2 > Flashcards

Surgery 2 Flashcards

(103 cards)

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1
Q

Hoof bandage

A

Can be wet or dry
After surgical procedures-softening
Extends under fetlock
3-5 days

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2
Q

Distal limb bandage

A

Surgical sites or intraarticular injections
From coronary band to carpus or tarsus
Fixed to hoof capsule by impermeable tape

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3
Q

Robert-Jones bandage

A

Immobilization of the limb and joints!
Standard bandage with additional sheet cotton
1.5x the circumference of the limb
Split can be applied to strengthen

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4
Q

Carpal bandaging

A

From coronary/fetlock to above the carpus
Hole/pressure releasing pads over acc carpal bones to prevent pressure sores or pressure necrosis of skin
Normal bandage plus strengthening additional layers
Splints can be applied for more restriction of movements

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5
Q

Carpal splint

A

When need stabilization of the limb- luxation, fracture, tendon rupture
On top of Robert-Jones
Proper protection of acc!!!
Split from coronary band/fetlock to under the elbow

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6
Q

Tarsal bandaging

A

Same as carpal but this time pressure releasing pads over the common calcaneal tendon

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7
Q

Common problems of bandages

A 
Slipping/rotation of bandage and splint 
Too tight or too loose 
Pressure necrosis of skin
Uneven tension of bandage 
Contamination
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8
Q

What is neuroleptanalgesia

A

sedatives and analgesic
for standing position procedures and diagnosis
head comes down to carpal level- head support may be needed
Partial unconsciousness and muscle relax– can add analgesia for surgical procedures

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9
Q

Combos for neuroleptanalgesia

A

ACP and Butorphanol
Xylazine and Butorphanol
Detomidin and Butorphanol
ACP and Xylazine and Butorphanol

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10
Q

Cardiopulmonary effects of alpha2 agonists

A
  1. Vagal tone incr– bradycard– decr CO
  2. Hypertension at beginning.. then hypotension
  3. if give IV– temp grade I and II AV block
  4. Dysrhythmia or arrhythmia
  5. Central resp depression
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11
Q

GI effects of alpha2 agonists

A

Block the swallow reflex
Reduced visceral motility and perfusion to the organs
Hyperglycaemia
Are good visceral analgesics– therefore good for colic

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12
Q

Cardiopulmonary effect of opioids

A

Resp depression
Hypotension
Bradycardia

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13
Q

Opioid drugs used: agonists

A

Methadone: 3-4x more potent than morphine
Morphine
Morphinum hydrochlorium
Fentanyl- lipophilic so use a patch

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14
Q

Opioid drugs used: agonists-antagonist

A

Butorphanol

Pentazocin

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15
Q

Opioid drugs used: antagonist

A

Naloxon

Nalorphin

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16
Q

Local anaestheisa: physical methods

A

Ties and tourniquets: nerve press and anaemia

Cool: at 4degrees- stops the potency of nerve stim

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17
Q

Local anaesthesia: chemical

A

Esters: cocaine, procaine and tetracaine.. are hydrolysed by plasma pseudo-cholinesterase

Amides: lidocaine, mepivacaine and bupivacaine- are metab by the liver and so are better

Cannot be absorbed through intact skin

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18
Q

Local anaesthetic used in optho

A

Oxibuprocaine and proparacaine
These are 10-15x more effective than procaine
Can be toxic for the corneal epithelium

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19
Q

Local anaesthetics for mucus membranes and skin

A

Lidocaine: most stable, good penetration: 1.5-2hrs
Bupivacaine: 4-6 hrs
Mepivacaine: fast effect! only lasts 1-2hrs

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20
Q

Methods of local anesthesia

A 
Topical
Infiltration
Regional IV
Intrasynovial
Perineural
Paravertebral
Epidural
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21
Q

Local anaesthesia: Infiltration

A

Safest
2% lidocaine
SE: hematoma

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22
Q

Local anaesthesia: Regional IV

A

IV catheter and Esmarch tourniquet

2% lidocaine (same as for infiltration)

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23
Q

Local anaesthesia: Intrasynovial

A

Intraarticular
Intrathecal bursa
Tendon sheath: Mepivacaine, bupivacaine, lidocaine

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24
Q

Local anaesthesia: Perineural uses and types

A

Lameness diagnosing
Palliative- laminitis hoof cast
Surgery of the head

Periorbital
Dental and muzzle
Corneal

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25
Local anaesthesia: Paravertebral anaesthesia
Laparoscopy and flank laparotomy | If successful block-- vasodilation, sweating-- Horner's syndrome like
26
Local anaesthesia: Epidural
``` Sedation Btw Cc1 and Cc2 Drugs used: 2%lidocaine Xylazine (and saline) Detomidne and morphine Morphine ```
27
ASA classification of risk categories for surgery
1. Healthy horse 2. Mild systemic disease-- mild anemia, RAO 3. Severe systemic disease-- severe RAO 4. Severe systemic that is life-threatening-- colic, polytrauma 5. Moribound horse, not expected to survive for more than 24hrs-- foal with uroperitoneum E. Emergency
28
Preoperative evaluation
Goal: to define the risk for the owner To select the best strategy to minimize the risks 1. Free airway- intubation 2. O2 supply 3. IPPV= intermittent Postive Pressure Ventilation 4. Venous Pressure Catheter 5. CPR= cardio pulmonary resuscitation
29
Patient prep for surgery
1. History- prev anaesthesia 2. Physical exam- focus on resp, CV, musculoskeletal and CNS 3. For emergency cases- first treat shock and stabilize 4. Lab tests: elective selection: PCV, TPP sometimes hematology 5. Fasting-- no water for 6 hrs prev--lung function, decr chance of stomach rupture and decr risk of postop ileus 6. Body weight- drug dosages
30
Surgical Complications and emergencies
``` Cardiopulmonary resuscitation Anaphylaxis Intraoperative hypotension During maintenance Hypoxemia and Hypoxia Hypercapnia Postop myopathy Postop neuropathy Postop laryngeal edema ```
31
Cardiopulmonary resusitation
Intraop mortality 30% due to cardiac arrest Caused by deep hypotension and the anesthesia ``` Signs: EtCO2 decreases Weak pulse Cyanotic mm Dilated pupils Kussmaul type breathing ``` ``` Tx: discontinue anesthetic admin IPPV Chest compression 60x/min O2 supply IV drugs ```
32
Anaphylaxis
Causes: vasoD and incr vessel permeability AB's- penicillin and aminoglycosides Just after drug admin there is: spO2 decr, weak pulse, bronchospasm, pulmonary edema ``` Tx: Stop giving the drug IPPV O2 Give epinephrine, AH's etc ```
33
Intraoperative hypotension: what it is and causes:
Happens with inhalational more so than TIVA or PIVA Make sure ABP is over 70mmHg, foals should be lower Myocardial depression- endotoxaemia Bradycard Hypovolemia, acidosis and electrolyte imbalance--shock
34
Intraoperative hypotension: consequences
``` Poor tissue perfusion Postop myopathy SC ischaemia Cerebreal necrosis Myocardial dysfunction ```
35
Intraoperative hypotension: treatment
Infusion-- electrolyte, colloid, hypertonic (+)inotrop-- dobutamin calcium
36
During maintenance
hypovent-- V/Q mismatch-- hypoxemia | decr CO
37
Hypoxemia and hypoxia: what it is and causes
Hypoxemia: paCO2 is less than 60mmHg Hypoxia: inadequate tissue oxygenation ``` Causes: Failure in O2 supply Hypoventilation Problems with endotracheal tube Distended abdomen putting pressure on thorax RAO Acute pulmonary edema Shunt ```
38
Hypoxemia and hypoxia: Methods of improving
Early vent--IPPV Increase FiO2 Albuterol bronchoD Pulsed delivered NO
39
Hypercapnia: What it is, causes, effects and treatment
When paCO2 is greater than 45mmHg Causes: Resp centre depression Hypovent Incr CO2 prod Effects: Symp stim Arrhythmia, resp acidosis Intracranial P incr Tx: IPPV-- get to anesthesia depth
40
Postop myopathy: causes and treatment
``` Causes: Large body Long anesthesia time Inadequate padding Intraop hypotension and hypoxemia ``` ``` Tx: Adequate padding Assistance in standing Mild cases- exercise and walking Mannitol infusion Vit E and selenium Massage ```
41
Postop neuropathy
Caused by inadequate padding and conditioning, overextension of limbs Radial, femoral and facial nerve injury Treatment similar to myopathy
42
Postop laryngeal edema: what it is, causes and treatment
Spinal cord myelomalacia-- very severe in young- hypotension, embolus "dog-sit position- loss of deep pain- poor prognosis Cerebral cortical necrosis- severe and fatal Causes: Bilateral nasal/ laryngeal edema Bilateral laryngeal neuropathy- hemiplagia Negative pressure pulmonary edema Tx: Temp tracheostomy
43
Anesthesia of risk patients: foals-- considerations
Pulm changes within the first few hours Circ changes within 3 days PaO2 is less in lateral recumbency (10-15mmHg) than it is in standing-- provide O2 if in lateral recumbency Lung and chest compliance is less than in adult
44
Anesthesia of risk patients: foals- preoperative evaluation
Congenital heart defect very high risk because the ductus arteriosus can reopen- hypoxemia or acidosis Colostrum intake- measure IgG- if less than 800mg/dl- give plasma infusion or colloids Blood glucose- hypoglycaemia- not sucking, bacteremic
45
Anesthesia of risk patients: foals-- fasting
Neonatal- allowed to suck If tube fed- withold milk- sick foals have delayed gastric emptying Foals over 3 months- max 4-6 hrs fasting
46
Anesthesia of risk patients: foals- Newborns thermoregulation
CO2 production is HR dependent so avoid bradycardia Small body mass, low fat, large surface area leads to significant heat loss High metabolic rate- leads to hypoxia and hypoglycaemia faster than it would in adult horses ``` Effects of hypothermia: decr MAC bradycard and decr CO decr perfusion decr metab incr bleeding time delayed recovery with incr O2 consumption ```
47
Anesthesia of risk patients: foals- sedation
T=Young easily become recumbent Have to prevent hypotension and hypoglycaemia Always provide O2!!! Drugs: Butorphanol BZD: diazepam midazolam give exact dose IV Xylazine and detomidine- only to not critically sick and older- because of the CV SE's Medetomidine and romifidine IV All low doses to effect Avoid giving in the sick neonatal foal
48
Drugs to neonatal foals
``` Injectable Considerations: High sensitivity of receptors High TBW and plasma fluid Permeable BBB Low albumin therefore low plasma protein binding .. but weaker drug metabolism-- longer lasting effect Inhal can have a lower MAC ```
49
Anesthesia of risk patients: foals-- Induction
INHALATIONAL ANESTHETICS ARE NOT RECOMMENDED In neonates after minimal sedation Facemask/ nsotracheal tube Very quick uptake of these drugs With IV Drugs: Light plane: ketamine and xylazine Deep plane: ketamine and xylazine and alpha2 agonist Propofol on its own
50
Anesthesia of risk patients: foals-- maintenance
Inhal or TIVA or PIVA | PIVA: ketamine, isoflurane and lidocaine
51
Anesthesia of risk patients: foals-- Monitoring
They have a lower blood pressure bradycardia <50 beats High RR- this is why the inhal an are very rapidle acting Endotracheal intubation difficult-- therefore easier to get hypercapnia PaCO2 is less than 50-60mmHg- small volume breathing circle needs to be used Active heating Check blood glucose-- give IV dextrose if very low During recovery get to sternal recumbency ASAP because of the compliance of thorax
52
Anaesthesia of Geriatric Horse: general considerations
``` Over 20 years of age Loss of functional reserve Lower ABP Lower ventricular filling Lower TBW Lower metab, liver, kidney and heart function ```
53
Anaesthesia of Geriatric Horse: sedation
ACP IM and xylazine and butorphanol IV
54
Anaesthesia of Geriatric Horse: anesthesia
Not a good option Inhal, TIVA, PIVA-- IPPV is essential Preferred: Neurolept- analgesia and local anesthetics-- in standing position
55
Anaesthesia of Geriatric Horse: monitoring
``` positioning body temp thermoreg decr ABP supporting- hypovol ECG dysrrhythmias Blood gas analysis ```
56
Anaesthesia of Geriatric Horse: some age associated diseases
RAO Cushings Aortic valve insufficiency Hypothyroidism Recovery with assistance
57
Anaesthesia of donkeys and mules: general considerations
Narrower, deeper larynx and trachea-- smaller ET Jugular catheterization is more difficult Faster elim of drugs- therefore more freq dosing needed-- around 30% higher than for a horse Plasma GGT is 3x greater than horses Sedation: IM first then give IV alpha2
58
Anaesthesia of donkeys and mules: maintenance
TIVA: triple drip: alpha2 and ketamine and GGE- small donkeys can be easily OD, GGE sensitivity- hemolysis PIVA Inhal an NSAIDS- shorter elim half life than horse Opioids Prone to hypoxemia
59
Anaesthesia of horses with intestinal emergencies (colic): general considerations
10x greater risk--which is multifactorial- CV compromise and endotoxemia
60
Anaesthesia of horses with intestinal emergencies (colic): Preop Evaluation
Hypovolaemic shock: HR, Pulse and CRT all incr cyanotic and pale mm Abdominal pain, shock- stomach and intestinal distension Endotoxaemic shock
61
Anaesthesia of horses with intestinal emergencies (colic): Preparation
1. Stomach tube- for better resp and CV function 2. Fluid therapy: Isotonic fluids-- maybe intestinal edema and reflux Hypertonic saline Colloids Acid-base correction
62
Anaesthesia of horses with intestinal emergencies (colic): Sedation and analgesia
``` Xylazine NSAIDS Opioids can combo with alpha2 agonist Antiendotoxin like polymixin B ABx- penicillin or gentamicin before induction ``` PHENOTHIAZINES ARE CONTRA!!
63
Anaesthesia of horses with intestinal emergencies (colic): Maintenance and recovery
IPPV- can actually further compromise CV give low dose Isoflurane, make sure there is adequate oxygen PIVA: Lidocain CRI If theres hypocalcaemia give Dobutamine in an infusion slowly with calcium Recovery is usually slow
64
Anaesthesia of pregnant mare: general considerations
Paramount to maintain BP and normal O2 Minimal surgery time-- minimize the fetal exposure Big belly presses against thoracic cavity- intraop hypovent and hypoxemia-- IPPV is therefore NB!!!
65
Anaesthesia of pregnant mare: sedation
alpha2 opioids-- but they can cross the placental barrier Flunixin can block PGF2alpha release- ensures fetus is not lost after uterine manipulation
66
Anaesthesia of pregnant mare: Maintenance
Inhal: isoflurane half-lateral recumbency to avoid v.cava compression TIVA can cause fetal bradycard if continuously given PIVA lidocaine can be toxic
67
Anaesthesia of pregnant mare: Monitoring
ABP Blood gas analysis Fetal HR If doing C-section- give oxytocin to prevent blood loss Trendelenberg position- worst position for pregnant mare becuase put more P on the thorax
68
Anaesthesia of pregnant mare: Recovery
Myopathy: because large body, hypotonia and hypoxemia Mare is exhausted so needs assistance Fracture risks: so calcium decreases
69
Hyperkalemic periodic paralysis (HYPP) | Signs and treatment
``` GA can act as a trigger Signs: Hyperkalemia Tachy/ bradycardia ECG changes Hypotension Muscle tremor Hypercapnia Normothermia ``` ``` Treatment: Ca-gluconate infusion Dextrose inf insulin all act to move K out of blood into the IC space ```
70
Anaesthetic and equine malignant hyperthermia
Freq: QH's, thoroughbred, appaloosa, arabian, pony When an. for more than 3hrs ``` ETCO2 incr PaCO2 incr Muscle rigidity Tachpnea Body temp incr 2nd metab acidosis- arrhythmia, CK and K incr ``` Mechanism: the volatile anesthetic stim Ca release from the SR into the myoplasm-- muscle contration-- heat and acid prod Tx: Pure O2 IPPV TIVA and good monitoring is preferred Dantrolene to block the calcium release
71
Anaesthesia of horse with RAO:
``` Prior to surgery: Secretolytic and bronchodilator Inhal an: IPPV and O2 supplementation is essential Longer insp and exp phase- defective elastic recoil- airway closure Albuterol into ET- Ventolin spray ```
72
Anaesthesia of horse with CV problem
Rare!! is usually secondary
73
Anaesthesia Practice- principles
``` Physical exam Catheter site Lavage of oral cavity Premed Induction Intubation Reflexes in surgery-plane Recovery ```
74
Anaesthesia Practice: physical exam
``` CV and resp systems!!! Heart beat auscultation at least 5 mins on both sides ]Auscultate lungs both sides RR and quality of breath Intestinal- colic Conjunctiva and mm CRT in the mouth Core temp ```
75
Anaesthesia Practice: Catheter site
Clipping Clean with soap Disinfection with alcohol containing solutions No LA or sedation to be used through it Secure with one-stitch suture- short term
76
Anaesthesia Practice: premedication drugs
IM in semitendinous muscle | IV for sedative e.g xylazine
77
Anaesthesia Practice: Reflexes in surgery plane
Remains: Corneal reflex Ventromedial rotated eyeball Pupillary light reflex Gone: Palpebral reflex Nystagmus Tears
78
Anaesthesia Practice: recovery
Stop inhal an and disconnect the breathing circuit Move to recovery box ET remains with the inflated cuff- give O2 and then remove it Cover shoes with tape Keep in lat recumbency for as long as possible
79
Anaesthesia practice: IPPV
Volume icr-- injury to lung Pressure incr-- less injury to lung small: 10 H2Ocm large: 20 H2Ocm
80
Anaesthesia practice: TV
In generak 10ml/kg bw, for a thin horse it is more
81
Anaesthesia practice: O2 consumption
Minimum 2-3ml/kg
82
Types of narcosis systems
Open Semi-open Semi-closed Closed
83
Narcosis system- open
No - rebreathing balloon - CO2 absorption - re-breathing
84
Narcosis system- semi-open
Yes- rebreathing balloon No- CO2 absorption Partial- rebreathing -pendulum like cyst
85
Narcosis system- semi-closed
Yes - rebreathing balloon -CO2 absorption Partial- rebreathing
86
Narcosis system- closed
Yes - rebreathing ballon - CO2 absorption - rebreathing
87
Anaesthesia machine: components
``` Mixing part Breathing circle Endotracheal tube IPPV (when is it indicated) Monitoring ```
88
Anaesthesia machine: Mixing part
``` Gas source Regulator and reductor valves, manometer Flow meter: l/min- max is 10l/min O2 flush valve/bypass Vaporiser= out of circuit ```
89
Anaesthesia machine: Breathing circuit
Y-shape rebreathing hoses Rebreathing balloon/bag- needs to be at least 2x thhe TV CO2 absorber- sodalime or sodium and Calcium hydroxide Pop-off valve Central scaveneger apparatus and tube One- way inhal and exhal valves
90
Anaesthesia machine: Endotracheal tubes
Cuffed silicone | Bifurcation at shoulder joint
91
Anaesthesia machine: IPPV and when is it indicated
``` When RR <2-6/min Large abd volume causes dyspnoea Open thorax surgery Resp acidosis Hypoxemia nd hypercapnia ``` It is a pressure limited ventilator- insp pressure should reach 20 H2Ocm at the end of inhalation, at expiration should be >0 H2Ocm Volume/time limited To return to spontaneous at the end of IPPV: decr iso and incr O2-- and watch capnogram
92
Anaesthesia machine: Monitoring
``` Eye Pulse MM Breathing frequency and quality ECG RR Pulsoximetry <90%--- IPPV Capnography: ETCO2> 45Hgmm-- hypercapnia Blood gas analysis- use arterial sample: pH <7.35-- acidosis (ABE < 2.5) PaCO2 > 45mmHg-- resp acidosis-- hypercapnia HCO3 < 20mmol/l-- metabolic acidosis ``` If ABP > 70mmHg- give Dobutamine
93
Stages and planes of GA
``` I stadium analgesiae II stadium excitationis III stadium tolerantiae III/1 superf III/2 surgical- this is the one that has to be reached III/3 deep III/4 stadium paralyticum ```
94
General anaesthesia: CV system- ECG
Rate and rhythm Leads: Left- caud to olecranon and electrode Right: caud to olecranon Neutral: on loose skin on chest
95
General anaesthesia: CV system-- heart rate
Normal: 35-45/min brady < 25/min tachy > 55/min Frequency largely determines CO
96
General anaesthesia: CV system-- causes of bradycardia
Dtugs: alpha2, opioids, OD any anaesthetic Increased vagal tone Metabolic: hypotherm, end stage hypoxaemia, hyperkalemia Heart diseases
97
General anaesthesia: CV system-- causes of tachycardia
Light level of anaesthesia- slight nociception during surgery Drugs- ketamine Metabolic- hypovolemia, hypoxemia, hypercapnia Endocrine- pheochromocytoma, hyperthyreoidosis Heart diseases
98
General anaesthesia: CV system-- Blood pressure
Indirect: not useful in horses but maybe in foals, on forelimb and tail Direct: Facial, transv facial and metatarsalis Normotension systolic: 90-130 mmHg diastolic: 60-90 mmHg mean: 70-110 mmHg Hypotension When systolic is under 80mmHg and /or mean is under 60 mmHg-- compromised cerebral and coronary perfusion Hypertension When systolic pressure is above 180mmHg and/or mean pressure above 140 mmHg-- edema and bleedings in the brain and lungs
99
General anaesthesia: Resp system-- changes
Apnea- can even occur during light anaesthesia Bradypnea-- deep anesthesia hypothermia Tachypnea-- occurs during light due to hypoxemia, hypercapnia, atelectasis airway obstruction
100
General anaesthesia: Resp system-- pulse oximetry
Measures HB oxygen saturation, emits red and UV light Normal: 98-99% Hypoxaemia: < 95% Severe hypoxaemia: < 90%
101
General anaesthesia: Resp system-- partial pressure of oxygen in the arterial blood (PaCO2)
``` Determined by blood-gas analysis Normal: 80-110 mmHg Hypoxaemia- anything under 80 Severe life-threatening hypoxaemia under 60 mmHg Hyperoxaemia- above 110mmHg ```
102
General anaesthesia: Resp system-- Capnography
``` Uses infrared light absorption technology- can be side-stream or mainstream CO2 of exhaled air End tidal CO2 partial pressure/conc Resp status Ventilation Perfusion Metabolism ```
103
General anaesthesia: Resp system-- Temperature
Hypothermia is not a big issue because of the large size, but may be an issue for foals

Equine Surgery and Medicine (10 decks)

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