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CVNT2 > Surgical Approaches - Respiratory > Flashcards

Surgical Approaches - Respiratory Flashcards

(72 cards)

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1
Q

What does BOAS stand for?

A

Brachycephalic obstructive airway disease

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2
Q

How can the nares differ in dogs with BOAS?

A

Nares are stenotic

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3
Q

How can the soft palate differ in dogs with BOAS?

A

Overlong, interacts with epiglottis

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4
Q

How can the tonsils differ in dogs with BOAS?

A

Tonsils are hyperplastic

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5
Q

What can happen in the diaphragmatic region of dogs with BOAS?

A

Hiatal hernia due to force exerted trying to breathe

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6
Q

How can the trachea differ in dogs with BOAS?

A

Can be hypoplastic causing narrow airway

Everted laryngeal succules can be pulled into the trachea and cause obstruction

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7
Q

What is stertor?

A

Snoring noise caused by partial obstruction of the upper airways at the level of the pharynx and nasopharynx

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8
Q

What is stridor?

A

High-pitched breathing sound commonly associated with laryngeal disease

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9
Q

What can happen to the larynx in severe BOAS cases?

A

Laryngeal collapse

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10
Q

What are the risk factors for BOAS in bulldogs?

A

Males
Moderate/severe stenotic nares
Thicker neck
Wider and shorter skull

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11
Q

What are the risk factors for BOAS in french bulldogs?

A 
Males 
Moderate/severe stenotic nares 
Thicker/shorter neck
Shorter/wider skull 
Proportionally shorter muzzle
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12
Q

What are the risk factors for BOAS in pugs?

A 
Female 
Moderate/severe stenotic nares 
Obese 
Proportionally wider distance between eyes 
Wider/shorter skull
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13
Q

How do narrow nares exacerbate symptoms of BOAS?

A

Dramatically increases the resistance to air flow into the nose
Cartilage support of nares tends to collapse during inspiration

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14
Q

How does an elongated soft palate exacerbate symptoms of BOAS?

A

Partially obstructs air flow into the trachea

Causes turbulent airflow in the larynx

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15
Q

Is laryngeal collapse progressive?

A

Yes

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16
Q

Which breed is most commonly affected by tracheal hypoplasia?

A

English bulldogs

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17
Q

What owner considerations should be made for BOAS patients?

A 
Avoid stress/heat 
Use harness (not collars) 
Avoid obesity 
Carefully managed exercise regimes 
Oxygen therapy 
Awareness of signs of respiratory distress
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18
Q

What nursing assessments should be done with BOAS patients?

A

TPR
Mucous membranes
SpO2
BOAS grading assessment with vet

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19
Q

What 5 procedures are involved in the multilevel surgical correction of BOAS?

A 
Soft palate resection 
Tonsil resection 
Nostril resection 
Removal of everted laryngeal saccules 
Laser-assisted turbinectomy
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20
Q

Why should a full biochem/haematology assessment be carried out before BOAS surgery?

A

Identify any extra risk factors for surgery

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21
Q

Why should patients be pre-oxygenated before BOAS surgery?

A

Pre-oxygenate for at least 5 mins - delays oxygen desaturation at induction

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22
Q

What ocular considerations should be taken with BOAS surgery patients?

A

Ocular lubrication regularly peri-operatively

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23
Q

How can intubation of BOAS patients be made easier?

A

Good lighting/laryngoscope
Urinary catheter can be used as a guide
Have rescue ET tube plus range of sizes

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24
Q

What is involved in patient prep for BOAS surgery?

A

Oral mouth rinse e.g. hexarinse

Nares - dilute clorhex/idodine

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25
How should patients for BOAS surgery be positioned?
Sternal recumbency Use 2 drip stands either side of table to tie mouth open Tilted table helps prevent regurgitation
26
What should oxygen saturation be maintained at during BOAS surgery?
>98%
27
What should end tidal CO2 be during BOAS surgery?
35-45mmHg - use capnography
28
Which breathing circuits are appropriate for BOAS surgery?
High flow rates - circle, T-piece, bain
29
What should blood pressure be maintained at during BOAS surgery?
>60mmHg (mean)
30
What are the common complications of BOAS surgery?
Airway swelling Vomiting and regurgitation Aspiration pneumonia
31
When should BOAS surgery patients be extubated?
When they will no longer tolerate ET tube - keep in sternal recumbency with head elevated
32
Should BOAS surgery patients still be given oxygen supplementation after extubation?
Yes - mask/flow by
33
How should exercise be restricted during recovery from BOAS surgery?
5-10 mins twice daily for 6 weeks, always on harness
34
What food should be given to patients recovering from BOAS surgery?
Solid wet food for 6 weeks post-op - limit airway irritation
35
What is laryngeal paralysis?
A condition where the vocal cords are unable to abduct in response to exercise and respiratory demands
36
What are the possible causes of laryngeal paralysis?
Idiopathic Ageing changes (degenerative) Congenital disease Trauma Cancerous infiltration of nerve which controls laryngeal muscles
37
What are the signs of laryngeal paralysis?
Exercise intolerance Noisy respiration Coughing/gagging/dysphagia Change/loss of vocal sounds (dysphonia) Cyanosis and collapse (if severe)
38
How are mild cases of laryngeal paralysis managed?
``` Anti-inflammatories Antibiotics (where indicated) Sedatives Raised feeding Manage exercise, reduce stress ```
39
How are severe cases of laryngeal paralysis managed?
Laryngeal tie-back (Unilateral arytenoid lateralisation)
40
Where is the laryngeal tie-back surgery performed?
Left side of the neck
41
What is achieved during a laryngeal tie-back surgery?
Left arytenoid cartilage is permanently abducted
42
What should be considered for post-operative care after a laryngeal tie-back procedure?
Small regular soft meals Avoid dusty feed/atmospheres Raised food/water Wound management
43
Why shouldn't animals which have had a laryngeal tie-back surgery be allowed to swim?
Risk of aspiration of water too great - permanently open trachea
44
Where can palate defects occur?
Clefts of upper lip, hard and/or soft palates
45
What are the clinical signs of a palate defect?
Difficulty feeding | Nasal discharge
46
How are congenital palate defects managed?
Surgery performed at 3-4 months - closure of tissues separating the oral and nasal passages with minimal tension
47
How are acquired palate defects managed (e.g. RTA trauma)?
Primary/secondary closure depending on severity of damage caused
48
Which dogs are most likely to suffer with tracheal collapse?
middle aged small and toy breeds
49
how is tracheal collapse caused?
degeneration of the tracheal cartilage rings leads to dorsoventral flattening of the trachea
50
what re the signs of tracheal collapse?
dry, harsh, loud cough (goose honk) triggered by excitement/exercise/eating stridor may build up over weeks/months
51
how is tracheal collapse diagnosed?
through radiography, bronchoscopic imaging (endoscopy) and fluoroscopy
52
how is tracheal collapse graded?
``` according to percentage of collapse of lumen grade I = 25% grade II = 50% grade III = 75% grade IV = total loss ```
53
what are the management options for tracheal collapse?
``` weight loss management harness avoiding smoky atmospheres medical surgical ```
54
what is involved in medical management of tracheal collapse?
weight loss and controlled exercise programmes removal of environmental irritants pharmacological - antitussives, steroids, bronchodilators (antibiotics only if secondary infection present)
55
what are the surgical methods for managing tracheal collapse?
only grade II or higher extraluminal ring prosthesis intraluminal stent placement
56
what are the complications of extraluminal ring prosthesis?
vascular damage tracheal ring migration coughing, dyspnoea laryngeal paralysis due to iatrogenic nerve damage
57
what are the advantages of intra-luminal stent placement?
less invasive surgery than prosthesis | flexible materials available
58
what are the disadvantages/complications of intraluminal stent placement?
stent can fatigue under pressure (repeated coughing) | excessive inflammatory tissue around the trachea
59
what is involved in patient prep for extraluminal ring prosthesis?
dorsal recumbency - prep large area of ventral neck pre-oxygenation careful handling calm/stress free
60
what is involved in patient prep for intraluminal stent placement?
``` lateral recumbency fluorosopic guidance pre-oxygenation careful handling calm/stress free ```
61
what are the key aspects of post-op care after respiratory surgery?
calm and quiet environment monitor respiration constantly initially, give flow-by oxygen analgesia and sedation raised head to reduce aspiration risk maintenance of IV access, access to crash box suction equipment ICOE
62
what is a lateral thoracotomy?
surgical incision performed between the ribs - excellent view of one side of thorax
63
what are the indications for a lateral thoracotomy?
lung lobectomy | abscessation, lung lobe torsion, neoplasia
64
what is a median sternotomy?
surgical incision through sternum - provides view of bilateral thorax
65
what are the indications for a median sternotomy?
pyothorax mediastinal masses heart surgery
66
what is a tracheostomy?
emergency procedure to bypass the nares/pharynx/larynx/proximal trachea - artificial opening in the neck
67
what are the indications for a tracheostomy?
facilitate anaesthesia when airway is compromised stabilise patient and allow airway management provide definitive airway until swelling/obstruction is resolved
68
with which conditions may a tracheostomy be required?
BOAS laryngeal paralysis laryngeal trauma foreign body
69
what is involved in the care of a tracheostomy?
24/7 high level monitoring for maintenance/comfort/asepsis prevent buildup of secretions through suctioning/cleaning tube tube care every 15 minutes until stable, then every 4-6 hours
70
what should you be continually checking for in patients with a tracheostomy tube?
harsh respiratory sounds dyspnoea/coughing/distress discharge discomfort stoma - pain/swelling/heat (clean 3-4x daily)
71
what is involved in suctioning of a tracheostomy tube?
always pre-oxygenate at least 5 mins before aseptic technique sterile, soft, pre-measured catheter placed and suction unit turned on for 15 seconds as withdrawing
72
why should you aid humidification in patients with a tracheostomy tube?
it bypasses normal humidification in the URT - can cause damage to mucosa and thick mucus

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