Surgical Conditions of the Ruminant (incl. Caesarean) Flashcards
(33 cards)
Considerations when preparing for ruminant surgery.
- Handling and restraint facilities.
- Environment.
- Surgical procedure.
- Patient and assistant.
- Considerations for location of ruminant surgery.
- Flooring considerations for ruminant surgery.
- Under cover / outdoors.
- Sheltered from prevailing wind/rain.
- Protection from dust.
- Lighting.
- Under cover / outdoors.
- Non-slip.
- Clean, deeply bedded straw pen.
- Sand.
- Rubber matting.
- Non-slip.
Considerations for restraint for ruminant surgery.
Halter
- securely fitted.
- quick release knot.
- no slack.
Crush
- w/ good side access.
Tail restraint / bull holders.
Small ruminants generally in lateral recumbency. - Tied on a table / straw bale.
Assistance esp. for laparotomy.
Ideally 2 helpers.
– esp. caesarean in cattle.
– one at shoulder.
– one at hip.
Remember farmers are not trained on aseptic technique!
Environmental hygiene implications.
Surgical site heavily contaminated pre-op.
Preparation time-consuming.
High likelihood of contamination during surgery.
Need for perioperative ABX.
Pre-operative considerations.
- Anaesthesia.
- Analgesia.
- Antibiotic therapy.
- Fluid therapy.
- Surgical preparation.
Anaesthesia for ruminant surgery.
- Local anaesthetic techniques.
– Local infiltration.
– Paravertebral (T13 to L2 +/- L3).
– Epidural (L6-S1 or C1-C2). - Speed of onset (5-15mins).
- Licensed anaesthetic agents.
– Procaine w/ adrenaline.
Analgesia for ruminant surgery.
- Pre-emptive NSAIDs.
- Licenced products for cattle are:
– Carprofen.
– Flunixin meglumine.
– Ketoprofen.
– Meloxicam. - No licenced opioids in food producing animals.
Considerations for antibiotic therapy for ruminant surgery.
Responsible use – “As little as possible but as much as necessary”.
- Infection status of surgery
– Non-contaminated (e.g. LDA correction).
– Contaminated (e.g. caesarean section).
– Infected (e.g. Traumatic reticulopericarditis, C section to remove dead calf).
- Risk of contamination during surgery.
- Likely bacteria present:
– G+ = skin.
– G- = GIT, repro tract.
– Anaerobic organisms = GIT, established infections.
- Resistance
- Culture/sensitivity.
- Route of admin.
- Duration of treatment.
Suggested ABX for ruminant surgery.
First generation ABX.
- Aminopenicillins.
- Early generation cephalosporins.
- Tetracyclines.
Fluid therapy for ruminant surgery.
Pre-op assessment.
- Hydration status and degree of shock.
- Likelihood of electrolyte imbalances.
- Acid / base balance.
Surgery condition.
Route and timing.
- IV or oral.
- Pre, intra, post.
Surgical preparation of the ruminant.
- Secure tail in cattle – prevent swishing and surgical site contamination.
- High level of contamination.
- Wide clip of area.
– Consider whether externalisation of viscera will be necessary.
– Generally a 25cm margin sufficient. - Surgical scrub – 2 bucket rule.
- Why is access for laparotomy in the ruminant challenging?
- What does the approach of laparotomy depend on?
- Large abdo size.
- Cranial extension of abdo cavity beneath rib cage.
- Short mesenteries and omenta.
- Rumen obstructs the left flank.
- Large abdo size.
- Area of pathology.
- Familiarity of surgeon.
- Compliance of patient.
- Facilities available.
- Area of pathology.
- Reasons for caesarean.
- Contamination risk of caesarean.
- Other considerations.
- Foetomaternal disproportion.
Malpresentation.
Insufficient dilation of cervix.
Elective. - Calf dead/alive.
- Previous surgeries.
Timing of intervention.
Incision options for laparotomy.
- Ventral midline.
- Paramedian.
- Paralumbar fossa.
- Oblique.
- Paracostal.
- Ventrolateral.
Caesarean section positioning of cow.
- Standing.
– Generally preferred.
– Facilitates easier manipulation of uterus. - Right lateral recumbency.
– If unable to stand.
– or requires heavy sedation to handle.
Anaesthesia for caesarean.
Paravertebral.
- Anaesthetises whole flank.
- Allows extension of incision if required.
Caudal epidural as an optional extra.
- Reduces abdominal straining.
- But risk ataxia.
- 2ml local anaesthetic maximum.
Additional pre-operative considerations for caesarean.
Clenbuterol (10ml Planipart IV in cattle).
Preparation for resuscitation.
Tie a long rope to the contralateral HL.
Use of sedation.
- If required.
- Beware xylazine cause uterine contraction so can make uterus harder to handle.
Additional useful equipment for caesarean.
- Sterile calving ropes.
- Embryotomy knife.
- Uterine clamps.
How to prepare the farmer for caesarean.
- Get 2 clean buckets.
- Scrubbing in?
– sometime needed.
– ASEPSIS! - Ensure farmer aware of calf revival techniques.
Common approach for caesarean.
– Why is it common?
Left sided paralumbar fossa laparotomy.
– Rumen easier to manipulate than distal GIT.
– Minimises egress of viscera and abdominal contamination.
Method of paralumbar fossa laparotomy
- Incise halfway between last rib and stifle.
- Hands breath below lumbar process ventrally.
- Large dorsoventral incision.
– ~40cm.
– avoids trauma to the incision while manipulating uterus.
– think of hock-foot length of calf and add a little bit.
– Shorter incisions would be used for DA surgeries. - Identify and incise muscle layers individually.
– Depth very variable.
–> 3-13cm. - Transverse abdominal muscle and peritoneum should be tented w/ forceps and a cut made carefully into the abdomen.
- Sharp hiss as air sucked into peritoneal cavity.
- Extend incision dorsally and ventrally, using fingers or scissors to elevate body wall.
Incising the uterus and calf delivery in caesarean.
- Determine calf position within uterus.
- Identify closest calf HL in anterior, or FL in posterior and presentations.
- Gently grasp a limb, apply traction and ‘rock’ the limb toward the incision.
- Lock limb in incision, w/ hock over ventral aspect of incision and hoof pointing dorsally.
- Incise uterus outside abdomen to decrease contamination.
- Embryotomy knife can be used to safely incise inside if required.
- Longitudinal incision over plantar metatarsus and hock
– avoid placentomes.
– avoid damage to calf.
– Make incision large enough to avoid tearing. - Other limb identified and exteriorised.
- Calf can be elevated and rotated as an assistant applies traction to deliver, pulling dorsally and caudally.
– Sterile calving ropes can help. - ALWAYS check for a second calf.
Calf revival in caesarean.
- Farmer’s job while you continue surgery.
- Give instructions to help.
- Straw up the nose.
- Cold water down ears.
- Acupuncture site: small needle in nasal septum.
