thoracic surgery

Question 1

what is a thoracotomy?

Answer 1

incision of the chest wall

Question 2

what is an intercostal/lateral thoracotomy

Answer 2

performed by incising between ribs

Question 3

what is a median sternotomy

Answer 3

performed by splitting the sternum

Question 4

what is a pulmonary lobectomy

Answer 4

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

Question 5

what is a complete lobectomy

Answer 5

removal of a lung lobe

Question 6

what is a partial lobectomy

Answer 6

removal of a portion of a lung lobe

Question 7

what is a pneumonectomy

Answer 7

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

Question 8

indications for thoracic surgery

Answer 8

diagnostic biopsy, cardiovascular surgery, pulmonary lobectomy, tracheal sx, esophageal sx, mediastinal neoplasia, thoracic duct ligation

Question 9

what are techniques for emergency stabilization

Answer 9

stabilize rib segments, thoracentesis, oxygen therapy

Question 10

what is one of the most common regions injured following blunt trauma

Answer 10

thorax

Question 11

how many animals having blunt trauma also have thoracic injuries

Answer 11

3/4

Question 12

how many animals have concurrent abdominal and thoracic injury

Answer 12

1/2

Question 13

how should an animal be positioned for large neoplastic lesions

Answer 13

sternal or lateral recumbency with affected side down with supplemental oxygen

Question 14

what can be used to detect and define the severity of respiratory impairmnet

Answer 14

blood gas analysis/pulse oximetry

Question 15

how should patients be induced and intubated

Answer 15

rapidly

Question 16

describe intubation of a bronchus in compromised animals

Answer 16

disastrous

Question 17

when should prophylactic antibiotics be given

Answer 17

give at induction and repeat once to twice at 90 min to 2 hours intervals

Question 18

when should therapeutic antibiotics be initiated

Answer 18

at the earliest signs of infection - leukocytosis, fever

Question 19

what are the common surgical approaches to the thorax

Answer 19

lateral approach - left or right
median sternotomy

Question 20

how should the skin incision extend for an intercostal thoracotomy

Answer 20

just below the vertebral bodies near the sternum

Question 21

which retractor is used to hold the ribs open

Answer 21

finochietto retractor

Question 22

how should residual air from the thoracic cavity be removed when closing an intercostal thoracotomy

Answer 22

remove residual air using the preplaced thoracostomy tube or an over the needle cathetoer

Question 23

if exposure of the lungs of heart is necessary, where is the location of the median sternotomy

Answer 23

should extend from the xiphoid cartilage cranially to the second or third sternebra

Question 24

if exposure of the cranial mediastinum is desired, what is the location of the median sternotomy

Answer 24

extend from the manubirum caudally to the 6th or 7th sternebra

Question 25

how should the sternebrae be transected during a median sternotomy

Answer 25

transect longitudinally on the midline with a sternal saw, bone saw, or chisel and osteotome

Question 26

if a thoracostomy tube is to be placed, when should this be performed for a median sternotomy procedure

Answer 26

before closing the sternotomy

Question 27

where should the thoracostomy tube exit

Answer 27

exit from between the ribs or through the diaphragm, not between the sternebrae

Question 28

what should be done during closure of median sternotomy procedure

Answer 28

remove residual air from thoracic cavity

Question 29

if respiratory excursion are inadequate, what should be evaluated post op

Answer 29

evaluate thorax to verify that residual air was removed after closure

Question 30

what if there is inadequate ventilation due to pain post operatively?

Answer 30

median sternotomy may cause decreased ventilation compared to intercostal thraocotomy

Question 31

if post op hypoventilation, thoracic rads are indicated to rule out...

Answer 31

pneumothorax, hemothorax, pulmonary edema

Question 32

is hypo or hyperthermia common after thoracic surgery?

Answer 32

hypothermia

Question 33

what is the incidence of pyothorax after thoracic surgery?

Answer 33

6.5% in a study of 232 dogs with a mortality rate of 67%

Question 34

what prevents delayed healing or nonunion of the sternebrae during median sternotomy?

Answer 34

adequate closure and leaving several sternebrae intact

Question 35

what are indications for a median sternotomy

Answer 35

mediastinal tumors, pericardiectomy, spontaneous pneumothorax, trauma, exploratory thoracotomy, cranial lung lobe tumors

Question 36

what should be avoided when closing median sternotomy with wire

Answer 36

double loop cerclage wiring should be avoided due to high failure rate under load