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small animal surgery > approach to the thorax > Flashcards

approach to the thorax Flashcards

1
Q

how will u perform surgfery with fb at base of the heart

A

do lateral thoracotomy at 4th ics

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2
Q

discuss how cardiopulmonary pass is done

A

right lateral thoracotomy at forth intercostal space

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3
Q

discuss the tech n surgical margin for cr. lobectomy

A

right or left lateral thoracotomy at the 5th ics

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4
Q

discuss the tech. and sx area for intermidiate lung lobectomy

A

right lateral thoracotomy at the 6th ics

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5
Q

discuss the tech. and sx location for caudal lung lobectomy

A

right/left lateral lobectomy at the 7th ics

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6
Q

sx tech and location of the thoracic duct in dog

A

ritht lateral thoracotomy at the 8th ics

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7
Q

sx tech and location of the thoracic duct in a cat

A

left lateral thoracotomy at the 8th ics

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8
Q

where do u open thorax to do sx for caudal esophagus

A

9th ics

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9
Q

sx approach for doing cr. thoracic duct in thorax

A

left lateral thoracotomy at the 3rd ics

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10
Q

where do u open the thorax to do the sx on the pda,ps praa,pericardium

A

left lateral thoracotomy at the 4ht ics

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11
Q

discuss sx approach to 4th lateral thoracotomy

A

elevate thorax so that 4th interspace is the highest point

incise parallel rib

cutaneous mm. transected

latisimus dorsi mm. transected or retracted dorsali

n.b be careful with temp in those patients.always hav the bear hugger

leaflests of serratus ventralis mm. sepaated bluntly ventral to dorsaly

cut thru the intercostal mm.-transect ventral to dorsal

stay away from the neuromm. blundle at the caudal margin of 4th rib

incise plura

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12
Q

how to close lateral thoracotomy

A
  • place thoracotomy tube
  • preplace sutures around ribs and tie
  • routine closure of musculature
    • do not suture intercostal mm.
    • close cutaneous trucnhi with subq in small patients
    • do not overlap ribs
  • routine closure of skin
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13
Q

discuss placement of thoracostomy tube

A
  • stab incision in skin and sub q 2-3 ics dorsal n caudal to thoracotomy incision
  • tunnel cranial 2-3 ics,enter pleural space,position tube in thorax
  • place purse string or chinese finger trap suture in skin around tube.
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14
Q

how to close the area after placing the thoracostomy tube

A

preplace the suture(4-6 depending on the size) nt too close bcoz u dnt want to squeez/overlap the ribs with a too tight closure of the primary layer of mm.

remeber on the caudal aspect of each rib there is a neurovascular bundle

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15
Q

post operative care of thoracotomy

A
  • maintain thoracic tube until pleural space is “free” of air and fluid
  • analgesics
    • intercostal nn block
    • narcotic analgesics
    • interpleural bupivicaine
  • thru the thoracotomy tube,bupivicane can be injected and the patient lied on the side u injected so that it baths in bupivicaine.make the patient comfortable to breath
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16
Q

indications for median thoracotomy

A
  • excess to entire lung field for exploratory sx
  • subtotal pericardectomy
  • subtotal pericardectomy
17
Q

discuss the sx tecnique for meian thoracotomy

A
  • dorsal recumbecy
  • cut through the skin/subq
  • peel off pectorialis mm.
  • use rib cutter toseparate sternum from cranial to caudal leaving the sternabra intact to help align afterwards,vice versa if cut from caudal to cranial
18
Q

discuss closing median sternoctomy

A
  • thoracotomy tube placed
  • sternebra closed with orthopedic wire
  • remaining tissues closed routinely
19
Q

discuss median thoracotomy tube placement

A
  • stab incision over 7th-9th ics
  • tunnel cranially 1-2 spaces to enter pleural cavity
20
Q

advantages of median sternotomy

A
  • excess to entire thoracic cavity
    *
21
Q

disadvantages of median thoracotomy

A
  • more lengthly and difficult procedure
  • increased morbidity
    • more severe post operative pain
    • more severe physical dysfuntion- patients may not be able to ambulate without assistance

small animal surgery (7 decks)

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