C Section Ruminant Flashcards
What are the 2 Paravertebral Nerve blocks?
1) Proximal
2) Distal
How can you block the paralumbar fossa in cattle?
1) infiltration anesthesia
- Line block
- inverted L block
2) Paravertebral Nerve block
- Proximal
- Distal* (what we did in lab)
What are the 2 infiltration anestheia blocks used to block the paralumbar fossa?
1) inverted L
2) line block
Why is infiltration anesthesia more risky than para vertebral, in ruminants?
Because you will be approaching the lidocaine toxic dose.
5mg/kg
-goats more sensitive dilute to 1%
What is the toxic dose of lidocaine for ruminants?
5mg/kg
-goats more sensitive dilute to 1%
Describe the parameters for line block/ inverted L
- 1cm deep (SQ)
- 2-7cm deep (Muscle
- 1-2 Mls per site
How do you do the inverted L block
- Parallel to the last rib
- under the transverse process of the lumbar vertebrae
- all the way to the tuber coaxe
What are the advantages of infiltration anesthesia?
EASY to perform
What are the disadvantages of infiltration anesthesia?
- large amounts of lidocaine required (easy to reach toxic dose)
- anesthesia may be inadequate
- more block required to enlarge incision
- Lidocaine in incision site (delays healing)
What are the parameters of the Proximal paravertebral nerve block
Blocks: T13, L1, L2
-dorsal and ventral roots
What nerves provide sensation to the paralumbar fossa?
T13, L1,L2
-dorsal and ventral roots
What are the advantages of the Proximal paravertebral block
1) less lidocaine than infiltration
2) excellent anesthesia of ENTIRE FLANK
3) No lidocaine in incision
What are the disadvantages of Proximal paravertebral block?
1) more difficult to perform
2) scoliosis to side of block
3) Ataxia ( if migration of lidocaine to L3)
4) Risk of penetrating major vessels/ spinal chord
What Nerves does the distal paravertebral nerve block block?
Same nerves
What are the advantages of performing the DISTAL paravertebral nerve block over the proximal?
1) easier to perform/ regular size needle
2) no scoliosis
3) less risk of ataxia
4) less risk of damaging vessels/ spinal chord
What are the disadvantages of the Distal paravertebral nerve block?
*variable position of the nerves = potential failure
What are the indications for performing a C section?
To relieve or prevent dystocia :
1) maternal indication:
- small pelvis
- abnormal pelvic conformation
- uterine inertia/torision/rupture
- hydrops (amnion, Allantosis)
- Vaginal constriction
2) fetal indication:
- oversized fetus
- fetal malposition
- fetal monsters/emphysematous fetuses
What does a reproductive examination for dystocia involve?
1) vaginal examination
- cervix dilation
- calf Presentation, Postion, Posture
- Dead/Alive, monster/emphysematous
2) Transrectal palpation
When performing a C section from which side do you approach?
LEFT
-easier to manipulate rumen than SI
- Standing = most common
What is the standard approach to C section in cattle?
Standing PL fossa celiotomy (LEFT side)
Where do you make the incision for C section in cattle?
Caudal 1/3 of the left paralumbar fossa
- 10cm ventral to the transverse process
- extend incision ventrally (40cm)
What are the muscle layers that are cut during a C-section?
- Skin
- EAO
- IAO
- transverse abdominal
- Peritoneum
Why make the C-section incision in the caudal 1/3 of the PL fossa?
Ease exteriorization of uterus
T/F: you should attempt lifting the uterus out during a C- Section in cattle?
FASE
-Do not attempt lifting uterus
*grasp limb (MT3/MC3) and rock uterus towards incision
How would you close the uterus following C-section in a cow?
1) Single layer
- ONLY if live calf and no IU contamination (closed cervix—> elective C-section)
- continuous inverting
- avoid mucosal penetration
Or
2) Double layer
-simple continuous + and inverting sutuer:
——>Lemberg
——>Utrecht
——>Cushing
(DO not penetrate the mucosa)
The closure of the uterus following C-section is dependent on What?
- calf alive or not
- IU contamination
WHat suture pattern has been associated with better fertility following C-section?
Utrecht suture patter
Other than the standing PL celiotomy (standard) what approach can be used for C-section?
Left oblique Celiotomy
1) gravity horn readily exteriorized
- lesss strength needed to exteriorize uterus
- large calves
- minimized abdominal contamination
2) anesthesia of ventral body wall may occur
3) Incision 10 cm cranial and 10 cm ventral to cranial aspect to TC
- extended cranioventrally @ 45 degrees
- end 3 cm caudal to last rib
- grid technique
When should you use the Ventral midline celiotomy approach?
1) fractious cattle not amendable for standing Sx
2) Recumbent cows
40 cm incision starting just cranial to udder
-extend cranially
More risk of vessel damage
-mainly in diary cattle
What vien runs just cranial to the udder?
MAjor Transverse vein
What is the best approach for a recumbent cow that requires Celiotomy?
Ventrolateral
What C-section approach is recommended when you have an EMphysematous calf and why?
Ventrolateral Celiotomy
- minimalists abdominal contaimination
- want to be able to bring the uterus out of the abdomen before incising
Describe Ventrolateral celiotomy (C-section)
1) incision parallel to superficial mammary vien
- mark vien when cow is standing (more prominent)
- Axial to vein
2) time consuming
3) large incision
- wound care
- wound closure
Why is the Paramedian celiotomy approach a poor surgical approach for C-section?
1) dorsal recumbancy —> CV compromise
2) Poor holding layer for closure
3) hemorrhage
4) No additional advantages—> NOT recommended
What are the complications of C-section?
1) Peritonitis, Metritis (ET), Adhesions
2) wound infections
- 25% more with emphysematous fetus
3) 15% decline in fertility vs vaginal delivery
4) calf survival rate 60%
- shorter duration of Sx
5) Cow survival rate 80%
- uterus exteriorization upon Sx
- removal of blood clots upon Sx
- no retained placenta
What is the survival rate of the calf during C-section?
60%
What is the survival rate of the Cow during C-section?
80%
Decreased mortality due to:
1) uterus exteriorization
2) removal of blood clots
3) no retained placenta
What percent decline in fertility do you have with c-section compared with vaginal delivery?
15%
What is another indication for C-section in SMALL Ruminants ?
Pregnancy ketosis
What are the most commonly used approaches for C-section in SMALL ruminants?
1) PL fossa Celiotomy (STANDARD)
2) Ventrolateral approach
3) ventral midline Celiotomy
