Colic 3: Post Op Management/complications Flashcards by Rebecca Harris

What is one of the most important things to manage Post op?

Fluid therapy

VOLUME of fluids most important
Dehydration/electrolyte imbalance
Daily maintenance 50ml/kg/day
Add losses to maintenance 
Electrolytes add to fluids

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What 2 electrolytes imbalances are common post op (exploratory celiotomy) in a horse?

Hypocalcemia

Hypomagnesemia

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What are the supplements post op that should be considered after a horse has an exploratory celiotomy?

K+, Ca, Mg

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What is the Daily maintenance for a horse?

50ml/kg/day

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What are the common causes of Hypokalemia in the horse?

1) lack of intake (only get it from their diet)
2) Diuresis
3) GI loss through diarrhea

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When should you supplement K+ in a horse?

1) lack of intake >24hrs and/or IV fluids >24hrs
* **Remember not greater than 0.5meq/Kg/hr

Usually add 80mEq/5L bag!!!

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What is the maximum K+ a horse can receive?

0.5mEq/kg/hr!!!!!

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What is the goal of post op fluid therapy in a horse?

Maintain vascular volume to sustained cardiovascular output

Mucosal damage—> increased capillary permeability—> fluid/protein loss into interstitial = difficult to maintain vascular volume

Indicators:
HR <80, PCV <50%, TP >4.1

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Post op monitoring: (Refluxing colic and foals)

PCV/TP
Gastric decompression
Exam
CBC/fibrinogen/lactate/electrolyte

PCV/TP q6hrs
Gastric decompression q2-3hrs (if needed)
Exam q1-3
CBC etc… one day post op and 3 days post op

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Following exploratory surgery on a horse when do you discontinue meds?

EAT
afebrile
normal CBC

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What can be given to a horse post op to manage pain and anti-endotoxins effects?

Banamine

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What is lidocaine CRI prescribed for post op in horses?

Anti-inflammatory properties

- post op ileus (POI)

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What are the clinical signs of Endotoxemia?

tachycardia
Abnormal mm (hyperemic, cyanotic)
Pain
edema
hypomotility
GI distention
NG net reflux
Thrombosis/coag disorders

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How do you manage endotoxemia in a horse?

Maintain circulatory volume:

1)FLUIDS!!!!
2)NSAIDS (low does Banamine BID-QID)
3)Anti-endotoxin therapy:
—>Di-tri-octahedral (DTO) smectite (Biosponge)
bind endotoxins, bind clostridium enterotoxin
—>Polymyxin B (bind endotoxins, Lipid A, neutralizes endotoxin)
—>Plasma (colloidal, provides abs)

In cases of DIC —-> Heparin therapy

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What are the 3 risks to look for with Endotoxemia?

1) hypovolemia/endotoxemia (GI stasis, reflux, cap. Prep.)

2) Protein loss (albumin)
—>edema formation (2ndary to protein loss)

3) laminitis

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What are the risk factors for Post op ileus. (POI) in the horse?

BAsically some kinda small intestinal lesion at surgery!

-old horse
-abnormal CBC:
—-PCV>45%
—-High TP and ALbumin
—-Hypergylcemia

anesthesia >2.5hrs
Surgery >2hr
R/A
SI lesions
Ischemic small intestine

What is the incidence of POI in the horse?

10-21%

Up to 40% of all post op deaths in horses treated for colic

What is the most common lesion leading to POI in horses?

-What is the prognosis for POI

Strangulating small intestine

Prognosis = favorable but $$$$

What are the clinical signs of a horse with POI?

Colic, depression
decreased/no borborygmi
elevated HR
increased PCV/TP, electrolyte derangement

How do you diagnose POI in the horse?

Dx:
Rectal Palpatine
U/S
Gastric reflux 12-48hrs post op!

How do you treat POI in the horse?

1) supportive therapy:
- NG decompression
- Fluids
- electrolytes
- antibiotics

2) pro kinetic agents
- Lidocaine (anti inflammatory, free radical scavenger)
- Metoclopromide
- erythromycin (we do not use this very much causes pain)

How does Lidocaine CRI help with POI?

1) decreases catecholamines
2) supremes primary afforestation neuron activity
3) directly stimulates smooth muscle
4) inhibits:
- prostaglandin = decreases inflammation in gut wall
- granulocyte migration/lysosomal enzyme release
- free radical production

What is important to remember about the administration of Lidocaine CRI?

Toxicity
Can cause muscle fasciculations, ataxia, SEIZURES

DO NOT BOLUS!!!!!!!!!!! Give it slow over 5 mins

What is metoclopramide used for? And how does it work? What should you be careful of?

Stimulate gut motility in POI!

1) increases ACH release
2) stimulations smooth muscle in stomach and small intestine!!!

Toxicity/ Extrapyramidal effects ()
excitement, restlessness, sweating, SEIZURES

What is the occurrence of incisional complications?

10-37% Not uncommon | -increases with additional surgeries

What is the number one cause of incisional complication?

1) INFECTION!! 2) Hernia 13-16% 3) suture sinus formation 4) Acute incisional dehiscence 2-3%

When would you see an incisional infection? | And what must you do?

``` >= 3 days post op Febrile Pain/edema Drainage Culture ``` Needs abdominal support - minimize hernia/dehiscence

Why would you potentially not use antibiotics in a horse presenting with incisional infection?

Drainage | Resistance

What is the most common complication from incisional infection?

Incisional hernia????

Should you repair an incisional hernia, secondary to incisional infection immediately?

No, do not repair for a minimum of 3 months: - Want to make sure the infection resolves first - allow the incision (body wall) site to heal more,because it has weak granulation tissue that wont hold sutures - need fibrous ring to form, so we have tissue to hold to close that up

What type of repair should eventually be used for incisional hernia treatment?

Primary !!!!! | We don’t really like mesh

How common does Acute total dehiscence of an incision site occur post op? -What are the predisposing factors?

RARE - Violent recovery - severe post op pain - prolonged surgery time - continuous suture pattern!!!!

What is the second most common reasons for repeat surgery? | -who is it more common in?

Adhesions | Foals > Adults

How can you prevent Adhesions Post op?

1) maintain intact mesothelial layer 2) minimize trauma-good technique (wet bowel, hemostasis, minimal suture exposure) 3) decide on surgery in a timely manner 4) Peri-op NSAIDs and antibiotics Peritoneal lavage, HA (everyone one should get a shot), CMC 3% (belly jelly, physical barrier lubricant), omentectomy, DMSO (free radical scavenger, anti edema)

In a horse with Post op peritonitis, why is it important to do a cytological evaluation?

Bacteria Neutrophilic Degenerate

What is a good indicator of septic peritonitis in a horse?

**pH and Glucose** Serum: peritoneal glucose difference >50mg/dL Or Peritoneal pH <7.2 + peritoneal glucose <30mg/dL = septic

What else can be used to diagnose septic peritonitis?

Other than glucose and ph -culture /sensitivity. (Peritoneal fluid) -CBC/Fibrionogen: —->left shift —->thrombocytopenia —->hypoproteinemia

How do you treat Septic peritonitis?

``` Fluids Electrolytes Plasma NSAIDs Antibiotics Possible repeat laparotomy Closed drains ```

WHat is a huge post op complication of an Endotoxemia horse?

LAMINITIS 5x higher risk in horses with endotoxemia