Equine Respiratory Surgical Approach Flashcards
what is dynamic endoscopy?
where the larynx and pharynx is examined during fast exercise which mimics the conditions when performance is suboptimal
name some of the elective surgical procedures of the equine URT
aryepiglottic fold resection
tie back (prosthetic laryngoplasty) + hobday
tie forward (laryngeal advancement)
soft palate cautery
epiglottic entrapment release
sinus surgery
tracheostomy
name some of the emergency surgical procedures of the equine URT
emergency tracheotomy
occlusion of artery in guttural pouch mycosis cases
trauma
thoracic drain placement
should you starve a horse pre-op?
2 hours for GA, preferable to starve for standing sedation in case it escalates to GA
what are the advantages of standing sedation?
reduced GA risks
may reduce costs
anatomical advantages - access/position, reduced haemorrhage
less facilities and experts required
what are the disadvantages of standing sedation?
not all horses have suitable temperament
less control of situation if complications arise
need environmental control (noise and movement)
limited duration - speed critical
may need to change plan to GA if complications arise
what vessel is used for IV catheter placement for standing surgery?
left jugular vein
why is the left jugular vein used for IV placement in standing surgery?
the left recurrent laryngeal nerve is prone to pathology - placing catheter in left jugular avoids bilateral damage to the laryngeal nerves if there was a perivascular reaction
what drugs are typically used for standing sedation in horses?
ACP premed a2 agonist (detomidine) and opioid combination
what types of regional local anaesthetics are used in standing surgery?
nerve blocks
local infiltration
(lidocaine/mepivacaine/prilocaine)
why might a sinus flap surgery (standing) be performed?
treatment of sinus emphysema, sinus cysts, ethmoid haematoma
what are the advantages of GA for horse surgery?
more control of horse - safer in fractious patients
less time pressure (but takes longer)
less noise/movement sensitive
oxygen available
what are the disadvantages of GA for horse surgery?
extra cost/expertise/time/facilities
1% risk of mortality in healthy horse
airway supervision required at all times
longer duration
which elective procedures are usually done under GA rather than standing?
tie forward
soft palate cautery
which elective procedures are usually done standing rather than GA?
sinus surgery
tracheostomy
which emergency procedure is usually done under GA rather than standing sedation?
occlusion of artery for guttural pouch mycosis cases
why is GA avoided in horse respiratory surgery unless required?
lateral/dorsal recumbency in the horse is likely to cause significant ventilation/perfusion mismatch
what equipment is required for laser equine surgery?
PPE vital - goggles and signage
unlocking device for machine
spare fibre, ceramic scissors, fibre stripper
suction - toxic gases
which anaesthetic gas cannot be used during laser surgery?
nitrous oxide - fire hazard
which elective surgeries can be done via laser?
ventriculocordectomy (Hobday)
aryepiglottic fold resection
sinus surgery (after initial hole is made)
how can you achieve a patent airway intra-operatively?
oro/naso/laryngotracheal tube
tracheostomy tube
how can the airway be protected against aspiration intra-operatively?
use a cuffed tube
suction/absorption (swabs)/drainage
what is the aim of soft palate cautery?
attempts to create scarring and tighten the soft palate to prevent dorsal displacement from occurring
what are the possible surgical post-op complications?
swellings may compromise airway - always have tracheostomy kit available
inhalation pneumonia - monitor breathing and temp post-op
how should a horse be fed after respiratory surgery?
moist, soaked hay/haylage always
high haynet for tie forward to avoid pressure on sutures
from floor for remainder - allows drainage from airway
what analgesia is commonly given after respiratory surgery?
NSAIDs
topical throat spray
what is the post-op management for a laryngostomy?
site is usually left open to drain as contaminated surgery
laryngostomy tube placed at end of surgery for recovery and left in situ overnight
always occlude the tube before removal to ensure horse can breathe on its own
where would a chest drain be placed for fluid collection?
ventral thorax
where would a chest drain be placed for gas collection?
dorsal thorax
what is a thoracoscopy?
procedure to investigate and/or treat pleural/pulmonic disease (exudate from pleuropneumonia, neoplasia, pneumo/haemothorax)
how is a thoracoscopy perfomed?
under standing sedation
set up as laparoscopy
suction and oxygen essential
what is the difference between a tracheostomy and a tracheotomy?
tracheostomy = long-standing, stoma or metal tube tracheotomy = temporary emergency airway access, plastic tube
why might a patient require an emergency tracheotomy?
direct airway obstruction e.g. laryngeal obstruction/paralysis/spasm/oedema, tracheal collapse
external obstruction e.g. abscess, strangles, oedema following trauma
