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AAA VMS4001 > Equine Tx + Procedures > Flashcards

Equine Tx + Procedures Flashcards

1
Q

Local anaesthesia

A
  • Procaine (+ adrenaline)
  • Lidocaine
  • Lidocaine (+ adrenaline)
  • Mepivicaine
  • Bupivicaine
  • Local infiltration
  • Intra-abdominal infiltration
  • Para-vertebral
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2
Q

Increasing duration of local anaesthetic

A
  • Combine w/ vasoconstricting drug e.g. Epinephrine (adrenaline)-> slower systemic uptake
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3
Q

Use of morphine

A
  • Epidural
  • Intra-articular
  • Horses only
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4
Q

Local anaesthetic injection sites in head - equine

A
  • Mandibular foramen
  • Mental foramen
  • Infraorbital
  • Mental
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5
Q

Epidural - horse

A
  • Co1 - Co2
  • Lidocaine 0.2 mg/kg + Xylazine 0.17 mg/kg
    OR
  • Morphine 0.1 mg/kg diluted to 10 - 30 mL w/ saline
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6
Q

Open castration

A
  • Standing sedation
  • Parietal tunic is incised to expose testis, epididymis + cord structures before any haemostatic procedure
  • Grab both testes + squeeze caudally so scrotal skin is tight + median raphe is visible
  • Make bold (8 cm) scrotal skin incision(s), 2 cm either side + parallel to medial raphe
  • Prolapse testis through incision + incise parietal tunic
  • Release testis away from body + find ligament of tail of epididymis
  • Cut/emasculate ligament of tail of epididymis (place emasculators 90 degrees to cord, nut to nut) - don’t suture up
  • Apply emasculator nut to nut + leave for 2 min
  • Repeat for other side
  • Sx wound left to heal by second intention
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7
Q

Closed castration

A
  • Surgical incision not made through parietal tunic
  • Hospital conditions - sterile environment - dorsal recum
  • On field - lateral recum, hind limbs restrained
  • Make bold scrotal skin incision (not through parietal tunic)
  • Exteriorise testicle as much as possible
  • Use dry swab to strip fascia back
  • Place transfixing ligature around whole cord - vicryl (not always put)
  • Emasculate distal to ligature - closure of parietal tunic optional (suture)
  • Close skin - intradermals
  • Repeat for other testicle
  • Can do in one or two initial incisions
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8
Q

Semi-closed castration

A
  • Like closed, but parietal tunic is opened to allow inspection inside parietal tunic - better ligature placement = gold standard
  • Make incision in scrotum + exteriorise/prolapse testis + place ligature of 5 metric vicryl (around parietal tunic - may need to make window between parietal + cremastor m.)
  • Make 5 cm incision in parietal tunic to expose testis -> evert
  • Sharp transection of ligament of the tail of the epididymis
  • Optional - second ligature - double ligated w/ transfixing + circumferential - around vas deferens + blood vessels
  • Emasculate distal to ligature - check for bleeding
  • Close parietal tunic w/ monocryl or can leave to heal by 2nd intention on field when opened parietal tunic to inspect for herniation then emasculate everything from cremastor m.
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9
Q

Henderson castration

A
  • Closed castration
  • Low-speed cordless drill w/ sterile clamp attachment
  • Place on testicle + twists at high speed until it tears
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10
Q

Castration local anaesthesia

A
  • 10 - 20 mL along planned incision sites under skin (cranially + caudally)
  • 5 - 10 mL into each testis (will diffuse up into spermatic cord)
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11
Q

Standing sedation

A
  • Alpha-2 agonist + butorphanol
  • Consider nose twitch
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12
Q

Donkey castration

A
  • GA + closed or semi-closed
  • Has larger than normal vessels, require ligation -> inc risk of infection + FB reaction
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13
Q

Sx patient prep

A
  • Clean
  • Tail tied/bandaged
  • Long hair trimmed/clipped
  • Povidone-iodine or Chlorhexidine scrub
  • IV catheter if GA
  • Mouth washed if GA
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14
Q

Pre-op therapeutics

A
  • IV sedatives
  • IV induction if GA
  • IV NSAIDs
  • Prophylactic AB?
  • Tetanus antitoxin?
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15
Q

Pre-med sedation

A
  • IV Alpha-2 agonist + butorphanol
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16
Q

Induction GA

A
  • Alpha-2 pre-med
  • Ketamine + Diazepam IV
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17
Q

IV pre-op NSAIDs

A
  • Flunixin or Phenylbutazone
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18
Q

Pre-op prophylactic AB

A
  • IM procaine penicillin or IV oxytetracycline
    (Cheap, safe, licensed, first line, correct dose)
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19
Q

Prevention of tetanus pre-op

A
  • Tetanus antitoxin + toxoid vacc
  • Should vacc + do procedure later
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20
Q

Open castration post-op management

A
  • Confinement in clean stable for 24 h to allow stabilisation of clots
  • Excercise - start after 24 h, turn out in paddock
  • Oral NSAID administration for 3 d
  • O observe castration site (leave site, don’t manually clean)
  • Maybe oral antimicrobials - TMPS
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21
Q

Closed/semi-closed post-op management

A
  • Confinement in clean stable for several days
  • Return to restricted exercise over next week
  • Oral NSAID admin for at least 3 d
  • O observe castration site (leave site, don’t manually clean)
  • Maybe oral antimicrobials - TMPS
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22
Q

Cryptorchid Sx techniques

A
  • Para-inguinal
  • Inguinal
  • Laparoscopic Sx = standing or GA, more expensive, gold standard when testes abdominal
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23
Q

H+ prevention in castration

A
  • Keep hold of the spermatic cord until assessed H+ w/ Allis tissue forceps
  • Larger/older horses + donkeys - do closed/semi-closed under GA + ligatures
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24
Q

Blood transfusion

A
  • When PCV < 20% in acute bleeding episode
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25
Q

H+

A
  • Don’t panic, give time
  • Try clamping vessel w/ Mixter right angle forceps
  • Packing w/ unrolled bandage
  • GA + clamp/ligate a. - referral if possible
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26
Q

Seroma prevention - open castration

A
  • Big surgical incisions
  • Lots of movement post-Sx = important factor
  • Ligatures not used, risk of H+ + swelling
  • (Stretching incisions will improve drainage)
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27
Q

Seroma prevention - closed castration

A
  • Reduce dead space
  • Good Sx technique
  • Rest + slow return to exercise post Sx
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28
Q

Seroma - open castration

A
  • Re-open wound w/ sterile gloved finger
  • Focus on re-establishing drainage
  • Pos antimicrobials
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29
Q

Seroma - closed castration

A
  • Don’t open wound if not believed to be infected
  • Focus on reducing risk of 2y infection
  • Pos antimicrobials
  • Wound care
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30
Q

Scrotal infection - open castration

A
  • Swab first -> C&S
  • Clean wound w/ antiseptic
  • Thoroughly open wound (gloved finger) + lavage
  • Systemic AB - TMPS, Procaine Penicillin
  • Systemic NSAID - Flunixin meglumine
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31
Q

Scrotal infection - closed castration

A
  • Culture if pos
  • Broad spectrum AB - TMPS
  • Systemic NSAID - Flunixin meglumine
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32
Q

Emasculation of root of penis (iatrogenic penile trauma) from castration

A
  • Emergency referral -> repair or phallectomy
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33
Q

Septic funiculitis (‘Scirrhous Cord’) (castration)

A
  • C&S
  • First line = antimicrobials (recurrent failure of appropriate antimicrobials = Dx)
  • Bold Sx excision of thickened avascular + necrotic tissue
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34
Q

Peritonitis (castration)

A
  • Referral for intensive care - IVFT, supportive care, injectable AB, anti-inflams, +/- peritoneal lavage)
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35
Q

Things protruding from incision site / evisceration of omentum (castration)

A
  • High degree of sterility
  • Pull out as far as possible
  • Emasculate
  • Monitor closely
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36
Q

Evisceration of SI (castration)

A
  • Initial aim to protect bowel from further damage + further contamination + prepare for transportation
  • Make protective sling + urgent transport to clinic w/ Sx facilities
  • Pos - field anaesthetic, lavage, place back in scrotum + suture skin if possible
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37
Q

GA

A
  • General anaesthetic
  • Recum - horses don’t cope well in recum, particularly dorsal, dome of diaphragm, a lot of weight of gut contents on lungs - won’t perfuse blood as well, ventilation problem
  • Full anaesthetic kit
  • GA recovery facilities
  • Accessibility/versatility
  • Evidence base
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38
Q

Standing Sx

A
  • Local anaesthetic - local infiltration of body wall + ligaments that hold structures; intra-abdo infiltration; paravertebral
  • Standing in stocks = safer
  • Specialist Sx kit
  • Specialist approaches
  • New
  • No GA needed
  • In a field - owner’s stables
  • No anaesthetic equipment needed
  • Ovariectomy/Cryptorchidectomy - better Sx access - hanging dorsally
  • Quicker return to work/exercise
  • Better ventilation
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39
Q

Laparoscopic cryptorchidectomy / orchiectomy

A
  • Standing sedation + local block
  • Secure haemostasis - by ligasure
  • Excellent wound healing
  • Rapid return to exercise - flank - within 2 - 4 w
    (Ventral midline - out of work for long time)
  • Can aspirate fluid from ovary if enlarged to make smaller + remove from smaller lateral body wall incision
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40
Q

Old method of ovariectomy / non-laparoscopic

A
  • Colpotomy - incision along ventral midline of cervix through vagina -> access to abdo - surgeon carries Ecraseur through - twists ovaries off ovarian ligament
  • Ventral midline approach
  • Flank approach
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41
Q

Ovariectomy aftercare

A
  • 4 d AB + NSAIDs
  • 1 w box rest + hand-walking
  • 3 w paddock rest
  • Gradual return to exercise
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42
Q

Prevention of recurrence of NSE (nephrosplenic entrapment)

A
  • Laparoscopic closure of nephrosplenic space
  • Place sutures between dorsal aspect of spleen and body wall
  • Stops colon slipping into nephrosplenic space
  • (V rare to have NSE colics)
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43
Q

Ventriculectomy

A
  • By endoscope
  • Excision of saccule - grasping forceps/transnasal burr
  • Ablation of laryngeal saccule - scar tissue forms within saccule
  • Laryngeal ventricles - blind-ended sacs of larynx
  • Removal - dec noise
  • Turn mucosa inside-out and remove - ventrally
  • Clean-contaminated sx - leave incisions to heal by 2nd intention
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44
Q

Laser vocal cordectomy

A
  • Laser used to excise vocal cord
  • Grasping forceps
  • H+
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45
Q

Dorsal displacement of soft palate

A
  • Laser cautery of caudal part of soft palate
  • Repeated application at 2 - 4 mm intervals
  • Total = 1000J
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46
Q

Baseline post-op care of colic patient/abdo Sx

A
  • Analgesia = Flunixin, 1.1 mg/kg/day IV divide into smaller doses
  • CRI IVFT - isotonic, 40 - 60 mL/kg/24 h) - dehydrated, if endotoxaemic, losing fluid from vascular space
  • Intestinal obstruction - still secreting fluid more proximal (SI) from obstruction but cannot be absorbed, fluid absorbed from distal intestinal tract (large colon)
  • Monitor C/V status - HR inc, PCV inc, TP inc, membrane colour - check q 2 - 4 h
  • Protect Sx site - belly bandage
  • Manage - IV cannula
  • Gut motility - don’t feed until normal
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47
Q

Restoration of gut motility post-op colic Sx

A
  • Monitor signs of gut motility
  • Movement, gentle walking
  • Oral fluids + food - fluid by mouth after 12 h, offer small amounts of feed early (12 - 24 h post-op)
  • (Average onset of ileus = 24 h) - inc intestinal secretions, if ileus -> dehydration
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48
Q

Gut motility signs

A
  • US
  • HR + PCV
  • Gastric reflux (q 3 - 4 h)
  • Auscultation
  • Faeces - but still produce w/ ileus
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49
Q

Post-op colic (colic Sx)

A
  • Relaparotomy
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50
Q

Incisional hernia avoidance

A
  • Avoid wound infection
  • Minimise movement/exercise strain - reduce strain on abdo wound
  • Box rest 8 w
  • Paddock rest 8 w
  • Belly band
  • Hernia belt
51
Q

Post-op ileus

A
  • Decompression - pass stomach tube to decompress stomach
  • IV fluids
  • Walk-out in-hand
  • Prokinetic drugs - metoclopramide
  • Lidocaine - anti-inflam/prokinetic?
52
Q

Long-term colic Sx post-op management - once gut motility returned

A
  • Remove cannulas as soon as redundant
  • Re-introduction of oral fluids + feed
  • Small vols of feed given regularly
  • Monitor for signs of colic
  • Monitor for CS BID
  • Maintain belly bandage
  • Frequent walks ‘in-hand; - can graze on lead-rope
53
Q

Long-term colic Sx post-op management - following hospital discharge

A
  • 8 w box rest
  • 8 w paddock turnout before return to exercise
  • Remove skin sutures/stables 10 d post-op
  • Maintain belly bandage, first 2 - 3 w
  • Low energy diet
  • Monitor signs of colic
54
Q

Long-term colic prevention

A
  • Minimise amount of CHO fed
  • Maintain regular feeding + management
  • Monitor gut parasite status + Tx
  • Maintain good dental care
  • Early referral before endotoxaemia -> severe CVS parameters
  • Early detection + Tx
  • Anastomosis choice
  • Dec stereotypies - wind-sucking/crib-biting
55
Q

Osteochondritis dissecans/Chip fractures

A

Arthroscopy
- Removal of OCD fragments
- Debridement of cartilage lesions
- Lavage

56
Q

Synovial sepsis

A

Arthroscopy
- Removal of bacterial debris
- Debridement of contaminated or traumatised tissue
- Lavage

57
Q

Arthroscopy technique

A
  • GA
  • Dorsal recum
  • Sterile prep
  • Drape = imperviously (no gaps)
  • +/- Distend joint prior to making skin portal for insertion of arthroscope
  • Insufflate joint w/ sterile fluid
  • Equipment
  • Triangulation technique - bringing one or more operating instruments through separate portals into visual field of arthroscope w/ tips of instrument arthroscope forming apex of triangle
  • Three holes, two for instruments, one for arthroscope
58
Q

Fx

A
  • Conservative
  • Sx removal
  • Sx repair - fixation
  • Euthanasia
59
Q

Fx fixation

A
  • GA
  • Strict Sx asepsis
  • Pre-op planning
  • AO/ASIF fixation systems
  • Intra-op radio
  • Bandage/cast for recovery
60
Q

Arthrodesis

A
  • Fusion of bones to a joint
  • Best outcomes in low-motion joints, hind limbs have less weight, lighter horses
  • Salvage procedure
  • Pastern arthrodesis - low motion joint, return to modest athletic activity, better Px in hind > fore leg
  • Tarsal arthrodesis - when medication not effective, chemical (kill chondrocytes, articular cartilage) or mechanical (drill across joint surface) arthrodesis, must be no communication w/ PIT (proximal intertarsal) joint - do contrast study
61
Q

Impingement/overriding of dorsal spinous processes (kissing spines)

A
  • Sx ostectomy
  • Interspinous ligament desmotomy
62
Q

Impingement/overriding of dorsal spinous processes (kissing spines) - Sx osectomy

A
  • Bone removal
  • Positioning - standing under sedation + local anaesthetic
  • Spinous process resection - resection of summit of dorsal spinous process impinging
  • Subtotal ostectomy - resection of portion of DSP (dorsal spinal process)
  • 6 m recovery (more invasive)
  • Px = good, 79% return to work
63
Q

Impingement/overriding of dorsal spinous processes (kissing spines) - interspinous ligament desmotomy

A
  • Ligament removal
  • Positioning - standing under sedation + local anaesthetic
  • Resection of interspinous ligament between adjacent impinging DSP
  • 6 - 8 w recovery time (minimally invasive)
  • Px = good, 82% return to work
64
Q

Annular ligament constriction

A
  • Annular ligament desmotomy
  • Open or endoscopically-guided technique
  • Px = excellent
65
Q

DIP flexural deformity of the forelimb

A
  • Inferior check ligament desmotomy
  • Stretches muscle, allows DIP joint to come back to normal
  • Open technique
  • Px = good (w/ hoof trimming)
66
Q

Periosteal transection - angular limb deformity

A
  • ‘Release’ of periosteal tissue on the epiphysis to stimulate growth (growth plate)
  • Transection of periosteum - allows bones to correct w/ bone growth - will compensate for flexion deformities
  • Earlier, the better, foals
  • Releases periosteal constriction - bone grows out after Sx
67
Q

Tendon repair

A
  • Various suture patterns
  • Apposition of severed edges
  • Support in cast for extended period post-op
  • Px = poor, salvage (procedure only)
68
Q

Post-op care of orthopaedic patients - Sx-specific

A
  • Dressings/bandage to protect surgical site
  • Monitor for swelling or discharge indicative of infection
  • Post-op AB - may not be necessary
  • Analgesia - phenylbutazone (NSAID)
  • Removal of sutures/staples 7 d post-op
69
Q

Post-op care of orthopaedic patients - husbandry

A
  • Consider effect of movement on injury repair
  • Controlled return to exercise
  • Low-energy diet
  • Risk of colic
  • Weight-bearing?
  • Analgesia?
  • Foot support?
  • Risk of contralateral laminitis
70
Q

Orthopaedic cast management

A
  • Inspection - integrity, heat (warmer over joints), discharge above?, seal top w/ bandage, early removal if signs of discharge or severe discomfort
  • Duration - maintain for 2 w of comfortable/weight-bearing, remove standing, may need GA to replace half-limb cast
71
Q

Surgical site infection - ventral abdo

A
  • Wound cleaning + lavage - drain -> improve appetite
  • Natural drainage - gravity
  • Once open + draining
  • AB use only if oedema + cellulitis (infection spread in tissues)
  • Most infections in subcut
72
Q

Synovial sepsis

A
  • Rapid < 24 h surgical lavage
  • Intensive AB Tx
  • If left late -> euth
73
Q

Restricting movement of lesion during wound healing

A
  • Stable
  • Even less, maintain standing - cross tying - head collar, lead ropes attached to wall, stopping sitting down, when gets up, puts strain on Fx site
  • Bandage
  • Robert jones bandage - inc layers
  • External support - if suspect Fx, add splint to bandage
  • Cast material
74
Q

Types of wound dressings

A
  • Dry, semi-occlusive e.g. Melolin - sterile, limited absorption capacity - only absorb bit of blood/serum from Sx wound/minimally contaminated, clean traumatic wound
  • Poultices - anything wet to apply hoof wall -> softens hoof wall, keeping moisture in, allowing drainage of e.g. solar abscess
75
Q

Wound management - dealing w/ infection, minimising bacterial load

A
  • Lavage - high-pressure fluid
  • Drainage (passive/active) - incision stays open + pus material drained out
  • Sx debridement
76
Q

Wound suturing

A
  • First intention healing mixed in w/ second intention - be selective about cases
77
Q

Colic - relief of intestinal obstruction

A
  • Enterotomy
  • Evacuation of obstruction
  • Lavage
  • Closure of enterotomy
78
Q

Colic - large colon evacuation

A
  • DV pos
  • Tapwater for external lavage - don’t want to contaminate serosa of intestine, flushing it away
  • Pelvic flexure enterotomy
  • Ingesta into bucket
79
Q

Colic - small intestinal enterotomy

A
  • Use inverting suture pattern
80
Q

Small colon - Faecolith

A
  • Enterotomy
81
Q

Colon displacement correction

A
  • Decompress gas w/ needle
  • Evacuate ingesta - enterotomy incision
  • Manipulate + reposition colon
82
Q

Nephrosplenic entrapment

A
  • Starvation + patientence
  • Gentle exercise e.g. trotting
  • Phenylephrine (40 mg in 1 L saline) + lunge, vasoconstriction causes spleen to contract to dislodge colon from nephrosplenic space -> intestines move out
  • GA + roll - rarely needed
  • GA + laparotomy - only if persistent - any evidence of ischaemia
83
Q

Enterotomy closure

A

Inverting suture patterns: to minimise adhesion formation
- Lembert
- Cushing

84
Q

Intestinal strangulation - intestinal resection

A
  • Ligate mesenteric vessels
  • Cut mesentery - remove ischaemic gut -> secure ligation
  • Section aborally (away from mouth)
  • Decompress via ischaemic gut
  • Section orally
  • Anastomosis - of healthy bowl
  • Aim to restore continuity of gut
  • If > 50% of SI resected, will need diet modification
  • > 60% - consider euth
  • Most important component of post-op care = IVFT for restoration of CVS func
85
Q

End-to-end anastomosis

A
  • Equal diameter ends
  • Two layer technique - mucosal continuous suture, inverting oversew (cushing)
  • 3M absorbable material
  • Close mesentery
  • Lower complication rate
86
Q

Side-to-side (stapled) anastomosis

A
  • Jejuno-caecal anastomosis
  • Minimises risk of contamination
  • Time saving
  • Reinforce ends w/ sutures
  • Can perform hand-sewn equivalent
87
Q

Sampling for histology

A
  • Small piece of full thickness intestine
  • Single layer closure
  • Pot = formalin/Bouin’s
88
Q

No wound contraction below carpus/tarsus

A
  • Skin graft - to provide epithelial tissue to keep granulation tissue in check
89
Q

Proud flesh (exuberant granulation tissue)

A
  • Granulation tissue not sensitive, doesn’t contain nerves
  • V vascular, drapes unerneath
  • Resect/cut
90
Q

Anaesthetic nasal oedema prevention

A
  • Use lateral recum (if pos)
  • Intra-nasal phenylephrine - vasoconstriction to eliminate oedema
  • ET or nasopharyngeal tube for recovery
  • Should correct quickly when horse stands up, but horse has to recovery, only remove ET tube when standing + swallowing - replace epiglottis returns to soft palate
  • If bad acute airway obstruction + attempts to place tubs then tracheostomy
91
Q

Anaesthetic neuropathy + myopathy prevention

A
  • Reduce pressure on all points - remove head collar; padding; lateral: dependent forelimb pulled forward, upper limbs supported; dorsal: don’t allow stifles to lock -> inc muscle perfusion
  • Ensure Major veins unobstructed
  • Avoid tension of nerves – don’t overextend neck or limbs - support neck - if hyperextend can stretch recurrent laryngeal n. + cause laryngeal paralysis
  • Need to allow surgical access
92
Q

Anaesthetic hyopxaemia prevention

A
  • Prevention of V / Q mismatching - low inspired gas conc (30 - 50%) - prevent absorption atelectasis
  • Inc FiO2 if PaO2 is below 100 mmHg
  • Positive-end-expiratory pressure (PEEP) of 5 - 10 cm H2O w/ Intermittent positive pressure ventilation (IPPV)
  • Pre-med w/ ACP to reduce pul shunt
  • [Beta-agonists - clenbuterol injection - too many side effects; salbutamol (albuterol) by inhalation]
93
Q

Anaesthetic hypotension

A
  • Dobutamine
  • IVFT - as infusion
  • Controlled mechanical ventilation
94
Q

Sedatives/antagonists (not licensed but 6 m withdrawal times for FPAs)

A
  • ACP
  • Atipamezole - romifidine antagonist
95
Q

Muscle relaxants (not licensed but 6 m withdrawal times for FPAs)

A
  • GGE (Glyceryl Guaicolate Ether)
  • Diazepam
  • Midazolam
96
Q

GA (not licensed but 6 m withdrawal times for FPAs)

A
  • Propofol
  • Sevoflurane
97
Q

Opioids (not licensed but 6 m withdrawal times for FPAs)

A
  • Buprenorphine
  • Morphine (not licensed)
  • Pethidine
  • Butorphanol
98
Q

Inotropes/vasopressors (not licensed but 6 m withdrawal times for FPAs)

A
  • Dobutamine
  • Dopamine
  • Ephrdrine
99
Q

Local anaesthetics (not licensed but 6 m withdrawal times for FPAs)

A
  • Bupivacaine
  • Prilocaine (EMLA cream)
100
Q

Anaesthesia patient prep

A
  • IV catheter
  • Rinse mouth
  • If using padded induction box - remove shoes or cover
101
Q

Pre-medication for anaesthesia (neuroleptanalgesia)

A

(Sedation - ACP)
- Alpha-2 agonist (in order of inc duration) - xylazine, detomidine, romifidine
- Opioid - butorphanol, buprenorphine, pethidine, morphine

102
Q

Induction of anaesthesia

A
  • Ketamine + central muscle relaxant (midazolam (licensed)/diazepam IV or GGE (guaifenesin) IV to effect
  • Encourage head to dog-sit
103
Q

Maintenance anaesthesia (TIVA)

A
  • Ketamine induction dose gives ~ 10 minutes of surgical anaesthesia
  • Short procedures: maintain
    with intermittent bolus doses of ketamine
  • Long procedures: variable rate infusion (e.g.‘Triple Drip’)
104
Q

Intermittent IV bolus

A
  • Ketamine (1/3 induction dose q 8 min, 2 min onset)
    OR
  • Thiopental 1 - 2 mg/kg when patient moves not licensed, accum may affect recovery
  • Xylazine 1/2 pre-med dose w/ every top up
  • Detomidine 1/2 pre-med dose every other top up
105
Q

Variable rate infusion (triple drip)

A
  • Guaifenesin 10% in 500 mL, Ketamine 100 mg/mL 10 mL + detomidine 10 mg/mL 1 mL or xylazine 100 mg/mL 5 mL / 20 mg/mL 25 mL
  • 1 mL/kg/hr, 2 - 3 drops/s
  • Adv - more stable plant of anaesthesia
  • Disadv - relative cost, 90 min max
106
Q

Anaesthesia monitoring

A

Field
- Physiological parameters - pulse – facial artery; respiratory rate (HR may not change when light)
- Eye pos - unreliable w/ ketamine (doesn’t depress cranial reflex)
Hospital
- Eye Position - central with sluggish palpebral reflex for surgical anaesthesia; too light: eye rotates, palpebral brisk; too deep: eye central, no palpebral
- Pulse Oximeter, Blood pressure, capnography, blood gas analysis, etc

107
Q

Anaesthesia recovery

A
  • Minimise noise/light stimulation - towel over upper eye, pack ears with cotton wool
  • Keep quiet - observe from a distance if in recovery box
  • Usually stay with horse if recovering in field
  • Keep in lateral as long as possible - head collar + lead rope
  • Additional sedation - w/ inhalational if pre-med worn off, unlikely to need in field, shouldn’t need w/ Romifidine - wears off
  • Catheterise bladder
108
Q

Post-anaesthesia analgesia

A
  • Phenylbutazone IV at time of Sx
  • PO for 5 d
109
Q

Standing sedation therapeutics

A
  • Acepromazine 0.03 mg/kg - dec dose, less ataxic
  • Alpha-2 agonist
  • Opioid
  • IV in same syringe (can sometimes exclude ACP)
110
Q

Extending standing sedation duration

A
  • 1). Top-up IV bolus of alpha-2 agonist
  • 2). Alpha-2 agonist infusion
111
Q

Sedation in foals (< 2 w/o)

A
  • Cardiac output directly related to heart rate; hypotension occurs quickly
  • Avoid alpha-2 agonists due to cardiovascular effects
  • Benzodiazepines and opioid combination readily cause recumbency -> short procedures e.g. imaging
  • Sedation: Diazepam/MIDAZOLAM (0.2 mg/kg) + morphine (01. - 0.1 mg/kg)/butorphanol (0.2 mg/kg)
112
Q

Multimodal anaesthesia

A
  • NSAID - Phenylbutazone, Suzibutazone, Flunixin, Firocoxib, Meloxicam, Carprofen etc
  • Opioid - Butorphanol, Buprenorphine, Pethidine or Morphine
  • Local - Lidocaine, Mepivacaine or Bupivacaine
  • Adjunct - MLK (Morphine, Lidocaine and Ketamine) Infusions α-2 agonists, paracetamol, gabapentin
113
Q

Jugular vein catheterisation

A
  • Teflon (angiocath) - short stay, max use 3 d, advanced imaging
  • Polyurethane (Mila) + silicone - longer stay, 3 - 4 w if maintained properly, less rigid, e.g. fluids post-colic Sx
114
Q

Catheter maintenance

A
  • Adequately secured
  • Regularly inspected for kinking, bung/extension secure, skin around catheter kept clean
  • Flushed with heparinised saline at least 4 times daily
  • Injection port wiped with spirit or removed prior to injection
  • ALWAYS check for patency prior to injection
  • Do not leave in longer than necessary or recommended
115
Q

Catheter complications - placement

A
  • Haematoma - puncture of jugular v gone through other side - reposition/apply pressure to area to stop blood flow if hit carotid
  • Catheter tip extravascular
  • Catheter embolism
116
Q

Catheter complications - in-dwelling

A
  • Occlusion of catheter - ensure patency, kinking
  • Thrombus
  • Thrombophlebitis
  • Septic thrombophlebitis
  • Air embolism
117
Q

Common problems encountered in hospitalised horse

A
  • GI problems
  • Unexplained fever
  • Hyperlipaemia
  • Jugular vein thrombophlebitis
  • Unwillingness to drink + inappetence
118
Q

GI hospital issues

A
  • Hospital environment unnatural for horse - used to being turned out + fresh grass
  • Inc susceptibility to - colic, D+ + gastric ulceration
119
Q

Colic - hopitalised

A
  • Stall confinement linked to large colon impactions, 53.7% of horses had increased stall confinement prior to developing large colon impaction
  • Caecal impactions - can develop very quickly, reduced faecal output and mild depression
  • Most at risk: Thoroughbred in training (reduction in exercise), hospitalised for orthopaedic injury, confined to a stall and on NSAID
  • NSAIDs/analgesia - can mask early signs of colic, need to monitor!
120
Q

D+ hospitalised

A
  • Isolate (barrier nursing -> isolation) - pyrexic, systemic signs, suspicious of infection, profuse watery diarrhoea +/- foul smell
  • Identify cause (not always possible!) - Hx, blood, faecal samples - Salmonella (PCR or culture-repeat samples advised, required neg result for 5 d to leave isolatioin) C. difficile toxin analysis, abdominal US
  • Treat symptomatically - restore + maintain circulating blood volume → Intra venous fluid therapy
  • Control systemic inflammation - analgesia/anti-inflam +/- anti-endotoxic therapy
  • Antimicrobial therapy
  • Nutritional support - encourage to eat correct diet
121
Q

Thrombophlebitis

A
  • Immediately remove IV catheter
  • Collect catheter tip and send for culture & sensitivity
  • Avoid catheterising other JV due to risk of bilateral JV thrombosis
  • Hot pack site several times daily
  • Systemic antimicrobial therapy if infection suspected
  • NSAID
    In addition
  • Topical anti-inflammatories e.g DMSO, Compagel
  • Anti-thrombotic: aspirin administered every other day
122
Q

Thrombophlebitis - prevention

A
  • Minimise vein trauma in critical horses
  • Sterility during placement
  • Use minimally thrombogenic catheters
  • Long catheters less complications that short catheters
  • Consider how at risk a patient is – hypercoagulable state?
  • Flush with heparinised saline q 4 - 6 hrs at least
  • Keep catheter site clean and dry
  • Check patency before catheter flushed and drugs administered
  • Monitor for heat, swelling or discharge at catheter site
123
Q

Unwillingness to eat (hospitalised)

A
  • Treat underlying cause
  • Offer a variety of feeds
  • Fresh grass – appetite stimulant
    If no clinical reason to explain unwillingness to drink
  • If horse receiving IVFT then likely sufficiently hydrated
    Fussy horses
  • Bring in water bucket/water from home
  • Flavour the water - apple juice, electrolyte mix
  • Oral salt (30 - 60 g NaCl) to stimulate intake
  • Soak hay and feed to increase fluid intake
  • Place small bore indwelling nasogastric feeding tube for ongoing fluid delivery
124
Q

Hyperlipaemia

A
  • Resolution of underlying disease process
  • Establish positive energy balance
  • Reduce stress to limit anxiety and encourage appetite
  • Most patients inappetent - enteral or parenteral nutrition often required
  • Horse: glucose/dextrose infusion 1-2 mg/kg/min of 50% solution
  • Ponies/miniature horses/donkeys - may also require tube feeding or parenteral nutrition containing amino acids
  • Daily monitoring of triglyceride levels in blood until they have returned to normal limits
  • Px guarded unless diagnosed and treated early

AAA VMS4001 (15 decks)

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