EVJ 2022 Flashcards
ACVS LA Phase II
Hann et al.
EVJ 2022
“acute abdominal dehiscence, multicentre”
-Surgical site infection developed prior to ADD in 28 horses (44%) at a median of 5 days post-operatively (range 1-9 days). Skin dehiscence occurred prior to linea alba dehiscence in 20 horses (32%); 13 of these horses had SSI prior to dehiscence.
-Skin dehiscence occurred at a median of 3 days (range 1-8 days) prior to AAD.
-Septic peritonitis was diagnosed prior to development of AAD in five horses (8%).
-Leakage of peritoneal fluid from the ventral midline incision was reported in three horses (5%) prior to ADD being identified
-Failure of the body wall tissue due to tearing of sutures through the linea alba or rupture of the body wall adjacent to the suture line was identified as the cause of AAD in 46 horses (73%).
-In those horses that eviscerated, jejunum most commonly protruded (n = 18) followed by omentum (n = 6), large colon (n = 6).
-Acute abdominal dehiscence occurred early following laparotomy, at a median of 5 days postoperatively. The four cases (6%) in which AAD occurred subsequent to hospital discharge demonstrate that AAD may rarely occur up to 70 days following initial laparotomy. Careful ongoing monitoring of the incision by the horse-owner/carer and veterinary surgeon overseeing the horse’s care is therefore important, particularly where horses have developed a SSI. Contrary with previous reports,3 leakage of peritoneal fluid from the incision was not a consistent sign of impending AAD in the present study based on evidence from the case records
-most incisions with AAD were closed with a simple continuous pattern
Haspeslagh et al.
EVJ 2022
“NPWT in contaminated versus non-contaminated wounds”
-In noncontaminated wounds, there was significantly less wound retraction in the early healing stages when treated with NPWT (mean difference [95% CI] = 19.2% [13.3%-25.1%]; P = .005), although wound size was not significantly different between NPWT and control wounds at later healing stages.
-Noncontaminated control wounds had a significantly higher neutrophil influx (OR [95% CI] = 1.99 [1.49-2.66]; P < .001) and lower macrophage influx (OR [95% CI] = 0.75 [0.60-0.93]; P = .008) compared with NPWT-treated wounds.
-Contaminated NPWT wounds had a significantly higher bacterial load in the treatment period than in the early and late period after treatment (MD [95% CI] = 42.2% [36.1%-48.3%] and 45.5% [38.5%-52.5%] respectively, both with P < .001).
Hicks et al.
EVJ 2022
“Proximal interphalangeal LCP for pastern arthrodesis”
-Arthrodesis using a three-hole dynamic compression plate (DCP) applied dorsally combined with abaxial transarticular lag screws produced superior outcomes with an 87% return to intended use.
-A 3-hole, 4.5 mm LCP (PIP-LCP) is commercially available for arthrodesis of the PIPJ. The two proximal combi- holes allow use of cortex screws in the dynamic compression unit or locking screws in the thread hole. The distal hole is a stacked combi- hole, which can accommodate either a cortex or locking screw but does not provide for dynamic compression.
-3 month follow-up, average lameness grade was AAEP 3,
-long term followup was a median of 5 years, Fourteen of 18 performance horses were sound for their intended use at long-term follow-up.
-Complications, other than cast sores, were noted in 6 of 30 arthrodeses (20%, CI 8%-39%), including implant infection (3), support limb laminitis (2) and extensor process fracture (1).
Pseudomonas was cultured in implant infections (2) and MRSA (1).
Loomes et al.
EVJ 2022
“recovery of horses from general anesthesia:review of risks”
-Since the elimination of inhalant agent is dependent on cardiac output and alveolar ventilation, as well as specific agent solubility and duration of administration,73 it is more likely that the potential beneficial effect is due to an increase in time allowed for elimination of inhalant anaesthetic as well as provision of additional analgesia.
Xylazine: lay down longer, fewer attempts to stand, more coordinated recovery.
Detomidine: No difference when compared to other alpha-2, improved recovery at 2 ugkgIV
Romifidine: 0.02. mg/kg IV, no difference when compared to xylazine at 0.1 or 0.2 mg/kg
Dexmedetomidine: No significant data.
-A 17% incidence of pulmonary oedema has been reported
The use of an Anderson sling method resulted in good recoveries.
Time to attain sternal and standing was longer but number of attempts to stand were fewer for horses recovering on the air-pillow compared to those recovering in the conventional box.
Head and tail: commonly used in 95% of hospitals surveyed, but no clear advantage over other types of recovery.
Lopes et al.
EVJ 2022
“case series on standing colic surgery”
-Among the eight animals that had the intestine opened during surgery, five survived to discharge.
-Among the 22 animals that did not have the intestine opened during standing flank laparotomy were not euthanised immediately after standing flank laparotomy, 15 (68%) survived to discharge
-Survival based on disease: peritoneum (0/5 survived), SI (5/9 survived) and caecum and/or LC (15/23 survived).
-survival based on procedure: R&A=2 underwent, 1 survived
Louro et al
EVJ 2022
“head and tail rope recovery from GA”
-Multivariable logistic regression analysis showed that head and tail rope recovery (OR 2.2, 95% CI 1.4-3.3, P < .001) and sevoflurane administration (OR 1.6, 95% CI 1.2- 2.3, P = .02) were associated with better quality of recovery when compared with unassisted recovery and isoflurane administration respectively.
-Increasing GA duration (OR 1.0, 95% CI 0.99-1.0, P = .03), increasing intraoperative dosages (in mg/ kg) of thiopental (OR 0.85, 95% CI 0.75-0.98, P = .02) or ketamine (OR 0.67, 95% CI 0.46-0.99, P = .04) were linked to poor quality of recovery
Plevin et al.
EVJ 2022
“ultrasound of osteochondral frags in the PP”
-Sagittal ultrasonography was significantly more sensitive for identification of dorsoproximal P1 fragments than any radiographic category (P <.001). Specificity for sagittal ultrasonography was 87% (95% CI 74%–99%).
-Ultrasonography was shown to have high levels of sensitivity (94%, 95% CI 89%–99%) and specificity (97%, 95% CI 92%–100%) for identification of DPP1 fragments, with transverse ultrasonographic images being more sensitive than sagittal ultrasonography (P = .001).
-When pathology was considered per joint, transverse ultrasonography was also more sensitive than combined radiographic grades ( P <.001) or sagittal ultrasonography (P =.01).
-Although specificity for transverse ultrasonography was 97% (95% CI 92%–100%), compared with 87% (95% CI 74%–99%) for sagittal ultrasonography, no statistically significant difference existed between the specificity of transverse and sagittal ultrasonography ( P =.3).
Smanik et al
EVJ 2022
“CT guided fixation of type II coffin bone fractures”
-86% (95% CI 74%-94%; n = 44) successfully returned to work. Implant infection (n = 15) and distal interphalangeal joint osteoarthritis (n = 9) were the most common complications, with the latter reducing the likelihood of success (OR = 0.09, 95% CI 0.01-0.7, P = .02).
-The odds of delayed infection decreased by filling the hoof defect with acrylic hoof adhesive rather than poly(methyl methacrylate) and deeply countersinking the screw head (OR = 0.08, 95% CI 0.02-0.38, P = .001).
-Radiographic healing was not associated with likelihood of success.
-Thoroughbreds were 92% less likely to return to work compared with Standardbreds (OR 0.08, 95% CI 0.010.7, P = .02).
-There was no significant difference in association between non-racehorses and Standardbreds ( P = .7) for returning to work.
-Horses with DIPJ osteoarthritis were 91% less likely to return to work than those without osteoarthritis (OR 0.09, 95% CI 0.01-0.7, P = .02).
Vermedal et al. EVJ 2022
“harness horses, laryngeal tie forward”
-Thirty of the 95 horses (31.6%, 22%-41%) re-presented to the hospital due to suspected recurrence of URT problems postoperatively. Twenty of these 95 horses (21.1%, 13%-29%) were diagnosed with recurrence of iDDSP (mean 248 days, range 46-708 days).
-The current study revealed a prevalence of around 43% for complex (≥2) forms of exercise- induced URT disorders in harness racehorses diagnosed with iDDSP. This study also revealed a prevalence of 36.7% for complex forms of exercise induced URT disorders in horses that returned for recurrence of URT problems following LTF.
Acutt et al.
EVJ 2022
“DDFT tendinopathy and distal lesions on MRI”
-Lesion location and type were recorded. Distal DDFT lesions were found in 75% (95% CI: 66.0-84.0) of total cases of pastern DDF tendinopathy and in 97% (95% CI: 91.6-100.0) of cases with core lesions of the DDFT in the pastern.
-The majority (18/27, 63%, 95% CI: 43.9-82.1) of horses with DDF lesions in the proximal pastern (P1A or P1AB) did not have concurrent tendinopathy within the foot.
-Conversely, the majority (57/61, 93%, 95% CI: 86.6-99.4) of horses with DDF lesions in the distal pastern (P1C, P1BC) and with tendinopathy throughout P1 (P1ABC) did have concurrent foot DDFT lesions.
Broyles et al.
EVJ 2022
“laryngeal function prior to tie back”
-horses diagnosed with laryngeal function grade III.2/III.3 had 1.88 times higher odds of racing after surgery than horses diagnosed with grade IV
-laryngeal function grade did not influence the mean postoperative earnings per start.
Hawkins et al.
EVJ 2022
“oblique and straight sesamoidean ligament MRI”
-76% had unilateral limb lameness, 24% had concurrent lameness in other limb with OA of DIP and PIP being more common.
ODSL: 79% painful when palpating between P2 and DDFT compared to only 44% of SDSL injuries which were painful over midline of DDFT on back of P2
Blocking: 78% blocked to abaxial sesamoid, 94% to lateral/medial palmar/plantar nerves (L4/6, anaesthesia of the lateral/medial palmar/plantar nerves).
Radiograph: Only four cases (10%) had radiographic abnormalities consistent with ODSL injury.
-Ultrasonographic examination identified SDSL injuries (Figure 3) in 15/16 (94%) of cases and ODSL injuries (Figure 4) in 20/26 (77%) of cases.
-Standing, low field MRI: In 18 (72%) cases, MRI abnormalities consistent with ODSL (10/14, 71%) or SDSL (8/11, 73%) injury were identified. The most common findings consisted of increased signal intensity, enlargement, presence of periligamentar fibrosis and enthesopathy
-SDSL injuries were more common in the forelimb (13/21, 62%), whereas ODSL injuries were equally distributed between fore- (15/30, 50%) and hindlimbs (15/30, 50%).
-Thirteen of fifteen (87%) hindlimb ODSL lesions were within the lateral ODSL and 9/15 (60%) forelimb ODSL lesions were within the medial ODSL. Twenty-five of 30 (83%) ODSL injuries were located within the proximal third of the ligament.
Krause et al.
EVJ 2022
“synovial sepsis hosp versus ambu”
-The frequency of septic synovitis was 10.4 cases per 10 000 injections, or 1 in 967 injections.
Performing injections in the field (P = .2) or without antibiotics (P = .7) did not alter the risk of synovial sepsis.
Nelson et al
EVJ 2022
“slab fractures of 3rd carpal bone in radial and intermediate facets”
-The injury occurred during racing in 59% (CI 39%-80%; n = 13) horses, during training in 14% (CI 0%-28%; n = 3) of horses
-Of the 22 horses with C3 slab fractures involving both radial and intermediate facets, 91% (CI 79%-100%; n = 20) were characterised as collapsing and 9% (CI 0%-21%; n = 2) as not collapsing on preoperative radiographs.
-Avulsion of the MPICL was documented in 91% (CI 79%-100%; n = 20) of horses (Figure 3; Table S2). C3 comminution accompanying the principal fracture was present in 77% (CI 60%-95%; n = 17) of horses.
-Articular cartilage erosion and osteochondral fracture of the radial carpal bone was observed in 91% (CI 79%-100%; n = 20) and 41% (CI 20%-62%; n = 9) of horses respectively.
Perioperative complications were found in 14%. Support limb laminitis, incisional infection, cast sores.
Pezzanite et al.
EVJ 2022
“cervical vertebral interbody fusion, polyaxial”
-For eight horses with ≥1-year follow-up, improvement of ataxia was seen in 6 (3/6:1 grade, 2/6:2 grades; 1/6:3 grades) with average improvement of 1.25 grades.
-Overall, this technique resulted in at least one grade gait improvement in 6/10 of cases operated and 6/8 of cases for which ≥1-year follow-up was available.
Two mature Tennessee Walking horses (Horses 2 and 10) were noted to have the least improvement in ataxia over the time period evaluated; however, neck comfort was reportedly improved with increased range of motion and willingness to eat off the ground in both cases.
-Three owners noted that complications had occurred associated with the surgical procedure, including implant infection (Horse 6), airway obstruction requiring tracheotomy, neck pain resulting in a thoracic limb gait deficit and mildly elevated creatinine (Horse 9), and post-operative pain (Horse 10).
