Exam 2: Lecture 17: Pre-operative Assessment and Preperation - LA Flashcards
Before taking a LA into surgery, who should we communicate to
referring vet, owner/trainer/agent, and insurance company
before taking a LA into surgery, what should we do for animal prep
Get this history, confirm the need for sx, PE, any additional diagnostics, and prep for anesthesia
What is the role of referring DVM in communication
a liaison, complete referral history, post-op management, and case followup
what should we tell the owner/trainer/agent
risks of sx, risk of anesthesia, intra-operative communication, outcomes, progress of post-op, finances, and insurance
why should we talk to the insurance company before surgery
not all horses are insured so make sure to ask
why should we talk to insurance before euthansia
because sometimes euthanasia can forfeit the insurance policy and they want you to do everything you can to save the animal
what factors increase risk for LA anesthesia
- more time = more risk
- larger horses have more complications
- Age
- a high ASA score
- hypotension
- quality of induction
before we anesthetize any animal, what should we always have the owner do
sign a consent form!!
what are the surgical outcomes we should talk about to the owner
- communicate all possible negative outcomes to client before sx
- talk to the owner about the intended use for the horse and what the problem/sx is
what are some post-op expectations we should mention
is there a proper set up at home?
medications, bandage changes, stall rest, complications
when talking to owner about finances for LA sx, what is important to remember to do
give an accurate estimate and update regularly (esp if there are any changes in procedure/condition)
what are some things we talk about with intra-operative communication
if there is severe disease, if there are complications during sx, or if we need to euthanize during sx
What are inherent risk factors
signalment and medical history
what are some variable risk factors
primary disease (physical and cardiovascular status), elective vs emergent, and extent of procedure
what is important to get in the history for pre-op information
past medical treatments (including any surgeries and anesthesia), nutritional status, vaccination status, and owners perception of the problem
what specific inherent factors increase risk
foals (<1 yr), geriatric (>20 yr), cardiopulmonary status, increased size of patient
what are the specific variable factors that can increase risk
morbidity/mortality status, body system involved, severity of injury, and progression of disease
what surgeries have the greatest variable risk factor
colic and fractures!
T/F: Emergency surgery does not increase morbidity/mortality possibility
false, emergency surgery does increase both of these
what are the categories of ASA risk classification
I, II, III, IV, and V
what is the physical status and clinical example of a category I ASA
physical - normal healthy patient
clin - routine castration, routine arthroscopy
what is the physical status and clinical example of a category II ASA
physical - patient with mild system disease
clin - pregnant, obese, skin tumor removal
what is the physical status and clinical example of a category III ASA
physical - patient with severe systemic disease
clin - dehydration, anemia, fever, hypovolemia
what is the physical status and clinical example of a category IV ASA
physical - patient with severe systemic disease that is a constant treat to life
clin - sepsis, colitis, emaciation, severe dehydration
what is the physical status and clinical example of a category V ASA
physical - mortibund (point of death) patient not expected to survive sx
clin - colon torsion, severe trauma
what is included in the PE o pre-op
weight and drug calculations, careful auscultation of heart and lungs, demeanor of animal, lameness/neurological issues?, wounds near sx site
what should we always do for ortho sx
double check the leg !!! and confirm lesion previously described
what are the 4 classifications of surgical wounds/procedures
- clean
- clean-contaminated
- contaminated
- dirty
how should we treat dehydration pre-op
IV fluids
how should we treat anemia pre-op
blood transfusion
how should we treat hypoproteinemia pre-op
colloids
how should we treat electrolyte imbalances pre-op
IV fluids +/- electrolytes
under what conditions should we delay elective sx?
fever or systemic illness, abnormal bloodwork, wound near sx site, any cardio abnormalities
if we notice something pre-op that we think should delay sx, what should we ALWAYS do
communicate that with the owner!
when should you delay an emergency sx
if the patient is unstable but can be stabilized before surgery or if the patient is stable enough to delay for normal business hours
how do we prep equines for general anesthesia
fast overnight, free choice of water, groom/pick feet, place jug cath
how do we prep ruminants for general anesthesia
fast for 24-48 hours (decreased rumen volume to decrease regurg), withhold water for 24 hours, +/- catheter placement
how do we prep camelids for general anesthesia
fast overnight, free choice water, place jug cath
what is the most important question for surgery in the field
is performing the surgery in the field what is best for the patient? Does it compromise the care?
what 5 things should we consider when doing surgery in the field
- proper facilities
- equipment needed
- personnel needed
- patient care
- weather
what animal(s) is/are standing surgery common
cattle and TBD for equine depending on procedure
why is standing cattle the best for sx
because it has the best abdominal approach
what procedures can we do for equine standing
laparoscopy, enucleations, and mass removals
what type of anesthesia do we use for standing sx
none vs bolus vs CRI
also can use local or regional nerve blocks
what is a tilt table for cattle
it is a table that puts cattle on their side
what are the advantages and disadvantages of a tilt table
advantages - good restraint for foot/distal limb procedures, sedation/anesthesia
disadvantages - expensive, need sedation or anesthesia, must be fast bc of bloat or neuropraxia
explain the history we should get for equine colic surgery
detailed history from client and rDVM
explain the history we should get for elective arthroscopy surgery
specific to ortho problem, previous rads
explain the history we should get for bovine LDA
drop in milk production/feed intake, typically within weeks of parturition
explain the PE we should do for equine colic sx
complete PE, GI focus
explain the PE we should do for elective arthroscopy
complete, focus on specific problem, may do a lamness evaluation first
explain the PE we should do for bovine LDA
complete, GI focus, PING
explain any other diagnostics we should do for equine colic sx
complete colic work up: rectal, NG tube, ultrasound, bloodwork +/- abdominocentesis
explain any other diagnostics we should do for bovine LDA
chemistry or blood gas with electrolytes and UA
explain any other diagnostics we should do for elective arthroscopy
PCV/TP, review radiographs +/- new rads if needed
explain any antibiotics (If any) we should use for equine colic sx
broad spectrum, injectable, penicillin/gentamicin most common
explain any antibiotics (If any) we should use for elective arthroscopy
none, some people give one dose pre-op
explain any antibiotics (If any) we should use for bovine LDA
generally none (milk withdrawl on abx)
explain any pain management we should use for equine colic sx
flunixin meglumine - pre-op and several days post op
explain any pain management we should use for elective arthroscopy
phenylbutazone or flunixin meglumine for several days
explain any pain management we should use for bovine LDA
flunixin meglumine - day of sx and day after
explain pre-op prep we should do for equine colic sx
emergency sx - performed immediately
explain pre-op prep we should do for elective arthroscopy
admit the day before sx, withhold feed overnight, free choice of water
explain pre-op prep we should do for bovine LDA
semi-emergency, no withholding feed
what position should we put patient in for equine colic sx
dorsal recumbency, general anesthesia
what position should we put patient in for elective arthroscopy
dorsal or lateral recumbency, general anesthesia
what position should we put patient in for bovine LDA
standing procedure, right paralumbar fossa block
what is the prognosis for equine colic sx
good to grave, lesion dependent (may not know until we are in sx)
what is the prognosis for elective arthroscopy
excellent to guarded, lesion dependent (may change during sx)
what is the prognosis for bovine LDA sx
good, fairly routine sx
