Intro

Question 1

Surgery is a discipline!
There is a system of rules by which the art of surgery is practiced. Such rules applies to:
Asepsis
Anesthesia
Tissue manipulation
Suturing
Adherence to the rules helps ______________. The rules of asepsis are probably the most crucial to an acceptable outcome…

Answer 1

to reduce the frustrations & complications of surgery

Question 2

Otherwise known as complete asepsis, it refers to exclusion of all micro-organisms, this degree of asepsis is impossible. (e.g. it impossible to sterilize skin or the environment)

Answer 2

Integral Asepsis

Question 3

It implies that all practical steps are taken to achieve complete asepsis. In this context, micro-organisms can gain access to surgical wound without resulting an infection.

Answer 3

Relative Asepsis

Question 4

Surgical Asepsis
Involves the ________________ to preserve an inherent defenses.

Answer 4

relative exclusion of micro-organisms and careful handling of tissues

Question 5

How to protect tissue defenses?

Answer 5

1.Limit exposure.
2.Minimize imposition of foreign materials (sutures, blood clots etc.).
3.Preservation of circulation.

Question 6

How much less than ideal aseptic tech. can be & still preclude infection depends on:

Answer 6

*Species involved

*Susceptibility of tissues to become inflamed

*The type and number of micro-organisms present

Question 7

Sources of contamination:

Answer 7

Surgical Instruments
Environment
Personnel
Animal patient

Question 8

All instruments, implants, and equipment w/c are to be used during surgery must be sterilized before use: Sterilization can be divided into 2 types:

Answer 8

*Cold Sterilization process
*Heat sterilization process

Question 9

– dry heat (oven), autoclave (steam under pressure), moist heat (boiling)

Answer 9

Heat sterilization process

Question 10

• the use of chemical solutions.

Answer 10

Cold Sterilization process

Question 11

factors that influence wound infection include:

Answer 11

> Duration of surgery
Surgical technique
Impaired host resistance
Contamination of the wound

Question 12

What is the most widely used and efficient method of sterilization?

Answer 12

Autoclave

Question 13

Autoclave -
Items w/c may be sterilized:

Answer 13

surgical instruments
drapes
gowns
swabs
most rubber articles
glasswares
some plastic goods

Question 14

Items which may be damaged in the autoclave:

Answer 14

1.fibre-optic equipment
2. lenses and plastics
3. dispossable items like catheters

Question 15

The surgical team

Answer 15

1.Surgeon
2.Assistant surgeon/Scrubbed nurse
3.Anesthetist
4.Circulating assistant

Question 16

Duties/responsibilities of the Surgeon:

Answer 16

Considered as the team of captain.
Take responsible in the pre-op, intra-op and post-op.
Take responsible in the surgical judgment.

Question 17

Duties of the Asst. Surgeon:

Answer 17

1.Prepare the instrument trolley.
2.Assist in draping the patient.
3.Pass instruments, swabs, etc. to the surgeon.
4.Assist with surgery: retract tissue, cut sutures, etc.
5.Be responsible for all equipment, swabs, sutures, needles etc.

Question 18

Duties of the Anesthetist:

Answer 18

1.Responsible in the objective assessment of the surgical patient.
2.Administer the appropriate pre-anesthetic and anesthetic drugs. Has the authority on what anesthetic agents to use to a particular patient and type of operation.
3.Responsible in monitoring the vital signs, maintenance & level of surgical sleep.

Question 19

Duties of the Circulating Assistant:

Answer 19

Help prepare theatre, instruments & equipment for surgery.
Tie the surgical team into gowns.
Help position the patient on the table.
Preparation of the surgical site.
Connect apparatus (diathermy, suction, etc).
Open packs of sutures/instruments etc.
Count swabs, sutures etc. with the asst. surgeon.
Be in theatre at all times when surgery is in progress.
Assist the anesthetist.
Prepare post-operative dressings.
Help clear theatre at the end of surgery.

Question 20

________________ skin & coat are the 2 greatest sources of wound contamination as it is not possible to remove all bacteria from the skin. Common bacteria found in the ____ (_________ and __________)
Potent scrub solutions: chlorhexidine, povidone
iodine.

Answer 20

> Preparation of the skin
skin ( Staph. spp., Bacillus spp., and ocasionally Streptococcus spp.)

Question 21

Potent scrub solutions:

Answer 21

chlorhexidine, povidone
iodine.

Question 22

Preparation of the eyes & mucous membranes – for surgery in this area ___________ are commonly used to irrigate as antiseptic.

Positioning the patient for surgery – there are standard position for specific operation.

Draping the patient – ______,______,_______

Answer 22

> 0.1-0.2% diluted povidone iodine
Plain drapes, Fenestrated drapes, Adhesive barrier drapes.

Question 23

Care of the patient during surgery:

Answer 23

Care must be taken to avoid leaning on animal’s chest.
Careful positioning of towel clips.
Attention should be paid in the conservation of heat esp. in the small or very young patient.
Careful positioning of the patient on the operating table.

Question 24

Immediate post-operative care:

Answer 24

1. Recovery from anesthesia
2. Hemorrhage
   3.Recognition of pain
3. Application of Dressings or Cast
4. Comfort

Question 25

Recovery from anesthesia:

Answer 25

The patient should not be left unattended until it is conscious and sitting-up.
The Endotracheal tube is usually removed just before the cough reflex returns.
Color of the mucous membrane, absence or presence of resp. noise and effort will be indicators of effective ventilation by the animal.

Question 26

The ability to maintain body temp. is lost under anesthesia, so steps should be taken to prevent ________.

Answer 26

hypothermia

Question 27

During recovery the patient should be observed for signs of

Answer 27

external or internal hemorrhage (development of shock)

Question 28

It is important to be able to recognize when the animal is in pain so that proper post-operative analgesia should be instituted.

Answer 28

Recognition of Pain

Question 29

This should be done before the animl regain its consciousness. Take care not to apply too tightly.

Answer 29

Application of Dressings or Cast

Question 30

Comfort

Answer 30

provide comfortable bedding.
turn the animal regularly if it is disinclined or unable to do so by itself.
give opportunities for the animal to urinate, or empty the bladder manually if necessary.

Question 31

The pre-operative procedure of the surgical team:
If good surgical asepsis is to be achieved, all those involved in the surgery should change from their ordinary clothes into correct theatre attire. These includes:

Answer 31

1.Scrub suit/ OR gown
2 Theatre footwear
3 Headwear/OR cap
4 Mask & Goggle
5.OR gloves

Question 32

What is the importance of the pre-operative procedure of the surgical team?

Answer 32

To minimize contaminants/microbes: It has been established that most surgical wound infections occur at the time of surgery, not during the post-operative period.

A normal naked individual may disquamate:
100T- 30 M particles/minute
3T – 50 T are microbes

Question 33

A normal naked individual may disquamate:

Answer 33

100T- 30 M particles/minute
3T – 50 T are microbes

Question 34

PROCEDURE OF SCRUBBING UP
Many different scrub routines have been described and no single tech. is necessarily better than the other, it should take _______. Here’s an example of the general procedure:
Remove watch and jewelries.
Finger nails should be cut short and any nail varnish removed.
Adjust the water supply (ideally elbow or foot operated). Once the scrubbing-up routine has started, the hands should not touch the taps, sink or scrub dispenser.

Answer 34

5-10 minutes
1 Remove watch and jewelries.
2. Finger nails should be cut short and any nail varnish removed.
3 Adjust the water supply (ideally elbow or foot operated). Once the scrubbing-up routine has started, the hands should not touch the taps, sink or scrub dispenser.
4.Wash the hands thoroughly using a plain soap. At this stage clean the nails using a nail pick.
5.Wash the arms up to and including the elbows. Always keep the hands higher than the elbows so the water drains down towards un-scrubbed upper arms.
6.Rinse the hands and then the arms by allowing water to wash away the soap from the hands towards the elbows.
7. Repeat the procedure using a surgical scrub solution eg. chlorhexidine or povidone iodine.
8. Rinse off the scrub solution as in stage 6.
9. Take a sterile scrubbing brush and systematically scrub the hands, palms, wrist, and 4 surfaces of each finger and thumb (back, front, and both sides).
10.Wash the hands and arms is surgical scrub but this time the scrubbing process is not extended .
11. Wash the hands and arms is surgical scrub but this time the scrubbing process is not extended to include the elbow, so that there is no danger that a previously unscrubbed area is touched.
12. Rinse the hands and arms as before.
13. Take a sterile hand towel, holding it at arm’s length . Use4 a different quarter to dry each hand and each arm. Then discard the towel.

Question 35

Putting on a Surgical Gown:

Answer 35

1. The sterile gown (folded inside out) is taken from its sterile pack, held at the shoulders and allowed to open.
2. One hand should be slipped into each sleeve. The circulating assistant should pull the back of the gown over the shoulder (touching only the inside surface of the gown) and secure the ties at the back.
3. With the hand retained within the sleeves, the waist ties should be picked up and held to the sides.

> > > The back of the gown is now unsterile and must not come into contact with sterile equipment, drapes and surgical instruments

Question 36

The hands are kept inside the sleeves while gloving takes place. This tech has the advantage that it minimises the chances of contaminating the gloves, since the outside of the gloves do not contact the skin.

Answer 36

Closed gloving:

Question 37

Closed gloving:
The hands are kept inside the sleeves while gloving takes place. This tech has the advantage that it minimises the chances of contaminating the gloves, since the outside of the gloves do not contact the skin.

Answer 37

1.Hands remain within the sleeves of the gown. The glove pocket is turned so that the fingers point towards the body. (The right glove will now be on the left and vice versa)
2.The glove is picked up at the rim of the cuff of the glove.
3.The hand is turned over so that the glove lies on the palm surface with fingers of the glove still pointing towards the body.
4. The rim is picked up with the opposite hand.
5. It is then pulled over the fingers and over the dorsal surface of the wrist.
6.. The glove is then pulled on as the fingers are pushed forwards.

Question 38

The hands are extended out of the sleeves while gowning. This technique has the disadvantage that the gloves are relatively easily contaminated by skin contact.

Answer 38

Open gloving:

Question 39

Open gloving:
The hands are extended out of the sleeves while gowning. This technique has the disadvantage that the gloves are relatively easily contaminated by skin contact.

Answer 39

1.The glove pack is opened by the assistant.
2 With the left hand, pick up the right glove by the turned down cuff, holding only the inner surface of the glove.
3 Pull on to the right hand. Do not unfold the cuff at this stage.
4. Place the gloved fingers of the right hand under the cuff of the left glove and pull onto the left hand holding only the outer surface of this glove.
5. The rim of the left glove is hooked over the thumb whilst the cuff of the gown is adjusted.
6. Pull the cuff of the left glove over the cuff of the gown using the fingers of the right hand.
7. Repeat for the right hand.

Question 40

With this method the sterile glove is hald open by a scrubbed assistant and the hand inserted. There is a risk of contaminating both personnel involved. This technique is not commonly employed in vet. operating theatre.

Answer 40

Plunge method:

Question 41

Commonly performed surgeries in dogs and cats

Answer 41

SPAY/OVH
CASTRATION
lump removal
digit amputation
exploratory laparotomy
orthopaedics
enucleation

Question 42

Spaying of bitches is recommended for the following reasons…

Answer 42

prevents unwanted pregnancy/puppies
no psuedo-pregnancy
avoids pyometra and other uterine diseases
reduced risk of mammary cancer

Question 43

Castration should be considered

Answer 43

treatment to limit straying
treatment for unacceptable sexual behaviour
medical reasons e.g. prevent or remove testicular cancer, reduce risk of prostatic hyperplasia and peri-anal adenoma
to prevent perpetuation of genetic defects

Question 44

Routine bitch spay

Answer 44

ventral midline incision, laparoscopy (keyhole surgery)
premedicate with Atropine SO4, ACP and opioid e.g. buprenorphine
induce with propofol, intubate, isoflurane/sevoflurane or IV gen. Anesthetic e.g. Zoletil, Ketamine etc..
total surgical time: 20 - 90 minutes depending on patient
post operative analgesia (NSAIDs), meperidine etc.
NO routine antibiotics unless sterility/aseptic tech. Compromised.

Question 45

Routine dog castration

Answer 45

Anaesthesia as for OVH.
2 - 10 minutes surgical time
Post operative analgesia
Single midline prescrotal incision
‘Open’, or ‘closed’ technique
In some dogs (Bassett hounds) may perform scrotal ablation at the same time.

Question 46

Routine Dog Castration
Complications:

Answer 46

Haemorrhage
Infection
Anaesthetic problems - death!!
Pain
Self inflicted trauma
Wound dehiscence