L21: Respiratory and Thoracic Surgery (Ellison) Flashcards
upper airway obstruction in brachycephalic breeds (brachiocephalic syndrome)
-presenting complaint = respiratory distress-stertorous breathing, gagging/regurg, cyanosis or collapse (22%)
6 components of brachiocephalic syndrome***
stenotic nares
elongated soft palate
everted laryngeal saccules
laryngeal collapse/stenosis (arytenoid cartilages come together)
hypoplastic trachea (cartilage ring overlaps, narrowing diameter)
enlarged tonsils
pre-surgical considerations for brachiocephalic syndrome
- tracheostomy site prep
- minimize swelling: perioperative steroids (ie. short-acting hydrocortisone)
Caudal Wedge Technique
- lifts and lateralizes skin folds around nose to correct stenotic nares
- if done in puppyhood, can prevent buildup of negative pressure in nasopharynx and overlengthening of soft palate later in life
Elongated Palate Resection: Cut and Sew technique
- stay sutures on either side and then shorten palate and use monocryl or biosyn (absorbable) to suture oral and nasal tissues
- give steroids to prevent swelling
Elongated Palate Resection: CO2 laser
- no sutures needed
- creates good hemostasis
- traction added then tip of elongated soft palate removed
correction of everted laryngeal saccules
tenotomy scissors used to excise laryngeal saccules and open up more space to breathe
chars. of laryngeal paralysis
- hereditary or idiopathic acquired form (latter more common)
- older large breeds; Labs most common. Huskies have genetic component
- bilateral paralysis usually needs correction. Can get along with unilateral paralysis
- dx: visual exam w/ propofol and laryngoscope
Geriatric Onset Laryngeal Paralysis and Paresis
-progressive, SYSTEMIC condition that includes laryngeal paralysis, neuro signs, megaesophagus, and muscle wasting
Arytenoid Lateralization
- tie-back procedure
- corrects laryngeal paralysis
- atrophied cricoid arytenalis dorsalis m. is elevated using nonabsorbable prolene suture
- aspiration pneumonia most common complication (10%), less commonly: suture pullout, fracture of cartilage
Collapsing Trachea
- mini/toy breeds
- avg. age 7yr
- cartilage hypocellular and deficient in glycoprotein and GAG content
- CS: “goosehonk” cough, severe resp. distress, cyanosis
- tx: stent, medical management (cough suppressant, tranquilizers), extraluminal ring
Temporary Tracheostomy
- make permanent opening in neck
- incision b/w 3rd and 4th cartilage rings
- put loose ligature around cranial and caudal tracheal ring
- tolerated well for first 24hrs, then get inflamm. and mucus production
- larger dogs tolerate better than small dogs/cats
post-op management of tracheostomy
- observation
- oxygen
- suction q2-4hrs
- can put nebulizer up tracheostomy
Dx of Tracheal collapse
-CS
-inspiratory and expiratory rads
-fluoroscopy
-tracheoscopy under general anesthesia to evaluate laryngeal fx!!
+/- transtracheal wash and culture
lifespan of stent
2-3yr (for collapsing trachea); esp. doesn’t work well if there is collapse of mainstem bronchus
common surgical disease of thoracic cavity
- neoplasia
- lung lobe torsion
- lung lobe abscess
- chylothorax
- vascular ring anomaly
- PDA
- pericardial effusion
- pneumothorax
- tracheal collapse (and cervical)
suture material for thoracic sx
prolene
PDS or Maxon
Silk - good for ligating vessels; good knot security
instruments used in thoracic sx
finochietto
DeBakey tissue forceps (used a lot in GI sx)
Right Angled Mixters (good for clamping vessels)
Hemoclips (bleeding vessels, PDA, lung lobectomy cats, thoracic duct ligation)
Approaches to Thoracic cavity
- lateral/intercostal thoracotomy (intercostal most common)
- median sternotomy
- L 4th intercostal space used a lot
- elevate latissimus dorsi, incise through seratus ventralis
closure of thoracic wall muscles
have to wrap encircling sutures around the ribs or it won’t hold
-can use PDS (not rapidly absorbable)
what approach for pericardectomy? Large masses such as thymoma?
median sternotomy`
principles of individual ligation
- tie off pulmonary a. first, then v. (v. is red, a. is blue!)
- use horizontal mattress, oversew
- Prolene, PDS
principles of lung lobectomy
- ligate vessels, sew bronchus
- can use thoracoabdominal (TA) stapling device
what approach allows exploration of entire thorax?
median sternotomy
approach for PDA (DNK?)
Left 4th
appreach for PRAA (DNK?)
left 4th
approach for cranial lung lobe (DNK?)
R or L 4th
approach for cranial mediastinum (DNK?)
R or L 2nd or 3rd
approach for caudal mediastinum (DNK?)
R or L 8th or 9th
approach for middle and caudal lung lobes (DNK?)
R or L 5th or 6th?
approach for thoracic duct (DNK?)
dog: R 8-10th
cat: L 8-10th
