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Surgery I > Lec 17: Pre-Op Assessment and Preparation LA > Flashcards

Lec 17: Pre-Op Assessment and Preparation LA Flashcards

1
Q

communication before taking LA to surgery must occur between

A

the referring veterinarian, owner/trainer/agent of animal, insurance company

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2
Q

what animal prep needs to be done before going to surgery?

A

patient hx, confirm need for sx, PE, additional diagnostics, prep for anesthesia

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3
Q

what is the role of the referring DVM?

A

they can act as a liaison and offer a complete referral history (records: radiographs, previous tx, conversations with clients about expectations)

they also will be key in post op management and case follow up

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4
Q

what communication needs to take place between the surgeon and the owner/trainer/agent?

A

risks of surgery/anesthesia, intra operative communication, outcomes, progress post op, finances, insurance

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5
Q

what should we always ask before anesthesia of an equine surgery?

A

if their horse is insured

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6
Q

if the procedure is elective anesthesia, the owner must…

A

call the insurance company

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7
Q

Who must call insurance company for permission if it is an emergency procedure? (very rarely do the insurance companies say that the vet cannot take the horse to surgery)

A

The Veterinarian

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8
Q

what do insurance companies often times say when the vet calls about euthanasia?

A

that if they euthanize, the owners forfeit their insurance policy

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9
Q

myopathies, neuropathies, post anesthesia respiratory obstruction are _______ complications that can occur during large animal anesthesia/surgery

A

Non fatal

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10
Q

what risk factors must be communicated to the owner regarding anesthesia?

A

anesthesia time, surgeon experience level, weight, age, ASA score, hypotension, quality of induction

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11
Q

larger horses have ___ complications

A

more

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12
Q

before anesthetizing any animal the owner must…

A

sign a consent form

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13
Q

A consent form is needed for:

A

legal coverage!

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14
Q

ALL possible ____ outcomes should be communicated before surgery

A

negative! (the more informed they are initially, the more forgiving they will be if complications do occur)

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15
Q

communicate and understand the ___ use for the horse

A

intended (if a 3* eventer, may not end up going back to that job even after surgery)

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16
Q

what post op expectations need to be discussed?

A

proper set up (home? different facility?), medicaations, bandage changes, stall rest

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17
Q

if complications arise, _____ will change.

A

instructions (this needs to be communicated to the owner with post op expectations)

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18
Q

what can you NOT decide for the owner?

A

if they can afford surgery/treatment

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19
Q

what is a big difference between large and small animal surrounding finances?

A

veterinarian in large animal discusses finances, not the technician

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20
Q

estimates should be ___ and updated ____.

A

accurate ; updated regularly

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21
Q

what conversations need to be taken place intra-operatively with owner/agent/trainer?

A

findings of severe disease, complications during surgery, possible euthanasia

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22
Q

when deciding to euthanize “on the table” we must do two things

A

get a witness
put their name and information in the medical record

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23
Q

what are two inherent factors to consider risk assessment pre-op?

A

signalment and medical history

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24
Q

what are variable factors to consider risk assessment pre-op?

A

primary disease (physical and cardiovascular status), elective vs emergency surgery, extent of procedure

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25
Q

what patient information do we need to know to assess risk?

A

signalment, medical hx, nutritional status, vaccination status, owner’s perception of problem

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26
Q

foals ___ than 1 year are at an increased risk undergoing anesthesia/surgery

A

less

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27
Q

older horses ___ than ___ years are at an increased risk undergoing anesthesia/surgery

A

older; 20

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28
Q

foals, geriatric patients, cardiopulmonary issues, larger patients, and broodmares are all ___ factors of risk assessment

A

inherent

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29
Q

when considering variable factors in risk assessment,

A
  • examine the associated morbidity/mortality
  • body system involved
  • severity of injury
  • progression of the disease
30
Q

emergency surgery ____ the morbidity/mortality

A

increases

31
Q

what surgeries are at the greatest risk for morbidity/mortality?

A

colics and fractures

32
Q

increased complexity + decreased surgeon experience =

A

increased surgical time & increased morbidity/mortality

33
Q

ASA category 1 examples

A

normal healthy patient
routine castration, routine arthroscopy

34
Q

ASA category II examples

A

patient with mild systemic disease
pregnant, obese, skin tumor removal

35
Q

ASA category III example

A

patient with severe systemic disease
dehydraation, anemia, fever, hypovemia

36
Q

ASA category IV example

A

patient with severe systemic disease that is a constant threat to life
sepsis, colitis, emaciation, severe dehydration

37
Q

ASA category V example

A

moribund patients not expected to survive without surgery
colon torsion, severe trauma

38
Q

things to pay careful attn to in your PE before surgery:

A

weight for drug calcs
auscultation of heart and lungs
demeanor of animal
gait - lame? neurologic?
wounds near sx site

39
Q

additional diagnostics could consist of

A

pre op bloodwork and radiographs

40
Q

why would we do radiographs before surgery?

A

confirm lesion that was previously diagnosed
- DOUBLE CHECK WHICH LEG!

41
Q

describe a clean wound/procedure

A

elective, primarily closed & undrained
- non-traumatic, uninfected
- no break in technique
- no inflammation encountered
- respiratory/alimentary/genitourinary tracts not entered

42
Q

describe a clean-contaminated wound/procedure

A

gastrointestinal or respiratory tracts entered without significant spillage
- oropharynx entered
vagina entered
- genitourinary tract entered in absence of infected urine
- minor break in technique

43
Q

describe a contaminated woubd/procedure

A
  • major break in technique
  • gross spillage from GI tract
  • traumatic wound, fresh <4 hours after trauma
  • entrance of genitourinary tract or biliary tract in presence of infected urine or bile
44
Q

describe a dirty wound/procedure

A
  • acute bacterial inflammation encountered
  • transection of “clean” tissues for the purpose of surgical access to a collection of pus
  • traumatic wound with retained devitalized tissues, foreign bodies, fecal contamination and or delayed treatment >4 hr after trauma
45
Q

classifying your wound/procedure helps with _______.

A

antibiotic decisions!

46
Q

if your patient is dehydrated, what treatment do we need to consider pre-operatively?

A

IV fluids

47
Q

if your patient is anemic, what treatment do we need to consider pre-operatively?

A

blood transfusion

48
Q

if your patient is hypoproteinemic, what treatment do we need to consider pre-operatively?

A

colloids

49
Q

if your patient has an electrolyte imbalance, what treatment do we need to consider pre-operatively?

A

IV fluids +/- electrolytes

50
Q

when do you delay an elective surgery?

A

fever, systemic illness, abnormal BW, wound near sx site, cardipulmonary abnormalities (harsh lung sounds, arrhythmias, murmurs)

51
Q

when do you delay an emergency surgery?

A

unstable patient that cannot be stabilized before undergoing anesthesia, hemodynamically unstable, severe electrolyte derangements, severe anemia

52
Q

if the patient is stable enough….

A

delay until normal business hours

53
Q

equines, ruminants and camelids should be ____ overnight prior to general anesthesia

A

fasted. (ruminants 24-48 hours in order to decrease rumen volume & decrease poss regurgitation)

54
Q

which animals should we withhold water from before general anesthesia?

A

ruminants should have water withheld for 24 hours prior
- equines and camelids may have free choice water

55
Q

what animals should we 100% place jugular catheters in for surgery?

A

equines and camelids

56
Q

you should make sure to groom and pick feet in this species prior to general anesthesia:

A

equines

57
Q

catheter placement is not always going to happen in this species

A

ruminants

58
Q

when performing surgery in the field we must ask our selves if it is ___ for the patient, and if it _____ the care.

A

best ; compromises

59
Q

in field surgery, when possible, we should do the ____ prep as performed in the hospital

A

same

60
Q

factors to consider in field surgery are:

A

proper facilities, equipment, personnel, patient care, weather

61
Q

standing surgery is common in ____

A

cattle

62
Q

standing surgery in ____ depends on the procedure and the surgeon

A

equine

63
Q

standing surgery for cattle offers the best ______ approach

A

abdominal

64
Q

these procedures are best with an equine standing for surgery:

A

laparoscopy, enucleations, mass removals

65
Q

local nerve blocks are common for standing surgery in

A

horses and cattle

66
Q

regional, paravertebral nerve blocks are common in standing surgery for what species

A

cattle

67
Q

____ in standing surgery is challenging due to patient movement

A

draping

68
Q

you should block for _____ clamps

A

towel

69
Q

surgery on a tilt table in cattle is helpful for ____ procedures

A

foot & distal limb

70
Q

A couple cons of surgery on a tilt table for cattle is that it is generally _____, and you must be ____ unless the animal is fasted and under general anesthesia.

A

expensive ; fast (risk of bloat & neuropraxia)

Surgery I (10 decks)

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