Lec 17: Pre-Op Assessment and Preparation LA

Question 1

communication before taking LA to surgery must occur between

Answer 1

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

Question 2

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

Answer 2

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

Question 3

what is the role of the referring DVM?

Answer 3

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

Question 4

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

Answer 4

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

Question 5

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

Answer 5

if their horse is insured

Question 6

if the procedure is elective anesthesia, the owner must…

Answer 6

call the insurance company

Question 7

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)

Answer 7

The Veterinarian

Question 8

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

Answer 8

that if they euthanize, the owners forfeit their insurance policy

Question 9

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

Answer 9

Non fatal

Question 10

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

Answer 10

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

Question 11

larger horses have ___ complications

Answer 11

more

Question 12

before anesthetizing any animal the owner must…

Answer 12

sign a consent form

Question 13

A consent form is needed for:

Answer 13

legal coverage!

Question 14

ALL possible ____ outcomes should be communicated before surgery

Answer 14

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

Question 15

communicate and understand the ___ use for the horse

Answer 15

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

Question 16

what post op expectations need to be discussed?

Answer 16

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

Question 17

if complications arise, _____ will change.

Answer 17

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

Question 18

what can you NOT decide for the owner?

Answer 18

if they can afford surgery/treatment

Question 19

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

Answer 19

veterinarian in large animal discusses finances, not the technician

Question 20

estimates should be ___ and updated ____.

Answer 20

accurate ; updated regularly

Question 21

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

Answer 21

findings of severe disease, complications during surgery, possible euthanasia

Question 22

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

Answer 22

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

Question 23

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

Answer 23

signalment and medical history

Question 24

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

Answer 24

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

Question 25

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

Answer 25

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

Question 26

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

Answer 26

less

Question 27

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

Answer 27

older; 20

Question 28

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

Answer 28

inherent

Question 29

when considering variable factors in risk assessment,

Answer 29

- examine the associated morbidity/mortality - body system involved - severity of injury - progression of the disease

Question 30

emergency surgery ____ the morbidity/mortality

Answer 30

increases

Question 31

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

Answer 31

colics and fractures

Question 32

increased complexity + decreased surgeon experience =

Answer 32

increased surgical time & increased morbidity/mortality

Question 33

ASA category 1 examples

Answer 33

normal healthy patient routine castration, routine arthroscopy

Question 34

ASA category II examples

Answer 34

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

Question 35

ASA category III example

Answer 35

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

Question 36

ASA category IV example

Answer 36

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

Question 37

ASA category V example

Answer 37

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

Question 38

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

Answer 38

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

Question 39

additional diagnostics could consist of

Answer 39

pre op bloodwork and radiographs

Question 40

why would we do radiographs before surgery?

Answer 40

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

Question 41

describe a clean wound/procedure

Answer 41

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

Question 42

describe a clean-contaminated wound/procedure

Answer 42

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

Question 43

describe a contaminated woubd/procedure

Answer 43

- 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

Question 44

describe a dirty wound/procedure

Answer 44

- 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

Question 45

classifying your wound/procedure helps with _______.

Answer 45

antibiotic decisions!

Question 46

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

Answer 46

IV fluids

Question 47

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

Answer 47

blood transfusion

Question 48

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

Answer 48

colloids

Question 49

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

Answer 49

IV fluids +/- electrolytes

Question 50

when do you delay an elective surgery?

Answer 50

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

Question 51

when do you delay an emergency surgery?

Answer 51

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

Question 52

if the patient is stable enough....

Answer 52

delay until normal business hours

Question 53

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

Answer 53

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

Question 54

which animals should we withhold water from before general anesthesia?

Answer 54

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

Question 55

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

Answer 55

equines and camelids

Question 56

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

Answer 56

equines

Question 57

catheter placement is not always going to happen in this species

Answer 57

ruminants

Question 58

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

Answer 58

best ; compromises

Question 59

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

Answer 59

same

Question 60

factors to consider in field surgery are:

Answer 60

proper facilities, equipment, personnel, patient care, weather

Question 61

standing surgery is common in ____

Answer 61

cattle

Question 62

standing surgery in ____ depends on the procedure and the surgeon

Answer 62

equine

Question 63

standing surgery for cattle offers the best ______ approach

Answer 63

abdominal

Question 64

these procedures are best with an equine standing for surgery:

Answer 64

laparoscopy, enucleations, mass removals

Question 65

local nerve blocks are common for standing surgery in

Answer 65

horses and cattle

Question 66

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

Answer 66

cattle

Question 67

____ in standing surgery is challenging due to patient movement

Answer 67

draping

Question 68

you should block for _____ clamps

Answer 68

towel

Question 69

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

Answer 69

foot & distal limb

Question 70

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.

Answer 70

expensive ; fast (risk of bloat & neuropraxia)