Lecture 17: Pre-Op Assessment & preparation - LA (Exam 2) Flashcards
Before taking a LA to surgery what needs to happen
Communication & Animal Prep
What is the role of the referring DVM w/ communication
- Liaison
- Complete referral hx - provide prev records including radiographs, prev treatments, conversations w/ client abt expectations, etc
- Post-Op management
- Case follow up
What does the owner/trainer/agent need to be told
- Risks of the surgery itself
- Risks of anesthesia
- Intra-op communication
- Outcomes
- Progress of post-op recovery
- Financial discussions
- Insurance
What needs to be discussed abt or w/ the insurance company
- not all horses are insured by ask before anesthesia
- Elective anesthesia - owner needs to call
- Emergency anesthesia - vet need to call for permission
- Before euthanasia - insurance companies want you to do everything you can to save the animal
What are the risk factors that need to be communicated for LA anesthesia
- Anesthesia time (the longer under = increased risk)
- Surgeon experience
- Weight (larger horses have more complications)
- Age
- High ASA score
- Hypotension
- Quality of induction
What is needed before anesthetizing ANY animal
Owner needs to sign a consent form
What needs to be communicated about outcomes
Try to communicate all possible negative outcomes to the client before surgery
What are some post op expectations
- Proper set up @ home
- Go through expectations for after care - medications, bandage changes (supplies needed & frequency), & stall rest
- If complications arise instructions will change
Who decides if the owner can afford it
The owner
Who has all the money conversations in LA
The vets not the techs
What needs to be talked about in intra-operative communication
- Severe disease
- Complications during sx
- Decisions to euthanize “on the table” get a witness & put their name & info in the medical recod
What are some inherent pre op risk factors
- Signalment
- Medical history
What are some variable pre op risk factors
- Primary disease (Physical & cardio)
- Elective vs. emergency surgery
- Extent of procedure
What patient information should be gathered pre op
- Signalment (age, breed, & sex)
- past medical treatments (esp past surgeries/ anesthesia & how they did)
- Nutritional status
- Vax status
- Owners perception of the problem
Who has increased risk during surgery
- Foals ( < 1 Y)
- Geriatric ( > 20 Y)
- Cardiopulmonary
- Increased size of the px
- Broodmares
What does the surgeon need to think about in the risk assessment
- Examine the associated morbidity/mortality
- Body system involved
- Severity of injury
- Progression of disease
- Emergency or elective?
What pre-op should be done before surgery
- Talk to the client & rDVM
- Obtain rDVM records
- Physical exam
- Pre-op bloodwork
- Radiographs
What is the criteria of a clean wound/procedure
- Elective, primarily closed, & undrained
- Non traumatic, uninfected
- No break in tech
- No inflammation encountered
- Respiratory, alimentary, genitourinary tracts not entered
What is the criteria of a clean-contaminated wound/procedure
- GI or respiratory tracts entered w/out significant spillage
- Oropharynx entered
- vagina entered
- Genitourinary tract entered in absence of infected urine
- Minor break in tech
What is the criteria of a contaminated wound/procedure
- Major break in tech
- Gross spillage from GI tract
- Traumatic wound, fresh ( < 4 H after trauma)
- Entrance of genitourinary tract or biliary tract in presence of infected urine or bile
What is the criteria of a dirty wound/procedure
- Acute bacterial inflammation encountered
- Transection of “clean” tissues for the purpose of surgical access to a collection of pus
- Traumatic wound w/ retained devitalized tissues, foreign bodies, fecal contamination, &/or delayed treatment ( >4 H) after trauma
What pre op needs to be done if the px is dehydrated
Give IV fluids
What pre op needs to be done if the px is anemia
Give blood transfusion
What pre op needs to be done if the px has hypoproteinemia
Give colloids
What pre op needs to be done if the px has electrolyte imbalances
Give IV fluids +/- electrolytes
When do you delay an elective surgery
- Fever or other systemic illness
- Abnorm bloodwork
- Wound near the surgical site
- Cardiopulmonary abnorms like harsh lung sounds, arrhythmias, +/- murmurs
When do you delay emergency surgery
- Unstable px that can be stabilized before anesthesia (hemodynamically unstable, severe electrolyte derangements, or severe anemia)
- If stable enough to delay until norm business hours
What prep should be done to equine for general anesthesia
- Fast overnight
- Free choice water
- Groom & pick feet
- Place jugular catheter
What prep should be done to ruminants for general anesthesia
- Fast for 24 to 48 hours (decrease rumen volume to decrease regurgitation)
- Withhold water for 24 H
- Catheter placement?
What prep should be done to camelids for general anesthesia
- Fast overnight
- Free choice water
- Place jugular catheter
What is the most important question to ask when doing surgery in the field
Is performing the surgery in the field what is best for the patient? does it compromise the care
What is needed for surgery in the field
- Proper facilities
- Equipment needed
- Personnel needed
- Patient care
- Proper weather
Explain standing surgery
- common in cattle & depends on the procedure & the surgeon for equine
- Best abdominal approach in cattle
- Equine - Laparoscopy, enucleations, mass removals
Where are regional nerve blocks done in cattle
Paravertebral & is common in cattle
Is local nerve blocks don in cattle or horses
Both
