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Surgery 1 (SAB) > Lecture 17: Pre-Op Assessment & preparation - LA > Flashcards

Lecture 17: Pre-Op Assessment & preparation - LA Flashcards

1
Q

Before taking a LA to surgery what needs to happen

A

Communication & Animal Prep

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2
Q

What is the role of the referring DVM w/ communication

A
  • Liaison
  • Complete referral hx - provide prev records including radiographs, prev treatments, conversations w/ client abt expectations, etc
  • Post-Op management
  • Case follow up
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3
Q

What does the owner/trainer/agent need to be told

A
  • Risks of the surgery itself
  • Risks of anesthesia
  • Intra-op communication
  • Outcomes
  • Progress of post-op recovery
  • Financial discussions
  • Insurance
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4
Q

What needs to be discussed abt or w/ the insurance company

A
  • 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
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5
Q

What are the risk factors that need to be communicated for LA anesthesia

A
  • Anesthesia time (the longer under = increased risk)
  • Surgeon experience
  • Weight (larger horses have more complications)
  • Age
  • High ASA score
  • Hypotension
  • Quality of induction
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6
Q

What is needed before anesthetizing ANY animal

A

Owner needs to sign a consent form

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7
Q

What needs to be communicated about outcomes

A

Try to communicate all possible negative outcomes to the client before surgery

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8
Q

What are some post op expectations

A
  • Proper set up @ home
  • Go through expectations for after care - medications, bandage changes (supplies needed & frequency), & stall rest
  • If complications arise instructions will change
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9
Q

Who decides if the owner can afford it

A

The owner

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10
Q

Who has all the money conversations in LA

A

The vets not the techs

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11
Q

What needs to be talked about in intra-operative communication

A
  • Severe disease
  • Complications during sx
  • Decisions to euthanize “on the table” get a witness & put their name & info in the medical recod
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12
Q

What are some inherent pre op risk factors

A
  • Signalment
  • Medical history
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13
Q

What are some variable pre op risk factors

A
  • Primary disease (Physical & cardio)
  • Elective vs. emergency surgery
  • Extent of procedure
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14
Q

What patient information should be gathered pre op

A
  • Signalment (age, breed, & sex)
  • past medical treatments (esp past surgeries/ anesthesia & how they did)
  • Nutritional status
  • Vax status
  • Owners perception of the problem
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15
Q

Who has increased risk during surgery

A
  • Foals ( < 1 Y)
  • Geriatric ( > 20 Y)
  • Cardiopulmonary
  • Increased size of the px
  • Broodmares
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16
Q

What does the surgeon need to think about in the risk assessment

A
  • Examine the associated morbidity/mortality
  • Body system involved
  • Severity of injury
  • Progression of disease
  • Emergency or elective?
17
Q

What pre-op should be done before surgery

A
  • Talk to the client & rDVM
  • Obtain rDVM records
  • Physical exam
  • Pre-op bloodwork
  • Radiographs
18
Q

What is the criteria of a clean wound/procedure

A
  • Elective, primarily closed, & undrained
  • Non traumatic, uninfected
  • No break in tech
  • No inflammation encountered
  • Respiratory, alimentary, genitourinary tracts not entered
19
Q

What is the criteria of a clean-contaminated wound/procedure

A
  • 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
20
Q

What is the criteria of a contaminated wound/procedure

A
  • 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
21
Q

What is the criteria of 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 w/ retained devitalized tissues, foreign bodies, fecal contamination, &/or delayed treatment ( >4 H) after trauma
22
Q

What pre op needs to be done if the px is dehydrated

A

Give IV fluids

23
Q

What pre op needs to be done if the px is anemia

A

Give blood transfusion

24
Q

What pre op needs to be done if the px has hypoproteinemia

A

Give colloids

25
Q

What pre op needs to be done if the px has electrolyte imbalances

A

Give IV fluids +/- electrolytes

26
Q

When do you delay an elective surgery

A
  • Fever or other systemic illness
  • Abnorm bloodwork
  • Wound near the surgical site
  • Cardiopulmonary abnorms like harsh lung sounds, arrhythmias, +/- murmurs
27
Q

When do you delay emergency surgery

A
  • 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
28
Q

What prep should be done to equine for general anesthesia

A
  • Fast overnight
  • Free choice water
  • Groom & pick feet
  • Place jugular catheter
29
Q

What prep should be done to ruminants for general anesthesia

A
  • Fast for 24 to 48 hours (decrease rumen volume to decrease regurgitation)
  • Withhold water for 24 H
  • Catheter placement?
30
Q

What prep should be done to camelids for general anesthesia

A
  • Fast overnight
  • Free choice water
  • Place jugular catheter
31
Q

What is the most important question to ask when doing surgery in the field

A

Is performing the surgery in the field what is best for the patient? does it compromise the care

32
Q

What is needed for surgery in the field

A
  • Proper facilities
  • Equipment needed
  • Personnel needed
  • Patient care
  • Proper weather
33
Q

Explain standing surgery

A
  • common in cattle & depends on the procedure & the surgeon for equine
  • Best abdominal approach in cattle
  • Equine - Laparoscopy, enucleations, mass removals
34
Q

Where are regional nerve blocks done in cattle

A

Paravertebral & is common in cattle

35
Q

Is local nerve blocks don in cattle or horses

A

Both

Surgery 1 (SAB) (16 decks)

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