Lecture 18 - Standing & Flank Surgery Flashcards
What are advantages to standing surgery?
- Expense
- Decrease facility needs
- No need to stand up for recovery
- Hemorrhage
- Positioning
What are disadvantages to standing surgery?
- Patient motion
- Sterility
- Specialized equipment
- Hemorrhage - can sometimes decrease but can be difficult to control
- Positioning
What should you consider when selecting a patient for standing surgery?
- Is it able to stand? (concurrent ortho issues, cardio status)
- is it able to be restrained? (patient compliance, available equipment, size, age)
- Do you have sufficient help? (surgeon, assistant, anesthetist, holder)
- Is the condition amenable to standing surgery?
What is one common method for physical restraint of horses?
stocks
Where should the horse’s head be positioned in the stock?
between the upright bars
What does the holder need to make sure of when a horse is sedated in a stock?
That their trachea isn’t impinged upon - their head tends to drop when they are sedated
Which gate in a stock needs to be closed first after walking a horse into it?
Back gate - the horse will back up if the front gate closes first
Which end of the stock should the horse be walked out of?
The front
What gate of the stocks should be opened first if you need to back a horse out?
front
Stocks are a _____ form of restraint that still requires an _____ to manage the head.
secondary, assistant
What do bovine stocks have that equine stocks do not?
head catch
What areas can a twitch be used on as a secondary form of restraint?
Nose, ear, skin, lip chain
What two forms of secondary restraint can be used on bovines other than the stocks?
Twitch and nose tongs
What types of chemical restraints can be used?
Sedation (acepromazine, alpha 2 agonists)
Analgesics (opioids, local anesthetics)
What type of tranquilizer is acepromazine?
phenothiazine
What does acepromazine do?
Mostly helps to calm anxiety (no analgesia)
What are routes of admin for ace?
PO, IV, IM
What is a side effect of ace and what patient would you NOT wanna give it to?
Hypotension; do not give to patient with a history of bleeding
What are alpha 2 agonists used for?
Sedation and analgesia
How can alpha 2 agonists be admin?
Intermittent IV bolus, CRI, epidural, IM
What are side effects of alpha 2 agonists?
Paradoxical excitement/rage, increased urination, ataxia, bradycardia, hypertension –> hypotension, recumbency
What are 3 types of alpha 2 agonists?
- Xylazine
- Romifidine
- Detomidine
Rank the alpha 2 agonists in order from shortest to longest acting.
Shortest = Xylazine
Moderate = Romifidine
Longest = Detomidine
What is the cheapest alpha 2 agonist? What is a side effect?
Xylazine; greatest degree of ataxia
What alpha 2 agonist is not frequently available? What are side effects?
Romifidine;
Least cardio effects, don’t tend to drop head as much
What is the most expensive alpha 2 agonist?
Detomidine
What are reversals for alpha 2 agonists?
Yohimbine, Atipamezole (Antisedan), Tolazaline
Opioids are _____ that helps to “_____” feet.
analgesics, plant
How are opioids administered?
IV/IM bolus, CRI, epidural
What are side effects of opioids?
Head twitches, ileus, rage
What are 2 examples of opioids used in vet med?
Butorphanol, morphine
What kind of agonist/antagonist is butorophanol?
Partial mu agonist, mu antagonist
Partial kappa agonist
What kind of agonist/antagonist is morphine?
Full mu agonist
Which opioid is more common and which has more side effects?
Butorphanol = more common
Morphine = more side effects
What is the opioid reversal?
Naloxone
How are local analgesics admin?
IM/SQ, eqpidural, perineural, splash block
What are side effects of local analgesics?
Burning on injection, neurologic signs (if overdose)
What are 3 local anesthetics used in vet med? Which has the longest duration? Which has the shortest duration?
- Lidocaine - shortest
- Mepivicaine (Carbocaine)
- Bupivicaine - longest
What is the duration of lidocaine?
~1 hour
What is the duration of mepivicaine?
~2 hours
What perioribital nerve blocks can we do?
- Auriculopalpebral
- Supraorbital
- Lacrimal
- Zygomatic
- Infratrochlear
Identify the red nerve block.
Supraorbital
Identify the green nerve block.
Lacrimal
Identify the orange nerve block.
Infratrochlear
Identify the blue nerve block.
Zygomatic
What nerve block is this?
Retrobulbar
What nerve blocks near the eye need a full sterile prep?
Retrobulbar
What analgesics are needed to perform a caudal epidural block?
Opioid
+/- alpha 2 agonist
+/- local anesthetic
What is a potential complication of a caudal epidural block?
Ataxia, recumbency
What are the different methods of approach for flank anesthesia?
- Inverted L
- Distal paravertebral
- Proximal paravertebral
- Segmental dorsolumbar block
What key things must be considered before performing standing/flank surgery?
- Antibiotics
- Nonsteroidal anti-inflammatory
- Tetanus (booster if needed)
- Restraint (ear plugs, eye masks, ucath, evacuate rectum, tie tail)
What 3 steps are taken to prepare the surgical site?
Clip, aseptically prepare, drape
What steps should be taken to prepare the surgeon?
- Caps
- Masks
- Aseptic hand prep
- Gloves
- +/- gowns
What are common abdominal procedures done in bovines?
RDA, LDA, RTA, C-section, rumenotomy
Why are abdominal procedures (standing) more limited in the horse than in the bovine?
Don’t stand as well, don’t tolerate peritonitis, flank incisions don’t heal as well as ventral midline incisions
Why is standing surgery limited in cases of acute colic?
Horse won’t stand, peritonitis, limited access
What preventative surgeries for colic are performed standing in the horse?
- Nephrosplenic space ablation
- Epiploic space ablation
What surgeries can possibly be done standing in the horse and what is needed?
Cryptorchidectomy, ovariectomy; need specialized equipment (laparascope)
Castrations
Why are standing castrations in horses beneficial?
No need to wait for horse to stand/recover, economic, tradition
In what horse is standing castration appropriate and what is a disadvantage?
Those with 2 descended testicles with no history of herniation;
Higher complication rate reported
What are some urogenital procedures that can be done in a standing horse?
- Rectovaginal tears
- Urethral extensions
- Cervical laceration
What musculoskeletal procedures can be done in a standing horse?
- Fracture repair
- Implant removal
- Certain arthroscopies
