Lecture 18 - Standing & Flank Surgery

Question 1

What are advantages to standing surgery?

Answer 1

1. Expense
2. Decrease facility needs
3. No need to stand up for recovery
4. Hemorrhage
5. Positioning

Question 2

What are disadvantages to standing surgery?

Answer 2

1. Patient motion
2. Sterility
3. Specialized equipment
4. Hemorrhage - can sometimes decrease but can be difficult to control
5. Positioning

Question 3

What should you consider when selecting a patient for standing surgery?

Answer 3

1. Is it able to stand? (concurrent ortho issues, cardio status)
2. is it able to be restrained? (patient compliance, available equipment, size, age)
3. Do you have sufficient help? (surgeon, assistant, anesthetist, holder)
4. Is the condition amenable to standing surgery?

Question 4

What is one common method for physical restraint of horses?

Answer 4

stocks

Question 5

Where should the horse’s head be positioned in the stock?

Answer 5

between the upright bars

Question 6

What does the holder need to make sure of when a horse is sedated in a stock?

Answer 6

That their trachea isn’t impinged upon - their head tends to drop when they are sedated

Question 7

Which gate in a stock needs to be closed first after walking a horse into it?

Answer 7

Back gate - the horse will back up if the front gate closes first

Question 8

Which end of the stock should the horse be walked out of?

Answer 8

The front

Question 9

What gate of the stocks should be opened first if you need to back a horse out?

Answer 9

front

Question 10

Stocks are a _____ form of restraint that still requires an _____ to manage the head.

Answer 10

secondary, assistant

Question 11

What do bovine stocks have that equine stocks do not?

Answer 11

head catch

Question 12

What areas can a twitch be used on as a secondary form of restraint?

Answer 12

Nose, ear, skin, lip chain

Question 13

What two forms of secondary restraint can be used on bovines other than the stocks?

Answer 13

Twitch and nose tongs

Question 14

What types of chemical restraints can be used?

Answer 14

Sedation (acepromazine, alpha 2 agonists)

Analgesics (opioids, local anesthetics)

Question 15

What type of tranquilizer is acepromazine?

Answer 15

phenothiazine

Question 16

What does acepromazine do?

Answer 16

Mostly helps to calm anxiety (no analgesia)

Question 17

What are routes of admin for ace?

Answer 17

PO, IV, IM

Question 18

What is a side effect of ace and what patient would you NOT wanna give it to?

Answer 18

Hypotension; do not give to patient with a history of bleeding

Question 19

What are alpha 2 agonists used for?

Answer 19

Sedation and analgesia

Question 20

How can alpha 2 agonists be admin?

Answer 20

Intermittent IV bolus, CRI, epidural, IM

Question 21

What are side effects of alpha 2 agonists?

Answer 21

Paradoxical excitement/rage, increased urination, ataxia, bradycardia, hypertension –> hypotension, recumbency

Question 22

What are 3 types of alpha 2 agonists?

Answer 22

1. Xylazine
2. Romifidine
3. Detomidine

Question 23

Rank the alpha 2 agonists in order from shortest to longest acting.

Answer 23

Shortest = Xylazine

Moderate = Romifidine

Longest = Detomidine

Question 24

What is the cheapest alpha 2 agonist? What is a side effect?

Answer 24

Xylazine; greatest degree of ataxia

Question 25

What alpha 2 agonist is not frequently available? What are side effects?

Answer 25

Romifidine; Least cardio effects, don't tend to drop head as much

Question 26

What is the most expensive alpha 2 agonist?

Answer 26

Detomidine

Question 27

What are reversals for alpha 2 agonists?

Answer 27

Yohimbine, Atipamezole (Antisedan), Tolazaline

Question 28

Opioids are _____ that helps to "\_\_\_\_\_" feet.

Answer 28

analgesics, plant

Question 29

How are opioids administered?

Answer 29

IV/IM bolus, CRI, epidural

Question 30

What are side effects of opioids?

Answer 30

Head twitches, ileus, rage

Question 31

What are 2 examples of opioids used in vet med?

Answer 31

Butorphanol, morphine

Question 32

What kind of agonist/antagonist is butorophanol?

Answer 32

Partial mu agonist, mu antagonist Partial kappa agonist

Question 33

What kind of agonist/antagonist is morphine?

Answer 33

Full mu agonist

Question 34

Which opioid is more common and which has more side effects?

Answer 34

Butorphanol = more common Morphine = more side effects

Question 35

What is the opioid reversal?

Answer 35

Naloxone

Question 36

How are local analgesics admin?

Answer 36

IM/SQ, eqpidural, perineural, splash block

Question 37

What are side effects of local analgesics?

Answer 37

Burning on injection, neurologic signs (if overdose)

Question 38

What are 3 local anesthetics used in vet med? Which has the longest duration? Which has the shortest duration?

Answer 38

1. Lidocaine - **shortest** 2. Mepivicaine (Carbocaine) 3. Bupivicaine - **longest**

Question 39

What is the duration of lidocaine?

Answer 39

~1 hour

Question 40

What is the duration of mepivicaine?

Answer 40

~2 hours

Question 41

What perioribital nerve blocks can we do?

Answer 41

1. Auriculopalpebral 2. Supraorbital 3. Lacrimal 4. Zygomatic 5. Infratrochlear

Question 42

Identify the red nerve block.

Answer 42

Supraorbital

Question 43

Identify the green nerve block.

Answer 43

Lacrimal

Question 44

Identify the orange nerve block.

Answer 44

Infratrochlear

Question 45

Identify the blue nerve block.

Answer 45

Zygomatic

Question 46

What nerve block is this?

Answer 46

Retrobulbar

Question 47

What nerve blocks near the eye need a full sterile prep?

Answer 47

Retrobulbar

Question 48

What analgesics are needed to perform a caudal epidural block?

Answer 48

Opioid +/- alpha 2 agonist +/- local anesthetic

Question 49

What is a potential complication of a caudal epidural block?

Answer 49

Ataxia, recumbency

Question 50

What are the different methods of approach for flank anesthesia?

Answer 50

1. Inverted L 2. Distal paravertebral 3. Proximal paravertebral 4. Segmental dorsolumbar block

Question 51

What key things must be considered before performing standing/flank surgery?

Answer 51

1. Antibiotics 2. Nonsteroidal anti-inflammatory 3. Tetanus (booster if needed) 4. Restraint (ear plugs, eye masks, ucath, evacuate rectum, tie tail)

Question 52

What 3 steps are taken to prepare the surgical site?

Answer 52

Clip, aseptically prepare, drape

Question 53

What steps should be taken to prepare the surgeon?

Answer 53

1. Caps 2. Masks 3. Aseptic hand prep 4. Gloves 5. +/- gowns

Question 54

What are common abdominal procedures done in bovines?

Answer 54

RDA, LDA, RTA, C-section, rumenotomy

Question 55

Why are abdominal procedures (standing) more limited in the horse than in the bovine?

Answer 55

Don't stand as well, don't tolerate peritonitis, flank incisions don't heal as well as ventral midline incisions

Question 56

Why is standing surgery limited in cases of acute colic?

Answer 56

Horse won't stand, peritonitis, limited access

Question 57

What preventative surgeries for colic are performed standing in the horse?

Answer 57

1. Nephrosplenic space ablation 2. Epiploic space ablation

Question 58

What surgeries can possibly be done standing in the horse and what is needed?

Answer 58

Cryptorchidectomy, ovariectomy; need specialized equipment (laparascope) Castrations

Question 59

Why are standing castrations in horses beneficial?

Answer 59

No need to wait for horse to stand/recover, economic, tradition

Question 60

In what horse is standing castration appropriate and what is a disadvantage?

Answer 60

Those with 2 descended testicles with no history of herniation; Higher complication rate reported

Question 61

What are some urogenital procedures that can be done in a standing horse?

Answer 61

1. Rectovaginal tears 2. Urethral extensions 3. Cervical laceration

Question 62

What musculoskeletal procedures can be done in a standing horse?

Answer 62

1. Fracture repair 2. Implant removal 3. Certain arthroscopies