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Intro to Surgery > Lecture 18 - Standing & Flank Surgery > Flashcards

Lecture 18 - Standing & Flank Surgery Flashcards

1
Q

What are advantages to standing surgery?

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

What are disadvantages to standing surgery?

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

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

A
  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?
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4
Q

What is one common method for physical restraint of horses?

A

stocks

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5
Q

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

A

between the upright bars

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6
Q

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

A

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

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7
Q

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

A

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

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8
Q

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

A

The front

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9
Q

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

A

front

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10
Q

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

A

secondary, assistant

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11
Q

What do bovine stocks have that equine stocks do not?

A

head catch

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12
Q

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

A

Nose, ear, skin, lip chain

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13
Q

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

A

Twitch and nose tongs

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14
Q

What types of chemical restraints can be used?

A

Sedation (acepromazine, alpha 2 agonists)

Analgesics (opioids, local anesthetics)

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15
Q

What type of tranquilizer is acepromazine?

A

phenothiazine

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16
Q

What does acepromazine do?

A

Mostly helps to calm anxiety (no analgesia)

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17
Q

What are routes of admin for ace?

A

PO, IV, IM

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18
Q

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

A

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

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19
Q

What are alpha 2 agonists used for?

A

Sedation and analgesia

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20
Q

How can alpha 2 agonists be admin?

A

Intermittent IV bolus, CRI, epidural, IM

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21
Q

What are side effects of alpha 2 agonists?

A

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

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22
Q

What are 3 types of alpha 2 agonists?

A
  1. Xylazine
  2. Romifidine
  3. Detomidine
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23
Q

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

A

Shortest = Xylazine

Moderate = Romifidine

Longest = Detomidine

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24
Q

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

A

Xylazine; greatest degree of ataxia

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25
Q

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

A

Romifidine;

Least cardio effects, don’t tend to drop head as much

26
Q

What is the most expensive alpha 2 agonist?

A

Detomidine

27
Q

What are reversals for alpha 2 agonists?

A

Yohimbine, Atipamezole (Antisedan), Tolazaline

28
Q

Opioids are _____ that helps to “_____” feet.

A

analgesics, plant

29
Q

How are opioids administered?

A

IV/IM bolus, CRI, epidural

30
Q

What are side effects of opioids?

A

Head twitches, ileus, rage

31
Q

What are 2 examples of opioids used in vet med?

A

Butorphanol, morphine

32
Q

What kind of agonist/antagonist is butorophanol?

A

Partial mu agonist, mu antagonist

Partial kappa agonist

33
Q

What kind of agonist/antagonist is morphine?

A

Full mu agonist

34
Q

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

A

Butorphanol = more common

Morphine = more side effects

35
Q

What is the opioid reversal?

A

Naloxone

36
Q

How are local analgesics admin?

A

IM/SQ, eqpidural, perineural, splash block

37
Q

What are side effects of local analgesics?

A

Burning on injection, neurologic signs (if overdose)

38
Q

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

A
  1. Lidocaine - shortest
  2. Mepivicaine (Carbocaine)
  3. Bupivicaine - longest
39
Q

What is the duration of lidocaine?

A

~1 hour

40
Q

What is the duration of mepivicaine?

A

~2 hours

41
Q

What perioribital nerve blocks can we do?

A
  1. Auriculopalpebral
  2. Supraorbital
  3. Lacrimal
  4. Zygomatic
  5. Infratrochlear
42
Q

Identify the red nerve block.

A

Supraorbital

43
Q

Identify the green nerve block.

A

Lacrimal

44
Q

Identify the orange nerve block.

A

Infratrochlear

45
Q

Identify the blue nerve block.

A

Zygomatic

46
Q

What nerve block is this?

A

Retrobulbar

47
Q

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

A

Retrobulbar

48
Q

What analgesics are needed to perform a caudal epidural block?

A

Opioid

+/- alpha 2 agonist

+/- local anesthetic

49
Q

What is a potential complication of a caudal epidural block?

A

Ataxia, recumbency

50
Q

What are the different methods of approach for flank anesthesia?

A
  1. Inverted L
  2. Distal paravertebral
  3. Proximal paravertebral
  4. Segmental dorsolumbar block
51
Q

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

A
  1. Antibiotics
  2. Nonsteroidal anti-inflammatory
  3. Tetanus (booster if needed)
  4. Restraint (ear plugs, eye masks, ucath, evacuate rectum, tie tail)
52
Q

What 3 steps are taken to prepare the surgical site?

A

Clip, aseptically prepare, drape

53
Q

What steps should be taken to prepare the surgeon?

A
  1. Caps
  2. Masks
  3. Aseptic hand prep
  4. Gloves
  5. +/- gowns
54
Q

What are common abdominal procedures done in bovines?

A

RDA, LDA, RTA, C-section, rumenotomy

55
Q

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

A

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

56
Q

Why is standing surgery limited in cases of acute colic?

A

Horse won’t stand, peritonitis, limited access

57
Q

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

A
  1. Nephrosplenic space ablation
  2. Epiploic space ablation
58
Q

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

A

Cryptorchidectomy, ovariectomy; need specialized equipment (laparascope)

Castrations

59
Q

Why are standing castrations in horses beneficial?

A

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

60
Q

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

A

Those with 2 descended testicles with no history of herniation;

Higher complication rate reported

61
Q

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

A
  1. Rectovaginal tears
  2. Urethral extensions
  3. Cervical laceration
62
Q

What musculoskeletal procedures can be done in a standing horse?

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

Intro to Surgery (36 decks)

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