Perioperative Considerations

Question 1

before doing surgery on a cow, what are some things you’d want to know before you do surgery on a cow?

Answer 1

• I would want to do a full PE, check for any underlying conditions
• I would want to get a full history as well, especially previous lactation issues, if the’ve tested pos for BLV, or if they’ve had surgery before

Question 2

what are 4 things to consider when giving fluids to a cow?

Answer 2

• what problem does the cow have
• what type of fluids do you want to use?
• how much am I going to give?
• what route will I give, and what rate?

Question 3

what fluid type can correct alkalosis? what can you add if there’s acidosis?

Answer 3

• LRS is acidifying, good for alkalosis
• bicarb to correct acidosis

Question 4

what is the basic calculation to determine how much fluid to give to a cow?

Answer 4

deficit + ongoing losses + maintenance

Question 5

what route is most common for giving fluids? calves vs cows?

Answer 5

calves usually IV
cows usually oral (be cautious, regurg can happen esp in jersey cows)

Question 6

what is ideal in terms of pre surgical fasting for cows?

Answer 6

calves: 12-18 hours feed, 8-12 hours water
cows: 18-24 hours feed, 12-18 hours water

Question 7

best way to prepare surgical field for cow surgery?

Answer 7

get off all excess dirt, clip first with 10 blade then a 40, have 30mm margins, clip sites for blocks as well, tie the tail either to the halter or to the leg, NEVER to the chute

Question 8

what solution should you be using to clean your surgically prepared site? Why?

Answer 8

in large animal: typically providone/iodine + alcohol

chlorohex is also equally as effective, it’s just more expensive. it used to be thought that chlorohex was better in preventing surgical site infections, but this was debunked

Question 9

your cow has been clipped and cleaned, what are 2 things you need to do before you start surgery?

Answer 9

• check your block!
• put a drape on and make sure it covers a wide area!

Question 10

since there aren’t sinks close by with field surgeries on cows, how do you “scrub” or prepare yourself for surgery?

Answer 10

surgical scrub is usually preformed from a clean bucket

Question 11

what is the best way to restrain cows/calves for surgery?

Answer 11

calves are easiest to do down on their sides

adult cows usually done standing with a halter/headlock

Question 12

what is the best way to “cast” a cow (get it down)? for example if you’re going to do the “toggle” procedure to fix an LDA?

Answer 12

best done with sedation ex) xylazine IV 30-50mg

wrap the rope around her right hind leg, gently pull it out from under her, causing her to go down on her right side

Question 13

best way to use the double half hitch casting technique?

Answer 13

halter and tie the cow LOW, tie the knots/half hitches on the side you want to “go down”, you need consistent force on the tail to maintain recumbency

Question 14

benefits of using a maternity pen and proper way to use it? (bovine surgery)

Answer 14

it’s easy to get the cow in and out, there’s a kick rail to protect the surgeon whilst allowing them to still work on the cow, if the cow does down you can keep doing surgery

may not be good for R sided surgeries

cow should be haltered and tied to the same side you want to do surgery on

Question 15

benefits of using a regular chute (rather than maternity pen) to do surgeries?

Answer 15

allows for good restraint but the sides are often too high for C sections, may be slippery for the cow, can be dangerous if cow goes down. tie them to the side you’re doing surgery in case they do go down

Question 16

how much xylazine is a good starting point for standing chemical restraint?

Answer 16

0.02 to 0.03mg/kg

Question 17

what drugs are involved in a “ketamine stun” for stnading chemical restraint, and how much does Stover use?

Answer 17

5mg butorphanol, 10mg xylazine, 20mg ketamine all IM–>takes 20-30 minutes to take effect

to remember this: BXK, 5-10-20, 30 (mins to take effect)

Question 18

what drugs are used for epidurals? pros and cons?

Answer 18

lidocaine, acts quick but not super long duration
xylazine: takes longer to take effect but lasts longer
lidocaine xylazine combo: quick onset and lasts a long time!

Question 19

what is a high epidural, when it it used, and what drugs are used to give it?

Answer 19

a high epidural is a lumbosacral epidural and gets rid of leg movement, usually only moved in calves or small ruminants, usually lidocaine 0.15 to 0.4ml/kg

dont use it in larger animals due to MSK injury upon recovery (think animals that can’t be down for too long)

Question 20

lidocaine is quite acidic and can burn upon injection. what can you to to prevent this?

Answer 20

mix lidocaine with bicarbonate to create a neutral pH

Question 21

why is epinepherine given with lidocaine?

Answer 21

• it increases duration by 2x, decreases hemorrhage, and decreases wound healing time

Question 22

when would adding epi to lidocaine be contraindicated?

Answer 22

in distal extremities, areas with compromised circulation, or with excessive volumes (I don’t know what this means)

Question 23

describe what suture and size youd use to close each of the following layers:
- transversus/perotoneum
- internal abd oblique
- external abd oblique
- abdominal wall skin

Answer 23

• transversus/peritoneum: absorbable #3 chromic gut
• internak: same
  -external: same

skin closure: non absorbable suture #3 polyamide with ford interlocking pattern (or simple interupted or cruciate), finish pattern with a few simple interupted

Question 24

is cat gut expensive?

Answer 24

YES apparently????

Question 25

what things do you need to consider before using antimicorbials in cattle?

Answer 25

is the drug on label, what dose/formulation, will the drug get to the target, when should you give it, and what is the withdrawal time

Question 26

for GI surgery in cattle, is antimicrobial use warranted? explain why or why not

Answer 26

YES because it is a clean contaminated environment, not sterile, and 2/3 cases get fibrinous peritonitis!

Question 27

what organisms are usually involved in infections after GI surgery in cattle?

Answer 27

trueperella pyogenes and E coli

Question 28

what 2 broad classes of antimicrobials can you use for Gi surgery in cattle?

Answer 28

tetracyclines and macrolides (can’t use in lactating cows)

Question 29

which of the following are banned in food and/or dairy animals:
- penicillin G, aminopenicillins, cephalosporins, sulfonamides, tetracyclines, chloramphenicols, florfenicols, macrolides, fluoroquinolones

Answer 29

chloramphenicols (can’t use in food animals in general)
florfenicols (not in dairy cows)
macrolides (not in dairy cows)
fluoroquinolones (not in dairy cows)

Question 30

do we want bacteriostatic or bacteriocidal antimicrobials for GI surgery? why?

Answer 30

bacteriocidial because we already know there’s bacteria there, it is a clean contamined procedure, so we want to kill these before they become a problem

Question 31

what are the 3 analgesia drug options for post op we talked about in class?

Answer 31

flunixin megulmine
ketoprofen
meloxicam

Question 32

what is flunixin labelled for in cows? what routes can this medication be given in?

Answer 32

not labelled for pain, only pyrexia and inflammation

injectable and transdermal available–>dont give it IM, it is irritating

Question 33

why is ketoprofen not ideal to give as an analgetic agent? what is it’s one major benefit?

Answer 33

it lasts for almost no time at all so may not be the best thing post op to use. it does have zero milk withdrawal tho which is very nice

Question 34

why is meloxicam seen as the preferred analgesic agent for cows in regards to GI surgery?

Answer 34

there are ORAL and injectable formulations and is SPECIFICALLY labelled for abdominal pain after surgery, and there are various formulations of the drug. oral formulation not for use in dairy cattle