Perioperative Considerations Flashcards by Madeleine Gauthier

what 4 questions should you ask yourself when evaluating a patient for fluid therapy?

what is the problem?
what solution do I admin?
how much?
what route and rate?

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which is more common in mature cattle, metabolic acidosis or metabolic alkalosis?

metabolic alkalosis

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what fluid solution do you use to correct dehydration?

fluid containing electrolytes

cattle lose most water due to iso/hyper osmorlality

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what fluid solution do you use to correct acid/base imbalances? tell me the one for acidosis and alkalosis

lactated ringers to correct base (alkalosis)
sodium bicarbonate to correct acidosis

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how much fluid should you admin? general

deficit + ongoing losses + maintenance

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what route should you give fluids to in calves?

normally IV dependent on % dehydration

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what route should you give fluids to adult cattle?

oral is easiest outside of hospital setting

can do combo (20-40L IV in severely dehydrated cow, + oral)

IV 14ga catheter can give as fast as possible

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how long should calves be fasted for before sx?

12-18 hrs
no water 8-12 hrs

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how long should adult cattle be fasted for before sx?

18-24hrs
no water 12-18 hrs

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what are the steps of sx prep for the pt?

remove excess dirt/manure
clip 25-30cm margins around sx site
tie tail (halter or leg, never chute!)
scrub
check block
apply drape over sx site

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what should you use to scrub the patient for sx?

povidone-iodine & alcohol
chlorhexidine & alcohol/water
you can use either

don’t use chlorhex near eyes or synovial structures !

chlorhex has residual effect = don’t remove fully

PVP-I requires alcohol for activation

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surgical physical restraint depends on the ____ & the ____. calves are easier ____. dairy often done w/ ____ ± _____. if patient is down, it may be best to keep it down via chemical ± physical methods.

surgery, patient
down
halter, headlock

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what are the two types of casting?

tripping & double half hitch technique

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how do you perform tripping casting?

best done with sedation: 30-50mg xylazine IV

used to perform Toggle technique on LDA

RH leg pulled out from under sedated cow causing her to go down on R side

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how do you perform double half hitch technique for casting?

haltered, tied with head low
bowline around neck, 2x half hitches
consistent force on tail end of rope required to est. and maintain recumbency
cow usually goes down on half hitch side - legs must be secured

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why should you use the maternity pen for sx?

easy to get cow in/out of
can continue sx/calving if cow goes down
kick rail to protect surgeon that is low enough to perform C-section

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why should you not use maternity pen for sx?

not great for right sided sx

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when using a maternity pen for sx, the cow should be haltered, and tied to what side and why?

tie to side you are working on
cow will go down on the other side

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why should you use a chute for sx?

good restraint capabilities

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why should you not use a chute for sx?

sides often too high for C-sections
footing often slippery/steel
if cow goes down, must drag cow out

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when using a chute for sx, the cow should be haltered and tied to what side and why?

tied to the side you are working on
cow will go down on the other side

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true or false: all chemical restraints for standing procedures will increase the risk of going down.

true

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what drugs can you use to chemically restraint a cow for a standing procedure?

xylazine
ketamine stun (ketamine, butorphanol, xylazine)
acepromazine in animals that are CV stable

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when using xylazine for chemical restraint, what is a good starting dose?

0.02-0.03mg/kg

what is a ketamine stun? include drug, dose, and how long it takes to effect.

5mg butorphanol, 10mg xylazine, 20mg ketamine (5/10/20) 20-30 mins to take effect

tell me the combos of drugs + doses that you can give IM, SQ, or IV to chemically restrain for standing sx.

xylazine 0.05mg/kg + acepromazine 0.05mg/kg xylazine 0.05mg/kg + butorphanol 0.05mg/kg acepromazine 0.035mg/kg + butorphanol 0.05 mg/kg

which drug should you use caution with if an animal has impaired CV stability?

acepromazine

for calf field anesthesia, what protocol does Stover recommend?

xylazine 0.05-0.2mg/kg butorphanol 0.025-0.05mg/kg 0.2-2mg/kg ketamine

what are things to think about when choosing an epidural?

duration of action straining onset time structures anaesthetized

tell me the onset/duration of action of lidocaine, xylazine, & xylazine/lidocaine for epidurals.

lidocaine: 3-5min, 1-2 hrs xylazine: 10-30min, 3-4 hrs xylazine/lidocaine: 5min, 6-7hrs

tell me the protocol, procedure, onset, and duration of effect for using xylazine as an epidural.

xylazine 0.07mg/kg + sterile saline (0.9%) = total vol 7mL clip+prep tail head (sa5-co1, co1-2), 18G x2" needle - hanging drop, slow injection systemic effects: 10-30min, sx analgesia: 25-30min lasts for 3-4 hrs

when do you use xylazine for epidurals?

sedation, sx/flank analgesia, post-op analgesia, loss of motor function to tail, reduced straining

what are the cons and potential adverse effects of xylazine?

risk of recumbency/time to onset hypersalivation/drooling, vocalization, ataxia/recumency, bradycardia, hypoventilation, resp acidosis, hypoxemia, ruminal atony

should you use high epidurals and LS epidurals for adults?

nope! only calves. adults might stay recumbent or might get MSK injuries

high epidurals and LS epidurals usually use what drug?

lidocaine

high epidurals eliminate what?

hind leg movement

what is the dose range for lidocaine for high epidural?

0.15-0.4mL/kg combine with systemic sedation/anesthesia

what is the dose for LS epidural lidocaine?

1mL/10kg lidocaine 0.1mL/kg

for flank anesthesia, what block do you perform?

paravertebral block or inverted L

why would you buffer lidocaine for local anesthesia?

lowers time for block to take effect also when buffered, the cows kick less (less pain during injection)

how do you buffer lidocaine?

8.4% Na bicarb to 1% lidocaine ~1mL/10mL

tell me the pros and cons of using lidocaine w/ epinephrine

- increase duration of analgesia x2 - decrease hemorrhage - decrease wound healing time - circulation issues (esp. w/ distal extremities & areas with compromised circulation)

tell me how to do abdominal wall & skin closures, from inner to outer layers.

1. transversus/peritoneum: - close together, SC/absorbable #3 chromic gut 2. internal abd. oblique: - single layer, SC/absorbable #3 chromic gut 3. external abd. oblique: - single layer, SC/absorbable #3chromic gut 4. skin: - non-absorbable (3 polyamide, remove after 10-14 days) - ford interlocking, finish pattern with 1-2 simple interrupted, removable if drainage needed

when choosing antimicrobials for abdominal sx in cows, what organisms do you want to target usually?

gram - anaerobes Trueperella pyogenes E. coli these are both gram - anaerobes

what complication happens in approx. 2/3 of abd. sx cases?

parietal fibrinous peritonitis

should you use penicillin G/benzylpenicillin for abd. sx?

nope doesn't target gram - anaerobes

should you use aminopenicillins for abd. sx?

depends on what bac t you are suspicious of. they target some gram - anaerobes

should you use cephalosporins for abd. sx?

in theory should work, they target some gram - anaerobes. but stover doesn't think they work well

should you use sulphonamides and potentiated sulphonamides for abd. sx?

yeah they target gram - anaerobes

can you use tetracyclines for abd. sx?

yes. they target gram - anaerobes but they have long withdrawal times

what antimicrobials can you use for abd. sx?

sulphonamides and potentiated sulphonamides tetracyclines

can you use chloramphenicol or florfenicol for abd. sx?

nope! chloramphenicol can't be used in food animals, and florfenicol can't be used in dairy animals

can you use macrolides, lincosamides, azalides, or triamilides for abd. sx?

sure, only if not dairy do not use in dairy

can you use fluoroquinolones for abd. sx?

not in dairy

when using flunixin meglumide for analgesia, what is important to know?

do not give oral to cows IM inj. should be avoided. b/c they cause muscle irritation not labelled for pain (only pyrexia and inflammation) transdermal absorption affected by temp must be dry and kept dry for 6hrs injectable and transdermal formulations

tell me more about these things when using ketoprofen for analgesia: 1. route 2. withdrawal in milk 3. acting time

1. IM or IV 2. 0 milk withdrawal 3. short acting affects <24hrs

tell me more about these things when using meloxicam for analgesia: 1. route 2. label use 3. what route do you NOT use in dairy?

1. oral, IV, SQ 2. abd. pain after sx in cattle 3. oral!

true or false: you do not have to know and communicate drug withdrawal times in your medical records.

false!!!! you must know and communicate directly and in your medical record all drug withdrawals