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Surgery final > Resp and thoracic sx (Ellison) > Flashcards

Resp and thoracic sx (Ellison) Flashcards

1
Q

Objectives

A
  • Common surgical respiratory diseases
  • surgical approaches, surgical techniques, closure
  • instrumentation
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2
Q

Upper airway obstruction incidence

(over long soft palates)

A
  • Brachycephalic breeds
    • bulldogs
    • boston terriers
    • pugs
    • pekinese
  • beagle
  • cocker
  • poodle
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3
Q

Presenting complaint

A
  • episodic or continuous respiratory distress-stertorus breathing
  • Gagging/regurgitation
  • cyanosis or collapse (22%)
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4
Q

Components

A
  • stenotic nares
  • elongated soft palate
  • everted laryngeal saccules
  • laryngeal collapse/stenosis: aretynoids thick
  • hypoplastic trachea
    • does not equal collapsing trachea
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5
Q

Pre-surgical considerations

A
  • be ready for an emergency in swelling
    • short acting glucocorticoids
    • be ready to put in a tracheostomy tube
  • tracheostomy site prepared
  • minimize swelling
    • perioperative steroids
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6
Q

widening nose

A
  1. caudal wedge technique
    • lifts and lateralizes
  2. Elongated palate resection
  3. Everted Laryngeal Saccules
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7
Q

Laryngeal paralysis

A
  • hereditary
  • idiopathic aquired form
  • older large breed dogs
    • labs
    • st. bernards
    • irish setters
  • bilateral paralysis
    • NOT HEMIPLAGIA
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8
Q

Arytenoid lateralization

(tieback)

A
  • 1-2 sutures through caudal aspect of cricoid cartilage
    • pass it thru aretynoid and tie down on one side
  • leaves airway unprotected
    • risk of aspiration pneumonia
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9
Q

Lar par post-op

A
  • Most serious complication is aspiration pneumonia
    • ~10% occurence
  • Suture pullout or fracture of cartilage
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10
Q

Temporary Tracheostomy

A
  • between 3rd and 4th rings
    • leave long stay sutures at 3rd and 4th ring
  • transverse incision
  • leave hole open when pulling trach tube
    • heals well
    • second hole to evacuate mucus
    • let heal by second intention
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11
Q

Post op management

A
  • observation
  • O2
  • suction q2-4hrs
    • whistle-tip catheter
  • tracheostomy tube kit ready OR care
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12
Q

Collapsing trachea

A
  • not hypoplastic
  • mini/toy breeds
  • average age at 7 yrs
  • eitology unknown
    • cartilage is hypocellular and deficient in glycoprotein and GAG content

*honking sound from trachealis membrane flapping

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13
Q

DX of collapsing trachea

A
  • Clinical signs
    • goosehonk cough
    • severe respiratory distress
    • cyanosis
  • Radiographs
    • inspiratory and expiratory
  • Fluoroscopy
  • Bronchoscopy under general anesthesia
    • evals laryngeal function
    • gold standard
    • trachealis muscle comes down like a hammock
  • +/- transtrach wash/culture
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14
Q

Common surgical diseases

Thoracic cavity

A
  • neoplasia
  • lung lobe torsion
  • lung lobe abscess
  • chylothorax
  • vascular ring anomalies
  • PDA
  • pericardial effusion
  • pneumothorax
  • tracheal collapse (and cervical)
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15
Q

Suture material

A
  • Prolene (non-absorbable)
    • tie backs
  • PDS or Maxon
    • lung lobectomy vessel ligation
    • tracheal anastomosis
  • Silk (vascular)
    • lung lobectomy vessel ligation
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16
Q

Intrumentation

A
  • rib retractors
    • Finochietto
  • Forcepts
    • DeBakey tissue forcepts (vessels)
  • Right angle Mixers
  • Hemoclips
17
Q

Approaches to Thoracic cavity

Lateral

A
  • Lateral / intercostal thoracotomy
    • bronchi at 5th and 6th interspace (incision here)
    • vascular rings approached at 3rd space
  • More caudal approach
    • esophageal issue
    • hiatal hernia
    • ligating a thoracic duct

*most intercostal approaches from the 4th-6th intercostal space

18
Q

Approaches to Thoracic Cavity

Median sternotomy

A
  • thymoma
  • generalize pyothorax
  • spontaneous pneumothorax

*this allows visualization of both sides of thorax

19
Q

Approach for PDA surgery

A
  • left side 4th intercostal space
20
Q

PRAA approach

A
  • left side, 4th intercostal space
21
Q

cranial mediastinum approach

A
  • right or left side, 2nd or 3rd intercostal space
22
Q

Cranial lung lobe approach

A
  • Right or left side, 4th intercostal space
23
Q

Middle & caudal lung lobes

A
  • right or left side, 5th or 6th intercostal space
24
Q

Caudal mediastinum approach

A
  • right or left side, 8th or 9th intercostal space
25
Q

Thoracic esophagus

heartbase approach

A
  • right side, 5th or 6th intercostal space
26
Q

thoracic esophagus

caudal mediastinum approach

A
  • left or right side, 8th intercostal space
27
Q

thoracic duct approach

A
  • Dog
    • right side, 8th-10th intercostal space
  • Cat
    • left side, 8th-10th intercostal space
28
Q

Muscles to transect

A
  • cutaneous trunci
  • latissimus dorsi
  • serratus ventralis
29
Q

Splenius muscle attaches at

A

5th rib

30
Q

Closure of thoracic sx

A
  • surround rib with PDS
    • monocryl in a puppy possible
  • Suture each muscle seperately
  • then put in chest tube to reinflate chest
31
Q

Median sternotomy procedure

A
  • big, long incision
  • elevate pectorals off sternebrae
  • saw/osteotome to cut sternebrae
  • Finochietto rib retraction
32
Q

If chest open, animal needs to be

A

ventilated

33
Q

Post-op median sternotomy

Closure

A
  • put in a chest tube
  • Closure
    • Dogs > 10kg
      • 22-24 guage wire
    • Cats or dogs < 10kg
      • # 1 or #2 polypropylene suture
    • alternating figure 8 and encircling sutures
    • Reoppose muscle bellies - 2/0 continuous pattern
    • postoperative bandage and analgesia
34
Q

Lung lobectomy

A
  • ligation of vessels and sew bronchus
    • ligate vessels individually (silk)
      • pulmonary artery
      • pulmonary vein
    • horizontal mattress, oversew (prolene, PDS)
  • thoracoabdominal (TA) stapling device
35
Q

Pneumothorax

A
  • spontaneous
  • median sternotomy allows exploration of entire thorax
36
Q

Chest tube placement

A
  • thoracostomy tube
    • tunnel a couple rib spaces (from the 11th to 8th or 9th)
    • tie in with chinese fingertrap
    • christmas tree adapter
    • 3 way stopcock
37
Q

Low (ventral placement of chest tube)

A

for fluid

38
Q

Higher (dorsal placement) of chest tube

A

for air

Surgery final (9 decks)

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