Respiratory & thoracic SX Flashcards
Brachycephalic airway CS
Stertor, inspiratory dyspnea, stridor, cyanosis, syncope, exercise intol.
- have increased intrathoracic negative pressure = labored breathing
- worse with stress, exercise or heat
Brachycephalic airway syndrome- primary changes
Stenotic nares, elongated soft palate, hypoplastic trachea, nasopharyngeal turbinates
Brachycephalic airway syndrome- secondary changes
Everted laryngeal saccules, mucosal edema, everted tonsils and laryngeal collapse
What portion of the airway creates the greatest source of air flow resistance?
Nose (stenotic nares)
What is the ideal soft palate length?
Caudal border of soft palate to tip of epiglottis (caudal edge of palatine tonsils)
“just touch”
A small change in diameter…
Makes a massive influence on resistance
- increase radius= reduce resistance
Surgical txmt for stenotic nares
Alaplasty or partial resection of the nostril
- couldnuse a trader technique
Sx treatment for elongated and thick soft palate
Folding flap palaoplasty (trim& thin)
Or
Staphectomy(trim soft palate)
Sx treatment for nasopharyngeal turbinates
Remove malformed ventral and medial nasal conchae via laser assisted turbinectomy
Sx tx for everted laryngeal saccules
Laryngeal sacculectomy
Non surgical txmt for brachycephalic airway syndrome
Weight loss, avoid hyperthermia, avoid overexcitment, and avoid respiratory irritants
Can you fix a hypoplastic trachea surgically?
No, the stent can only go to max size of trachea
What is the tube selected for temporary tracheostomy
No cuff, length of 6-7 tracheal rings and 50% diameter of tracheal lumen
- placed bw rings 3-4 or4-5
What nerve should you be cautious of while performing temp tracheostomy?
Recurrent laryngeal nerve runs lateral to trachea
How does the temp trachea heal.
No closure done, instead heals by second intension over 7-10 days
Laryngeal paralysis CS
Inspiratory stridor, exercise intol, acute resp. distress, bark change, gag (eat/drink), hyperthermia
Cyanosis
Others: relate to GOLP- hindlimb ataxia, regurg, pelvic limb hyporeflexia
What plane of anesthesia should laryngeal exam?
Light, to see laryngeal function
- propofol given to effect +/- doxopram
What is larpar?
Cricoartenoideus dorsalis muscle fails to abduct arytenoid cartilage during inspiration
-congenital: purebreed (rare)
Male>female
-acquired:
older large breed (lab/golden)
Lar Par Sx TX
Tie back or unilateral criocoarytenoid lateralization
Risk of aspiration pneumonia bc airway always open
After unilateral criocoarytenoid lateralization dogs cannot swim- T/F
True
Collapsing trachea- etiology
Progressive lower airway condition
Cause: unknown, but breed predilection, hypocellular tracheal cartilage, less GAGs
What factors worsen collapsing trachea
Obesity, pollution, smoke, allergens, URIs
Collapsing trachea CS
Goosehonk cough, dyspnea, cyanosis, syncope
Tracheal collapse cycle
Cough (antitussive)
airway collapse (bronchodilator)
inflammation (steroid)
secondary infection (abx)
excitement (sedative)
Tracheal collapse- medical management
Weight loss, avoid irritants, manage allergies and no harnesses
Consider these options before surgical txmt
KEY: manage owner expectation (dogs still cough regardless of tx & requires long term medical mgmt)
Tracheal collapse SX TX
Extraluminal ring: provides extra support around cervical trachea
Thoracic SX approaches (4)
Intercostal
Median sternotomy (explore complete thorax but manubrium&xiphiid remains intact)
Traumatic
Thoracoscopic
Thoracic SX- post op
Thoracotomy tube (8-12hr)
Resp.watch (trends)
+/- O2 therapy
