species specific peri-operative requirements Flashcards
orthopaedic instrumentation
locking screw
osteotome
plate benders
periosteal elevator
cortical screw
kirschner wires (k wires)
Kerrisons
rongeurs
cancellous screw
ellis pin/SCAT pin
Chisel
pin bender
considerations for recovery in exotics
wing flapping and emergency delirium is common in birds so we need to prevent self trauma in recovery e.g. wrap in a towel
In reptiles to prevent overly long periods of recovery it is advised that the inhalant agent be terminated 15-20 minutes before the end of surgery
to prevent overly long periods of recovery, maintain body temp - reptiles - low metabolic rate
avoid over wetting during patient preparation to reduce risk of hypothermia in recovery
Rabbits
Offer food and water asap to reduce risk of anorexia and gut stasis
gut stimulants in rabbits
consider types of substrate
- not straw or wood shavings - contaminate wounds/trauma to eyes
recover area
-rabbits are rodents away from cats and dogs
-quiet and warm
water may be provided after an animal has fully come around from anaesthetic i.e. they have controlled movements
aquatic reptiles should have access to water when they are fully awake and able to swim.
Extubation
- Dogs - once they have regained the ability to swallow, deflate the cuff just before extubation, as they are unable to protect their own airway until this point
cats - just before they regain the ability to swallow due to risk of laryngeal spasm
horses - differing opinions, majority once they have regained the ability to swallow
rabbits and small rodents - once they start to swallow or regain motor control
birds - when they are fully awake, breathing well and able to swallow
reptiles - when the pharyngeal reflexes have returned and the patient is breathing spontaneously
brachycephalics - leave as long as is tolerated
Removal of IV catheters
IV catheters are usually removed once the patient is fully recovered, and all vital signs appear normal. in certain cases, they should remain.
High risk patients
patients that require post op IV medications; to avoid painful IM injections
patients with risk of seizures
patients at risk of airway obstruction
diabetes
advise owner to administer half of insulin dose on morning of surgery
alpha 2 adrenergic agents should be avoided as they increase blood glucose
blood glucose monitored on admit, following pre-med, blood glucose should be tested. if under 3 mmol/IV glucose should be initiated, intra and post op
glucose should be diluted with saline or water for injection 10-20% solution for IV injection
on recovery, blood glucose usually returns to normal quickly or hyperglycaemia is seen
feed as soon as recovered enough
Extra considerations
CNS - IV access up to 12hrs, will have raised itracranial pressure, gentle elevation of the head
ophthalamic cases - prevent interference.
intra-ocular - label kennel to alert other staff, regular IOP readings and menace checks
thoracotomy - manage any chest drains, high risk of hypoxia so pulse ox invaluable
orthopaedic - small kennel, physio, hypothermia risk
abdominal - enema, frequent chance to defecate, analgesia
spinal - analgesia - opioid with NSAID, limited assisted exercise
Abdominal surgery
splenic rupture
gastric diliation volvulus
exploratory laparotomy
tumours
ovariohysterectomy
Abdominal surgery
the preparation of further instruments; retractors , froceps and laparotomy swabs should be employed
the technique of giving pre -surgery antibiotics to reduce bacteria intestinally is no longer considered good practice.
specific considerations for gastric surgery
offer small drinks of water
small bland diet offered
little and often feeding regime - increased over several days
feeding tube?
normal diet after 3-5 days
special considerations for intestinal surgery
electrolyte balance and nutritional support should be considered along with the return of normal function to the alimentary tract
monitoring should include standard TPR and mucous membrane colour
small amounts of water following surgery should be given to stimulate gut activity
in vomiting, total parenteral nutrition could be considered
abdominal surgery risks
observe signs of
- abdominal distention due to retained gas
- abdominal pain
-vomiting
-anorexia
these may indicate ileus
monitor faecal output
- consistency
- blood
- colour
- tenesmus
risk of septic peritonitis with abdominal surgeries
signs
- vomiting
- diarrhoea
-pyrexia
-abdominal pain
- collapse and shock
3-5 days post surgery
considerations caesarean
ensure clean surgical site before allowing the neonates to suckle
maintain fluid therapy
place the dam with her litter as soon as possible, never leave unattended, observe until recovered from anaesthesia to prevent injury to the litter
place in large kennel in enclosed area
ensure environment is draught free, warm but not hot as may overheat
ophthalamic surgery
- postioned with eye uppermost and head secured
- towel clips placed with care
intraocular pressure
assess pain and administer analgesics as directed
avoid emetic drugs
foot bandaging or elizabeth collar
avoid situations that can cause IOP
if blind animals need reassurance so talking to them more than usual may be of benefit.
Respiratory distress
arises inadequate oxygen delivery to the tissues which causes hypoxia
can be caused by.
obstruction to the passage of air into the respiratory tract
inefficient oxygen exchange at the air-tissue interface
inadequate blood supply to the alveoli, despite normal delivery gases
inadequate oxygen - carrying capacity
inadequate blood delivery tissues
respiratory distress
increased respiratory rate at rest
increased respiratory effort
exercise intolerance
open mouthed breathing
cyanosis of the tongue and gingiva
collapse
Thoracotomy
prepare everything so anaesthetic is not prolonged
oxygen may need to be supplied
pain can decrease ventilation so good analgesia should be maintained
keep ET tube in longer
observe RR and MM
Orthopaedic surgery
limb amputation
arthrotomy - dislocations
joint replacement
arthrodesis
fractures
patella luxation
arthroscopy
angular limb deformities
orthopaedic surgery
stabilisation prior to suregry
radiographs taken
peri - operative and post op prevention of infection - antibiotics as well as strict sterile environment
anaesthesia will result in loss of muscle tone so care has to be taken when handling limbs
radiographs after surgery to confirm success
good analgesia as well as hot/cold therapies and massage techniques may be considered.
orthopaedic surgery
mobility may be impaired; padded bedding, turn frequently
catheteriation of the bladder should be considered
support bandaging
bandaging and casts checked regularly
support when walking an animal
weight management
ensure clients know and understand the care required at home
limb amputation post op
surgery can be prolonged with considerate blood loss from cut msucle ends if diathermy is not available so IVFT fluids are important to ensure recovery
prevention of seroma formation at site of amputation
important to get patients on their feet asap so that they can adapt to their new gait
walking must be assisted if the floor is slippery or rubber mats need to be placed to give animal confidence
cruciate surgery
extracapsular technique
intracapsular technique
tibil plateau levelling oseteotomy
cranial closing tibial wedge osteotomy
tibial tuberosity advancement
