SURGERIES ON THORAX AND TRACHEA Flashcards
trachea can resist decompression
compression
tracheal rings are D-shaped
C-shaped
trachea is Joined by the ____ dorsally
trachealis muscle
connects each tracheal ring
annular ligament
indications of tracheotomy
gain access to lumen
remove obstruction
get sample
facilitate airwflow
Allows air to enter the trachea cranial to the nose, mouth, nasopharynx, and larynx
distal
tube is permanent while stoma is temporary
baliktad
provide airway before diagnostic and surgical procedures Of the upper airway or the oral cavity
Planned Tracheostomy
done when there is severe upper respiratory tract obstruction
Sudden and acute
Emergency Tracheostomy
most commonly performed to provide an alternate airflow during surgery
Temporary Tracheostomy
____ incision is generally preferred with two stay sutures placed ___ and ___ the intended incision.
transverse
above
below
what muscle is separated during tracheotomy
sternohyoid
The tracheal incision extends roughly ____ of the circumference of the trachea.
40% to 50%
why longitudinal incison is not recommended
not good healing
prone to scarring
granulation tissue formation
shirnkage of lumen
The tracheostomy site can be partially closed with a few subcu and skin sutures using
(simple interrupted or basic sutures)
in permanent tracheostomy , the stoma is created in the __by suturing the tracheal mucosa to the skin
ventral tracheal wall
key in permanent tracheostomy
chain the tracheal mucosa to skin
Tracheal Resection and Anastomosis
Indications
tracheal tumors
stenosis
avulsion
Trauma
generally ___of trachea can be resected which are about 8-10 rings
~20-50%
in TRA, how many tension relieving sutures shall be made
3-4
Progressive. Degenerative condition of the hyaline cartilage rings that support the tracheal lumen
Tracheal Collapse Tracheal Chondromalacia
Manifests as a “goose honk” cough varying degrees of dyspnea
Tracheal Collapse Tracheal Chondromalacia
whta grade: 50% reduction in diameter. Tracheal rings elongated and mildly flattened
2
Tracheal rings markedly flattened
3
minor protrusion Of dorsal membrane into airway lumen. reduction in diameter
1
what gradepossibly with dorsal deviation of ventral tracheal surface
4
One most successfully done and high rate of improvement
Woven mesh & self expanding
tracheal stents
position in tracheal stent surgery
lateral recumbency
to confirm appropriate placement & trachea condition
radiograph
is done to confirm precise stent placement
Tracheoscopy
what is avoided to being damaged during tracheal ring surgery
recurrent laryngeal nerves
position intracheal ring sugrery
dorsal recumbencu
ring spaces should be spaced _ mm apart
5
tracheal stents can be used for 55% tracheal lumen collpase
true
techniques for thoracotomy
lateral or intercostal
median
thoracotomy technique where the sternum is split
median sternotomy
what structure is first seen in lateral or intercostal sternotomy
lung lobes
what structure is first seen in median sternotomy
trachea
thoracostomy indications
Impaired respiration (Trauma)
Respiratory diseases
Emergency stabilization (Trauma)
Cardiovascular diseases
Esophageal Surgeries
Obstruction - rare
Neoplastic tissue removal
thoracic cavity is compressed ventrally
false. laterally
composition of thoracic skeleton
ribs, Sternum, vertebral column
how many unpaired ribs
8
how many paires of ribs
13
what forms the costal arch
10-12
fibers run caudoventral from caudal rib to cranial side of next rib (inspiration)
External intercostal mm
run from cranial rib going to caudal side of preceding rib (expiration)
Internal intercostal mm
standard approach for thoracotomy
intercostal
very common incision site of ICS
4-5th ICS
use a ___ to spread the ribs
Finochietto retractor
choose more___ space when deciding between two spaces
caudal
during internal thoractomy avpid incising the
internal thoracic vessels
what is used to remove residual air from thoracic cavity
over-the-needle catheter or pre-placed chest tube
how many sutures needed to close ribe
4-8
what muscles are apposed after thoracotomy
serratus ventralis, scalenus, pectoralis muscles, latissimus dorsi
indication of median sternotomy
Exploratory thoracic surgery
Bilateral exposure of the thorax
Access to dorsal or both sides of thoracic structures
Tumors: Mediastinal. Lung lesions
Cardiac Procedures.
Pericardiectomies
Hepatic Surgeries
Diaphragmatic Surgeries
in perfroming median sternotomy, leave ___ sternebrae intact
2-3
how thick should the sternebrae be cut with bone saw
2/3
what will be used to cut the last 1/3 of the sternebrae
osteotome and mallet
for median sternotomy, chest wires are only used if
animal is >15kg
chest tube placement indication
drain of fluid and air
Pyothorax
Post thoracotomy
Post diaphragmatic hernia repair
Continuous tension pneumothorax
what ICS should be the tip of chest tube be placed
2nd
to make the tunnel (pull skin from __
8th to 10th)
tube selection, weight to size
<7, 7-15, 16-30, >30
antibiotics
tetracycline, azith
cough suppres
hydrocodone, butorphanol, lomotil
antiinflamms
prednisone, fluticasone
minor protrusion, reduced diamter
Grade 1
markedy elongated 75%
grade 3
mildy elongated , 50%
grade 2
IV. >90% reduction in diameter, severely flattened tracheal rings. possibly with dorsal deviation of ventral tracheal surface
grade 4
Ix for young healthy dogs with cervical tracheal collapse
tracheal rings
Ix for dog clinical for intrathoracic collapse alone and severely debilatetd animal at anesthetic risk
tracheal stents
