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CVNT2 > Surgical Approaches - Respiratory > Flashcards

Surgical Approaches - Respiratory Flashcards

1
Q

What does BOAS stand for?

A

Brachycephalic obstructive airway disease

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2
Q

How can the nares differ in dogs with BOAS?

A

Nares are stenotic

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3
Q

How can the soft palate differ in dogs with BOAS?

A

Overlong, interacts with epiglottis

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4
Q

How can the tonsils differ in dogs with BOAS?

A

Tonsils are hyperplastic

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5
Q

What can happen in the diaphragmatic region of dogs with BOAS?

A

Hiatal hernia due to force exerted trying to breathe

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6
Q

How can the trachea differ in dogs with BOAS?

A

Can be hypoplastic causing narrow airway

Everted laryngeal succules can be pulled into the trachea and cause obstruction

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7
Q

What is stertor?

A

Snoring noise caused by partial obstruction of the upper airways at the level of the pharynx and nasopharynx

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8
Q

What is stridor?

A

High-pitched breathing sound commonly associated with laryngeal disease

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9
Q

What can happen to the larynx in severe BOAS cases?

A

Laryngeal collapse

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10
Q

What are the risk factors for BOAS in bulldogs?

A

Males
Moderate/severe stenotic nares
Thicker neck
Wider and shorter skull

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11
Q

What are the risk factors for BOAS in french bulldogs?

A 
Males 
Moderate/severe stenotic nares 
Thicker/shorter neck
Shorter/wider skull 
Proportionally shorter muzzle
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12
Q

What are the risk factors for BOAS in pugs?

A 
Female 
Moderate/severe stenotic nares 
Obese 
Proportionally wider distance between eyes 
Wider/shorter skull
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13
Q

How do narrow nares exacerbate symptoms of BOAS?

A

Dramatically increases the resistance to air flow into the nose
Cartilage support of nares tends to collapse during inspiration

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14
Q

How does an elongated soft palate exacerbate symptoms of BOAS?

A

Partially obstructs air flow into the trachea

Causes turbulent airflow in the larynx

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15
Q

Is laryngeal collapse progressive?

A

Yes

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16
Q

Which breed is most commonly affected by tracheal hypoplasia?

A

English bulldogs

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17
Q

What owner considerations should be made for BOAS patients?

A 
Avoid stress/heat 
Use harness (not collars) 
Avoid obesity 
Carefully managed exercise regimes 
Oxygen therapy 
Awareness of signs of respiratory distress
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18
Q

What nursing assessments should be done with BOAS patients?

A

TPR
Mucous membranes
SpO2
BOAS grading assessment with vet

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19
Q

What 5 procedures are involved in the multilevel surgical correction of BOAS?

A 
Soft palate resection 
Tonsil resection 
Nostril resection 
Removal of everted laryngeal saccules 
Laser-assisted turbinectomy
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20
Q

Why should a full biochem/haematology assessment be carried out before BOAS surgery?

A

Identify any extra risk factors for surgery

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21
Q

Why should patients be pre-oxygenated before BOAS surgery?

A

Pre-oxygenate for at least 5 mins - delays oxygen desaturation at induction

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22
Q

What ocular considerations should be taken with BOAS surgery patients?

A

Ocular lubrication regularly peri-operatively

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23
Q

How can intubation of BOAS patients be made easier?

A

Good lighting/laryngoscope
Urinary catheter can be used as a guide
Have rescue ET tube plus range of sizes

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24
Q

What is involved in patient prep for BOAS surgery?

A

Oral mouth rinse e.g. hexarinse

Nares - dilute clorhex/idodine

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25
Q

How should patients for BOAS surgery be positioned?

A

Sternal recumbency
Use 2 drip stands either side of table to tie mouth open
Tilted table helps prevent regurgitation

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26
Q

What should oxygen saturation be maintained at during BOAS surgery?

A

> 98%

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27
Q

What should end tidal CO2 be during BOAS surgery?

A

35-45mmHg - use capnography

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28
Q

Which breathing circuits are appropriate for BOAS surgery?

A

High flow rates - circle, T-piece, bain

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29
Q

What should blood pressure be maintained at during BOAS surgery?

A

> 60mmHg (mean)

30
Q

What are the common complications of BOAS surgery?

A

Airway swelling
Vomiting and regurgitation
Aspiration pneumonia

31
Q

When should BOAS surgery patients be extubated?

A

When they will no longer tolerate ET tube - keep in sternal recumbency with head elevated

32
Q

Should BOAS surgery patients still be given oxygen supplementation after extubation?

A

Yes - mask/flow by

33
Q

How should exercise be restricted during recovery from BOAS surgery?

A

5-10 mins twice daily for 6 weeks, always on harness

34
Q

What food should be given to patients recovering from BOAS surgery?

A

Solid wet food for 6 weeks post-op - limit airway irritation

35
Q

What is laryngeal paralysis?

A

A condition where the vocal cords are unable to abduct in response to exercise and respiratory demands

36
Q

What are the possible causes of laryngeal paralysis?

A

Idiopathic

Ageing changes (degenerative)

Congenital disease

Trauma

Cancerous infiltration of nerve which controls laryngeal muscles

37
Q

What are the signs of laryngeal paralysis?

A

Exercise intolerance

Noisy respiration

Coughing/gagging/dysphagia

Change/loss of vocal sounds (dysphonia)

Cyanosis and collapse (if severe)

38
Q

How are mild cases of laryngeal paralysis managed?

A 
Anti-inflammatories 
Antibiotics (where indicated) 
Sedatives 
Raised feeding 
Manage exercise, reduce stress
39
Q

How are severe cases of laryngeal paralysis managed?

A

Laryngeal tie-back (Unilateral arytenoid lateralisation)

40
Q

Where is the laryngeal tie-back surgery performed?

A

Left side of the neck

41
Q

What is achieved during a laryngeal tie-back surgery?

A

Left arytenoid cartilage is permanently abducted

42
Q

What should be considered for post-operative care after a laryngeal tie-back procedure?

A

Small regular soft meals
Avoid dusty feed/atmospheres
Raised food/water
Wound management

43
Q

Why shouldn’t animals which have had a laryngeal tie-back surgery be allowed to swim?

A

Risk of aspiration of water too great - permanently open trachea

44
Q

Where can palate defects occur?

A

Clefts of upper lip, hard and/or soft palates

45
Q

What are the clinical signs of a palate defect?

A

Difficulty feeding

Nasal discharge

46
Q

How are congenital palate defects managed?

A

Surgery performed at 3-4 months - closure of tissues separating the oral and nasal passages with minimal tension

47
Q

How are acquired palate defects managed (e.g. RTA trauma)?

A

Primary/secondary closure depending on severity of damage caused

48
Q

Which dogs are most likely to suffer with tracheal collapse?

A

middle aged small and toy breeds

49
Q

how is tracheal collapse caused?

A

degeneration of the tracheal cartilage rings leads to dorsoventral flattening of the trachea

50
Q

what re the signs of tracheal collapse?

A

dry, harsh, loud cough (goose honk) triggered by excitement/exercise/eating
stridor
may build up over weeks/months

51
Q

how is tracheal collapse diagnosed?

A

through radiography, bronchoscopic imaging (endoscopy) and fluoroscopy

52
Q

how is tracheal collapse graded?

A 
according to percentage of collapse of lumen 
grade I = 25% 
grade II = 50% 
grade III = 75% 
grade IV = total loss
53
Q

what are the management options for tracheal collapse?

A 
weight loss management 
harness 
avoiding smoky atmospheres 
medical 
surgical
54
Q

what is involved in medical management of tracheal collapse?

A

weight loss and controlled exercise programmes

removal of environmental irritants

pharmacological - antitussives, steroids, bronchodilators
(antibiotics only if secondary infection present)

55
Q

what are the surgical methods for managing tracheal collapse?

A

only grade II or higher
extraluminal ring prosthesis
intraluminal stent placement

56
Q

what are the complications of extraluminal ring prosthesis?

A

vascular damage
tracheal ring migration
coughing, dyspnoea
laryngeal paralysis due to iatrogenic nerve damage

57
Q

what are the advantages of intra-luminal stent placement?

A

less invasive surgery than prosthesis

flexible materials available

58
Q

what are the disadvantages/complications of intraluminal stent placement?

A

stent can fatigue under pressure (repeated coughing)

excessive inflammatory tissue around the trachea

59
Q

what is involved in patient prep for extraluminal ring prosthesis?

A

dorsal recumbency - prep large area of ventral neck
pre-oxygenation
careful handling
calm/stress free

60
Q

what is involved in patient prep for intraluminal stent placement?

A 
lateral recumbency 
fluorosopic guidance 
pre-oxygenation 
careful handling 
calm/stress free
61
Q

what are the key aspects of post-op care after respiratory surgery?

A

calm and quiet environment

monitor respiration constantly initially, give flow-by oxygen

analgesia and sedation

raised head to reduce aspiration risk

maintenance of IV access, access to crash box

suction equipment ICOE

62
Q

what is a lateral thoracotomy?

A

surgical incision performed between the ribs - excellent view of one side of thorax

63
Q

what are the indications for a lateral thoracotomy?

A

lung lobectomy

abscessation, lung lobe torsion, neoplasia

64
Q

what is a median sternotomy?

A

surgical incision through sternum - provides view of bilateral thorax

65
Q

what are the indications for a median sternotomy?

A

pyothorax
mediastinal masses
heart surgery

66
Q

what is a tracheostomy?

A

emergency procedure to bypass the nares/pharynx/larynx/proximal trachea - artificial opening in the neck

67
Q

what are the indications for a tracheostomy?

A

facilitate anaesthesia when airway is compromised

stabilise patient and allow airway management

provide definitive airway until swelling/obstruction is resolved

68
Q

with which conditions may a tracheostomy be required?

A

BOAS
laryngeal paralysis
laryngeal trauma
foreign body

69
Q

what is involved in the care of a tracheostomy?

A

24/7 high level monitoring for maintenance/comfort/asepsis

prevent buildup of secretions through suctioning/cleaning tube

tube care every 15 minutes until stable, then every 4-6 hours

70
Q

what should you be continually checking for in patients with a tracheostomy tube?

A

harsh respiratory sounds

dyspnoea/coughing/distress

discharge

discomfort

stoma - pain/swelling/heat (clean 3-4x daily)

71
Q

what is involved in suctioning of a tracheostomy tube?

A

always pre-oxygenate at least 5 mins before

aseptic technique

sterile, soft, pre-measured catheter placed and suction unit turned on for 15 seconds as withdrawing

72
Q

why should you aid humidification in patients with a tracheostomy tube?

A

it bypasses normal humidification in the URT - can cause damage to mucosa and thick mucus

CVNT2 (47 decks)

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