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Surgery > Surgical complications - LA (Bierdrzycki) > Flashcards

Surgical complications - LA (Bierdrzycki) Flashcards

1
Q

Surgical complication

A

any deviation from ideal postop course that isn’t inherent in procedure and doesn’t constitute failure

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2
Q

Intra-op complications

A

anesthesia

surgical issues

hemorrhage

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3
Q

Post-op complications

A

anesthesia

hemorrhage

airway

infection

procedure specific stuff

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4
Q

Common complications

A
  • Anesthesia
    • myopathy
    • neuropathy
  • Hemorrhage
  • Airway obstruction
  • Infection
  • Dehiscence
  • Post-operative colic
  • Laminitis
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5
Q

Anesthesia complications

Hypotension

A
  • particularly susceptible to negative inotropic and vasodilatory effects of inhaled anesthetics
  • MAP = 60mm Hg inc risk of post anesthetic myopathy
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6
Q

If hypotensive…

A
  1. dec delivery of inhaled anesthetic or other hypotensive agents
  2. inc IV fluid administration
  3. admin inotropic drugs
  4. admin vasopressors
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7
Q

Anesthesia complications

Hypercapnia

A
  • very susceptible to the respiratory depressant effects of inhalant anesthetics, combined with muscle relaxation and recumbency
  • frequently leads to hypoventilation with inc arterial PCO2
  • PCO2 between 45-65 mm Hg
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8
Q

Anesthesia Complications

Hypoxemia

A
  • arterial PO2 of less than 60 mm Hg
  • humans and dogs hemoglobin is 90% saturated at PO2 of about 57-58 mm Hg
  • equine hemoglobin has greater affinity for oxygen, 90% saturation is typically achieved at a PO2 of only 54 mm Hg
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9
Q

Anesthesia Complications

Bradycardia / AV block

A
  • heart rate in anesthetized horses tends not to vary much with the plane of anesthesia
  • Dobutamine
    • can cause reflex bradycardia < 20 bpm, atropine (0.002-0.003 mg/kg IV)
  • Horses that have received high doses of alpha-2 agonists or are receiving dobutamine during inhalation anesthesia, more likely to experience second-degree atrioventricular block
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10
Q

Monitor Hemorrhage by

A
  • counting sponges
  • heart rate
  • mucous membranes
  • arterial pressure
  • bucket
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11
Q

excess hemorrhage causes

A
  • Tachycardia
  • inc hypovolemia
  • inc hypotension
  • pale mucous membranes
  • inc respiratory rate
  • metabolic acidosis
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12
Q

PCV and TP

A
  • min 20% and 3.5 g/dL
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13
Q

amount of blood and plasma in a 500 kg horse

A
  • 40 L of blood (8%)
  • 25L of plasma (5%)
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14
Q

Healthy horse and acceptable blood loss

A
  • Healthy horse with normal PCV and TP and good CV function could lose up to 50% of its blood volume (20 L) with volume replacement and CV support are appropriate
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15
Q

Hemorrhage

TX

A
  • Fluid therapy (colloids)
  • Blood transfusions
  • Hypertonic saline (controversial tx)
    • shock
    • replace with isotonic
    • has been contraindicated
  • Pain relief
  • monitor PCV throughout recovery period
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16
Q

Complications

Fracture/soft tissue injury

A
  • FX: 0.2% of anesthetized horses 2 of every 1000
  • Soft tissue injuries and lacerations common
17
Q

Complications

Myopathy/neuropathy

A
  • masseter, triceps, gluteal
  • Superficial nerves subject to pressure damage during anesthesia and recumbency
    • racial n
    • radial n
18
Q

Upper Airway Obstruction

A
  • Kinked, or occluded ET tube
  • nasal passages blocked by secretions/swelling
  • soft palate remains dorsally displaced above epiglottis
  • Inspiratory efforts against closed airway => pulmonary edema
  • preexisting laryngeal hemiplegia
19
Q

Acute Airway Obstruction

A
  • Snoring sounds (Stridor)
  • No evidence air passage through nostrils
  • Inc abdominal effort
  • abnormal abdominal movements
  • nostril flaring
  • panic and struggling at attempts to stand
20
Q

Acute airway obstruction

TX

A
  • Remove obstruction
    • phenylephrine in nostrils before extubation
  • establish airway
  • Lasix (furoseminde) diuretic
  • oxygen therapy
  • corticosteroids
21
Q

Preventing acute airway obstruction

A
  • endotracheal/nasotracheal tube during recovery, tracheotomy before surgery
22
Q

Laparoscopic surgery

A
  • retroperitoneal insufflation
  • laceration of the circumflex iliac artery
    • located at the dorsal aspect of the IAO, in the region of the middle portal
  • bowel puncture
  • splenic puncture
  • caudal epigastric vessels
    • abaxial portion of the rectus abdominus muscle
23
Q

Preventing laminitis in fracture patient

A

Make the horse bear weight on all four limbs as soon as possible

24
Q

Internal fixation complications

A

probably no more common in horses than in other species

25
Q

margin for technical error…

A

especially slim in horses

26
Q

Hemarthrosis

A
  • More of an annoyance than a serious complication
  • most common in tibiotarsal joint with extensive synovial fluid
27
Q

If an osteochondral fragment becomes lost

A

if lost intrasynovially needs to be located, along with instrument breakage

28
Q

arthroscopy and joint infection risks

A
  • draft breeds
  • tibiotarsal joints
29
Q

Dehiscence

A

usually secondary to incisional infection or weakness

30
Q

Reasons for dehiscence

A
  • infection
  • high motion
  • excessive tension (always a problem with horses)
  • Poor blood supply
31
Q

Avoid in dehiscence

A
  • control infection
  • tension suture techniques
  • immobilization
  • abdominal support bandages
    • prevents eventuration
    • allows fibrosis
  • surgical herniorrhaphy after 4-6 months
  • suture/mesh herniorrhaphy
32
Q

Oral surgery

A
  • Dorsal buccal nerve
  • greater palatine artery
  • gingival damage
  • wolf tooth fractures
  • pulpar damage
  • damage to teeth and supporting bones
  • fistulae
33
Q

Guttural Pouch sx approach

A
  • hyovertebrotomy
  • viborg’s triangle
  • whitehouse
  • modified whitehouse
34
Q

Guttural pouch mycosis

A
  • about 50% of horses with hemorrhage from guttural pouch mycosis die from complication
  • artery most frequently

Surgery (11 decks)

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