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
2
Q
Intra-op complications
A
anesthesia
surgical issues
hemorrhage
3
Q
Post-op complications
A
anesthesia
hemorrhage
airway
infection
procedure specific stuff
4
Q
Common complications
A
- Anesthesia
- myopathy
- neuropathy
- Hemorrhage
- Airway obstruction
- Infection
- Dehiscence
- Post-operative colic
- Laminitis
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
6
Q
If hypotensive…
A
- dec delivery of inhaled anesthetic or other hypotensive agents
- inc IV fluid administration
- admin inotropic drugs
- admin vasopressors
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
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
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
10
Q
Monitor Hemorrhage by
A
- counting sponges
- heart rate
- mucous membranes
- arterial pressure
- bucket
11
Q
excess hemorrhage causes
A
- Tachycardia
- inc hypovolemia
- inc hypotension
- pale mucous membranes
- inc respiratory rate
- metabolic acidosis
12
Q
PCV and TP
A
- min 20% and 3.5 g/dL
13
Q
amount of blood and plasma in a 500 kg horse
A
- 40 L of blood (8%)
- 25L of plasma (5%)
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
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
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
margin for technical error...
especially slim in horses
26
Hemarthrosis
* More of an annoyance than a serious complication
* most common in tibiotarsal joint with extensive synovial fluid
27
If an osteochondral fragment becomes lost
if lost intrasynovially needs to be located, along with instrument breakage
28
arthroscopy and joint infection risks
* draft breeds
* tibiotarsal joints
29
Dehiscence
usually secondary to incisional infection or weakness
30
Reasons for dehiscence
* infection
* high motion
* excessive tension (always a problem with horses)
* Poor blood supply
31
Avoid in dehiscence
* control infection
* tension suture techniques
* immobilization
* abdominal support bandages
* prevents eventuration
* allows fibrosis
* surgical herniorrhaphy after 4-6 months
* suture/mesh herniorrhaphy
32
Oral surgery
* Dorsal buccal nerve
* greater palatine artery
* gingival damage
* wolf tooth fractures
* pulpar damage
* damage to teeth and supporting bones
* fistulae
33
Guttural Pouch sx approach
* hyovertebrotomy
* viborg's triangle
* whitehouse
* modified whitehouse
34
Guttural pouch mycosis
* about 50% of horses with hemorrhage from guttural pouch mycosis die from complication
* artery most frequently
