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VTT Equine 4
Anesthesia & Surgery
| Question | Answer |
|---|---|
| With horses how are most procedures performed? | Most procedures on performed on standing, awake patients |
| What is the primary benefit of performing procedures on standing, awake horses? | Avoids the risk of anesthesia, especially those associated with recovery |
| True or False: Standing surgery is not recommended for debilitated, sick, or elderly patients. | False, standing surgery is beneficial for these patients |
| True or False: Risks associated with recumbency under anesthesia are avoided with standing surgery. | True |
| True or False: Standing surgery is recommended for patients with a history of problems with general anesthesia or recovery. | True |
| True or False: Standing surgery is often more expensive than other surgeries such as those that use general anesthesia. | False, it is less expensive |
| True or False: Standing surgery is more stressful for patients who have experienced trauma | False, it helps them to avoid stress |
| For standing surgery what factors should be considered in regards to restraint? | Location of the procedure. - Duration of the procedure. - “Pain factor” of the procedure. - Temperament of the horse. - Facilities. - Skill and number of personnel. |
| What are 3 examples of Physical Restraints used for standing surgeries? | Lead rope with halter, Ropes, Twitches |
| True or False: Analgesics MUST be provided to minimize patient discomfort | True |
| True or False: Drugs used for chemical restraint have analgesic properties | True |
| True or False Since drugs used for chemical restraint have analgesic properties other analgesics are not necessary. | False, it depends on the surgery |
| What are 3 types of local anesthesia used for pain control in standing surgery? | Nerve blocks, Field blocks, Epidural anesthesia |
| In the field what type of environment is most ideal for a standing surgery? | Quiet, clean, and dust free. |
| How do we minimize patient discomfort during a standing surgery? | Through the use of analgesics |
| What type of surgery is most commonly used for minor procedures? | Standing surgeries |
| Why do we often mix the local anesthetic drugs that are often used for nerve blocks? | Because they have variable times with regard to duration of effect |
| What is another name for a field block? | line block |
| What are field blocks often used for? | Used to anesthetize skin or subcutaneous tissue around surgical areas. For example blocking around a lasceration |
| What are epidurals used for? | They are routinely used for analgesia of Tail, Perineum, Anus/Rectum, Vulva, and Vagina. Surgeries of the hind area. |
| Why are additional analgesics sometimes used for some standing surgeries? | Because the drugs in local anesthetics may not be in the amount needed for the patient's analgesic needs. |
| What are the three classes of drugs used for epidural anesthesia? | Local anesthetics, Alpha-2 agonist, Opiods |
| What do the local anesthetic drugs used for epidural anesthesia do? | They block, sensory, motor, and sympathetic fibers |
| Why might we not want to use local anesthetics as an epidural agent? | They can cause loss of motor control leading to ataxia and causing them to stumble around injuring themselves and/or staff |
| What do the alpha-2 agonist drugs used for epidural anesthesia do? | They block sensory fibers |
| Why are opioids and or alpha-2 agonist drugs a good choice for use as epidural anesthesia agents? | They have minimal effect on hind limb function |
| Where is an epidural performed on a large animal? | The site is between the first and second coccygeal vertebrae on the dorsal midline |
| What do the opioid drugs used for epidural anesthesia do? | They block sensory fibers |
| Postoperatively a patient should remain NPO for how long? | Water can be returned in slowly after they can swallow normally, light hay after 1-2 hrs and grain can be returned after about a full day. |
| Why should grain be withheld for about a full day after surgery? | To make sure mobility is correct and has returned to normal in order to avoid causing collic |
| What are the indications for standing surgery over general anesthesia? | Patient is sick, debilitated, elderly, or has a history of complications under anesthesia or during recovery |
| What are the benefits of standing surgery? | Avoids the risk of general anesthesia especially those associated with recovery and recumbency, it avoids stress for patients who've experienced trauma, and it's less expensive |
| Why do we restrict food prior to standing surgery | Drugs given can slow down GI mobility, which can potentially cause collic |
| How long do we withhold grains prior to surgery? | 12 hrs |
| How long do we withhold hay prior to surgery? | 2-6 hrs |
| When a patient needs emergency surgery what should we immediately do in regards to food? | Pull whatever food and water is immediately available ASAP |
| After standing surgery, and the horse has regained the ability to swallow normally, what should be returned first? | Water, in small amounts, slowly |
| 1-2 Hours after standing surgery what can be returned to the horse? | Hay and light grasses |
| After standing surgery what is returned last? | Grains |
| How many hours post-op should we wait before returning grains? | 24 hours |
| Why is it important to withhold grain for 24 hours after surgery? | To ensure that the GI mobility has returned to normal, thus preventing colic |
| Urine and Fecal output should be closely monitored for how many hours post-op? | 24 hours |
| Why are horses always hooked up to a ventilator while under general anesthesia? | In recumbent position the weight of their intestines pressing on their diaphragm and thoracic cavity keeps their lungs from fully expanding |
| What does "When in Rome" mean in regards to general anesthesia? | That while generalizations can be made you should take everything with a grain of salt and that each hospital will have their own way of doing things due to preference of doctor and variations in equipment |
| True or False: Fasting patients before general anesthesia reduces the weight of their intestines. | True |
| What risks may be involved with equine general anesthesia? | Recovery, breathing, & the crushing of muscles and organs |
| Why is water seldom withdrawn more than 2 hours before general anesthesia? | Due to dehydration and GI mobility related issues |
| How long before induction are foals allowed to nurse? | 30 to 60 minutes |
| True or False: General Anesthesia is simple, but never without risks. | False because general anesthesia can be both simple AND complex and is never without risks. |
| Most anesthetic drugs cause some degree of what? | Depression of GI motility |
| Anticholinergic drugs have marked effects on depressing what? | GI motility which can lead to prolonged ileus and GI colic |
| Why are anticholinergic drugs rarely used with horses? | Due to their marked effect on depressing GI motlity |
| What are Anticholinergic drugs used for with horses? | Useful for treating bardycardia and 2nd or 3rd A-V block |
| Why are anticholinergic drugs sometimes used for ophthalmic surgeries? | When used intravenously they decrease vagal tone making the eye easier to manipulate |
| What are some things you can do beforehand to minimize anesthetic time for a general anesthesia surgery? | Surgical clip/prep, IVC, Prep supplies, discuss positioning w/ vet, cleanse mouth, Brush and bathe, remove horseshoes/clean hooves, prep leg wraps/bandages, protect eyes/helmet, PE/labs, fluid therapy, check anesthetic machine |
| What are "muscle compartments"? | Muscles and muscle groups that are encased in dense connected tissue |
| What is Compartment syndrome? | internal pressures in the muscles build up to the point that the muscle deteriorates. |
| What are the four clinically significant muscle compartments? | gluteals, triceps, masseters, quadriceps |
| What does compartment syndrome begin with? | It begins with collapse of veins and lymphatics that drain that compartment |
| How does compartment syndrome work? | Veins and lymphatics collapse under the weight of the body which means no drainage can occur, arteries remain open longer due to the high pressure, and muscle and nerve cells suffer b/c they cannot receive proper nutrition or eliminate waste |
| What is the primary way to protect your patient in regards to compartment syndrome? | Maintain blood pressure |
| What are the clinical signs of compartment syndrome? | Difficulty standing or inability to stand following general anesthesia, Palpable hardening of affected compartment, Paralysis, Lameness, Acute renal failure, Results from damage to kidney tubules from myoglobin |
| Is there a reliable way to predict or detect compartment syndrome? | No |
| What precautions should be followed to reduce the risk of compartment syndrome? | Minimize anesthesia, Maintain anesthesia only as deep as necessary, Use adequate padding, Position the patient properly, reduce carbohydrate intake, Maintain good BP, correct dehydration beforehand |
| What are the 3 methods for induction and maintenance of anesthesia? | Induction with injectable drugs/Maintenance with injectable drugs Induction with injectable drugs/Maintenance with gas anesthesia Induction with gas anesthesia/Maintenance with gas anesthesia |
| Of the 3 methods for induction and maintenance of anesthesia which is the most common method for short procedures (<1 hr) or where procedures must be rapid | Induction with injectable drugs/Maintenance with injectable drugs |
| Of the 3 methods for induction and maintenance of anesthesia which is preferred for procedures lasting longer than 1 hour Gas anesthetic machine assists with ventilation | Induction with injectable drugs/Maintenance with gas anesthesia |
| Of the 3 methods for induction and maintenance of anesthesia which is generally, only for foals and why? | Induction with gas anesthesia/Maintenance with gas anesthesia, because it cannot be delivered rapidly enough for adults |
| What is the most common route or intubation with horses? | Orotracheal |
| Which route of intubation is primarily used with foals or smaller individuals? | Nasotracheal |
| What type of intubation can be performed is Orotracheal or Nasotracheal intubation would interfere with surgery? | Direct tracheal intubation |
| What are the key differences between anesthetic machines for small animals and those for large animals? | Larger components, often a ventilator is utilized, and it takes 10 to 15 minutes for anesthetic gas to saturate the components |
| What are the basic parameters essential monitoring of anesthesia for horses? | Temp., pulse rate/quality, resp. rate/depth, CRT/MM Color |
| What are the primary concerns of anesthesia for horses? | Hypothermia, hypoventilation, hypotension, bradycardia |
| What do you want to do when prepping the anesthesia machine for an equine anesthesia that you wouldn't do for a small animal anesthesia and why? | Preload before hand so that the patient gets the right amount of gas from the start |
| What effect could a temp below 96 degrees have on a horse? | Ataxia during recovery. You should already be warming before they get to this point |
| In the rare case that a horse becomes hyperthermic what should you do? | Stop immediately and cool them down aggressively |
| True or False: Palpating pulses is misleading on a horse and as such it's best to monitor mechanically. | True, when relied upon for indicating blood pressure |
| What is the normal range on an adult horse for systolic blood pressure? | 100-120 mmHg |
| What is the normal range on an adult horse for diastolic blood pressure? | 70-80 mmHg |
| What is the normal range on an adult horse for the mean arterial pressure? | >70 mmHg |
| What is the normal range on a foal for the mean arterial pressure? | 60-70 mmHg, but highly variable |
| What is the best way to assess oxygenation? | Blood gas sampling |
| Are pulse oximeters a reliable means for monitoring SPO2 and/or heart rate? | No, they're not made for their large tongues. When used they should be above 90%, but are unreliable. |
| What is the respiration rate for an anesthetized an adult horse? Foal? | 8-12 bpm, 20 bpm (maintained by us) |
| How is pulse rate assessed and what should it be for adults? Foals? | Palpation, 30-50/min, 80-100/min |
| How is depth of anesthesia best assessed? | through eye position and reflexes |
| What type of palpebral reflex is desirable? | slow |
| With inhalant anesthesia what position do the eyes rotate to? | down and towards the nose |
| How does ketamine affect the eye position of an anesthesia and how long does it persist? | It will keep it in a central position, 20-30 minutes |
| If the horse develops a nystagmus what does it indicate? | that it's too light |
| What position will the eyes return to if the horse is getting too deep under anesthesia? | central |
| What are some signs that the patient may be too light? | Nystagmus, increased RR/HR/BP, and patient may move limbs |
| What is the most important thing to remember when moving a patient? | It needs to be done really really slowly to allow the lungs to adjust |
| How does moving a patient affect the lungs? | The down lung becomes the top lung and this can cause problems for their breathing |
| Which lung should primarily be on top? Why? | Right, it's larger |
| If a tourniquet is used what is important to remember? | It can be painful so it's important to make sure they are under the right amount of anesthesia |
| How early can damage occur where a tourniquet is concerned? | 30 minutes |
| How long is a tourniquet considered safe for? | Up to 2 hrs |
| What position should horses be recovered in? | lateral recumbancy |
| What can be used to keep the horse down longer so they don't injure themselves? | Xylazine |
| When can you not use Xylazine during recovery? | When a ketamine/Xylazine combination was used for induction and anesthesia |
| What are some recommendations for recovery with horses? | Allow horse to recovery in lateral recumbency Do not encourage the patient to try and stand Supplemental oxygen Staff member should stay with patient Do not leave patient unobserved during any phase of recovery |
| In addition to the recommendations for recovering and adult horse, what is true for foals in recovery? | They should always be closely attended during all phases and at least 2 people should assist the foal |
| When may staff quietly reenter the area? | After the horse is standing |
| After the horse is standing what should the staff do first? | Check the horse for trauma |
| How long after a horse is standing should they not be moved? | They can be moved after their legs are stable enough to walk safely |
| When walking a horse to a stall post recovery how many people are needed and why? | At least a second person to keep the horse steady |
| Who decides when a horse can eat post surgery? Why? | The doctor, due to the risk co post-anesthetic colic |
| What should be done to keep foals from nursing pre and post surgery? | They should be muzzled |
| External Coaptation refers to what? | Bandages, splints, casts |
| External fixation is what? | Method of fracture fixation using metal pins placed through bone and secured to an external frame |
| What are some indications for Coaptation? | Reduce dead space Reduce skin motion Minimize contamination Hold medications on Prevent further injury Compress open would Prevent self mutilation Immobilize limb/joint Provide support Protect limbs during transport/work Control hemorrhage |
| Basis of good bandage is what? | padding |
| Failure to apply adequate padding may lead to what? | Pressure sores Pressure necrosis Inflammation of tendons and ligam |
| True or False: It's important not to use too much padding. | False, better to use too much than too little |
| Pressure applied should be what? | throughout the length of the bandage |
| All layers applied how? | In the same direction and under constant tension |
| Bandages should be monitored how often? | at least once daily |
| Checks of bandages should include what? | If bandage has moved, tightness, soiling esp at hind limbs, strike through, swelling, unraveling |
| What is strike through? | where moisture on the outside is allowing bacteria to get to the wound |
| Bandages should not do what? | Increase lameness |
| True or False: Patient tampering is not common in large animals | True, it does occur just rarely |
| What is the most common form of patient tampering with large animals? | Chewing |
| What is one way that we can control patient tampering in large animals? | Neck cradles |
| What should never be used to discourage chewing and why not? | Caustic chemicals, they can damage mouth and eyes |
| What factors affect the choice of bandage used? | Anatomical location of bandage Available materials Patient factors Experience of personnel applying the bandage Purpose of bandage |
| What types of bandages are there? | Exercise bandages/wraps Shipping bandages Hoof bandages Distal limb bandage |
| What purpose do Exercise Bandages/Wraps serve? | Provide additional support or protection |
| What are the indications for Exercise Bandages/Wraps? | Protection of lower legs during exercise Protection of hoof/heel bulbs Support of lower legs during exercise |
| What purpose do Shipping Bandages serve? | Protecting the legs during transportation |
| What part of the leg do Shipping Bandages cover? | Complete lower leg coverage from below carpus/tarsus to the hoof, including coronary band |
| What purpose do Hoof Bandages serve? | Used to cover open surgical or traumatic hoof wounds |
| What kinds of Hoof bandages are there? | Ones that have been made from standard bandaging materials, ones applied as prescription horseshoes by a farriers, and ones purchased commercially |
| Before placement of Hoof bandage what needs to be done? | wounds should be cleaned and treated with medication |
| What is the most common type of bandage used? | Distal Limb Bandage |
| What purpose do Distal Limb Bandages serve? | Used for inflammatory conditions, can be used for protection and support, but the main purpose is to reduce swelling |
| What are the layers of a Distal Limb Bandage? | Wound dressing Layer to hold wound dressing Padding Securing layer Finishing layer |
| What are three types of wound dressing and which is most common | Dry gauze, Saline soaked gauze, Telfa pads(most common) |
| Which layer does not require compression? | the layer to hold wound dressing, it's simply there to do exactly that hold the wound dressing in place, and the padding layer |
| What are some common bandaging materials used to hold the wound dressing in place? | Roll gauze Not less than 3” 4” or 6” preferred Kling gauze has more elasticity Elastic foam rubber Elastic adhesive tape |
| What purpose does the padding serve? | Prevents strangulation of blood supply |
| What are some bandaging material options for the padding layer? | Cloth pads Towels Sheet cotton 6” brown roll gauze can be applied over to provide better “bite” for the securing layer Difficult to work with |
| Only layer used to apply compression is which one? | Securing Layer |
| What are some bandaging material options for the securing layer? | Cloth bandages Elastic self-adhesive tape Elastic adhesive tape Non-elastic adhesive tape |
| What is the purpose of the finishing layer? | Prevent bedding and other debris from entering bandage Prevent slipping of bandage |
| What is the finishing layer? | It's where you cover the top and bottom of the bandage with elastic adhesive tape |
| What is the purpose of a splint? | Applied to try to immobilize joint, bone or soft tissues following severe, destabilizing injuries |
| Splints usually made with what incorporated? | stuts |
| How are splints made? | Made with wooden poles, metal rods, casting tape, etc. Struts placed after additional padding added over basic limb bandage |
| What is the purpose of casts? | Immobilization |
| What are some different types of casts for large animals | Foot cast Lower limb cast Full limb cast Tube cast |
| Application of a cast is usually done how? | under anesthesia |
| Monitoring of a cast should be done how often? | Twice a day |
| What should the evaluation of the cast include? | Temperature, pulse and respiration Hot spots Odor Exudate Swelling Wear Cast integrity Inflammation Weight bearing |
| Sedation may be necessary during healing to do what? | Calm anxious horses |
| Cast removal preferably done how? | With patient standing to avoid reinjury |
| What are abdominal wraps used for? | Used to cover wounds, incisions and drains placed in abdominal cavity |
| How should abdominal wraps be applied? | Started cranially and spiraled caudally around patients body to cover desired area |
| Tail wraps are used for what? | Parturition, traveling, hind end surgeries, etc |
| What is the biggest thing you need to be aware of concerning a tail wrap? | Not to wrap too tightly because you can cut of circulation of the Coccygeal artery. |
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Adeprey4311
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