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A&S - Week 10
Exotic Anaesthesia & Orthopaedic Surgery
| Question | Answer |
|---|---|
| In What Ways Are Rabbits Different To Cats And Dogs? | -Strong oesophageal sphincter = they cannot vomit -Hindgut fermenters -Obligate nasal breathers -Different mouth anatomy -Often underlying respiratory problems -IV access difficult |
| Should Rabbits Be Staved Prior To Surgery? | Only for 30 mins to clear the mouth. Rabbits are hindgut fermenters and so require a constant provision of food to prevent GI stasis. |
| How Are Rabbits Anaesthetised? | -Historically knock down boxes were used to give inhalant anaesthesia -Now pre-meds (opioid or midazolam) and analgesia (NSAIDs) are more often used -Alfaxan or double (ketamine and medetomidine) used for induction (IV or IM) |
| What Is The Normal Reference Range For TPRs In Rabbits? | -HR = 200-300bpm -RR = 40-60bpm -Temp = 38.6-40.1 |
| What Are Some Nursing Considerations For Anaesthetic Monitoring In Rabbits? | -Can loose palpebral reflex with stress, also may not lose reflexes until very deep -Eye position will not drop -Capnography should be between 35-45mmHg -Pulse oximetry is often inaccurate -Possible to get blood pressure (large rabbits only) |
| How Is Inhalant Anaesthesia Delivered To Rabbits? | -Via a mask -Intubation difficult, as different mouth anatomy and very small, but possible (endoscopy can aid placement) -V-gels useful, but must use capnography as they move out of place easily |
| What Is The Fluid Therapy Requirement For Rabbits? | 100ml/kg/day |
| In What Ways Are Guinea Pigs Different To Cats And Dogs? | -Similar to rabbits -Intubation impossible (mouth too small, tongue too big) = mask needed -IV access even more difficult |
| Should Guinea Pigs Be Staved Prior To Surgery? | Only for one hour to clear the mouth. Guinea pigs are hindgut fermenters and so require a constant provision of food to prevent GI stasis. |
| How Are Guinea Pigs Anaesthetised? | -Historically atropine was used to stop hypersalivation, but not effective -Analgesia = opioid and NSAID -Induction agent = double/triple combinations, can use knockdown boxes |
| What Is The Normal Reference Range For TPRs In Guinea Pigs? | -HR = 230-380bpm -RR = 40-100bpm -Temp = 37.2-38.6 |
| What Are Some Nursing Considerations For Anaesthetic Monitoring In Guinea Pigs? | -Temperature can be difficult to obtain in male guinea pigs -Like rabbits, palpebral and pedal reflexes stay for longer -Eye position will drop -Most monitoring aids are inaccurate |
| What Is The Fluid Therapy Requirement For Guinea Pigs? | 100ml/kg/day *Never S/C in scruff as causes pain |
| In What Ways Are Ferrets Different To Cats And Dogs? | -Obligate carnivores -Able to vomit -IV access difficult but can be done |
| Should Ferrets Be Staved Prior To Surgery? | Yes, as ferrets are able to vomit. Max of 4 hours as can easily get hypoglycaemia. |
| How Are Ferrets Anaesthetised? | -Much like cats and dogs with minor changes in dose -Can give propofol if IV access -Can use knockdown boxes, or triple combination *Care as will bite |
| What Are Some Nursing Considerations For Anaesthetic Monitoring In Ferrets? | -Easily suffer from hypoglycaemia = check blood glucose before induction and during surgery, glucose drip if needed -Monitors can be difficult to attach to ferrets due to their size but they are easily intubated so capnography should be used |
| What Is The Fluid Therapy Requirement For Ferrets? | 50ml/kg/day |
| What Is The Normal Reference Range For TPRs In Ferrets? | -HR = 200-250bpm -RR = 30-40bpm -Temp = 37.8-40 |
| In What Ways Are Chinchillas Different To Cats And Dogs? | -Very similar to guinea pigs -Herbivores -Cannot vomit -Difficult to intubate so masked anaesthesia -IV access very difficult -Care when handling, fur slip, predator/prey escape response |
| Should Chinchillas Be Staved Prior To Surgery? | Can’t vomit so only 30min – 1 hour starvation. |
| How Are Chinchillas Anaesthetised And What Are The Monitoring Considerations? | -Analgesia very important, opioid and NSAID -Have limited muscle mass so IM injections difficult -Knock down only option with induction of iso -Monitoring aids often inaccurate -Reflexes are present until really deep anaesthesia -Hyperthermia common |
| What Is The Fluid Therapy Requirement For Chinchillas? | 100ml/kg/day |
| In What Ways Are Rats And Mice Different To Cats And Dogs? | -Cannot vomit, starvation not necessary expect to clear mouth -IV access may be possible in tail vein in big rats -Normally underlying respiratory disease |
| How Are Rats And Mice Anaesthetised And What Are The Monitoring Considerations? | -Analgesia important = grimace scales useful -Inhalant induction -Monitoring aids often inaccurate |
| What Are The General Considerations For Hedgehogs Brought Into The Practice? | -As they are wild safe to assume they are poorly and at a greater anaesthetic risk -Curl into a protective ball so pre-monitoring often difficult |
| How Are Hedgehogs Anaesthetised? | -Knock down induction required for assessment -Masked anaesthesia -All assessments in 1 anaesthetic if possible -Analgesia if deemed appropriate opioids and NSAIDS |
| In What Ways Are Birds Different To Cats And Dogs? | -Anatomy: air sacs work as bellows and push air over lungs on both inhale and exhale so optimum gas exchange can occur -Easy to intubate, cartilage rings are complete in trachea so tubes cannot be cuffed |
| How Are Birds Anaesthetised? | -Knockdown box required -Pre-meds useful (intranasal midazolam) as stressed very easily -Anaesthetic overdose occurs quickly so cannot go over 3% iso -In an emergency abdominal air sac can be cannulated to provide oxygen and anaesthesia |
| What Are Some Nursing Considerations For Anaesthetic Monitoring In Birds? | -TPRs vary with species, take a HR and RR before anaesthesia if possible -Blood pressure can be monitored in larger birds MAP (mean arterial blood pressure) should be 90mmGh -Capnography possible -Wake up very quickly |
| Should Birds Be Staved Prior To Surgery? | Birds can regurgitate food from the crop so must be starved long enough for this to empty. Owls and falcons must produce a pellet from their last meal before anaesthesia. |
| How Can IV Access Be Obtained In Birds? | Brachial wing vein or saphenous vein. |
| In What Ways Are Reptiles Different To Cats And Dogs? | -Do not have a diaphragm, rely on abdominal muscles and leg movements to breathe -When anaesthetised muscles are paralysed = so they cannot breathe on their own -Decrease in oxygen rather than the increase in carbon dioxide induces breathing |
| How Are Reptiles Anaesthetised? | -Tramadol IM for pre-med -Injectable induction as can breath hold (alfaxalone or propofol) -IV catheter placement in tail vein possible in large lizards but risk of damage to tail -Forelimbs should be used for IM, due to renal shunt from hindlimbs |
| What Are Some Nursing Considerations For Anaesthetic Monitoring In Reptiles? | -Capnography can sometimes show if waking up, or if too deep -Reflexes disappear at surgical plane of anaesthesia, first reflex to return is often anal tone before palpebral -IPPV or ventilation required -Exothermic animals |
| What Makes Horse Anaesthesia Difficult? | -Their temperament (prey species - flight response) -Their size -Their anatomy and physiology (cannot vomit, obligate nasal breathers, small thorax relative to size - compressed by abdomen when in dorsal recumbency) |
| Should Horses Be Staved Prior To Surgery? | -For 8-12 hours to reduce the pressure of gastric contents on the diaphragm -The mouth should also be flushed out with water to reduce risk of aspiration |
| Give Some Examples Of Surgical Procedures Performed On Horses Under Sedation | -Castration -Dental surgery -Wound management |
| Why Is It Important That A Horses Head Is Supported/Elevated During Sedation? | Because without support the head will droop downwards, which will increase the risk of nasal oedema. |
| What Sort Of Equine Surgeries Are Carried out In The Yard And What Sort Of Surgeries Are Carried Out In A Specialised Theatre? | -Yard = short and simple procedures -Theatre = long and complex procedures |
| What Form Of Anaesthesia Is Given To Horses Undergoing Surgery In A Yard/Field? | Total intravenous anaesthesia. |
| What Drugs Are Commonly Given To Horses As A Pre-Med? | Acepromazine, and alpha 2 agonist and an opioid |
| What Drugs Are Commonly Given To Horses As An Induction Agent? | -An alpha 2 agonist + ketamine or guaifenesin + ketamine, or ketamine + benzodiazepine -Propofol/alfaxalone is not used as the dose would be massive and would take too long to inject = unreliable |
| What Are Some Considerations For Safe Anaesthetic Induction In Horses? | -Field = large flat area, dry and clean, free of debris that could cause injury -Theatre = special induction box with padded walls and floor, window and escape hatch -Padded headcollar to prevent nerve damage by prolonged recumbency/pressure |
| How Are Horses Transported From The Induction Box To The Theatre Table? | Via a hoist. |
| How Is Anaesthesia Maintained In Horses? | -Field = TIVA, top up doses of induction agents (‘triple drip’) -Theatre = inhalational agents (Isoflurane/Sevoflurane) + intravenous anaesthetic agents (PIVA) |
| What Drugs Are Commonly Used In The Triple Drip Used To Maintain Anaesthesia In Horses? | -Guaifenesin -Ketamine -Alpha 2 agonist (xylazine) |
| What Equipment Is Needed Within An Equine Theatre? | -Often 2 surgeons -Designated anaesthetist -Assistants -Hoist -Padded table -Anaesthetic machine -Monitoring equipment -Ventilator |
| What Volumes Should A Ventilator Be Set To For Equines? | -Tidal volume = 10-12ml/kg -Resp rate = 6-10bpm -Inspiratory time = 2-3s -Peak pressure = 20cmH2O |
| What Breathing System Is Used For Equine Anaesthesia? | Non-rebreathing. |
| What Are The Aims/Ideal Outcomes For Recovery Of A Horse From Anaesthesia? | -Horse placed in recovery box -Inhalational anaesthesia discontinued -O2 provided for a while prior to ET tube removal -Horse regains consciousness slowly -Manages to stand on first attempt |
| What Complications Can Occur For Horses During Recovery From Anaesthesia? | -Traumatic injury -Failure of orthopaedic repair -Hypotension -Hypoxaemia -Respiratory obstruction -Pulmonary oedema -Muscle/nerve injury |
| What Are The Main Aims Of Fracture Repair? | -Restore the continuity of bone -Restore the length of bone -Restore functional shape of bone -Maintain essential soft tissue function |
| What Is Closed Fracture Reduction? | Involving the use of traction and/or manipulation of the limb to realign bone. |
| What Is Open Fracture Reduction? | Performing surgery whereby the fracture is visualised, and the individual fragments are manipulated surgically back into place. |
| What Is Surgical Fixation Of Bone? | Immobilisation of bone in correct alignment until clinical union occurs. |
| What Is External Coaptation? | Closed fracture reduction followed by applying casts, splints, plasters, etc to fixate. |
| What Are The Advantages To External Coaptation? | -Non-invasive -Economical -Simple |
| What Are The Disadvantages To External Coaptation? | -Risk of pressure sores -Slow healing -Insufficient support for some fractures -Restricts activity of joints and muscles |
| What Are The Nursing Considerations For External Coaptation? | -Sedation or GA needed for application -Careful positioning for recovery -Ensure no rough edges of cast/splint in contact with skin -Observe for signs of discomfort -Cage rest -May need several cast changes, especially if growing animal |
| What Is Internal Fixation? | Open fracture reduction followed by the application of surgical plates, pins, screws and wires. |
| What Are The Advantages To Internal Fixation? | -Good reduction and stability -Rapid bone union -Sooner procedure performed, less soft tissue inflammation -Can be used for many fractures |
| What Are The Disadvantages To Internal Fixation? | -Expensive and time consuming -High skill needed -Risk of anaesthesia |
| List Some Equipment Used In Internal Fixation? | -Intramedullary pins -Lag screws -Cerclage wire -Interfragmentary wire -Bone plates |
| What Are The Nursing Considerations For Internal Fixation? | -Care to avoid post op infections = leading to failure of clinical union -Pre-op imaging needed to confirm placement -Monitoring pain -Strict exercise, 10-15min on lead, cage rest -Sling support |
| What Is External Fixation? | Stabilisation of fracture from outside, pins placed through skin and into bone, externally fixed to a bar frame. |
| What Are The Advantages To External Fixation? | -Minimal instruments required -Minimal disruption of soft tissue -Minimal foreign material at fracture site -Easy to combine with other implants -Easily adjustable and easy to remove |
| What Are The Disadvantages To External Fixation? | -Skill required -Difficult to use in proximal limb -Premature loosening of pins possible |
| What Is An Acrylic Pin External Fixator? | -Bar replaced by corrugated tubing filled with bone cement -Lighter, useful for mandibular fractures and in small dogs and cats -Care as cement produces heat until set – risk of tissue necrosis |
| What Are The Nursing Considerations For External Fixation? | -Care to avoid post-operative infections -Pre-operative imaging vital for successful planning -Small amount of scab must be left to form around pins -Cover pin ends with bandage to prevent damage -Cats must be cage rested, dogs strict lead exercise |
| What Are The Clinical Signs Of Elbow Dysplasia? | -Lameness -Swelling and pain -Atrophy of muscles |
| What Are The Surgical Treatment Options For Elbow Dysplasia? | -Removal of fragmented coronoid process, ulna osteotomy -Removal of reattachment of anconeal process, ulna osteotomy -Removal of cartilage flap/joint mice |
| What Are The Clinical Signs Of Patella Luxation? | -Lameness (bunny hoping) -Pain -Osteoarthritis |
| What Is The Surgical Treatment For Patella Luxation? | -Recession sulcoplasty = deepening of bone groove where patella ligament normally sits |
| What Are The Clinical Signs Of Cruciate Ligament Disease? | -Lameness -Stiffness -Reduced ROM -Instability -Swelling -Muscle atrophy -Positive cranial drawer test |
| What Are The Surgical Treatment Options For Cruciate Ligament Disease? | -TTA = tibial tuberosity advancement -TPLO = tibial plateau levelling osteotomy -ELSS = extracapsular lateral suture stabilisation |
| What Are The Pre-Operative Nursing Considerations For General Orthopaedic Surgery? | -Careful patient handling -Large area of skin to be aseptically prepared -Hanging limb prep common for limb surgery -Free limb draping may also be used |
| What Are The Intra-Operative Nursing Considerations For General Orthopaedic Surgery? | -Strict asepsis -Careful tissue handling -Lots of equipment needed |
| What Are The Post-Operative Nursing Considerations For General Orthopaedic Surgery? | -Light dressing often applied -Must avoid post-operative infections – PPE, hygiene, dressing changes etc -Initial cage rest, then room rest (cats) or short lead-only exercise (dogs) -Physio and pain scoring important |
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aimee_knows_nothing
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