AAA VMS4001 > Equine Tx + Procedures > Flashcards

Equine Tx + Procedures Flashcards

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1
Q

Local anaesthesia

A
  • Procaine (+ adrenaline)
  • Lidocaine
  • Lidocaine (+ adrenaline)
  • Mepivicaine
  • Bupivicaine
  • Local infiltration
  • Intra-abdominal infiltration
  • Para-vertebral
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2
Q

Increasing duration of local anaesthetic

A
  • Combine w/ vasoconstricting drug e.g. Epinephrine (adrenaline)-> slower systemic uptake
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3
Q

Use of morphine

A
  • Epidural
  • Intra-articular
  • Horses only
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4
Q

Local anaesthetic injection sites in head - equine

A
  • Mandibular foramen
  • Mental foramen
  • Infraorbital
  • Mental
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5
Q

Epidural - horse

A
  • Co1 - Co2
  • Lidocaine 0.2 mg/kg + Xylazine 0.17 mg/kg
    OR
  • Morphine 0.1 mg/kg diluted to 10 - 30 mL w/ saline
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6
Q

Open castration

A
  • Standing sedation
  • Parietal tunic is incised to expose testis, epididymis + cord structures before any haemostatic procedure
  • Grab both testes + squeeze caudally so scrotal skin is tight + median raphe is visible
  • Make bold (8 cm) scrotal skin incision(s), 2 cm either side + parallel to medial raphe
  • Prolapse testis through incision + incise parietal tunic
  • Release testis away from body + find ligament of tail of epididymis
  • Cut/emasculate ligament of tail of epididymis (place emasculators 90 degrees to cord, nut to nut) - don’t suture up
  • Apply emasculator nut to nut + leave for 2 min
  • Repeat for other side
  • Sx wound left to heal by second intention
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7
Q

Closed castration

A
  • Surgical incision not made through parietal tunic
  • Hospital conditions - sterile environment - dorsal recum
  • On field - lateral recum, hind limbs restrained
  • Make bold scrotal skin incision (not through parietal tunic)
  • Exteriorise testicle as much as possible
  • Use dry swab to strip fascia back
  • Place transfixing ligature around whole cord - vicryl (not always put)
  • Emasculate distal to ligature - closure of parietal tunic optional (suture)
  • Close skin - intradermals
  • Repeat for other testicle
  • Can do in one or two initial incisions
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8
Q

Semi-closed castration

A
  • Like closed, but parietal tunic is opened to allow inspection inside parietal tunic - better ligature placement = gold standard
  • Make incision in scrotum + exteriorise/prolapse testis + place ligature of 5 metric vicryl (around parietal tunic - may need to make window between parietal + cremastor m.)
  • Make 5 cm incision in parietal tunic to expose testis -> evert
  • Sharp transection of ligament of the tail of the epididymis
  • Optional - second ligature - double ligated w/ transfixing + circumferential - around vas deferens + blood vessels
  • Emasculate distal to ligature - check for bleeding
  • Close parietal tunic w/ monocryl or can leave to heal by 2nd intention on field when opened parietal tunic to inspect for herniation then emasculate everything from cremastor m.
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9
Q

Henderson castration

A
  • Closed castration
  • Low-speed cordless drill w/ sterile clamp attachment
  • Place on testicle + twists at high speed until it tears
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10
Q

Castration local anaesthesia

A
  • 10 - 20 mL along planned incision sites under skin (cranially + caudally)
  • 5 - 10 mL into each testis (will diffuse up into spermatic cord)
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11
Q

Standing sedation

A
  • Alpha-2 agonist + butorphanol
  • Consider nose twitch
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12
Q

Donkey castration

A
  • GA + closed or semi-closed
  • Has larger than normal vessels, require ligation -> inc risk of infection + FB reaction
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13
Q

Sx patient prep

A
  • Clean
  • Tail tied/bandaged
  • Long hair trimmed/clipped
  • Povidone-iodine or Chlorhexidine scrub
  • IV catheter if GA
  • Mouth washed if GA
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14
Q

Pre-op therapeutics

A
  • IV sedatives
  • IV induction if GA
  • IV NSAIDs
  • Prophylactic AB?
  • Tetanus antitoxin?
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15
Q

Pre-med sedation

A
  • IV Alpha-2 agonist + butorphanol
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16
Q

Induction GA

A
  • Alpha-2 pre-med
  • Ketamine + Diazepam IV
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17
Q

IV pre-op NSAIDs

A
  • Flunixin or Phenylbutazone
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18
Q

Pre-op prophylactic AB

A
  • IM procaine penicillin or IV oxytetracycline
    (Cheap, safe, licensed, first line, correct dose)
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19
Q

Prevention of tetanus pre-op

A
  • Tetanus antitoxin + toxoid vacc
  • Should vacc + do procedure later
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20
Q

Open castration post-op management

A
  • Confinement in clean stable for 24 h to allow stabilisation of clots
  • Excercise - start after 24 h, turn out in paddock
  • Oral NSAID administration for 3 d
  • O observe castration site (leave site, don’t manually clean)
  • Maybe oral antimicrobials - TMPS
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21
Q

Closed/semi-closed post-op management

A
  • Confinement in clean stable for several days
  • Return to restricted exercise over next week
  • Oral NSAID admin for at least 3 d
  • O observe castration site (leave site, don’t manually clean)
  • Maybe oral antimicrobials - TMPS
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22
Q

Cryptorchid Sx techniques

A
  • Para-inguinal
  • Inguinal
  • Laparoscopic Sx = standing or GA, more expensive, gold standard when testes abdominal
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23
Q

H+ prevention in castration

A
  • Keep hold of the spermatic cord until assessed H+ w/ Allis tissue forceps
  • Larger/older horses + donkeys - do closed/semi-closed under GA + ligatures
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24
Q

Blood transfusion

A
  • When PCV < 20% in acute bleeding episode
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25
H+
- Don't panic, give time - Try clamping vessel w/ Mixter right angle forceps - Packing w/ unrolled bandage - GA + clamp/ligate a. - referral if possible
26
Seroma prevention - open castration
- Big surgical incisions - Lots of movement post-Sx = important factor - Ligatures not used, risk of H+ + swelling - (Stretching incisions will improve drainage)
27
Seroma prevention - closed castration
- Reduce dead space - Good Sx technique - Rest + slow return to exercise post Sx
28
Seroma - open castration
- Re-open wound w/ sterile gloved finger - Focus on re-establishing drainage - Pos antimicrobials
29
Seroma - closed castration
- Don't open wound if not believed to be infected - Focus on reducing risk of 2y infection - Pos antimicrobials - Wound care
30
Scrotal infection - open castration
- Swab first -> C&S - Clean wound w/ antiseptic - Thoroughly open wound (gloved finger) + lavage - Systemic AB - TMPS, Procaine Penicillin - Systemic NSAID - Flunixin meglumine
31
Scrotal infection - closed castration
- Culture if pos - Broad spectrum AB - TMPS - Systemic NSAID - Flunixin meglumine
32
Emasculation of root of penis (iatrogenic penile trauma) from castration
- Emergency referral -> repair or phallectomy
33
Septic funiculitis ('Scirrhous Cord') (castration)
- C&S - First line = antimicrobials (recurrent failure of appropriate antimicrobials = Dx) - Bold Sx excision of thickened avascular + necrotic tissue
34
Peritonitis (castration)
- Referral for intensive care - IVFT, supportive care, injectable AB, anti-inflams, +/- peritoneal lavage)
35
Things protruding from incision site / evisceration of omentum (castration)
- High degree of sterility - Pull out as far as possible - Emasculate - Monitor closely
36
Evisceration of SI (castration)
- Initial aim to protect bowel from further damage + further contamination + prepare for transportation - Make protective sling + urgent transport to clinic w/ Sx facilities - Pos - field anaesthetic, lavage, place back in scrotum + suture skin if possible
37
GA
- General anaesthetic - Recum - horses don't cope well in recum, particularly dorsal, dome of diaphragm, a lot of weight of gut contents on lungs - won't perfuse blood as well, ventilation problem - Full anaesthetic kit - GA recovery facilities - Accessibility/versatility - Evidence base
38
Standing Sx
- Local anaesthetic - local infiltration of body wall + ligaments that hold structures; intra-abdo infiltration; paravertebral - Standing in stocks = safer - Specialist Sx kit - Specialist approaches - New - No GA needed - In a field - owner's stables - No anaesthetic equipment needed - Ovariectomy/Cryptorchidectomy - better Sx access - hanging dorsally - Quicker return to work/exercise - Better ventilation
39
Laparoscopic cryptorchidectomy / orchiectomy
- Standing sedation + local block - Secure haemostasis - by ligasure - Excellent wound healing - Rapid return to exercise - flank - within 2 - 4 w (Ventral midline - out of work for long time) - Can aspirate fluid from ovary if enlarged to make smaller + remove from smaller lateral body wall incision
40
Old method of ovariectomy / non-laparoscopic
- Colpotomy - incision along ventral midline of cervix through vagina -> access to abdo - surgeon carries Ecraseur through - twists ovaries off ovarian ligament - Ventral midline approach - Flank approach
41
Ovariectomy aftercare
- 4 d AB + NSAIDs - 1 w box rest + hand-walking - 3 w paddock rest - Gradual return to exercise
42
Prevention of recurrence of NSE (nephrosplenic entrapment)
- Laparoscopic closure of nephrosplenic space - Place sutures between dorsal aspect of spleen and body wall - Stops colon slipping into nephrosplenic space - (V rare to have NSE colics)
43
Ventriculectomy
- By endoscope - Excision of saccule - grasping forceps/transnasal burr - Ablation of laryngeal saccule - scar tissue forms within saccule - Laryngeal ventricles - blind-ended sacs of larynx - Removal - dec noise - Turn mucosa inside-out and remove - ventrally - Clean-contaminated sx - leave incisions to heal by 2nd intention
44
Laser vocal cordectomy
- Laser used to excise vocal cord - Grasping forceps - H+
45
Dorsal displacement of soft palate
- Laser cautery of caudal part of soft palate - Repeated application at 2 - 4 mm intervals - Total = 1000J
46
Baseline post-op care of colic patient/abdo Sx
- Analgesia = Flunixin, 1.1 mg/kg/day IV divide into smaller doses - CRI IVFT - isotonic, 40 - 60 mL/kg/24 h) - dehydrated, if endotoxaemic, losing fluid from vascular space - Intestinal obstruction - still secreting fluid more proximal (SI) from obstruction but cannot be absorbed, fluid absorbed from distal intestinal tract (large colon) - Monitor C/V status - HR inc, PCV inc, TP inc, membrane colour - check q 2 - 4 h - Protect Sx site - belly bandage - Manage - IV cannula - Gut motility - don't feed until normal
47
Restoration of gut motility post-op colic Sx
- Monitor signs of gut motility - Movement, gentle walking - Oral fluids + food - fluid by mouth after 12 h, offer small amounts of feed early (12 - 24 h post-op) - (Average onset of ileus = 24 h) - inc intestinal secretions, if ileus -> dehydration
48
Gut motility signs
- US - HR + PCV - Gastric reflux (q 3 - 4 h) - Auscultation - Faeces - but still produce w/ ileus
49
Post-op colic (colic Sx)
- Relaparotomy
50
Incisional hernia avoidance
- Avoid wound infection - Minimise movement/exercise strain - reduce strain on abdo wound - Box rest 8 w - Paddock rest 8 w - Belly band - Hernia belt
51
Post-op ileus
- Decompression - pass stomach tube to decompress stomach - IV fluids - Walk-out in-hand - Prokinetic drugs - metoclopramide - Lidocaine - anti-inflam/prokinetic?
52
Long-term colic Sx post-op management - once gut motility returned
- Remove cannulas as soon as redundant - Re-introduction of oral fluids + feed - Small vols of feed given regularly - Monitor for signs of colic - Monitor for CS BID - Maintain belly bandage - Frequent walks 'in-hand; - can graze on lead-rope
53
Long-term colic Sx post-op management - following hospital discharge
- 8 w box rest - 8 w paddock turnout before return to exercise - Remove skin sutures/stables 10 d post-op - Maintain belly bandage, first 2 - 3 w - Low energy diet - Monitor signs of colic
54
Long-term colic prevention
- Minimise amount of CHO fed - Maintain regular feeding + management - Monitor gut parasite status + Tx - Maintain good dental care - Early referral before endotoxaemia -> severe CVS parameters - Early detection + Tx - Anastomosis choice - Dec stereotypies - wind-sucking/crib-biting
55
Osteochondritis dissecans/Chip fractures
Arthroscopy - Removal of OCD fragments - Debridement of cartilage lesions - Lavage
56
Synovial sepsis
Arthroscopy - Removal of bacterial debris - Debridement of contaminated or traumatised tissue - Lavage
57
Arthroscopy technique
- GA - Dorsal recum - Sterile prep - Drape = imperviously (no gaps) - +/- Distend joint prior to making skin portal for insertion of arthroscope - Insufflate joint w/ sterile fluid - Equipment - Triangulation technique - bringing one or more operating instruments through separate portals into visual field of arthroscope w/ tips of instrument arthroscope forming apex of triangle - Three holes, two for instruments, one for arthroscope
58
Fx
- Conservative - Sx removal - Sx repair - fixation - Euthanasia
59
Fx fixation
- GA - Strict Sx asepsis - Pre-op planning - AO/ASIF fixation systems - Intra-op radio - Bandage/cast for recovery
60
Arthrodesis
- Fusion of bones to a joint - Best outcomes in low-motion joints, hind limbs have less weight, lighter horses - Salvage procedure - Pastern arthrodesis - low motion joint, return to modest athletic activity, better Px in hind > fore leg - Tarsal arthrodesis - when medication not effective, chemical (kill chondrocytes, articular cartilage) or mechanical (drill across joint surface) arthrodesis, must be no communication w/ PIT (proximal intertarsal) joint - do contrast study
61
Impingement/overriding of dorsal spinous processes (kissing spines)
- Sx ostectomy - Interspinous ligament desmotomy
62
Impingement/overriding of dorsal spinous processes (kissing spines) - Sx osectomy
- Bone removal - Positioning - standing under sedation + local anaesthetic - Spinous process resection - resection of summit of dorsal spinous process impinging - Subtotal ostectomy - resection of portion of DSP (dorsal spinal process) - 6 m recovery (more invasive) - Px = good, 79% return to work
63
Impingement/overriding of dorsal spinous processes (kissing spines) - interspinous ligament desmotomy
- Ligament removal - Positioning - standing under sedation + local anaesthetic - Resection of interspinous ligament between adjacent impinging DSP - 6 - 8 w recovery time (minimally invasive) - Px = good, 82% return to work
64
Annular ligament constriction
- Annular ligament desmotomy - Open or endoscopically-guided technique - Px = excellent
65
DIP flexural deformity of the forelimb
- Inferior check ligament desmotomy - Stretches muscle, allows DIP joint to come back to normal - Open technique - Px = good (w/ hoof trimming)
66
Periosteal transection - angular limb deformity
- 'Release' of periosteal tissue on the epiphysis to stimulate growth (growth plate) - Transection of periosteum - allows bones to correct w/ bone growth - will compensate for flexion deformities - Earlier, the better, foals - Releases periosteal constriction - bone grows out after Sx
67
Tendon repair
- Various suture patterns - Apposition of severed edges - Support in cast for extended period post-op - Px = poor, salvage (procedure only)
68
Post-op care of orthopaedic patients - Sx-specific
- Dressings/bandage to protect surgical site - Monitor for swelling or discharge indicative of infection - Post-op AB - may not be necessary - Analgesia - phenylbutazone (NSAID) - Removal of sutures/staples 7 d post-op
69
Post-op care of orthopaedic patients - husbandry
- Consider effect of movement on injury repair - Controlled return to exercise - Low-energy diet - Risk of colic - Weight-bearing? - Analgesia? - Foot support? - Risk of contralateral laminitis
70
Orthopaedic cast management
- Inspection - integrity, heat (warmer over joints), discharge above?, seal top w/ bandage, early removal if signs of discharge or severe discomfort - Duration - maintain for 2 w of comfortable/weight-bearing, remove standing, may need GA to replace half-limb cast
71
Surgical site infection - ventral abdo
- Wound cleaning + lavage - drain -> improve appetite - Natural drainage - gravity - Once open + draining - AB use only if oedema + cellulitis (infection spread in tissues) - Most infections in subcut
72
Synovial sepsis
- Rapid < 24 h surgical lavage - Intensive AB Tx - If left late -> euth
73
Restricting movement of lesion during wound healing
- Stable - Even less, maintain standing - cross tying - head collar, lead ropes attached to wall, stopping sitting down, when gets up, puts strain on Fx site - Bandage - Robert jones bandage - inc layers - External support - if suspect Fx, add splint to bandage - Cast material
74
Types of wound dressings
- Dry, semi-occlusive e.g. Melolin - sterile, limited absorption capacity - only absorb bit of blood/serum from Sx wound/minimally contaminated, clean traumatic wound - Poultices - anything wet to apply hoof wall -> softens hoof wall, keeping moisture in, allowing drainage of e.g. solar abscess
75
Wound management - dealing w/ infection, minimising bacterial load
- Lavage - high-pressure fluid - Drainage (passive/active) - incision stays open + pus material drained out - Sx debridement
76
Wound suturing
- First intention healing mixed in w/ second intention - be selective about cases
77
Colic - relief of intestinal obstruction
- Enterotomy - Evacuation of obstruction - Lavage - Closure of enterotomy
78
Colic - large colon evacuation
- DV pos - Tapwater for external lavage - don't want to contaminate serosa of intestine, flushing it away - Pelvic flexure enterotomy - Ingesta into bucket
79
Colic - small intestinal enterotomy
- Use inverting suture pattern
80
Small colon - Faecolith
- Enterotomy
81
Colon displacement correction
- Decompress gas w/ needle - Evacuate ingesta - enterotomy incision - Manipulate + reposition colon
82
Nephrosplenic entrapment
- Starvation + patientence - Gentle exercise e.g. trotting - Phenylephrine (40 mg in 1 L saline) + lunge, vasoconstriction causes spleen to contract to dislodge colon from nephrosplenic space -> intestines move out - GA + roll - rarely needed - GA + laparotomy - only if persistent - any evidence of ischaemia
83
Enterotomy closure
Inverting suture patterns: to minimise adhesion formation - Lembert - Cushing
84
Intestinal strangulation - intestinal resection
- Ligate mesenteric vessels - Cut mesentery - remove ischaemic gut -> secure ligation - Section aborally (away from mouth) - Decompress via ischaemic gut - Section orally - Anastomosis - of healthy bowl - Aim to restore continuity of gut - If > 50% of SI resected, will need diet modification - > 60% - consider euth - Most important component of post-op care = IVFT for restoration of CVS func
85
End-to-end anastomosis
- Equal diameter ends - Two layer technique - mucosal continuous suture, inverting oversew (cushing) - 3M absorbable material - Close mesentery - Lower complication rate
86
Side-to-side (stapled) anastomosis
- Jejuno-caecal anastomosis - Minimises risk of contamination - Time saving - Reinforce ends w/ sutures - Can perform hand-sewn equivalent
87
Sampling for histology
- Small piece of full thickness intestine - Single layer closure - Pot = formalin/Bouin's
88
No wound contraction below carpus/tarsus
- Skin graft - to provide epithelial tissue to keep granulation tissue in check
89
Proud flesh (exuberant granulation tissue)
- Granulation tissue not sensitive, doesn't contain nerves - V vascular, drapes unerneath - Resect/cut
90
Anaesthetic nasal oedema prevention
- Use lateral recum (if pos) - Intra-nasal phenylephrine - vasoconstriction to eliminate oedema - ET or nasopharyngeal tube for recovery - Should correct quickly when horse stands up, but horse has to recovery, only remove ET tube when standing + swallowing - replace epiglottis returns to soft palate - If bad acute airway obstruction + attempts to place tubs then tracheostomy
91
Anaesthetic neuropathy + myopathy prevention
- Reduce pressure on all points - remove head collar; padding; lateral: dependent forelimb pulled forward, upper limbs supported; dorsal: don’t allow stifles to lock -> inc muscle perfusion - Ensure Major veins unobstructed - Avoid tension of nerves – don’t overextend neck or limbs - support neck - if hyperextend can stretch recurrent laryngeal n. + cause laryngeal paralysis - Need to allow surgical access
92
Anaesthetic hyopxaemia prevention
- Prevention of V / Q mismatching - low inspired gas conc (30 - 50%) - prevent absorption atelectasis - Inc FiO2 if PaO2 is below 100 mmHg - Positive-end-expiratory pressure (PEEP) of 5 - 10 cm H2O w/ Intermittent positive pressure ventilation (IPPV) - Pre-med w/ ACP to reduce pul shunt - [Beta-agonists - clenbuterol injection - too many side effects; salbutamol (albuterol) by inhalation]
93
Anaesthetic hypotension
- Dobutamine - IVFT - as infusion - Controlled mechanical ventilation
94
Sedatives/antagonists (not licensed but 6 m withdrawal times for FPAs)
- ACP - Atipamezole - romifidine antagonist
95
Muscle relaxants (not licensed but 6 m withdrawal times for FPAs)
- GGE (Glyceryl Guaicolate Ether) - Diazepam - Midazolam
96
GA (not licensed but 6 m withdrawal times for FPAs)
- Propofol - Sevoflurane
97
Opioids (not licensed but 6 m withdrawal times for FPAs)
- Buprenorphine - Morphine (not licensed) - Pethidine - Butorphanol
98
Inotropes/vasopressors (not licensed but 6 m withdrawal times for FPAs)
- Dobutamine - Dopamine - Ephrdrine
99
Local anaesthetics (not licensed but 6 m withdrawal times for FPAs)
- Bupivacaine - Prilocaine (EMLA cream)
100
Anaesthesia patient prep
- IV catheter - Rinse mouth - If using padded induction box - remove shoes or cover
101
Pre-medication for anaesthesia (neuroleptanalgesia)
(Sedation - ACP) - Alpha-2 agonist (in order of inc duration) - xylazine, detomidine, romifidine - Opioid - butorphanol, buprenorphine, pethidine, morphine
102
Induction of anaesthesia
- Ketamine + central muscle relaxant (midazolam (licensed)/diazepam IV or GGE (guaifenesin) IV to effect - Encourage head to dog-sit
103
Maintenance anaesthesia (TIVA)
- Ketamine induction dose gives ~ 10 minutes of surgical anaesthesia - Short procedures: maintain with intermittent bolus doses of ketamine - Long procedures: variable rate infusion (e.g.‘Triple Drip’)
104
Intermittent IV bolus
- Ketamine (1/3 induction dose q 8 min, 2 min onset) OR - Thiopental 1 - 2 mg/kg when patient moves not licensed, accum may affect recovery - Xylazine 1/2 pre-med dose w/ every top up - Detomidine 1/2 pre-med dose every other top up
105
Variable rate infusion (triple drip)
- Guaifenesin 10% in 500 mL, Ketamine 100 mg/mL 10 mL + detomidine 10 mg/mL 1 mL or xylazine 100 mg/mL 5 mL / 20 mg/mL 25 mL - 1 mL/kg/hr, 2 - 3 drops/s - Adv - more stable plant of anaesthesia - Disadv - relative cost, 90 min max
106
Anaesthesia monitoring
Field - Physiological parameters - pulse – facial artery; respiratory rate (HR may not change when light) - Eye pos - unreliable w/ ketamine (doesn't depress cranial reflex) Hospital - Eye Position - central with sluggish palpebral reflex for surgical anaesthesia; too light: eye rotates, palpebral brisk; too deep: eye central, no palpebral - Pulse Oximeter, Blood pressure, capnography, blood gas analysis, etc
107
Anaesthesia recovery
- Minimise noise/light stimulation - towel over upper eye, pack ears with cotton wool - Keep quiet - observe from a distance if in recovery box - Usually stay with horse if recovering in field - Keep in lateral as long as possible - head collar + lead rope - Additional sedation - w/ inhalational if pre-med worn off, unlikely to need in field, shouldn't need w/ Romifidine - wears off - Catheterise bladder
108
Post-anaesthesia analgesia
- Phenylbutazone IV at time of Sx - PO for 5 d
109
Standing sedation therapeutics
- Acepromazine 0.03 mg/kg - dec dose, less ataxic - Alpha-2 agonist - Opioid - IV in same syringe (can sometimes exclude ACP)
110
Extending standing sedation duration
- 1). Top-up IV bolus of alpha-2 agonist - 2). Alpha-2 agonist infusion
111
Sedation in foals (< 2 w/o)
- Cardiac output directly related to heart rate; hypotension occurs quickly - Avoid alpha-2 agonists due to cardiovascular effects - Benzodiazepines and opioid combination readily cause recumbency -> short procedures e.g. imaging - Sedation: Diazepam/MIDAZOLAM (0.2 mg/kg) + morphine (01. - 0.1 mg/kg)/butorphanol (0.2 mg/kg)
112
Multimodal anaesthesia
- NSAID - Phenylbutazone, Suzibutazone, Flunixin, Firocoxib, Meloxicam, Carprofen etc - Opioid - Butorphanol, Buprenorphine, Pethidine or Morphine - Local - Lidocaine, Mepivacaine or Bupivacaine - Adjunct - MLK (Morphine, Lidocaine and Ketamine) Infusions α-2 agonists, paracetamol, gabapentin
113
Jugular vein catheterisation
- Teflon (angiocath) - short stay, max use 3 d, advanced imaging - Polyurethane (Mila) + silicone - longer stay, 3 - 4 w if maintained properly, less rigid, e.g. fluids post-colic Sx
114
Catheter maintenance
- Adequately secured - Regularly inspected for kinking, bung/extension secure, skin around catheter kept clean - Flushed with heparinised saline at least 4 times daily - Injection port wiped with spirit or removed prior to injection - ALWAYS check for patency prior to injection - Do not leave in longer than necessary or recommended
115
Catheter complications - placement
- Haematoma - puncture of jugular v gone through other side - reposition/apply pressure to area to stop blood flow if hit carotid - Catheter tip extravascular - Catheter embolism
116
Catheter complications - in-dwelling
- Occlusion of catheter - ensure patency, kinking - Thrombus - Thrombophlebitis - Septic thrombophlebitis - Air embolism
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Common problems encountered in hospitalised horse
- GI problems - Unexplained fever - Hyperlipaemia - Jugular vein thrombophlebitis - Unwillingness to drink + inappetence
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GI hospital issues
- Hospital environment unnatural for horse - used to being turned out + fresh grass - Inc susceptibility to - colic, D+ + gastric ulceration
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Colic - hopitalised
- Stall confinement linked to large colon impactions, 53.7% of horses had increased stall confinement prior to developing large colon impaction - Caecal impactions - can develop very quickly, reduced faecal output and mild depression - Most at risk: Thoroughbred in training (reduction in exercise), hospitalised for orthopaedic injury, confined to a stall and on NSAID - NSAIDs/analgesia - can mask early signs of colic, need to monitor!
120
D+ hospitalised
- Isolate (barrier nursing -> isolation) - pyrexic, systemic signs, suspicious of infection, profuse watery diarrhoea +/- foul smell - Identify cause (not always possible!) - Hx, blood, faecal samples - Salmonella (PCR or culture-repeat samples advised, required neg result for 5 d to leave isolatioin) C. difficile toxin analysis, abdominal US - Treat symptomatically - restore + maintain circulating blood volume → Intra venous fluid therapy - Control systemic inflammation - analgesia/anti-inflam +/- anti-endotoxic therapy - Antimicrobial therapy - Nutritional support - encourage to eat correct diet
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Thrombophlebitis
- Immediately remove IV catheter - Collect catheter tip and send for culture & sensitivity - Avoid catheterising other JV due to risk of bilateral JV thrombosis - Hot pack site several times daily - Systemic antimicrobial therapy if infection suspected - NSAID In addition - Topical anti-inflammatories e.g DMSO, Compagel - Anti-thrombotic: aspirin administered every other day
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Thrombophlebitis - prevention
- Minimise vein trauma in critical horses - Sterility during placement - Use minimally thrombogenic catheters - Long catheters less complications that short catheters - Consider how at risk a patient is – hypercoagulable state? - Flush with heparinised saline q 4 - 6 hrs at least - Keep catheter site clean and dry - Check patency before catheter flushed and drugs administered - Monitor for heat, swelling or discharge at catheter site
123
Unwillingness to eat (hospitalised)
- Treat underlying cause - Offer a variety of feeds - Fresh grass – appetite stimulant If no clinical reason to explain unwillingness to drink - If horse receiving IVFT then likely sufficiently hydrated Fussy horses - Bring in water bucket/water from home - Flavour the water - apple juice, electrolyte mix - Oral salt (30 - 60 g NaCl) to stimulate intake - Soak hay and feed to increase fluid intake - Place small bore indwelling nasogastric feeding tube for ongoing fluid delivery
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Hyperlipaemia
- Resolution of underlying disease process - Establish positive energy balance - Reduce stress to limit anxiety and encourage appetite - Most patients inappetent - enteral or parenteral nutrition often required - Horse: glucose/dextrose infusion 1-2 mg/kg/min of 50% solution - Ponies/miniature horses/donkeys - may also require tube feeding or parenteral nutrition containing amino acids - Daily monitoring of triglyceride levels in blood until they have returned to normal limits - Px guarded unless diagnosed and treated early
AAA VMS4001
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