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EQUINE SURGERY
Wound Management andEquine Surgical Procedures
Chapter 8 LACPPage #270Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#ObjectivesUnderstand the basic differences between standing surgical procedures and general anesthesia procedures. Prepare a patient for surgery. Assist with or perform induction and maintenance of anesthesia.Provide anesthetic monitoring. Manage the patient during recovery and immediate postoperative periods. Understand the basic risks and possible complications associated with anesthesia and surgery, and implement preventative measures when indicated.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Equine SurgeryAvailability of surgical proceduresAvailability of surgical facilitiesExpertise of available surgeonsPatient health statusAbility to provide aftercare and follow-upPrognosisEconomic constraints
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Equine Surgery (contd)Standing surgery proceduresMost commonIn the patients best interest if possibleGeneral anesthesia (recumbent) proceduresCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Wound TypesAbrasions- partial thickness wounds (road rash, scraped knees). They can be large and become quite contaminated, but they do not fully penetrated all the layers of the skinPuncture wounds- result from penetration with foreign objects- commonly nails, tree branches, or pieces of wire. They are narrow in diameter relative to their depthLacerations- full thickness wounds that transect the skin completely and often extend into underlying tissues.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Equine Surgery (contd)
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Equine Surgery (contd)
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Standing SurgeryMust be safeBeneficial for sick, debilitated, or elderly patientsNone of the risks of recumbent anesthesiaHistory of problems under general anesthesiaLess expensive
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Standing Surgery (contd)DrawbacksSurgeon comfortSurgeons visualization of the surgical fieldDifficult to maintain sterile fieldThe patient can move
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Show pictures N RoyalsCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Standing Surgery (contd)Patient preparationWithhold grain 12 hoursWithhold hay for 2 to 6 hoursWater is not withheld
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Why Castration?Removal of the testicles reduces or prevents sexual behavior and aggressive behavior and prevents reproduction by individuals judged to have inferior or undesirable genetic traits.Treats certain malignancies, testicular trauma, or inguinal or scrotal hernias.Most commonly done between 1 and 2 yrsCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Prerequisite for CastrationYou need two fully descended testicles; equines have a high incidence of retained testicles=cryptorchid. Sometimes they are located in the abdomen or the inguinal area. Retained testicles do not produce sperm as the temperature in the body is too high.Retained testicles do produce testosterone and these horses will exhibit stallion like behavior.Retained abdominal testicles can become tumorous.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Castration (contd)Age12 to 24 months of ageCan be done later to see how it developsAnesthesiaStanding castrationTranquilizersLocal anesthetics, directly into the testicles and the spermatic cord using a long 18- to 20-gauge needle.Recumbent animalsTriple drip combination of guaifenesin-ketamine-xylazine (GKX)KetamineThiopentalCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#20Castration (contd)PreppingThe recumbent animal will have its legs tied or held out of the way.Hold the head down on the recumbent animal; may want to put towel over the animals eye.No clipping or shaving is necessary.Scrub the surgical area.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#21Castration (contd)ProcedureClosed castrationSpermatic cord and vaginal tunic are emasculated.Greater chance that a vessel will emasculate improperly for this procedure; more bleeding.Open castrationIncision is made over each testicle.Dissecting out the testis and the spermatic cord separating them from the common vaginal tunic.The spermatic cord is then crushed with the emasculators, and the testicles are torn away.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#22Emasculators
Reimer (A) and Serra (B) emasculators. (From Auer JA: Equine surgery, St Louis, 1992, Saunders.)
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Castration Henderson tool
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Castration video..Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Castration (contd)Postoperative careCheck for hemorrhaging for several hours after.Recheck site periodically for one week for bleeding or swelling.Exercise two times a day until healed, as this will promote drainage and healing.If needed, rinse with hose to open and promote drainage.Separate from other horses until healed.Fly control is very important (spring or fall).No medications should be needed.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#27Castration (contd)Complications from castrationsSevere hemorrhagingExcessive swelling from inadequate drainageAcute wound infection and septicemiaProtrusion of abdominal visceraPersistent masculine behavior
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#28Standing Surgery (contd)Clean quiet placeSurgical instruments within reach but away from the horseRestraint: Halter and leadCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Standing Surgery (contd)Nerve blocksField blocksEpidural anesthesia
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General AnesthesiaRisksProne to ventilation problemsCompartment syndrome
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General AnesthesiaInductionCommonly use injectable drugs, as well as for maintenance Injectable drugs and maintenance with gas anesthesiaInduction with gas anesthesia and maintenance with gas anesthesia (Isoflurane) foalsCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)Intubation OrotrachealNasotracheal Direct tracheal intubationTracheotomyCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)What to monitor TemperaturePulse rate and rhythmRespiratory rate and depthCapillary refill timeMucous membrane colorECGBlood pressure Oxygenation/ventilationDepth of anesthesiaCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (speculum)
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)Rolling the patientThe down lung often partially collapsesRoll slowlyControl of bleeding TourniquetEsmarch bandageCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#General Anesthesia (contd)RecoveryLateral recumbencyDo not encourage the patient to try to stand before the drugs have had sufficient time to wear offAvoid external stimuli Do not allow to eat or drink immediatelyProvide water firstSupplemental oxygen Extubate horse until attempts to swallow are madeAssistance to stand may be necessaryTwo people typically stay with foalsCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Caslick (Pneumovagina Repair)ReasonsPrevents involuntary aspiration of air into the vagina.CausesPoor conformationInjury, breeding, foalingCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#51Caslick (Pneumovagina Repair) (contd)Horses that need CaslickOld thin mares with sunken anusesRacing mares that aspirate airBreeding maresMares foalingAXTranquilizeLocal ax: Vulva region
Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#52Caslick (Pneumovagina Repair) (contd)PreparationRemove feces from rectumTail bandage (keep out of the way)Scrub region and rinse thoroughlyUse nonirritating scrub and 4 4 gauzeCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#53Caslick (Pneumovagina Repair) (contd)ProcedureRemove a ribbon of mucosa tissue about 3 mm wide from each edge of the vulva labium (lips of vulva); done with tissue scissors.Cut halfway down or as much as two thirds the length of the vulva.Close raw edges together using a simple interrupted pattern.Use nonabsorbable or absorbable sutures.
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Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#Caslick (Pneumovagina Repair) (contd)Postoperative careRemove sutures in 7 to 10 days.Leave area alone until healed.Check periodically to make sure sutures or skin is intact.ComplicationsSutures may tear out.Too much tissue can be removed (hard to close); must be opened before parturition or breeding.Copyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#56Abdominal SurgeryVentral midline incisionClip Xiphoid to the udder/prepuce and laterally to each flank foldPurse-string suture or place several towel clamps to close the prepucePack with 4 4 gauzeCopyright 2012, 2006 by Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.#
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