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standard dressing forceps
used on gauze
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Brown-Adson forceps
- bilateral row of small teeth
- used on tissues
- do not use on viscera if possible
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rat-tooth forceps
coarse interdigitating teeth
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Backhaus towel clamp
secure quarter drapes
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Snook Ovariohysterectomy hook
used for retracting uterine horn
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Metzenbaum scissors
delicate soft tissue scissors
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Mayo scissors
heavy tissue scissors (ie- linea alba)
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Wire suture scissors
used for cutting wire suture and cerclage wire
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sharp-blunt operating scissors
used for cutting non-metallic suture and paper drapes
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Crile forceps
- hemostatic forceps
- transverse serrations covering entire jaw
- used for large bleeders
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Kelly forceps
- hemostatic forceps
- transverse serrations covering 1/2 of jaw
- used for large bleeders
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Carmalt forceps
- hemostatic forceps
- longitudinal serrations
- used to clamp large sections of tissue
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Allis tissue forceps
- interlocking serrations at tip
- crushing effect
- used only on tissues to be excised
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Olsen-Hegar needle holders
suture cutting capability
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Mayo-Hegar needle holders
no suture cutting capability
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Bard-Parker #3 scalpel handle
holds blade
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Doyen Intestinal Forceps
used to occlude bowel to be anastomosed without causing tissue trauma
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ASA II
- mild systemic dz
- skin tumor, fracture, hernia
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ASA III
- severe systemic disease
- fever, dehydration, mod hypovolemia, anemia
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ASA IV
- severe systemic disease that is a constant threat to life
- toxemia, severe dehydration, severe hypovolemia, cardiac decompensation
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ASA V
- moribund
- extreme shock, severe trauma
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inc HR
- light anesthesia
- pain
- hypovolemia
- anticholinergics
- catecholamines
- hyperthermia
- CO2 retention
- metabolic acidosis
- over distended urinary bladder
-
dec HR
- deep anesthesia
- waning of anticholinergics
- vagal stimulation- eyeball pressure, intubation, carotid pressure
- hypothermia
- hypoxemia
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inc RR
- CO2 retention
- metabolic acidosis
- light anesthesia
- hyperthermia
- CNS stimulation
-
dec RR
- deep anesthesia
- IPPV
- hypothermia
- muscle relaxtion
- CNS edema
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order of loss of reflexes
- swallowing- first
- laryngeal response
- withdrawal
- palpebral
- corneal
- anal
-
pupillary response under anesthesia
- light- dilated
- sx plane- constrict
- deep- dilate
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eye position under anesthesia
- light- ventral and medial
- sx- slight medial
- deep- dorsal
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inc HR and pulse
light anesthesia
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inc HR, dec pulse quality
low cirulationg volume
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dec HR and pulse
deep anesthesia
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injected mucous membranes
- vasodilation
- CO2 retention
- hyperthermia
- polycythemia
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causes of dead space
- multiple strokes with blade
- lifting while suturing
- poor tissue handling
-
epidermis
lacks blood vessels
-
dermis
- vascular
- provide nutrition to epidermis
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possible complications of skin incisions
- infection
- dehiscence of incision
- self mutilation
- hemorrhage and seroma
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mechanical dead space
part of breathing system and tube where there is no gas exchange, y-piece
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anatomical dead space
lips to bronchi
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clean operation
nontraumatic wounds without inflammation or beaks in surgical technique
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clean-contaminated operations
- GI or resp tracts are entered without significant spillage
- minor break in aseptic technique
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contaminated operation
- major break in sterile technique
- gross spillage from GI tract, genitourinary tract, or biliary tract with infected urine or bile
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dirty operation
- bacterial inflammation
- traumatic wound
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PVI scrub
- 5 minutes contact time
- can be alternated with alcohol
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chlorhexidine scrub
- 1 minute contact time
- binds to keratin
- continuous effect
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adverse effects of antibiotics
- anaphylactic reaction
- selecting for resistant strains
- masking infections
- increased cost
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basic principles of rational antibiotic useage
- present at time of contamination
- narrowest spectrum of activity that will protect
- keep duration of administration to a minimum
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when should prohylactic Ab be given
- 30 min prior to sx incision, depends on how long it takes to reach effective concentration
- during sx q2-4hr
- discontinue 3-6hr after sx
- given if sx longer than 90 min
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elliptical defect
- parallel to lines of tension
- length:width 4:1
- relieve tension
- V becomes Y
- Z plasty has the central limb perpindicular to ellipse
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changes in angle of z-plasty will inc length
- 30 degree angle- 25% inc length
- 45 degree angle- 50% inc length
- 60 degree angle- 75% inc length
-
-ostomy
- btw 2 things
- open and leave open
-
-otomy
create opening, implies closure
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dec effectiveness of Ab
- steroids
- malnourished
- hypoproteinemia
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possible complications of rumenotomy
- peritonitis
- wound infection/dehiscence
- intra-abdominal adhesions
- inadvertent injury to an organ
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laparotomy
open and close flank
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reasons for right flank exploratory laparotomy
- SI obstruction- strangulation, mesenteric volvulus, intussusception
- cecal volvulus/torsion/intussesception
- correct left displaced abomasum
- abomasal impaction
- palpate rumen, reticulum, omasum, abomasum, pylorus, duodenum, kidneys, liver, gall bladder, jejunum, cecum, spiral colon
- biopsy kidney or liver
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holding layer of the abdomen
external rectus sheath
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layers to suture when doing intestinal anastomosis
- serosa and muscularis
- muscosa and submucosa- do not leave and mucosa sticking when apposed
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complications of intestinal anastomosis
- dehiscence of anastomosis
- adhesions
- strciture at anastomotic site
- septic peritonitis
- incisional dehiscence
- strangulating hernia thru rents in mesentery
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reasons for right paramedian celiotomy
- correct left displaced abomasum
- palpate rumen, reticulum, omasum, abomasum, pylorus, duodenum, kidney, liver, gall bladder
- correct abomasal torsion/volvulus
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why biopsy?
- dx
- determine therapy
- indicate prognosis
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fluid bolus
- 25% of blood vol over 10 min
- 90 ml/kg dog
- 60 ml/kg cat
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try to maintain what mean BP
70 mmHg
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complication of OHE
- hypotension due ot maniplulation of gut
- hemorrhage due to inadequate ligation of vessels
- incomplete removal of ovary resulting in signs of estrus
- adhesions from excessive trauma or surgical sponges left in abdomen
- adhesion of uterine pedical to bladder or colon
- infection
- stump pyometra
- ureteral ligation
- fistulus draining tracts- wrong suture used
- incontinence
- eunuchoid syndrome- attitude changes
- suture rxn
- seroma
- patient induced trauma
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ID uterine horns
- longitudinal striations of horn
- blood vessels running parallel to horn
- uterine bifurcation
- presence of ovaries
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complications of castration
- scrotal hematoma
- cellulitis
- infection
- dehiscence of incision
- self mutilation of scrotum or incision
- hemorrhage
- penile/urethral trauma
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complications in early spay/neuter
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incision location for OHE
- adult- cranial 1/3
- young- middle 1/3
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advantages of spaying cats early
dec abscesses, agression, sexual behavior, urine spraying, asthma, gingivitis
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advantages of spaying/neutering dogs early
dec separation anxiety, escaping behavior
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disadvantages to spaying too early
- cystitis
- incontinence
- inc hip dysplasia (males also)
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safe age to spay puppy
3 mth
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why spay/neuter at early age?
- eliminate mammary neoplasia
- eliminate unwanted litters
- eliminate pyometra
- eliminate prostatic hyperplasia
- dec aggression
- dec aggression and territoriality
- faster recovery
- easier for doctor
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non-preventable complications during spay
- estrogen responsive eunuchoid syndrome
- obesity
- suture rxn
-
pregnant uterus removal
- more vascular and friable
- great blood/fluid loss
- individual ligatiion of uterine aa and vv
- milk fetus cranially before clamping
-
scrotal ablation
- bc neoplasia, trauma, pendulous
- don't remove too much
- be cautious of lacerationg underlying spermatic cord
-
pyometra
- pus filled uterus
- mild, chronic problem to acute and life threatening
- dz of diestrus
- need ovarian or exogenous PG
- E. coli
- closed cervix- always sx, more clinical signs
- pre and post op care very important
- friable uterus
- ligatures placed in cervix
- lavage
- samples for culture
-
cesarian section
- dystocia
- dam exhausted
- lift horns out
- milk puppies/kittens thru incision
- genlty pull out placenta
- if keeping uterus then double ligate- cushing then Lmebert
- omentum tacked over uterine incision
-
cryptorchid
- faillure of testes to descend
- can become neoplastic
- always remove both
- intra-abdominal
-
holding layer of SI
submucosa
-
longest side suring SI anastomosis
mesnteric
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