Principles in Bovine surgery

1
Principles in Bovine surgery
Chaiwat Jarassaeng Dept. Surgery and
Theriogenology
2
??????????????????????????

• ??????????????????????????????????????????????????
  ????????????????
• ???????????????????????????????????????????????
  ????????????????????????? ????
  ?????????????????????????????, ???????????????????
  ????????, ?????????????????????????,
  ???????????????, ??????????????????????
  ?????????????????? ???????????????????????????????
  ????
• 3. ??????????????????????????????????????
  ?????????????????

3
References 1. Techniques in
Large animal Surgery Turner, A,S. and
Mcilwraith, C,W. 1982 2. Food Animal Surgery.
Noordsy, L.J. 1994. 3. ???????????????????????
????? ?????? ????????
4
Principles in Bovine Surgery 1. Restraints and
preoperative evaluation 2. Anesthesia 3.
Surgical Instruments 4. Medication 5.
Diagnostic instruments 5. Postoperative care
5
Animal restraint and Preoperative
evaluation Restraints - depend on surgical
method - nose lead ----gt wounds dressing -
rope --gt hoof care - local anesthesia --gt
mammary gland - Region anesthesia --gt
Rumenotomy - General anesthesia
6
Nose lead
7
???????????? nasal septum
8
??????????????
9
Hock twitch
10
Front leg hobble
11
The beam-hook method
12
Burley method
13
hobble
14
(No Transcript)
15
(No Transcript)
16
?????????
17
????????
??????????
18
??????????????
19
(No Transcript)
20
(No Transcript)
21
Preoperative Evaluation Emergency or elective
surgery ?? 1. History 2. Physical examination
3. Clinical examination 4. Laboratory
tests 5. Patient and owner 6. Surgeon and
Teamwork
22
Evaluation of the patient (preoperation)
1. History data 2. Physical examination

• vital sign
• Temp.
• HR.
• RR.
• RCR.
• MM.
• CRT

101.5 /- 1.0 oF
48 - 84 tpm
20 - 30 bpm
3 time/ 5min
pink
lt 2 sec.
23
Physical examination (cont.) -
dehydration, jugular pulse, Heart sound
lung sound, ping sound, pinching test,
metallic detector 3. Laboratory test
- CBC - total protein -
electrolyte
24
??????????????????????????????????????????????????

• Dehydration
• - ??????????????? ???????????????????,
  ???????????

25

• Dehydration (cont.)
• - ????????????????????????????, ??????, ????????
• - ???? heat stroke ?????????????
• ????????
• - fluid therapy crystalloid isotonic osmollarity
• (hypertonic ????????? ???????????????????
• ????? blood volume ? ??????????????????????????
  ?
• - ???? electrolyte ????????? pH, electrolyte
  balance

26

• Anemia
• - physical exam. MM. pale, increase HR.
  RR.,
• haemoglobinuria, icterus
• - ?????? ????????????, internal bleeding,
• - platelet decrease or clotting
  cofactor deficit,
• - blood parasite
• - haemolysis

27

• Anemia (cont.)
• ????????
• - ??????????????????? ???????????????????????????
  ?
• - ???????????????????? ????????????
• - blood transfusion
• - fluid therapy avoid haemodilute

28
3.Shock - increase HR and fibrillation, increase
RR and decrease to unconsciousness, pupil
dilate, spasm seizure, pale MM, temp -
Emergency, hypovolemic shock, septic shock -
Dystocia? bleeding, hypoglycemia, dehydration -
bloat ? apnea, venous return down
29

• 3.Shock (cont.)
• Abomasal displace ? acute alkalosis
• Lactic acidosis ? acute acidosis, rumen
  enlargement
• Press diaphragm apnea, venous return
• ????????
• Monitoring vital sign, fluid therapy, steroid,
  oxygen
• Therapy, blood transfusion

30
4.Septicemia - temp , dehydration, HR , RR
, panting - tetanus? spasm, pupil dilation
???????? - ???????????????, ??????????????, ABO
IV - ??????????????????? ??????????????????????
??? ?????????? ?????? ABO ???????????????????
????
31
??????????????????????????????????????????

• ?????????????????????????
• - ???????????????? ????????????? general
  anesthesia
• - ??????? 8 16 ????????????????????
  ??????????
• content ??? rumen????????????????????????????????
  
• ?????????????? ???????????????? ???????????
• ??????? rumen ???????????????????????????????????
  ???

32
????????????????????????????? ??? ???????????
local anesthesia ??????????????????????????
sterile technique ???? ????
2. ???????????????????????????????
Protocol 3-3-3 step1 - scrubbing to remove
debris, dirt and dead skin cell - soft brush
disinfectant soap - 3 5 minutes in non
sterile scrubbing
33
(No Transcript)
34
Step 2 - sponge or brush sterile disinfectant
solution - start in the least contaminated area
toward the most contaminated area -
sterile scrubbing 3 5 minuted - rinse with
alcohol or sterile saline solution Step 3 -
disinfectant three time in area - alcohol,
chlorhexidine or iodine, alcohol
35
?????????????????????????? VET.KKU - ????? -
water Or water disinfectant ???????????????????
??????? ???????????????? - disinfectant
three time in area by alcohol, Tincture iodine,
alcohol ?????? povidone iodine
?????????????????? ??????????????????? ??????????
??????????????????????????
36
???????????????? ????????????????????????????????
????????????????????????????? -
???????????????????????????????????? disinfectant
??? alcohol ???? Tincture iodine ????
???????????, prepuce - ?????????????????
(???????????????????????????) ??? povidone
iodine dilute water ???????????????????????????
37
Disinfectants

• Povidone iodine
• disruption of cell wall, oxidation of cell
  contents
• broad spectrum
• less cutaneous reaction
• no contamination, concentration 0.75 3
  combined with detergent

• Chlorhexidine gluconate
• Effective against Gram,- bacteria fungi
• no cutaneous absorption
• possible contamination of low concentration
  solution (0.02 0.1)

• Alcohol
• damages lipid in the cell membrane
• use in 70
• irritation

38
Suture technique and suture materials
1. Skin - horizontral mattress, horizontral
mattress (half skin) - continuous lock
stitch - simple interrupted 2. Muscular and
subcutaneous - simple continuous -
continuous lock stitch - subcuticular
pattern
39
3.Visceral organ continuous lembert
cushing suture
40
4. Hernia ring - Mayo overlap technique
41
5.teat laceration - mucosa and submucosa simple
continuous - skin vertical mattress
42
Suture materials
1. Absorbable suture chromic catgut -
absorption by cell and tissue proteases -
strength 7 14 days - rapid breakdown when
infection - capillary and allergic reaction
43
Vicryl (polyglactin 910) - hydrolyzed at 60
90 days - strength 75 at 14 days, 50 at 21
days, 8 at 28 days, 0 at 35 days - little
reaction - traumatic tissue
44
2. Non absorbable suture - silk - nylon -
umbilical cotton tape - supramid - vetafil
45
(No Transcript)
46
?????????????????????????????????????????

• Recovery area
• - ???????????????????????????????????????????????
  ??
• ??????????????????????????????????
• - ??????????????????????? ????????????????
• ?????????????
• - ?????????????????????????????????????????????

47
2. Antibiotic - broad spectrum - anaerobes
sensitivity - gram negative sensitivity -
s.i.d, b.i.d, q.o.d, dose recommend
48
3. Analgesic or anti-inflammation drug
Narcotic Analgesic - morphine, oxymorphone,
hydromorphone, fentanyl, buprenorphine,
etorphine,butorphanol - tranquilizers/sedative
opioid ? Neuroleptanalgesia - post
operative administration
49
Non narcotic Analgesic NSAIDs - aspirin,
carprofen, ketoprofen, vedaprofen,
phenylbutazone, dipyrone, flunixin
meglumine Steroidal anti-inflammatory
drugs -prenisolone, methylprednisolone,
dexamethasone triamcinolone
50
4.Fluids therapy

• Dehydration
• pH or electrolyte imbalance
• ??????? alpha-2 agonists ????????? insulin
  inhibition ????????????
• ???? hypoglycemia ?????????? ?????????????????
  dextrose ???
• ( ???????????????????????????)
• ???????????????????? anemia, PCV down, pale MM,
  ??????????
• blood transfusion

51
5. Surgical wound cleaning

• Sterile water or NSS, antiseptic solution
• insecticide negasun ABO carbamate
• s.i.d or b.i.d / day ? stitch off

• 6. Observe complication
• shock, hypoglycemia, dehydration, anemia,
  hypoxia, collapse
• anorexia, septicemia, surgical wound -gt stitch
  rupture,
• hematoma, exudate
• - Vital sing, physical examination

52

• 7. Special care
• ???????????????????????????????????????????????
  ???? ????????????????
• rumen ???????????????????????????????,
  ?????????????? AD ??????????
• ?????????????????????????????????,
  ????????????????????????????????????
• ???????????????????????????????????????,
  ????????????????????????
• ?????????????????????????, ???????????????????????
  ????????????????????????
• ?????????
• 8. Stitch off
• - ??????? 10 14 ????????????????

53
??????????????? (???????????????????)
- ???????????????????????????????????????????

• abrasion
• laceration
• incision
• puncture

• Clean
• Clean contaminated
• contaminated
• dirty/infection

54

• Wound Cleaning
• - ?????, sterile technique
• - water or NSS, sterile water or NSS
  antiseptic solution
• H2O2 ( purulent, necrotic tissue)
• - washing, flushing
• Tissue debridement
• - trimming tissue necrosis infected
• - avoid damage of nerve and vessels

55

• Suturing ? antiseptic ? insecticide
• seton
• - gauze antiseptic solution or antibiotic
  ointment
• - ????????? ????, exudate, seroma, dead space,
  ????
• ????????????????? ?????????????????????
• - ??????????????? open wound healing

56
- Draining 1. Passive drain - gravity, capillary
- penrose - single exit, double exit
57
2. Active drain - close, open suction
58

• Myiasis wound
• - insecticide local, ivermectin
• - NSS H2O2
• - insecticide powder
• Abscess
• - ????? sterile technique
• - stab incision
• - flushing
• - seton

59
??????????????????????

• NSS, lactated acetated ringer s solution,
  acetar 5, D-10 s,
• D-5 ½ s, D-5 W
• Heamaceal
• blood CBC, serum electrolyte Na, K, Cl, Ca,
  P, TCO2 (H2CO-3)

Alkalosis - blood pH , TCO2 , H2CO-3
- D-10 s, NSS or NSS KCl
Hypocalcemia - calciumgluconate,
calciumborogluconate, ???????????????????
??????????????
60

• Acidosis
• - blood pH , TCO2 , H2CO-3
• - lactated, acetated ringer s solution, NSS
  NaH2CO-3
• ????????????????????????? ????, ??????????
  ?????????????????????
• - IV administration
• - maintain cardiac output venous return
  control blood pressure
• hypovolemic
  shock
• - NSS, lactated, acetated ringer s solution, D-
  5 W, D-5 ½ S

61

• ?????? lactated, acetated ringer s solution
• - ????? ????????????????? acidosis
  ??????????????????????
• ???? ????????????????????????????????????
• - ??????? lactated ??????????????????
  ???????????????????? ???
• ??????????????? ????????????????
• ??????????????????????????? dextrose or glucose
  ???? D-5 W, D -5 ½ S
• - ????? ????????????????? hypoglycemia
  ???????????????????
• ????? alpha-2 agonists
• - ??????? ????????????? microzomal
  ??????????????????
• ????????????????????????????? ????????????????

62
Blood Transfusions

• ???????????????? blood transfusions ???????????
• ????????????????????? MM, HR, RR, CRT
• ????????????????????? anemia, blood loss, blood
  parasite PCV of
• below 10
• - ??????????? hypovolemic shock ????,
  ???????????????????????

63
Donner cow - normal blood volume 8 of body
weight ( 600 kg -- 48 liters) - normal PCV 24
48 - donate 10 15 ml of body weight ( 600 kg
-- 8 liters) Recipient - PCV 0.75 per 1
liter of blood given - 5 8 liters take 30
45 minutes - 200 ml transfuse wait for 10
minutes -repeat transfusion within a one week
(low reaction)
64
???????????????????????????????

• Pre-anesthetic drugs
• Anticholinergic
• 2. Phenothiazine decrease blood pressure
• 3. Alpha-2 agonist
• - common use xylazine hydrochloride
• - sedative, analgesia, muscle relaxation,
  decrease RR
• - increase urination, bradycardia, AV block
• - dose 0.03 - 0.11 mg/kg IV, 0.11- 0.22 mg/kg
  IM
• - duration time 40 - 60 min.

65
- bloat, regurgitation, aspiration - antidose
yohimbine 0.125 mg/kg IV, tolazoline 0.2 -
2 mg/kg IV - pregnancy cattle action similar
oxytocin
66
Local anesthesia 1. Cornual nerve block 2.
Auriculopalpebral nerve block 3. Retrobulbar
nerve block 4. Flank local anesthesia 5.intravenou
s regional anesthesia(IVRA) 6. Epidural anesthesia
67
1. Cornual nerve block - cosmetic dehorning
surgery - zygomaticcotemporal nerve line under
zygomatic ridge - lidocaine hydrochloride 2
3-5 ml duration of acting 2hrs. - block
cornual branch of infratrochlear nerve or
local infiltrate
68
(No Transcript)
69
2. Auriculopalpebral nerve block - Prevent
eyelid closure during examination of the
eyeball - Auriculopalpebral nerve supplies motor
fiber to the orbicularis oculi muscle -
injection middle the base of the ear at the
end of the zygomatic arch and insert needle
along dorsal border of arch - lidocaine
hydrochloride 2 10 - 15 ml
70
(No Transcript)
71
3. Retrobulbar nerve block - surgery of eye
ball - ophthalmic and mixillary branches of
trigeminal nerve (sensory n.)
abducent,trochlear and oculomotor nerve (motor
nerve) - four-point retrobulbar block lidocaine
HCl 5 ml/point - Petersons method lidocaine
HCl 15 -20 ml
72
(No Transcript)
73
(No Transcript)
74
4. Flank local anesthesia 4.1 local infiltration
75
4.2(field block) - reverse L block
76
(No Transcript)
77
4.3 Paravertebral nerve block - T13, L1,
L2 - dorsal and ventral root -
medial and lateral branch
78
(No Transcript)
79
(No Transcript)
80
4.3.1 proximal paravertebral nerve block -
Cambridge method - locate by anterior border of
transverse process of lumbar 1, 2 and 3 -
start at L2 for block L1 nerve, L3 for block
L2 nerve - the last about length between point
L2 and L3 for locate point injection of L1
for block T13 nerve
81
4.3.1 proximal paravertebral nerve block -
lidocaine HCl 15 - 20 ml/point - under
intertransverse ligament 10-15 ml for block
ventral branch - over intertransverse ligament 5
ml for block dorsal branch
82
proximal paravertebral nerve block (Cambridge
method)
83
(No Transcript)
84
(No Transcript)
85
(No Transcript)
86
4.3.2 distal paravertebral nerve block(Magda
method) - T13, L1, L2 nerve - transverse
process of lumbar 1, 2, 4 - under transverse
process lidocaine HCl 15 - 20 ml for block
ventral branch - over transverse process
lidocaine HCl 5 ml for block cutaneous branch
of dorsolateral branch
87
(No Transcript)
88
(No Transcript)
89
(No Transcript)
90
Advantages and disadvantages of four common local
anesthetic techniques
91
(No Transcript)
92
(No Transcript)
93
5.intravenous regional anesthesia(IVRA) - fore
limb tourniquet under carpal joint palmar
metarcarpal or common dorsal metarcarpal
vein, radial vein(tourniquet over carpal
joint - hind limb cranial branch of lateral
saphenous vein or dorsal metatarsal vein -
lidocaine HCl 2 10 - 20 ml IV
94
(No Transcript)
95
6. Epidural anesthesia - sarcococcygeal space,
intercoccygeal space 1 - caudal epidural
anesthesia lidocaine HCl 5 ml/bodies, 0.22
mg/kg duration 60 - 90 min. - cranial epidural
anesthesia lidocaine HCl 1 ml/5kg, 60 - 100
ml/bodies lumbosacral foramen but
difficult - xylazine 0.05 mg/kg duration 250
min, morphine
96
Locate intercoccygeal space 1 for epidural
anesthesia
97
Epidural anesthesia and area of anethesia
98

• General anesthesia
• - sedative
• - induction
• thiopental dose 6 -10 mg/kg IV
• ketamine HCl 10-15 mg/kg IM, 2-5 mg/kg IV
• Zolitil (tiletamine and zolazepam) 4 mg/kg IM
  1mg/kg IV 60 min
• propofal 4-6 mg/kg IV
• maintain by halothane, isoflurane
• ET tube
• visual direct laryngoscope
• tactile technique

99
Drug Administration
1. Intramuscular 2. Intravenous 3.
Subcutaneous 4. Intramammary 5. Intrauterine 6. PO
100
Postoperative Complication
1. Shock 2. Dehydration CPR ? ABC -
atropine - sodiumbicarbonate - peripheral
vasoconstrcit drug
101
??????????????????????
102
Bar-type suture use trocar-canula
103
Weingarts Remenotomy Set
104
(No Transcript)
105
(No Transcript)
106
(No Transcript)
107
(No Transcript)
108
(No Transcript)
109
(No Transcript)
110
End