KARANDE DIPALI DATTATARAI

304-A
Pre-Surgical Planning:
Pre-surgery Examination & Blood work
Fasting
Set-up of prep area and operating room
Thermo regulation
Aseptic Preparation
Analgesic Regimen
Anesthesia
Aseptic Transfer to Surgical Field
Examination should include:

Physical examination and blood work in large

animals

Check animal identification

Take and record temperature, HR, CRT, RR, BW
Check cage for signs of loose stool or vomiting
Observe animal in home cage for normal behaviors
Review animal medical record
Rodents & Rabbits (mice, rats, guinea pigs, hamsters, rabbits):
High metabolic rate
No fasting prior to surgery
Rodents DO NOT have vomit reflex, no regurgitation

Monogastric animals (e.g. dogs, cats, swine):

Fast 6-24 hours prior to surgery

Ruminants (e.g. sheep, goats, cattle)

Fast for 12-36 hours prior to surgery.
Reduces fermentation in the rumen
Placing stomach tube reduces rumenal tympany.

All animals should have free access to water.

Restricting water results in dehydration and more difficult anesthesia.
Ensure prep area has:
Working heat support on table
Functioning anesthesia machine (if required)
Stethoscope
Appropriate drugs and reversal agents (analgesics and anesthetics)
Functioning monitoring equipment
Prep supplies and clippers
Vacuum

Ensure OR area has:

Working heat support on table
Functioning anesthesia machine (with ventilator)
Functioning monitoring equipment
Fluid support as needed
Emergency supplies (Ambu bag, and crash cart supplies)
 RECOMMENDED HARD SURFACE DISINFECTANTS
(e.g., table tops, equipment)
Always follow manufacturer's instructions for dilution and expiration periods

AGENT EXAMPLES* COMMENTS

Alcohols 70% ethyl alcohol Contact time required is 15 minutes. Contaminated surfaces
85% isopropyl alcohol take longer to disinfect. Remove gross contamination before
using. Inexpensive

Quaternary Sodium hypochlorite Corrosive. Presence of organic matter reduces activity.

Ammonium (Clorox ® 10% solution) Chlorine dioxide must be fresh; kills vegetative organisms
Chlorine dioxide within 3 minutes of contact.
(Clidox®, Alcide®, MB-10®)

Glutaraldehydes Glutaraldehydes Rapidly disinfects surfaces

(Cidex®, Cetylcide®, Cide
Wipes®)

Phenolics Lysol®, TBQ® Less affected by organic material than other disinfectants

Chlorhexidine Nolvasan® , Hibiclens® .Presence of blood does not interfere with activity. Rapidly
bactericidal and persistent. Effective against many viruses.
 Preparation of the patient
 Bland ophthalmic ointment to eyes
 remove hair from the surgery site (
#40 blade, vacuum)
 initial or preparative scrub
 Povidone-iodinefollowed by alcohol rinse
 Chlorhexidine followed by saline rinse
 move to surgical room / area
 final surgical scrub/paint
 Povidone-iodine followed by alcohol rinse
 Chlorhexidine followed by saline rinse
 Duraprep®, Chloraprep®
 sterile draping of surgical site
 establish a sterile field
 RECOMMENDED SKIN DISINFECTANTS
Alternating disinfectants is more effective than using a single agent.

AGENT EXAMPLES* COMMENTS

Idophors Betadine®, Prepodyne®, Reduced activity in presence of organic matter. Wide range
Wescodyn® of micobicidal action Works best in pH 6-7

Cholorhexadine Nolvasan®, Hibiclens® Presence of blood does not interfere with activity. Rapidly
bactericidal and persistent. Effective against many viruses.
Excellent for use on the skin.
 Adequate anesthesia.

 Adequate analgesia

 Adequate immobilization

 Early notice of trends which may develop into life-

threatening conditions
 Reflexes
 Jaw tone
 Eye position, pupil size and pupillary
light response
 Heart and respiratory rates
 Response to surgical stimuli
 Palpebral (blink) - tested by lightly tapping the medial
or lateral canthus of the eye

 Pedal - Elicited by pinching a digit or footpad

 Corneal - Tested by touching the cornea with a sterile

object

 Laryngeal - Stimulated when the larynx is touched by

an object.
 ECG (EKG)
 Peripheral Perfusion
 Pulmonary Monitoring
 Temperature
 Blood Pressure
An EKG measures the electric currents generated by the heart.
Monitors heart function
Continuous monitoring with an EKG allows early recognition of
electrical changes associated with disorders of conduction in the heart
and arrhythmias that may need to be treated.
 Cardiac dysrhythmias:
 Tachycardia: excessive rapidity of the heart

 Bradycardia: slowing of the heart

 Ventricular fibrillations: total disorganization of the

ventricular activity
Premature ventricular contractions (PVCs): early
contraction

Heart Block: loss of or non-P-wave associated

QRS complexes
Indicate lack of electrical transmission in the heart
 Monitored by :
 Palpation of heart beat through chest wall

 Palpation of peripheral pulse for strength and quality

 Auscultation of heart beat with stethoscope

 Electrocardiogram (EKG, ECG) with continuous display

 Heart Rate
Know the acceptable HR for the species you are monitoring.
Bradycardia: excessive anesthetic depth, “too deep”
vagal stimulation
hypertension
hypothermia
drug effects
elevated cranial pressure
Tachycardia: inadequate anesthetic level, “too light”
pain/surgical stimulation
hypotension
hypoxemia
hypercarbia
drug effects
 Capillary refill time (CRT)
 Measures the time taken for refilling blanched mucus
membranes
 Observe the color of mucus membranes
 CRT should be 1-2 seconds and gums (when not pigmented)
should be pink
 Other sites for color are tongue, buccal mucous membrane,
conjunctiva of the lower eyelid, and the mucous membranes
about the prepuce or vulva
 Pale membranes indicate poor perfusion, blood loss, or
anemia
 Purple/blue membranes indicate cyanosis
 Measures the percentage of oxygenated
hemoglobin and heart rate
 Is broadly accurate for SaO2
 sensory probe needs to be placed on
nonpigmented area (tongue, tail, ear ,etc.)
Sensor beams infrared light through tissue and records the
absorption either of light passing through the tissue to a
receiver on the other side (transmission) or reflected
back to the sensor (reflectance)

Reflector sensor Transmission sensor

 Normally SaO2 is 80-90% in spontaneously breathing
animals and 95-100% in ventilated animals
 Numbers reflect animal on 100% oxygen
 SaO2 readings are susceptible to lowering by
positional factors (slipping away from tissue, thick
tissue, pigment), vasoconstriction, drying of contact
surface, and confusion with respiratory artifact
 Without pulse oximetry, early hypoxia can be difficult
to assess as cyanosis only becomes apparent if values
fall below 85% saturation.
Pulse Oximetry Monitors
 Capnography measures ETCO2 concentration, at
the end of an exhalation
 Usually somewhat lower than PaCO2
 A PaCO2 measurement requires blood gas analyzer
and arterial blood samples.
• Accuracy is subject to mechanical factors with the
breathing circuit such as volume, dead pockets, tubing
diameter, gas flow, etc.

 Animals with ETCO2 over 30-40 mm Hg will

usually breathe on their own
When displayed as a capnographic waveform much useful
information may be derived such as:
“Spiky” topped waves may indicate a waking animal taking short, sharp
breaths
Plateau with a drop to the right may indicate a leak in the circuit as the
pressure of inspiration is not held
 Monitored by :
Observation of chest wall movement
Observation of breathing bag movement
Auscultation of breath sounds
Audible respiratory monitor
 Respiratory volume may be estimated visually, by
reservoir bag inflation, or by using a ventilator or
ventilometer
 Normal tidal volume is 10-20 mL/kg/respiration
 Normal respiratory sounds are almost inaudible
 Normal respiratory rates can vary widely
 Should be evaluated along with tidal volume and respiratory
trends
 May indicate an underlying physiologic change
 Arrhythmic breathing patterns are usually the effect of a
medullary respiratory control problem
 However, some abnormal patterns may be normal in certain
species
A Cheyne- stokes pattern is normal for horse
but could be sign of heart failure or brain
damage.
Apneustic breathing (inspiratory hold) seen in
healthy cats, dogs, and animals anesthetized
with ketamine
Tachypnea: inadequate anesthetic level, “too light”, pain,
hypoxemia, hypercarbia, hyperthermia,
CSF acidosis, drug effects

Hypoventilation : Inadequate or reduced alveolar ventilation

leads to
Atelectasis : partial collapse of the lung
Periodic 'bagging/sighing' (every 5 minutes) throughout
the procedure can prevent this.

Apnea: excessive anesthetic depth, “too deep”,

hypothermia, recent hyperventilation,
musculoskeletal paralysis, drug effects
 Respiration
 Harsh noises, whistles or squeaks may indicate
narrow or obstructed airways or the presence of
fluid in the airways.

 Difficult or labored breathing may indicate the

presence of an airway obstruction.

 An abnormally low respiratory rate (<8-10 bpm) is

cause for concern. Apneic animals may need to be
manually ventilated throughout the procedure at a
rate of 8-12 bpm.
 Respiratory Acidosis
 Inadequate Elimination Of C02
 Production Of C02 Exceeds Elimination
 Causes: Reduced Effective Alveolar Ventilation
from:
 Pulmonary Edema
 Pneumonia
 Airway Obstruction
 Interstitial Fibrosis
 Inadequate Ventilation
 (<20 Cm H20 Intra-alveolar Pressure)
 slow Respiratory Rate
 Hypoxemia

 Diagnosis: EtCO2 > 45 mm Hg

 Enhanced Elimination Of C02
 Elimination Of C02 Exceeds Production
 Causes: Increased Effective Alveolar Ventilation
From:
 High Intra-alveolar pressure
 Hyperoxemia
 Hypotension
 Pulmonary edema
 Interstitial fibrosis
 Endogenous catecholamines (from stress)
 Mechanical ventilation

 Diagnosis: EtCO2 < 35 mm Hg

 Pressure is introduced into the trachea which
inflates the lungs.
 Causes a significant loss in lung compliance
 Necessary in all procedures in the thoracic cavity.
 Ventilation can be severely compromised by
pneumothorax, hemothorax, hydrothorax or a
diaphragmatic hernia.
 Routine manual “bagging/sighing” of the
patient can prevent atelectis.
Anesthetized animal lose the ability to
thermoregulate normally.

 Will lose heat via loss of hair to shaving, the evaporation of prep
solutions, evaporation at and chilling of tissues within surgical
incisions, and vasodilatation caused by anesthetic
agents/adjuncts

 Hypothermia will prolong anesthesia recovery

 Should be countered with warmed fluids, heating blankets, and
towels/wraps

 Hyperthermia is also possible and dangerous

 May be due to overheating with heating pads and tables or due to
anesthesia reactions such as malignant hyperthermia in swine Anesthetized
animals lose the ability to thermoregulate normally
Monitor Temperature throughout surgery
Ways to prevent Hypothermia
Keep animal warm during induction
Warm IV Fluids and irrigating solutions
Circulating warm water/air blankets
Pad between animal and metal table
Hot water bags/bottles wrapped in towel
Covering feet, hands, paws, & head
Heat lamps
BP = hydrostatic force that blood exerts on wall of vessels
Systolic Pressure= pressure of blood when
ventricles at maximum contraction
Normal range 100 to 160mmHG
Diastolic Pressure= pressure of blood when ventricles
relax
Normal range 60 to 100mmHg
MAP= (2 x DP) + SP divided by 3
Normal range 80 to 120mmHg
Pulse Pressure= systolic – diastolic
Normal ~ 40mmHg
 Blood Pressure
MAP < 60 mmHg is hypotension
 Decreased perfusion due to low BP can cause tissue ischemia
 Susceptibility of tissue to ischemia depends on metabolic rate of the
tissue
Hypertension: Systolic >180 mm Hg and
Diastolic >110mm Hg
 Inadequate anesthesia, partially or fully occluded airway
Controlling Blood Pressure:
anesthetic level
IV fluids
Body temperature
Noninvasive/Indirect- accurately reflects trends
Oscillometric method Ultrasonic Doppler
Invasive/ Direct – accurate quantitative value
Arterial catheter connected to pressure
transducer
 Move the animal to a warm, dry area and monitor
vital signs every 15 minutes until the animal is sternal.
 Turn side to side frequently to prevent pooling of fluid
in recumbent side.
 Remove endotracheal tube when swallowing/chewing
this prevents regurgitation and vomiting.
 Do not return to home cage until able to maintain
body temperature and hold itself in sternal position.
A ”stormy “ recovery could be related to surgical pain.

All animals subject to major surgery must have

analgesic agents (i.e. painkillers) available to them
for at least the initial 24-48 hours post-surgery

Provide analgesics as directed by veterinarian.

 Post-Operative Care
Daily evaluation parameters:
appearance
attitude
appetite
Hydration
TPR
Signs of pain
Surgical Incision - for clinical signs of
infection, seroma, hematoma,
suture breakdown, wound
dehiscence.
 Post-Operative Care
Administration of drugs
 SID or QD once daily
 BID twice daily
 TID three times daily
 QID four times daily

Suture/Staple Removal
The goal of the staples / sutures are to keep the skin
margins closed.
Evaluate incision healing prior to removal
Normal removal time is 10 to 14 days