1887

Preoperative stabilization

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Abstract

The best results from surgery come from following an appropriate plan, based on an accurate preoperative diagnosis. This plan includes a thorough evaluation and investigation of the presenting complaint and any other concurrent disease an animal may have. Many animals requiring surgery in general practice are young and healthy and are presented for routine ovariohysterectomy or castration. After a thorough history, complete physical examination, evaluation for possible congenital abnormalities and, if indicated, a minimum database (including packed cell volume (PVC), total protein, evaluation of urea and blood glucose level), the majority of these animals require little if any stabilization prior to anaesthesia and routine surgery. Intravenous access, careful endotracheal intubation, strict attention to asepsis and meticulous surgical technique all ensure a successful surgical outcome. This chapter looks at Gastrointestinal diseases; Haemoperitoneum; Hepatic disease; Respiratory system; Cardiovascular system; Urogenital system; Orthopaedic surgical conditions; and Endocrine diseases. Techniques for Placement of a trochar chest drain; Chest drain placement using haemostat forceps and Placement of a small-bore wire-guided chest drain are included.

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Figures

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9.1 Dog with gastric dilatation–volvulus. Two cephalic catheters have been placed to administer intravenous fluids. Orogastric intubation is being attempted. (© David Holt)
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9.3 Dog with progressive haemoabdomen and tachycardia following a Tru-cut liver biopsy. An abdominal counterpressure bandage has been firmly placed using elasticated adhesive bandage material. (Courtesy of V Lipscomb)
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9.4 Oxygen supplementation. Dog with dyspnoea due to laryngeal paralysis in an oxygen cage. Dog with laryngeal paralysis receiving ‘flow-by’ oxygen whilst awaiting placement of an intravenous catheter. (a, © David Holt; b, courtesy of V Lipscomb)
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9.5 Crash trolley stocked with an organized system of endotracheal tubes, stylettes, polypropylene catheters, laryngoscopes, and emergency drugs. (Courtesy of V Lipscomb)
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9.7 PVC chest drain (top) with its trochar (middle), and (bottom) a silicone non-trochar chest drain with extra side holes cut in by the clinician (holes should be approximately one-third of the tube diameter). Equipment for trochar chest drain placement. Multi-fenestrated chest drain catheter (Chest Tube – Guideware Inserted; MILA International). (a, © David Holt; b,c, courtesy of R Goggs)
Image of (Courtesy of V Lipscomb)
(Courtesy of V Lipscomb) (Courtesy of V Lipscomb)
Image of (Courtesy of V Lipscomb)
(Courtesy of V Lipscomb) (Courtesy of V Lipscomb)
Image of (Courtesy of V Lipscomb)
(Courtesy of V Lipscomb) (Courtesy of V Lipscomb)
Image of (© David Holt)
(© David Holt) (© David Holt)
Image of (© David Holt)
(© David Holt) (© David Holt)
Image of (© David Holt)
(© David Holt) (© David Holt)
Image of (Courtesy of R Goggs)
(Courtesy of R Goggs) (Courtesy of R Goggs)
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9.8 Dalmatian with a ruptured bladder secondary to prolonged urethral obstruction. The obstruction has been relieved and an indwelling urethral urinary catheter, as well as a peritoneal dialysis catheter draining urine from the peritoneal cavity, have been placed. (© David Holt)
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9.9 Dog with an open forelimb fracture and wound that has been dressed with a Robert Jones bandage whilst the dog is stabilized with intravenous fluids for hypovolaemic shock and nasal oxygen for pulmonary contusions. An indwelling urinary catheter has also been placed, due to the dog’s recumbency and for monitoring of urine output, and ECG pads have been attached to the dog’s paws to monitor ventricular tachycardia. (Courtesy of V Lipscomb)

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