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Intrathoracic surgery and interventions

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Abstract

A thoracotomy is still required for many procedures but less invasive procedures are becoming more popular. These include thoracoscopic approaches to pericardiectomy, lung lobectomy, and the use of implantable coils to treat patent ductus arteriosus. This chapter looks at preoperative evaluation, preparation, surgical approach, analgesia, monitoring, individual conditions, thoracoscopy and postoperative care.

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Figures

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23.1 Cyanosis of the tongue in a dog with hypoxaemia.
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23.2 A positive end-expiratory (PEEP) valve for use in breathing systems.
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23.3 Insertion of a sterile endotracheal tube into the distal trachea of a dog to continue administration of oxygen and anaesthetic gases. (Courtesy of Dan Brockman, Royal Veterinary College, London, UK)
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23.4 (a) A Univent endotracheal tube with bronchial blocker. a = breathing system end; b = tube to allow low-flow oxygen to be insufflated into collapsed lung or gently remove any air in alveoli and promote collapse; c = valve to inflate bronchial blocker cuff; d = valve to inflate main tube cuff; e = main tube cuff; f = bronchial blocker with cuff. (b) The distal end of the Univent tube. g = the D shaped main tube for ventilation and the channel for the bronchial blocker with cuff (f). (Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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23.5 Insertion of a bronchial blocker into a bronchus using an endoscope.
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23.6 Diagram of the Arndt endobronchial blocker system. The adapter is connected to the endotracheal tube and the anaesthetic breathing system is attached to the right-angled port. The endoscope can then be put down the central port while the endobronchial blocking catheter is fed down the angled side port. The loop is slipped over the end of the bronchoscope and the catheter and endoscope can be advanced together. The balloon is shown inflated to illustrate its shape but it would not normally be inflated until placed into the airway. Once it is in place the endoscope is removed and the central port closed. The screw cap on the side port is tightened to fix the catheter in place. The blocked lung can be deflated, or positive end-expiratory pressure can be applied through the catheter. (Drawing adapted from Cook Medical diagrams)
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23.7 Bronchial blockers. (a) Cohen bronchial blocker. (b) Coopdech bronchial blocker. (c) EZ bronchial blocker.
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23.8 Temporary pacemaker inserted through an introducer in the jugular vein. The pacing generator can be seen in the foreground. The animal has had the pacemaker inserted under sedation and will have a constant regulated heart rate during the induction and maintenance of anaesthesia.
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23.9 Diagram showing the sites for an intercostal nerve block. The standard approach to the intercostal nerve only blocks the ventral half of the thorax. Approaches dorsally close to midline or ventrally from inside the thorax can block the whole thoracic wall by reaching the thoracic nerve before it branches.
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23.10 A dog with a diaphragmatic hernia being prepared for surgery. Note that the board provides a head-up position to alleviate lung compression. (Courtesy of Tanya Duke-Novakovski, Western College of Veterinary Medicine, University of Saskatchewan, Canada)
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23.11 Evacuation of pleural air using a catheter inserted through the diaphragm and attached to a 3-way stopcock and syringe.
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23.12 Arterial blood pressure and ECG tracing from a dog undergoing a patent ductus arteriosus occlusion. Note the increase in diastolic pressure with minimal change in systolic pressure. The heart rate decreases from 128 to 108 beats/minute in response to the increased pressure (baroreceptor response). The trace is at 6.25 mm/second.
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23.13 Diagram of the trachea and bronchi of the dog with a Robertshaw tube placed in the left mainstem bronchus. Note the proximity of the distal end of the tube to the bronchi in the left cranial lobe, showing the likelihood of occluding one or more of these bronchi.
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23.14 Disposable Broncho-Cath CPAP system for use with bronchial blockers and double-lumen endotracheal tubes.

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