Module 1. Introduction to Veterinary Surgery.pdf

Principles of Veterinary Surgery and Anesthesiology  Module 1 Introduction to Veterinary Surgery  Introduction S u r g e r y a medical specialty t h a t u s e s o p e r a t i ve m an u al an instr umental t e ch n i q u e o n p a t i e n t t o i nve s t...

Principles of Veterinary Surgery and Anesthesiology  Module 1 Introduction to Veterinary Surgery  Introduction S u r g e r y a medical specialty t h a t u s e s o p e r a t i ve m an u al an instr umental t e ch n i q u e o n p a t i e n t t o i nve s t i g at e a n d / o r t r e a t a pathological condition such as di se a s e o r injur y, a n d sometimes for breed standards.  Introduction S u r g ica l p r o ced u r es a r e co m m o n ly c at e g o r i e s by ur gency, t ype of p r o ced u r e, body s y s t em inv o lv ed , d e g r ee o f inv a s iv en es s , a n d s p ecia l i n s t r u m e n t at i o n.  Category of Surgery Elective s u r g e r y Emer gency sur ger y Explorator y sur ger y Reconstr uctive sur ger y Cosmetic surger y  Terminologies Amputation - cutting off Incision - c u t t i n g into Excision- c u t t i n g R e s e c t i o n - par tial r e m ov a l D e b r i d e m e n t - r e m ov a l o f d e a d t i s s u e Ligation - t y i n g o f f A n a s t o m o s i s - sur gical c o n n e c t i o n  Surgical Nomenclature - o t o m y [a c u t t i n g ] m a y involve t r a n s e c t i o n o f non-hollow s t r u c t u r e s s u c h a s t e n d o n ( t e n o to m y) , ligam e nt ( d e s m o t o m y ) o r b o n e ( o s t e o t o m y ) m a y involve c u t t i n g i n to a hollow o r g a n such as t h e s t o m a c h (gastrotomy), cecum (typhlotomy), l a r yn x (laryngotomy) and bladder ( cystotomy)  Surgical Nomenclature - e c t o m y ["ek" out, "tomy" c u t t i n g ] a sur gical p r o c e d u r e in which a p o r t i o n o f t i s s u e is r e m ove d. e.g. ov a r i o h y s t e r e c t o m y, n e p h r e c t o m y, s p l e n e c t o m y, v a s e c t o m y.  Surgical Nomenclature - o s t o m y ["stoma" m o u t h , "tomy" c u t t i n g ] A sur gical p r o c e d u r e in which a n e w opening is c r e a t e d o n a t e m p o r a r y o r p e r m a n e n t basis. e.g. C o l o s t o m y, t r a c h e o s t o m y  Surgical Nomenclature -plasty["plassein" t o fo r m , mold, s h a p e ] A sur gical p r o c e d u r e in which t h e r e is a manipulation p e r f o r m e d t h a t a l t e r s t h e s t r u c t u r e o f t h e o r g a n / b o d y. t h e t e r m is also u s e d w h e n a n ar tificial r e p l a c e m e n t is involved. Ex. t o t a l hip a r t h r o p l a s t y, lar yngoplasty, blephar oplasty.  Surgical Nomenclature -oscopy["skopein" t o view, examine] a sur gical p r o c e d u r e involving t h e u s e o f a n optical i n s t r u m e n t s e.g. a r t h r o s c o p y, la par oscopy, pleur oscopy, g a s t r o s c o p y.  Surgical Nomenclature -rhapy["rhaphe" a s e a m ] a sur gical p r o c e d u r e in which a s t r u c t u r e is s u t u r e d. m a y involve t h e r e p a i r o f a n injured, t o r n tissue. e.g. h e r n i o r r h a p h y, c y s t o r r h a p h y.  Surgical Nomenclature -pexy["pexis" fixation] a sur gical p r o c e d u r e in which t i s s u e is fixed in position, typically w i t h s u t u r e material. ex. A b o m a s o p e x y  Halsted Principles Introduced b y W illiam S t e w a r t Halsted g e n t l e handling o f t i s s u e meticulous h a e m o st a si s p r e s e r v a t i o n o f blood s u p p l y s t r i c t a s e p t i c t e ch n i q u e minimum tension on tissues a c c u r a t e t i s s u e a p p o si t i on obliter ation o f d e a d s p a c e Tissue Handling during Surgery gentle proper use of instr uments do not cr ush keep t i s s u e m o i s t d r y t i s s u e is d e a d t i s s u e minimize t i m e Description of Surgical Procedure S u r g e r y is o f t e n d o n e in a n o p e r at i n g r o o m using sur gical i n s t r u m e n t s , a n o p e r at i n g t a bl e f o r t h e p a t i e n t a n d o t h e r equipment. t h e e nv i r o n m e n t a n d p r o c e d u r e s u s e d in s u r g e r y a r e g ove r n e d b y t h e principles o f s e p t i c technique. Description of Surgical Procedure m e m b e r s o f t h e o p e r at i n g m u s t w e a r sterile attir e, a n d t h e y m u s t s c r u b h a n d s and ar ms. p r i o r t o s u r g e r y, t h e p a t i e n t is given a medical examination, c e r t a i n o r e - o p e r a t i ve t e s t s , a n d i t s physical s t a t u s. Description of Surgical Procedure p a t i e n t s sho uld also b e f a s t e d 12 h o u r s (monogastric) and 18-24 hours (polygastric), in t h e p r e - o p e r a t i ve holding area, t h e patients ar e pr epar ed for s u r g e r y s e t o f vital s i g n s a r e r e c or d e d, p r e - o p e r a t i ve m e d i c at i o n s a r e given. Description of Surgical Procedure w h e n t h e p a t i e n t e n t e r s t h e o p e r at i n g r o o m , t h e skin s u r f a c e t o b e o p e r a t e d o n is shaved, cleaned a n d p r e p a r e d b y appl ying a n a n t i s e p t i c s u c h a s chlorhexidine o r povidone-iodine. sterile d r a p e s a e u s e d t o c ov e r all o f t h e p at i e n t ' s b o d y ex c e p t f o r t h e sur gical s i t e a n d t h e p at i e n t ' s head. Description of Surgical Procedure A n e s t h e s i a is a d m i n i s t e r e d t o p r e v e n t pain f r o m incision, t i s s u e manipulation a n d suturing. b a s e d o n t h e p r o c e du r e , a n e s t h e s i a m a y b e p r ov i d e d locally o r a s gener al anesthesia. Description of Surgical Procedure epidural a n e s t h e s i a m a y b e u s e d w h e n t h e sur gical s i t e is t o o lar ge o r d e e p f o r a local block. w i t h local a n d epidur al anesthesia, t h e sur gical s i t e is a n e s t h e t i ze d. In c o n t r a s t , gener al a n e s t h e s i a r e n d e r s the patient unconscious and paral yzed d u r i n g s u r g e r y. Description of Surgical Procedure a n incision is m a d e t o a c c e s s t h e sur gical s i t e a n d t o l oc at e t h e t a r g e t or gan. blood ve s s e l s m a y b e cl a m p e d t o p r e v e n t bleeding o r c a u t e r i z e t h e a r e a t o s t o p t h e bleeding r e t r a c t o r s m a y b e u s e d t o ex p o s e t h e s i t e o r keep t h e incision open. Description of Surgical Procedure o n c e t h e p r o c e d u r e is complete, s u t u r e s o r s t a p l e s a r e u s e d t o close t h e incision. a f t e r c o m p le t i o n o f s u r g e r y, t h e p a t i e n t is t r a n s fe r r e d t o r e c ove r y r o o m and closely m oni t o r e d. Description of Surgical Procedure d u r i n g p o s t - o p e r a t i v e period, t h e p at i e n t ' s gener al f u n c t i o n is a s s e s s e d , t h e o u t c o m e o f t h e p r o c e d u r e is a sse sse d , a n d t h e sur gical s i t e is checked f o r s i g n s o f infection. if r e m ov a b l e skin cl o su r e a r e used, t h e y are r e m ove d a f t e r 7 - 1 0 d ays post- o p e r at i ve l y, o r a f t e r healing o f t h e incision.  Early Surgery T h r e e main d e v e l o p m e n t s p e r m i t t e d t h e t h e t r a n s i t i o n o f m o d e r n surgical a p p r o a c h e s. C o n t r o l o f bleeding C o n t r o l o f infection C o n t r o l o f pain  Early Surgery Bleeding: 1.Cauterization 2. Ligatur es 3. Blood tr ansfusion  Early Surgery Control of infection: 1.sterilization 2. a s e p t i c t e ch n i q u e 3. m edi cat i on  Early Surgery Pain: moder n pain control through anesthesia was d i s c ove r e d by two American dental surgeons, H o r a c e We l l s a n d W i l l i a m T. G M o r t o n. be ginning in t h e 1 8 4 0 ' s s u r g e r y b e g a n t o ch a n g e dr amaticall y in c h a r a c t e r w i t h t h e d i s c ove r y o f e f fe c t i ve a n d pr actical a n e s t h e t i c chemical s u c h a s E t h e r a n d C h l o r o fo r m. L a t e r pioneer ed in B r i t a i n b y J o h n S now.  History of Sterile Technique H i p p o c r a t e s ( 4 6 0 BC): u s e d boiled w a t e r w h e n ir rigating wounds. Galen (131-210 A D ) : boiled i n s t r u m e n t s a r e u s e d f o r wounds. J o s e p h Lister(1827 -1912): i n t r o d u c e s t h e u s e o f chemicals. Louis P a s t e u r : sterilization b y boiling be gan around 1880.  Patient preparation a b a t h should b e given w h e n e v e r practical, b u t elimination o f ex t e r n a l p a r a s i t e is essential. A n h o u r b e f o r e s u r g e r y t h e animal should b e exe r c i s e d t o e n c o u r a g e voiding. if t h e animal fails t o urinate, t h e b l a d d e r c a n b e e x p r e s s e d o r c a t h e t e r i z e d w h e n t h e animal is a n e s t h e t i ze d.  Preparation of the Surgical Environment A cleaning a n d disinfecting p r o t o c o l m u s t b e e s t a b lis h e d and m a in ta in e d at regular inter vals.  Cleaning and disinfection of the operating room and its equipment Prior to surger y 1. t h e o p e r at i n g r o o m should b e d a m p d u s t e d w i t h d i s i n fe c t a n t solution. 2. E q u i p m e n t s u ch a s h e at i n g pad, E G C etc. should b e checked a n d r e a d y f o r use. 3. I n s t r u m e n t p acks a n d supplies should be assembled.  Cleaning and disinfection of the operating room and its equipment Between cases 1.Soiled i n s t r u m e n t s a n d d i s c a r d e d m at e r i a l s b e p r o m p t l y r e m o v e d f r o m t h e o p e r at i n g table, 2. Table, kick buckets, s t a n d a n d h e at i n g p a d s should b e cleaned a n d disinfected. 3. T h e floor should b e m o p p e d o r w e t v a c u u m e d w i t h a disinfectant.  Cleaning and disinfection of the operating room and its equipment Post-sur ger y 1.All f u r n i t u r e a n d e q u i p m e n t in t h e o p e r at i n g r o o m should b e m o v e d a t t h e e n d o f t h e d a y f o r cleaning a n d disinfecting. 2. D r y mopping, sweeping, a n d d r y d u s t i n g should n o t b e d o n e in t h e o p e r at i n g r o o m. 3. T h e s o a p d i s p e n s e r s a n d f o o t pedals shoul d b e included in t h e cleaning a n d disinfecting.  Operating Room Attire sur gical c u p s a n d m a s k s m u s t b e wo r n w h e t h e r s u r g e r y is p e r f o r m e d o r not. S c r u b t ops and p a n t s o r scr ub d r e s s e s are acceptable. light blue, jade g r e e n o r m i s t y g r e e n color s p r o d u c e s less g lar e t h a n white. if a s e p a r a t e p a i r s o f s h o e s f o r s u r g e r y is impractical, s h o e c o v e r s should b e wor n.  Preparation of the Operative site Skin c a n n o t b e sterilized; howeve r, b a c t e r i a c a n b e r e d u c e d t o a r elativel y s a f e level f o r s u r g e r y. H a i r r e m ov a l a n d initial skin p r e p a r a t i o n s should t a ke place o u t s i d e t h e o p e r at i n g r o o m. Povidone -iodine s c r u b should b e applied w i t h friction, 2 fol l owed b y a t h o r o u g h rinsing w i t h w a r m wat e r.  Preparation of the Operative site t h e p r e p a r a t i o n s o l u t i o ns should b e applied w i t h sterile g l ove s o r sterile s p o n g e f o r c e p s t h e sur gical p r e p a r a t i o n s should be gin a t t h e incision a n d in cir cular m o t i o n p r o c e e d o u t w a r d t h e peripher y.  Draping the Patient t h e p a t i e n t is d r a p e d b y t h e s u r g e o n a f t e r scrubbing, gowning a n d gloving. d r a p i n g m a t e r i a l s include cloth, w a t e r p r o o f paper, a n d plastic. t h e p a t i e n t should b e d r a p e d p r i o r t o o t h e r responsibilities. Principles and Practices of Surgical Asepsis Sterilize all supplies used for sterile procedures. W h e n p u t t i n g o n sterile gloves, d o n o t t o u c h t h e outside. t h e o u t e r wrapping and edges of packs t h a t c o n t a i n sterile i t e m s a r e n o t sterile. o p e n sterile p a c k a g e s w i t h t h e e d g e s o f t h e w r a p p e d d i r e c t e d a w a y f o r m y o u r body. Principles and Practices of Surgical Asepsis A v o i d sneezin g, coughing o r talking dir ectl y o v e r a sterile field. D o n o t r e a ch a c r o s s o r a b ove a sterile field o r wound. H o l d sterile o b j e c t s a n d g loved h a n d s a b ove w a i s t level o r level t o t h e sterile field. Principles and Practices of Surgical Asepsis Fr e q u e n t l y wash hands using cor rect t e ch n i q u e B e constantl y aware of need for clean sur roundings.  Methods of Sterilization 1. P hysical M e t h o d s s t e a m ther mal/Autoclave - s e t t i n g f o r gener al w r a p p e d items: - Te m p : 2 5 0 F - Time: 3 0 m i n s - Pressure: 2 0 PSI  Methods of Sterilization 1. P hysical M e t h o d s R a d i at i o n u s e o n m at e r i a l s t h a t c a n n o t b e sterilized b y h e a t o r chemicals radiant energy d e s t r oy s microorganism  Methods of Sterilization 1. P hysical M e t h o d s Filtr ation methods utilizing filter s capable of screening o u t microorganism  Methods of Sterilization 2. Chemical M e t h o d s E t h y l e n e oxide g a s v e r y t ox i c a n d ir ritating t o skin m u c o u s membrane m i c r o o r g a n i s m d e s t r u c t i o n is c a u s e d b y a chemical r e a c t i o n M a t e r i a l s sterilized n e e d t o b e a e r a t e d in well ve n t i l at e d r o o m o r placed in a n a e r at o r.  Methods of Sterilization 2. Chemical M e t h o d s C o l d sterilization I n s t r u m e n t soaking solution: 1 0 - 2 0 m i n u t e s e m e r s i o n only disinfects. incomplete d e s t r u c t i o n o f spor e, unless s o a k is f o r 10 hour s. Ex. I n s t r u m e n t a l ger micide (Phenol and e t h y l alcohol), C i d ex (Glutar aldehyde).  Antiseptics A n t i s e p t ic : a g e n t applied t o living tissue. D i s i n fe c t a n t : a g e n t applied t o inanimate object.  Antiseptics Chlorhexidine G l u c o n a t e Iodophors: B e t a d i n e Isopropyl Alcohol 70% o r E t h y l alcohol 90% Hexachlorophene Phisohex  References: P.T. Colahan, A. M. M e r r i t t , J.N. M o o r e ; Equine M e d i c i n e a n d S u r g e r y, Vol. I & II 5 t h Ed. C o p y r i g h t 1 9 9 9 ; M o s b y Inc. 1 1 8 3 0 W e s t l i n e Industrial, S t. Lois M i s s o u r i 6 3 1 4 6 J o r g e A. Au e r, J o h n A. Stick; Equine S u r g e r y, 2 n d Edition Copyright 1992 W. B. Sanders Co. Cur tis Center Independence S q u a r e W e s t , Philadelphia, Pe n n s y l v a n i a Te x t b o o k o f Small An i m a l S u r g e r y ( 1 9 8 5 ) b y D H S l a t t e r Small A n i m a l S u r g e r y. A n A t l a s o f O p e r a t i v e Te ch n i q u e s ( 1 9 7 9 ) b y W E W i n g f i e l d a n d C A Ra w l i n g s F u n d a m e n t a l Te ch n i q u e s in Ve t e r i n a r y S u r g e r y (1981) b y D. K n e t c h e t al. Thank you!