E q u i v e t s C o r n i s a - H u g h S u f - PowerPoint PPT Presentation

E q u i v e t s C o r n i s a - H u g h S u f f e r n

E q Field Caesarian In The Mare u i v e t s C o Hugh Suffern MRCVS. r n i s a - Tullyraine Equine Clinic. H u Banbridge. g h Co. Down. S u f Northern Ireland f e r n

E q u i v e t s • I am not a surgeon , this is not a new C o technique . r n i • It is a technique that has been streamlined s a and simplified over the years to make it a - H viable and successful option for the equine u g practitioner in stud practice h S u f f e r n

E q Stashak,Vandeplassche 1992 u i v e t s • ….although in experienced hands most C o dystocias are managed by reposition, partial r n i fetotomy and traction - caesarian section s a should not be considered a last resort. - H • Delay in decision for surgery usually results u g in more trauma to the mare, and greater h S chances of losing the mare and foal…. u f f e r n

E • FARM PRACTICE VETS. BOVINE q u CAESARIAN SECTION i v e t s C • examine a cow at calving and make a o r decision within a few moments as to n i s whether caesarian required a - H u • a caesarian operation holds no fear or g h trepidation to perform S u f • results are very good with a high success f e r rate n 5

E q u • 24 caesarians in 18 years i v e t s C • 2 mare fatalities o r n i s a • 8 dead foals - H u g • 14 known to return in foal h S u f f e r n 6

E q Resolution of Dystocia 
 u i v : Choices e t s C o r n • repositioning of foetus and traction i s a • G.A and repositioning - H • Fetotomy u g • Caesarian h S • Euthanasia! u f f e r n

E q Neck deviation u i v e t s C o r n i s a - H u g h S u f f e r n

E q Shoulder flexion u i v e t s C o r n i s a - H u g h S u f f e r n

E q repositioning u i v e t s C o r n i s a - H u g h S u f f e r n

E q Hock flexion u i v e t s C o r n i s a - H u g h S u f f e r n

E q Hip flexion , Breech u i v e t s C o r n i s a - H u g h S u f f e r n

E q Vaginal delivery under GA. u i v e t s C o r Lifting the hind legs by hoist or tractor n i can give more room for repositioning s a - Planipart will relax uterine wall H u g Inflate the uterus with warm water h S u f f e r n

E q Fetotomy u i v e t s • Specialist equipment C o • experience + skill r n • long arms !! i s a • Dead foal - H • lacerations u g • cervical damage common h S • not a quick resolution u f f e r n

E q u i v e t s C o r n i s a - H u g h S u f f e r n

E q Caesarian section u i v e t s • Will usually arise as an emergency in the C o middle of a busy day (or night!) r n i • for a successful outcome - time is of the s a utmost importance - H u • No specialist equipment or drugs required g h • Be prepared S u • fail to prepare - prepare to fail f f e r n

E Caesarian kit in clinic, ready to go q u i v e t s C o r n i s a - H u g h S u f f e r n 17

E q Key requirements u i v e t s C o r • Safe field anaesthesia n i s a - • Simple, effective (and fast!) surgical H u technique g h S u • Effective post operative care f f e r n

Field surgery E q u i v e • POSITIVES t s • Less stress no boxing C o • no travel time r n • no strange surroundings or people i s • a sense of urgency which can get lost in the hospital a environment - H u g • NEGATIVES h • imperfect knockdown and recovery facilities S u • no effective resusitation ? f f e • asepsis ? r n

E q R.E. Clutton 1997 u i v e t s “… field anaesthesia works best for field C o surgery and disasters are likely when r n i attempting to replicate theatre s a - conditions in the field ,ie. time is wasted H u attaching monitors, laying drapes, g h administering fluids, and generally S u buggering about…..” f f e r n

E q Anaesthetic Timetable u i v e t s C o • 1. Pre Medicate r n • Place I/V Catheter, Prepare instruments etc i s a • 2. Induction with Ketamine (after 5 minutes) - • Scrub up H u • 3. Top up (1/2 dose Ketamine plus 1/2 romifidine) g h • Commence surgery and remove foal S • 4. Initiate Triple Drip Anaesthesia u f • Completion of surgery f e r n

Anaesthesia E q u i v • Pre Med. Romifidine 40 m(4ml sedivet), e t s Butorphanol 10mg.(1ml torbugesic) C o r n i • Induction. Ketamine 1 - 1.8g. (10-18ml ). s a - H u • Top up Ketamine/romifidine ( 1/2 g h induction dose) S u f f e r • Maintenance - Triple Drip Anaesthesia n

Maintenance of anaesthesia 
 E q u other options i v e t s • Pentobarbitol C Euthethal !! 200mg/ml. o r n Saggital 6% w/v i s a • Deadly easy, easily dead! - H • Usually a low dose required u g h • Cheap option if single handed S u • Poor recovery is common f f e • NOT recommended r n

E q u i v e t s C o r n i s a - H u g h S u f f e r n 24

E Guaiphenesen,Sedivet,Ketamine q u i v • 500ml 15% Guaifenesin, 3.8ml Sedivet, e t s 15ml Ketamine C o • Infusian rate 1.1ml/ kg/ h r n i • 3 drops/second. higher initially slowing s a later - H u • best to have someone monitoring anaesthesia g h • Overdosage possible S u • less uterine haemorrhage? f f e r • very safe n

E q Surgical technique u i v e t s C • standing flank ? o r n i s a • lateral recumbency flank ? - H u g h • APPROACH OF CHOICE = S dorsal recumbency, ventral midline u f f e incision r n

E q Abdominal incision u i v e t s A. 30- 35 cms midline incision, C Commence at the anterior aspect of the mammary o gland. r n Can be extended if required, but try to keep i s minimal. a - H u g h S u f f e r n

E Ventral midline q u i v • Linea alba e t s • minimum C haemorrhage o r n • no involvement of i s muscle or nerves a - H u g h S u f f e r n

Uterotomy E q u • Uterus lies directly i v e under incision t s • Grab limb through C o uterine wall r n • exteriorise, i s pack? a - • Incise length of H cannon bone u g h • remove foal S • NB. No need for u f whip stitch as f e r illustrated n

E q Uterine closure u i v e t • Foal to assistant s C • Commence Triple drip o r Anaesthesia n i s • control Haem. ie. tie a off individual bleeders - H • Remove afterbirth if u g possible h • Modified S u Lembert ,double layer f f e • 5m vicryl r n •

Suture material for Uterine Wall E closure q u i v NB. round bodied needle ! e t s C o r n i s a - H u g h S u f f e r n 31

Abdominal wall closure E q u i v e • Linea Alba double t s strand 5m vicryl C o simple continuous r n i • Tie off every 8 cms s a • subcutaneous - - H 5m vicryl single strand u g simple continuous h (usually 2-3 layers) S u f f e r n

E q suture u i v e material for t s C abdominal o r n wall closure i s a - H u g h S u f f e r n 33

E q Skin Closure u i v e t s C • Simple interupted o r n i s • Blanket stitch a - H u • Staples g h S u f f e r n

E q u i v Option for e t s skin closure if C o r there are likely n i s a difficulties in - H removing u g h sutures S u f f e r n 35

Aftercare E q u i • Tet. Antitoxin. v e t • I/V fluids 20 – 30 Lts. Intra and post op.very s C important o r • Aggressive prophylactic antibiotic therapy to help n i s counteract unsterile surroundings. Pene/ Gent. a - • afterbirth removal / gentle uterine lavage H u • Oxytocin 1 cc before GA recovery , then ½ cc TID g h • NSAID s S u • DMSO I/V f f e • Gentle palpation/ mobilisation of uterus per r n rectum, 2-3 days post op.