Small Animal Surgical Emergencies. Группа авторов
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Box 2.15 Instruments Recommended for a Pericardiectomy
Vascular clamps (Figure 2.24)
Right‐angle mixter forceps (Figure 2.25a,b)
Sterile cotton tip applicators
Sterile tongue depressors
Malleable retractors (various sizes) (Figure 2.26)
Vessel loops (Figure 2.6b)
Hemostatic agents (Gel foam®, Surgicel)
Figure 2.24 Cooley/Satinsky vascular clamps.
Figure 2.25 (a) Right‐angle mixter forceps (size appropriate) to aide with blunt dissection. (b) Close‐up view of the tips.
Figure 2.26 Malleable retractors for retraction of the lungs during thoracic procedures. These retractors come in different widths and lengths.
Neonatal Care
Adequate numbers of trained personnel are needed for neonate resuscitation. It is helpful to have a neonatal resuscitation supply box (Box 2.17). This box should include a list of required resuscitation supplies including instrumentation to support respiration, resuscitation drugs, and suture to ligate the umbilical cord. The box should be stocked regularly (Figure 2.27).
Box 2.16 Instruments and Supplies for Cesarean Section
Routine soft tissue instrument set
Sterile suction tubing
Suction canister
Balfour retractor
Monopolar cautery
Additional mosquito hemostats for clamping the umbilical cords of the neonates, prior to transection
Additional laparotomy sponges and sterile towels when the gravid uterus is lifted from the abdominal cavity (also useful to avoid contaminating the abdomen with amniotic fluid when the amniotic sacs are ruptured)
Pyometra
The surgical approach for a pyometra surgery is a ventral midline celiotomy. The patient is placed in dorsal recumbency. Instruments needed are listed in Box 2.18.
Penile Emergencies
The most common surgical procedures performed include partial penile amputation and subtotal penile amputation with scrotal urethrostomy. The most common emergency condition of the canine penis requiring surgical intervention is trauma. Priapism and paraphimosis can also result from trauma and may require emergent intervention. The patient is positioned in dorsal recumbency. Instruments recommended for penile surgery are listed in Box 2.19.
Prostatic Abscessation
Surgical interventions for the management of prostatic abscessation include omentalization, marsupialization, passive and active drainage, and partial prostatectomy. Prostatic omentalization is the most common technique currently performed to treat prostatic abscessation. The approach for a prostatic abscess is a ventral midline celiotomy. The patient will be placed in dorsal recumbency. The necessary instruments are listed in Box 2.20.
Vaginal Prolapse
The surgical procedure is performed with the patient in sternal recumbency, with the patient's hind legs hanging over the end of the table and the tail retracted cranially. Proper padding is placed to prevent obturator nerve compression (Figure 2.11a). Instruments used for vaginal prolapse are listed in Box 2.21.
Box 2.17 Neonatal Supply Box
Respiration:Securely fitting oxygen masksInfant suction bulbsMucous trapsCotton tip applicatorsPediatric endotracheal tubes with stylets or smaller gauge IV catheters if intubation required25 gauge needle for GV‐26 acupuncture point [1] a
Resuscitation drugs and reversal agents:EpinephrineNaloxone (if opioid given to dam)
Ligation of umbilical cords:SutureSuture scissorsPovidone iodine solution
Warming devices:Infant incubators (set to 90°F/32°C and 50–60% humidity)Circulating hot water or hot air heating padsRadiant lampsWarm water bottlesSnuggle Safes™Warm surgical towels for tactile stimulation
a Governing vessel 26 (GV 26) is located on the nasal philtrum at the level of the ventral aspect of the nares. Appropriate stimulation of GV‐26 in dogs increases heart rate, stroke volume and cardiac output.
b Neonates can lose heat through evaporation, conduction, radiation and convection. Shivering and vasoconstrictive reflexes are not yet functional. Neonates have well‐developed behavioral heat seeking responses, if heat sources are provided [2].
Figure 2.27 (a) A neonatal supply box. (b) Contents of the box; appropriate items required for neonatal resuscitation.
Box 2.18 Instruments for Pyometra Surgery
Routine soft tissue instrument set
Balfour