During animal surgery. Postoperative care

Postoperative care - a fairly broad topic, because there are almost as many nuances of postoperative patient management as various types operations. Let's consider some general and specific aspects of postoperative patient management.

The postoperative period can be divided into “acute” and “chronic”.

The acute postoperative period begins immediately after the patient leaves the operating room.

Although technically the operation of ovariohysterectomy is comparable to that of sterilization, the general condition of the patient is immeasurably more severe due to intoxication. With such interventions, the animal may spend several days in the hospital. (In uncomplicated cases, infusion therapy (drips) on an outpatient basis is possible, but owners should be prepared for a significant investment of time (4-9 hours).

If the condition is clinically satisfactory, a long (7-14 days) course of antibiotic therapy (injections or tablets) is prescribed. Processing and removal of seams, blanket - as indicated above.

Surgeries to remove tumors (eg breast tumors). As a rule, in this case, a unilateral mastectomy is performed (removal of the entire ridge with capture of the lymph nodes). This is a major operation accompanied by significant tissue damage.

Patients are often older age group and have a number of concomitant pathologies. Infusion therapy may be required for 1-3 days, the animal must be anesthetized (injections of opiate analgesics or NSAIDs) for the first 2-5 days, a course of antibiotics for 5-7 days.

The sutures are treated with levomekol ointment and are usually removed on the 14th day.

Quite often, with such interventions, a seroma (liquid) forms under the skin along the suture on days 4-5, which in some cases must be aspirated (“sucked out” with a needle) or even the cavity drained. If you experience symptoms of “ichor” discharge along the suture or a “water ball” “rolling” under the skin, it is better to see a surgeon.

Urethrostomy.

The most common indication for surgery is the resulting blockage of the urethra. The essence of the surgical intervention is to dilate the urethra and form a new shorter one. urethra; In cats, the scrotum and penis are removed. During the operation it is installed and sutured urinary catheter, which should stand for 3-5 days until the stoma forms. Sanitation (washing) is carried out through a urinary catheter 2-3 times a day. Bladder. Patients after urethrostomy usually require a long course of antibiotics, antispasmodics, hemostatic drugs and a strict special diet. If acute renal failure occurs, intensive infusion therapy (drips) for several days and observation in a hospital are required.

The formed stoma must be carefully protected from licking at least until the sutures are removed (the sutures are removed on days 12-14) (put an Elizabethan collar or diaper on the animal). After the operation, a specialized diet is prescribed.

(removal of non-viable teeth, opening of abscesses oral cavity, osteosynthesis of jaw fractures, etc.) in the postoperative period require feeding with soft, mushy food for 7-20 days and thorough treatment of the oral cavity after each meal with an antiseptic (for example, copious rinsing with chamomile decoction or Stomadex tablets). An antibiotic is usually needed.

Operations on the stomach and intestines.

After most surgical interventions performed on the organs of the digestive system (removal of foreign bodies and neoplasms from the stomach, intestines or esophagus, surgical interventions for volvulus/acute dilation of the stomach), the patient needs a strict fasting diet for 2-4 days - no water, no food should not enter the gastrointestinal tract.

Fluids and nutrients must be given parenterally (intravenously). Since in such cases we are almost always talking about high volumes of infusion therapy and the need for strictly calculated administration of parenteral nutrition drugs, such animals are indicated for observation in a hospital before the start of feeding.

After discharge, you will need a course of antibiotic therapy, special dietary nutrition, and in the first weeks a fractional feeding regimen (5-6 times a day in small portions)

Osteosynthesis and other orthopedic operations.

Osteosynthesis- surgical intervention for fractures of varying complexity. It may involve installing an external fixation apparatus (Ilizarov apparatus in large dogs or a wire fixation apparatus in small animals), introducing a plate, screw, wire, wire cerclage, etc.

In simple cases, the owner will need to treat the sutures daily (chlorhexidine + levomekol) and limit the pet's exercise. The external fixation apparatus requires careful care (treatment of sutures and places where pins are inserted), protection with a gauze bandage until its removal (depending on the complexity of the fracture, up to 30-45 days, sometimes longer). It is mandatory to take a systemic antibiotic; in the early period, injections of analgesics may be required.

For a number of orthopedic interventions, the patient is given a special soft Robert-Johnson fixation bandage for up to a month, which needs to be changed from time to time in the clinic.

Spine operations.

Patients with spinal injuries (fractures) or disc herniations usually require inpatient observation for the first 2-3 days. Rehabilitation period up to full recovery supporting ability can last from several days to several weeks. The owner must monitor regular urination and, if necessary, express urine or catheterize the bladder. The animal must be limited in mobility (cage, carrier). The sutures are treated with levomekol ointment; a protective bandage is usually not required. Spinal patients require a course of antibiotics and steroids for 3-5 days.

To speed up rehabilitation, massage, swimming, and physiotherapy are indicated.

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Indications and contraindications for surgery

General preparation of the animal for surgery

Private preparation of an animal for surgery

Preparation of the surgeon's hands, instruments, sutures, dressings and surgical linen

Fixation of the animal during surgery

Anatomical and topographic data of the operated area

Anesthesia

Online access

Operational procedure

The final stage of the operation

Postoperative treatment

Feeding, care and maintenance of the animal

Bibliography

1. Indicationsme and contraindications for surgery

Castration (Latin castration - castration, sterility) is the artificial infertility of males and females by surgical removal of the gonads or by stopping their function using biological, physical and chemical methods.

Removal of male buttock glands is called orchidectomy (from Greek, orchis - testis and ectome - excision), and removal of female ones - oophorectomy (from Latin ovaium - ovary).

The gonads of males and females perform two main functions. 1) produce germ cells; 2) release hormones. Sex hormones, entering the blood, have a great influence on the state of the body through the nervous system. Only the presence of testes and ovaries can explain in animals the uniqueness of their exterior forms, individual parts of the body, behavior and other features characteristic of male or female individuals.

Castration causes fundamental changes in metabolism, due to which a new physiological state of the body is created, which causes new qualitative and quantitative changes in its organs and tissues. The behavior of animals also changes. They become calmer.

Castrated males develop traits characteristic of females, and, conversely, castrated females develop traits characteristic of male animals. Castration has a particularly strong effect on animals operated on at a young age, when the growth and development of tissues and organs has not yet ended. Males castrated at a young age become lethargic and voracious; They are submissive, therefore easy to use, as they do not show pugnacity and anger. In addition, timely culling and castration of males makes it easier to keep animals on pastures and prevents inbreeding.

Castration of animals is performed for economic, therapeutic and preventive purposes. Castration can also be considered as an act of surgical (non-surgical) intervention aimed at improving the qualitative and quantitative indicators of productivity, operation, and maintenance.

Meat products obtained after uncastrated slaughter have specific, bad smell. It is especially felt during cooking. To get rid of it, as well as to improve the taste of meat and lard, bulls must be castrated. More often, non-breeding males, meat and working animals are castrated in order to obtain quality products, as well as therapeutic purpose(purulent-necrotic processes, hernias, neoplasms in the scrotum and testes).

Castration of bulls is not only a cost-effective operation, but also necessary for the prevention of a number of diseases (sexual trauma, collagenosis, D-hypovitaminosis, etc.), as well as for therapeutic purposes (orchitis, dropsy of the common vaginal membrane, etc.). The effectiveness of castration depends on the age of the castrated animals, breed and housing system. Thus, bulls of the Simmental breed must be castrated at 5-7 months of age with a body weight of 150-160 kg, kept loose and slaughtered at 12 months.

Contraindications to castration of males are exhaustion, illness, early age, and orchidectomy cannot be performed two weeks before and after the end of preventive vaccinations against infectious diseases (anthrax, emkar, erysipelas, and others)

2. Generalpreparing the animal for surgery

First, the epizootological state of the farm is studied. Animals intended for castration are then examined clinically to rule out any diseases. During mass castrations, selective thermometry is performed, pulse and respiration are measured.

They study the surgical area, that is, the size of the testes,

damage to the testes, dropsy of the common vaginal membrane, hermaphroditism, cryptorchidism, the presence of inguinal scrotal hernias. Before surgery, animals are kept on a 12-24 hour fast and given only water. Before castration, animals should not be given water, and immediately before castration they are released for a walk to empty the intestines and bladder. Castration can be done throughout the year, but the operation is conveniently performed in spring and autumn, when there are no flies, and moderately cool temperatures and the absence of dust and dirt favor better healing. surgical wound.

Preparation before surgery also includes cleaning and general or partial washing of the animal, places of constant contamination (perineum, thighs, distal sections limbs). It is advisable to carry out the operation in the morning in order to monitor the animal throughout the day.

3. Private preparation of the animal for surgery

castration infertility postoperative pain relief

Treatment surgical field includes four main points: removal hairline, mechanical cleaning with degreasing, disinfection (asepticization) of the tanned surface and isolation from surrounding areas of the body.

The hair is cut or shaved. The latter has the great advantage that aseptic skin can be done with greater care. It is most convenient to use a regular safety razor with a broken blade. This treatment is easier to carry out on a fixed animal.

In young bulls, hair removal may not be necessary, since it is rare on the scrotum.

During mechanical cleaning and degreasing, the surgical field is wiped with a swab or napkin moistened with a 0.5% solution of ammonia or ether alcohol (equal parts), or with pure gasoline, only after dry shaving. There are many ways to asepticize and tan the surgical field. Thus, according to Filonchikov’s method, tanning is carried out by treating the surgical field twice with a 5% alcohol solution of iodine, and the interval between treatments should be at least 3 minutes.

According to the Borchers method - double treatment with a 5% alcohol solution of formaldehyde. This method is best used on skin with increased sweating. According to Lepsha, the surgical field is treated three times with a 5% aqueous solution of potassium permanganate (for dermatitis), and according to the Boccala method - with a 1% alcohol solution of brilliant green. Aseptic and tanning of the skin can be performed with a solution of altin, a 1% solution of degmin or 3 % degmicide.

An effective remedy for these purposes is a 1-3 solution of surfactant antiseptics Patanol and Atony.

Treatment of the surgical field with the solution consists of the following: mechanical cleaning and degreasing of the skin is carried out with an aqueous solution of furatsilin in a dilution of 1:5000, aseptic and tanning - with an alcohol solution of furatsilin in a concentration of 1:5000 - 500.0

Recipe: Solutions Furacilini 1:5000 - 500.0

Misce. Yes. Signa. For mechanical cleaning and degreasing of the surgical field.

When processing the surgical field, the surface of the skin is wiped and lubricated in a certain order - from the central part to the periphery. The exception is the presence of an open purulent focus. In this case, process from the periphery to the center

Modern antiseptics for preparing the surgical field: Septotsid k-1 (colored, used for pigmented areas of the skin); septotsid k-2 (not stained); assipur (contains iodine); altin (1% alcohol solution. Disadvantage - slippery field after treatment); aseptol (2% solution. The field is treated for 3 minutes); Iodonate (1% solution. Treat the field twice).

4. Preparation of the surgeon’s hands, instruments, sutures, dressings and surgeonssexy underwear

Preparing the surgeon's hands.

It is one of the aseptic measures that ensures the prevention of contact infection of the surgical wound. Modern methods The preparation of the surgeon's hands is based on the use of the tanning properties of antiseptics, which compact the upper layers of the skin and thereby close the skin openings of the gland ducts, blocking the exit of microorganisms from them during the operation. The preparation of the surgeon's hands includes three main components:

1. Mechanical cleaning- cut the overgrown parts of the nails short, remove hangnails, remove rings, watches, expose the hand to the desired length, wash with warm water and soap or in a 0.5% solution of ammonia in two baths, so that the hands are washed in the second bath clean water. Dry your hands with a clean, sterile towel.

2. Disinfection- destruction of microorganisms on the surface, as well as in the initial part excretory ducts sweat and sebaceous glands.

3.Tanning- thickening of the upper part of the skin, as well as closing of the excretory ducts of the sweat and sebaceous glands. This is done with alcohol. Hand treatment is carried out from fingertips to elbows. The most common methods in practice are the following:

- Spasokukotsky-Kochergin method: First, wash your hands in a 0.5% solution of ammonia in two basins for 2.5 minutes. Then the hands are wiped with a rough sterile towel and treated with 70% alcohol. Nail beds and tips - with a 5% alcohol solution of iodine.

Olivevo method: hands are washed in a 0.5% solution of ammonia, and then wiped twice with a swab soaked in an alcohol solution of iodine at a dilution of 1:3000 -1:1000.

-Kiyashov method: Hands are washed for five minutes in a 0.5% solution of ammonia in two baths, and then for three minutes under running water with a 3% solution of zinc sulfate. The fingertips are lubricated with a 5% iodine solution.

Hand treatment with furatsilin: in a 0.5% solution of ammonia in two baths, then treated with a solution of furatsilin 1:5000, and then with an alcohol solution of furatsilin 1:5000. Nail beds and fingertips - 5% iodine solution. Currently, modern antiseptics are used - dehyecid, novosept, septotsid, degmetsid, degmin, diotsid, rakkol, plivasept. In our case, hand preparation was carried out in the following way: hands were washed with a 0.5% solution of ammonia.

Then we treat our hands with an aqueous solution of furatsilin 1:5000, and then with an alcohol solution of furatsilin 1:1500.

Preparation tool

During castration bulls using the open method use the following tools: a sharp abdominal scalpel and scissors. You also need cotton-gauze swabs and ligatures made of artificial silk or cotton and linen threads. Deschano needles, injection, surgical needles, syringes, hemostatic tweezers, needle holder.

All metal instruments are sterilized in water with the addition of alkalis: 1% sodium carbonate, 3% sodium tetracarbonate (borax), 0.1% sodium hydroxide. Alkalis increase the sterilization effect, precipitate salts present in ordinary water, and prevent the occurrence of corrosion and darkening of instruments. Before boiling, the tools are cleaned of the lubricant covering them, large and complex tools are disassembled.

The liquid is boiled in special metal vessels - simple and electronic sterilizers. Sterilizers have a volumetric grille. The grid is removed with special hooks and instruments are placed on it, which are then lowered into the sterilizer after boiling the liquid for 3 minutes. During this period, the water is freed from oxygen dissolved in it and neutralized with alkali.

After boiling, the grid with instruments is removed from the sterilizer and the instruments are transferred to the instrument table. If instruments need to be prepared in advance, then after sterilization they are wiped with sterile swabs, wrapped in 2-3 layers of a sterile sheet or towel, and then in film; store and transport instruments in a sterilizer.

Other sterilization methods are used depending on the circumstances and type of instruments. In emergency cases, flambéing of metal instruments is allowed; they are placed in a basin, doused with alcohol and burned. However, cutting and stabbing instruments become dull and lose their shine when burned.

If there are no conditions for sterilization by boiling, instruments are sterilized chemically by immersing them for a certain time in an antiseptic solution: in an alcohol solution of furatsilin in a concentration of 1:500 for 30 minutes. You can lower the tools for 15 minutes. in Karepnikov's liquid: 20 g of formalin, 3 g of carboxylic acid, 15 g of sodium carbonate and 1000 ml of distilled water or in a 5% alcohol solution of formalin, 1% alcohol solution of brilliant green.

Preparation of suture material

The suture material must have a smooth, even surface, be elastic, sufficiently extensible and biologically compatible with living tissues, while having minimal reactogenicity and having an allergenic effect on the body.

When castrating boars, ligatures made of artificial silk or other synthetic threads are used. Before sterilization, they are loosely wound on glass rods or glass with polished edges, and then boiled for up to 30 minutes with the lid ajar so that the water temperature does not exceed 100 0 C, otherwise the threads will tear. You can also use cotton and linen threads. They are sterilized according to Sadovsky’s method: the threads in skeins are washed in hot water and soap, then rinsed thoroughly, wound on glass slides and immersed in 1.5% water for 15 minutes. ammonia, then for 15 minutes in a 2% formaldehyde solution prepared in 65 0 alcohol.

Can be immersed for 24 hours in a 4% formaldehyde solution.

Re-sterilize in an alcohol solution of furatsilin 1:1500, septocide.

Sterilization of cotton gauze swabs is carried out by autoclaving. Before autoclaving, swabs are placed (loosely) in containers. The holes on the side wall are opened before loading the autoclave and closed after sterilization. Several containers are placed in the autoclave at the same time. The duration of sterilization depends on the pressure gauge readings: at 1.5 atm. (126.8 0) - 30 min., at 2 atm. (132.9 0) - 20 min. Control of sterilization in an autoclave - look at the test tubes with sulfur, how it melted, then the sterilization was carried out reliably.

After the required time has passed, the heating is stopped, the release valve is carefully opened, steam is released and the pressure is brought to atmospheric (to zero), only after this the autoclave lid is carefully opened and the material is removed. Tampons can also be sterilized with flowing steam, either in a special Koch flowing steam sterilizer, or using a pan or bucket with a lid.

Sterilization begins from the moment when steam begins to flow out from under the lid in a continuous stream for some time. The steam temperature reaches 100 0; The duration of sterilization is at least 30 minutes.

5. Fixation of the animal duringI have surgery

The main thing when restraining animals is to use the necessary technique to calm them down and create conditions for safe examination and surgery.

Fixation in a standing position. During a group examination, closely spaced animals are tied to a hitching post or to a rope stretched tightly near a fence. In this position they fix each other. This makes it possible to examine the area of ​​the head, neck, pelvis, external genitalia, give vaccinations, perform rectal examinations for pregnancy, castrate bulls in a standing position, etc.

Fixation of cattle.

When practicing the Russian (Mikhailov) method of felling cattle, they take a long, strong rope and tighten it with a movable loop at the base of the horns (in polled animals - on the neck). On the side opposite the fall, the rope is directed back and at the level of the posterior corner of the shoulder blade, a tightening loop is placed around the body. After this, the rope is moved back again, a second such loop is tied in front of the maklaks and the end of the rope is pulled back under the limb. In this case, one of the clamps holds the bull's head, tilting it in the direction opposite to the fall, the other two pull the free end of the rope horizontally back. The animal, crushed by the rope, bends its limbs and lies down. The tension of the rope is not weakened until the bull is finally strengthened and the limb is fixed, and the head is pressed to the floor.

6. Anatomical and topographic data

The inguinal canal is formed by the oblique abdominal muscles. It has two openings - external (subcutaneous) and internal (abdominal), which are called inguinal rings. Within the scrotum, the vaginal canal expands and passes into the cavity of the common vaginal membrane. IN inguinal canal there are the external lifter of the testis, external pudendal arteries and veins, branches of the external spermatic nerve and lymphatic vessels.

The seminal sac or scrotum in ruminants and single-hoofed animals is placed between the thighs, and in the rest - in the perineum. It consists of a paired cavity, a paired external levator testis and a paired common tunica vaginalis. The wall of the scrotum consists of the following layers of skin, a muscular-elastic membrane and the fascia of the scrotum.

The muscular-elastic membrane is firmly connected to the skin and forms the scrotal septum.

The fascia of the scrotum is closely connected to the muscular-elastic membrane and loosely to the general vaginal membrane

The common tunica vaginalis is formed by the parietal layer of the peritoneum and the transverse fascia and lines each half of the scrotum, forming a cavity with the common tunica vaginalis. The latter communicates with the abdominal cavity through the vaginal canal.

A special vaginal membrane of the testicle covers the testis with the epididymis and the spermatic cord. Its lower section, connecting the tail of the appendage with the common vaginal membrane, is thickened. It is called the testicular inguinal ligament or transitional ligament.

The epididymis of the testis in stallions is on its dorsal surface. It has a head, body and tail.

The spermatic cord is covered on the outside by a fold of visceral peritoneum. It consists of two folds of the massive vascular serosa in front and a fold of the vas deferens behind.

The vascular fold contains the internal spermatic artery, the internal spermatic vein with their pampiniform plexus, the internal levator testis, the spermatic plexus and lymphatic vessels.

The fold of the vas deferens includes the vas deferens, the artery and the nerve of the vas deferens.

Innervation and blood supply of the scrotum. The scrotum and external levator testis are supplied with blood from the branches of the external spermatic and pudendal arteries.

The innervation of the scrotum and common tunica vaginalis is carried out by the branches of the external spermatic nerve, the ilioinguinal and iliohypogastric nerves, and in the posterior part of the scrotum it is supplied by the branches of the perineal nerve. Lymphatic vessels pass in the lateral walls of the scrotum and flow into the superficial inguinal lymph nodes. The testis is a paired reproductive organ in which germ cells (sperm) are formed and develop. It is an endocrine gland that produces and releases male sex hormones (androsterone and testosterone) into the blood. On the testis there is a head and a tail, two edges: free and accessory; two surfaces: lateral and medial.

7. Pain relief

The animal is fixed in a standing position and a mixed alcohol-chloral hydrate solution is injected intravenously at the rate of 50 ml of 33% ethyl alcohol and 7 g of chloral hydrate per 100 kg of animal weight. Chloral hydrate is administered in a 10% concentration prepared in a 40% glucose solution. After administration of the solution, the animal is monitored. At the same time, the onset of loss of sensitivity is noted (when tingling with a needle in various parts of the animal’s body), muscle relaxation (the animal lies down), pulse and respiration rates, duration of anesthesia, etc. are determined.

It is emphasized that the animal can be administered intravenously with chloral hydrate in an 8...10% solution at a dose of 10 g per 100 kg of weight, or 96° ethyl alcohol at a dose of 0.35...0.45 ml/kg of weight , and inject in a 33% solution.

Bull for anesthesia

Rp.: Chlorali hydrati 40 ml

Sol. Sodium chloride steril. 0.85% ad 400.0

M.D.S. Intravenous

8. Online access

In order to make an incision in the scrotum, the surgeon grabs it along with the testes with his left hand and pulls it back. It is most rational to dissect the scrotum on the cranial surface (along the greater curvature of the testis, because wounds in the front are more protected from contamination), retreating from the scrotal suture of 1-1.5 cm. The length of the incision should correspond to the size of the testis, Required condition is dissection scrotum for blood and exudate after operations did not accumulate in the scrotal cavity.

9. Surgical procedure

The freed testis is pulled out of the scrotal cavity, the transitional ligament is dissected, the mesentery is torn, and a ligature from the cleft is applied to the thinnest part of the spermatic cord. The ends of the ligature are tied with a nautical or surgical knot.

The first loop of the knot is carefully and gradually tightened in 2-3 steps with an interval of 2-3 seconds so that the threads are deeply immersed in the tissue, from which the liquid elements of their composition have been sufficiently squeezed out. The second loop of the knot is obtained with the ends of the ligature stretched, thereby preventing relaxation of the tightened first loop.

After this, the spermatic cord is crossed with scissors, retreating 1 cm below the ligature. At this moment, its ends are held in the hand and the quality of the ligation is checked, after which the ends of the ligature are cut off, retreating the knot by 1 cm. Performing these two techniques in reverse order is unacceptable. There is no need to place a castration loop on the spermatic cord. It is necessary to avoid additional tissue irritation with a double thick ligature. It is also unreasonable to leave a long stump (2-2.5 cm) of the spermatic cord, because this contributes to the development of infection.

Then blood clots are removed from the scrotal cavity with a sterile swab and the wound is powdered with tricillin or a mixture of streptocide and iodoform.

10 . The final stage operations

Blood clots are removed from the wound cavity and powdered with antibiotic powder.

Recipe: Benzylpenicilini-natrii 100000 ED

Streptocidi 20.0

Misce, fiat pulvis.

Yes. Signa. Powder on the wound.

The wound is not closed or sutures are applied so that ecussate does not accumulate in the wound cavity.

11. Postoperative treatment

After castration, the animals are monitored. If suppurative processes occur, the wound is cleaned and treated with an antiseptic solution.

Post-castration complications:

Bleeding from the vessels of the scrotum, bleeding from the artery of the vas deferens, bleeding from the stump of the spermatic cord, prolapse of the common tunica vaginalis, prolapse of the stump of the spermatic cord.

12. Feeding, care andanimal possession

After castration, the animals are placed in a clean pen. Sawdust is not advisable as bedding, as it can contaminate cassation wounds; straw (not barley) is desirable.

Bibliography

Veremey E. I., Korolev M. I., Masyukova V. N. Workshop on operative surgery with the basics of topographic anatomy of animals: Textbook. - Mn.: Urajai, 2000. - 153 pp.

Eltsov S. G., Itkin B. Z., Sorokova I. F. et al. Operative surgery with the basics of topographic anatomy of domestic animals Ed. S. G. Eltsova. - M.: State Publishing House of Agricultural Literature, 1958.

Magda I. I. Operative surgery with the basics of topographic anatomy of domestic animals. - M.: Selkhozizdat, 1963.

Olivekov V. M. Complications during castration, their prevention and treatment. - Kazan: Tatizdat, 1932. - 97 p.

Operative surgery / I. I. Magda, B. Z. Itkin, I. I. Voronin, etc.; Ed. I. I. Magda. - M.: Agpromizdat, 1990. - 333 p.

Plakhotin M.V. Handbook of veterinary surgery. - M.: Kolos, 1977. - 256 p.

Lecture notes on operative surgery given by Associate Professor I.V. Rakhmanov for 3rd year students of the Faculty of Medical Sciences in 2001.

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If your animal needs surgical care, you will definitely have questions about the safety of anesthesia and the consequences of its use. Elena Gorbunova, a veterinarian, anesthesiologist and resuscitator at the Vetera veterinary clinic, talks about all the nuances of this procedure.

Preparing an animal for anesthesia

Before surgery, try to follow all the recommendations of your attending physician and undergo the necessary preoperative examination prescribed for your pet.

The scope of such an examination depends on the type of animal, its age, breed predisposition to diseases, as well as the severity of the operation and general health.

As a result of the preoperative examination, problems may be identified that will negatively affect the patient’s condition, both during and after surgery. In such cases, the doctor prescribes treatment for the animal and undergoes surgery until the patient’s condition stabilizes. If the detected abnormality cannot be corrected before the surgical procedure, the physician, in consultation with the owner, will change the anesthesia plan and take additional precautions.

Before the planned procedure, the anesthesiologist will conduct another examination of the animal, select anesthesia and give recommendations for caring for the pet after surgery.

Immediately before anesthesia, it is necessary to maintain a fasting diet for 3 to 12 hours, depending on the age of the pet.

Types of anesthesia used at the VETERA veterinary clinic

Nowadays, pet owners have several types of anesthesia to choose from. The Vetera clinic offers almost all types of anesthesia for animals:

Non-inhalation anesthesia. This anesthesia is administered intravenously. It can be used in almost any conditions, does not require expensive equipment and is relatively well tolerated by animals. The anesthetic plan is selected individually depending on the type, complexity, duration of the planned operation and the patient’s condition. Installing a venous catheter and administering anesthesia intravenously allows you to reduce the dose of the anesthetic drug. Provides a more controlled depth of anesthesia and accelerates recovery from anesthesia after surgery. Despite the fact that fairly common drugs are used for such anesthesia (used in many clinics), their adequate dosage and directly fractional intravenous administration allow you to make anesthesia as safe as possible, and awakening the animal as easily as possible. Thus, our patients awaken from anesthesia after the most common operations, such as planned castration and sterilization, within 30 minutes to 1.5 hours, and restoration of coordination within 4-6 hours.

Inhalation anesthesia. This type of anesthesia is based on the introduction of anesthetics into the body in the form of gas through Airways. Its main advantages are high safety for the patient, easy controllability, the absence of absolute contraindications and the possibility of use in all types of animals. Inhalation anesthesia indicated for patients with a breed predisposition to cardiovascular diseases, during serious, difficult and lengthy surgical operations, and it is also excellent for performing operations on elderly and weakened animals. Patients tolerate it very well this type anesthesia, which passes for them practically without consequences and complications.

Local anesthesia is a reversible loss of pain sensitivity of tissues in limited areas of the body. In most cases, such anesthesia is used as additional pain relief when using general anesthesia, but there are also operations and procedures where only local anesthesia is used.

Combined anesthesia. Most often used by veterinary clinic specialists. This type of anesthesia consists of combining several anesthetics (both inhalational and non-inhalational), which significantly reduces the toxicity of each substance individually. The combined method of general anesthesia is quite safe for the animal and allows for both planned and long-term complex operations. Combinations of anesthetics directly depend on the type of surgery and the general condition of the patient admitted for surgery.

The type of anesthesia before a surgical procedure is determined by the anesthesiologist based on the collected medical history, medical history (if any), tests, as well as the results of the examination and the specific characteristics of the patient.

Anesthetic risks

During and after surgery, the animal may experience complications from anesthesia. The most common occurrences during anesthesia in animals are:

• breathing problems;
• violations by of cardio-vascular system;
• violations by the central nervous systems s;
• pain syndrome;
• anaphylactic reactions (allergy to drugs);
• renal, liver failure;
• violation of thermoregulation.

Anesthetic risk depends on the type of animal, breed, age, concomitant diseases and type surgery. Determination of the general condition of the animal before anesthesia (classification according to ASA (American Society of Anesthesiologists):

	General state	Clinical status	Intervention parameters
	Very good	Normal healthy patient	Castration, ovariohysterectomy, amputation of dewclaws in the absence of pathologies.
		Patient with minimal impairment of general condition	Skin neoplasms, fractures without shock, uncomplicated abdominal wall hernias.
	Satisfactory	Patient with serious illness	Fever, anemia, dehydration, moderate hypovolemia, mild pneumothorax.
		Life-threatening disease (without surgical intervention, death occurs)	Sepsis, severe fever, bladder rupture, diaphragmatic rupture, gastric volvulus, moderate pneumothorax.
	Very heavy	Severe, life-threatening organic and systemic disorders	Shock states, serious injury.
N (emergency operations)	Is getting worse and worse	Emergency surgeries with additional increased risk	Gastric volvulus, progressive shock, internal bleeding, severe pneumothorax.

Since it is practically impossible to take into account all the risk factors of surgical treatment and the selected type of anesthesia, the proposed systems for its assessment in veterinary surgery are rather conditional. In each specific case, the risk depends not only on the above factors, but also on the qualifications of the doctor, as well as the equipment of the veterinary clinic. Based on the table presented, the owner of the animal can approximately assess the condition of his pet before the planned operation.

The task of the anesthesiologist is to minimize possible risks and complications both during and after surgery.

Owners, in turn, should prepare the animal that requires surgery as much as possible: undergo a cardiac examination, take blood and urine tests. Additional examinations are prescribed, if necessary, on an individual basis by the attending physician or anesthesiologist.

Also, doctors at the Vetera center are always ready to answer your questions by phone. 8-902-907-11-33.

Anesthesia- this is a decrease in the sensitivity of the body or part of it, up to the complete cessation of perception of information about the environment and one’s own condition. There is a distinction between local and general anesthesia. By the term general anesthesia we usually mean the complete anesthesia of the animal and its introduction into an unconscious state.

Why is anesthesia needed?

Anesthesia is necessary to ensure that the surgeon can safely operate on the patient so that he does not move and is completely relaxed during the operation. And, most importantly, for pain relief, eliminating feelings of fear and anxiety, and aggression of the animal during diagnostic and some therapeutic manipulations.

Preparing the patient for a planned operation under anesthesia

Before planned operation, especially animals over 5 years of age, must undergo a preoperative examination, which includes clinical and biochemical analysis blood tests and cardiac examination, in some cases a chest x-ray and ultrasound may be needed abdominal cavity. This is necessary to evaluate the work internal organs and the body as a whole, which will help minimize the risks of anesthesia. The examination plan is drawn up by the doctor when examining the animal. It depends on the age, general condition of the animal, the severity of the surgical intervention, etc. It is very important not to feed the animal 10-12 hours before the intended anesthesia.

In our clinic, your animal will undergo a full range of examinations from blood tests to a cardiogram. And if necessary, they will refer you to specialized specialists for additional examination.

Anesthetic risks

The risk of anesthesia depends on the age of the animal, its general condition, the severity of the surgical procedure and many other factors. And even in a seemingly young and clinically healthy animal, this risk is present. It can be compared to the risk of getting hit by a car; it is not great, but it cannot be excluded. In order to reduce or anticipate it, the preoperative examination discussed above is carried out. Also during the operation, the anesthesiologist monitors the animal's heart rate, respiratory rate, blood pressure, oxygen saturation and level of consciousness.

Our clinic is well technically equipped in this regard: there is equipment that allows us to perform ultrasound of the heart, laboratory tests, x-rays. The anesthesiologist works with a patient monitor, which makes it possible to monitor the animal’s condition during surgery and instantly respond to its changes. In addition, the anesthesiologist and resuscitator have a veterinary tonometer, a capnograph, and an ECG machine in their arsenal. An oxygen concentrator in the operating room and hospital makes it possible to quickly cope with hypoxia and saturate the animal’s blood with oxygen. Apparatus artificial ventilation lungs allows operations to be performed using deep anesthesia in the absence spontaneous breathing, operations on the chest organs, resuscitation measures.

How is anesthesia performed?

Anesthesia is carried out in several stages. First, the animal is examined by an anesthesiologist and asks you the necessary questions to further select the method of anesthesia. Then premedication is carried out - this is the introduction of a complex of drugs to reduce the side effects of anesthesia, it also includes sedatives. Next, your animal is fitted with an intravenous catheter and taken away for surgery. During the operation, anesthesia can be given to the animal intramuscularly, intravenously or inhalation. Intramuscular administration drugs are used for short-term and mild surgical interventions Oh. It is easier to carry out technically, but it is more difficult to control the effect on the body, since the anesthetic is gradually absorbed into the blood from the injection site and it is no longer possible to interrupt the absorption of the drug into the blood.

Intravenous administration of anesthesia is used for long-term surgical interventions; it is easier to control its entry into the body, because the anesthetic enters directly into the bloodstream. In connection with this, a smaller dose is required to maintain the animal’s condition and it is easier to eliminate the undesirable effect.

Inhalation anesthesia is considered the safest, but has a number of features. One of which is the mandatory intubation of the animal - this is the insertion of a special tube into the trachea through which an anesthetic mixed with oxygen is supplied.

Coming out of anesthesia

Animals recover from anesthesia from 15 minutes to 24 hours, this depends on age, metabolism, duration of anesthesia and anesthetics used. After anesthesia, animals may have hallucinations, which are manifested by vocalization: barking or meowing, shaking the head from side to side, “catching flies.” It is very important to ensure that the animal does not injure itself, most often this is due to impaired coordination (animals stumble, bump into obstacles, cats can fall while trying to climb onto their favorite closet or bedside table).

It is necessary to monitor the animal’s body temperature, since after anesthesia it is not able to maintain it on its own; for this, the animal must be placed in a room without drafts, and a heating pad must be placed under it. After anesthesia, the animal must be given complete rest. Absolutely a necessary condition is oxygenation - an increase in the oxygen content in the air inhaled by an animal.

It is strictly forbidden to give the animal food or water until the animal has completely recovered from anesthesia. Otherwise, food or water may enter the trachea and cause aspiration pneumonia. When the animal becomes fully coordinated, you can offer it some food.

In our clinic, animals recover from anesthesia in a hospital with a controlled microclimate under the supervision of an anesthesiologist, which significantly reduces the risk of anesthesia. If the owner wishes, the animal can be taken away immediately after the operation, if there are no contraindications to this. But in this case, all the work of carrying out the postoperative period falls on the shoulders of the animal’s owners.

Risks of anesthesia. Myths and reality

Most owners and many veterinarians in our country consider anesthesia to be extremely dangerous event which should be avoided at all costs. In Western countries, on the contrary, sedation or anesthesia is carried out for any, even non-painful diagnostic procedures ah, for example, carrying out simple x-rays. So where is the truth?

To understand how justified anesthesia is in a particular case, you need to imagine what kind of stress, fear (panic) and pain the animal is experiencing at this moment. To do this, you need to understand what pain is and what pathological processes it causes in the body.

Pain is the reaction of the body, or rather the nervous system, to damage, injury, disease and dysfunction of internal organs, muscles and tissues. Pain is divided into acute and chronic. Acute pain occurs during injuries, after operations, during childbirth, and also during acute diseases internal organs ( urolithiasis disease, pancreatitis, nephritis). The pain may be accompanied by nausea, vomiting, changes in blood pressure, heart rate, and behavior changes. But pain has a positive side: it helps doctors localize the location of the damage. Acute pain goes away on its own or as a result of treatment within a few days. In cases where pain persists due to impaired restoration and healing of organs and tissues, it becomes chronic.

Chronic pain can last from 1 to 6 months. Most often it is associated with dysfunction of the peripheral or central nervous system. The most common chronic pain conditions are associated with conditions such as musculoskeletal diseases, chronic diseases internal organs, damage to the peripheral nervous system.
Moderate and intense pain, regardless of location, can affect almost all organs, increasing the risk of complications and mortality. Therefore, treating pain is not just a humane requirement, but also a key aspect of therapy.

Effect on blood circulation. Pain causes pronounced changes: a rise in blood pressure, an increase in the number of heart contractions, and vasoconstriction—narrowing of blood vessels. Which leads to myocardial ischemia, and this despite the fact that the heart simply needs oxygen at this time. It is not difficult to guess that such a situation could lead to disaster.

Effect on the body. An animal testing its will breathes frequently and shallowly. This creates additional stress on the lungs and respiratory muscles. If an attack of pain is not stopped, exhaustion sets in contractility muscles and a decrease in the amplitude of respiratory movements, the volume of inhaled air and a decrease in the volume of oxygen remaining in the lungs after exhalation. Which can lead to collapse of a section or the entire lung, cessation of oxygen exchange between lung tissues and blood vessels, oxygen starvation, and less often, to respiratory arrest.

In addition, under the influence of pain and stress, the hormonal status body: the concentration of cortisol increases, which, in combination with an increase in the concentration of renin, aldosterone, angiotensin and antidiuretic hormone, leads to sodium and water retention in the body. Blood clotting increases.

Stress leads to leukocytosis (an increase in the number of leukocytes - white blood cells that perform protective function in the body) and lymphopenia (a decrease in the number of lymphocytes - the main cells of the immune system), and also inhibits the reticuloendothelial system - this is a system of cells that, if necessary, turn into macrophages capable of capturing and destroying bacteria. The latter increases the risk of developing infectious diseases. Pain leads to increased sphincter tone and decreased motility of the intestines and urinary tract, which causes intestinal obstruction and urinary retention.

Similar physiological phenomena are accompanied by stress. Many breeders dwarf breeds Advise owners to remove baby teeth without anesthesia. Fearing the negative effects of anesthesia on the body and completely unaware that Negative influence stress and pain are much more dangerous.

This opinion is partly formed by negative experience. Indeed, until recently, most procedures were carried out by Russian veterinarians quite handicraft, often at home. The doctors had neither the experience, nor the equipment, nor the drugs for professional anesthesia. Now the situation has changed. Our clinic has assembled the necessary equipment for monitoring and resuscitation of patients. Qualified anesthesiologists work. Therefore, sedation or anesthesia is a reasonable choice for many painful or diagnostic procedures that require the animal to relax.

Veterinarian. anesthesiologist at Radenis Clinic Lipina S.M.
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Doctors at our clinic use the method of preoperative examination and assessment of anesthetic risk proposed by the American Society of Anesthesiologists.
Young animals undergo only a clinical examination before routine surgical interventions (castration, sterilization).
Animals belonging to breeds with high risk the occurrence of pathologies of the cardiovascular, respiratory, central nervous systems , for example, British, Scottish Fold and May Coon cats, dwarf or giant breed dogs,We recommend that you undergo examination by specialists.
We recommend that all animals over 5 years old, as well as animals with an unknown history (animals taken from a shelter or from the street), undergo hematological and biochemical studies.
This tactic allows us to adequately prepare the animal for anesthesia and prevent possible complications. And in some cases, postpone the operation or abandon it altogether.

ASA* scale for assessing the patient’s status before anesthesia.

1.	MINIMUM RISK	HEALTHY PATIENT
2.	LITTLE RISK	THERE IS MILD SYSTEMIC PATHOLOGY
3.	MEDIUM RISK	THERE IS A SERIOUS SYSTEMIC PATHOLOGY
4.	HIGH RISK	THERE IS A SERIOUS PATHOLOGY PRESENTING A CONSTANT THREATEN TO LIFE
5.	EXTREMELY HIGH RISK	THE PATIENT IS IN CRITICAL CONDITION, THERE IS A THREAT OF DEATH IN THE NEXT DAYS

*ASA (American Society of Anesthesiologists) - Americansocietyanesthesiologists.

Animals with a score of 3 or higher have a 4-fold higher risk of complications compared to animals with scores of 1 and 2.

To assess anesthetic risk it is necessary to carry out routine examination patient, including: medical history, physical examination, results of hematological and biochemical tests. If during the initial examination or laboratory tests any abnormalities are revealed, additional instrumental or laboratory tests and consultations with highly specialized specialists may be required.

There is a breed predisposition to diseases of the cardiovascular and respiratory systems that are not detected during routine studies.

If anesthesia is performed on an animal that has not been examined, the anesthetic risk is equivalent to category 3 on the scale A.S.A..

An operation or any procedure (manipulation) performed under anesthesia consists of several important stages:

• Preoperative period (pre-manipulation) - preparation of the animal.
• Operating period (the manipulation itself, requiring anesthesia) - performing a surgical intervention or procedure under sedation.
• Postoperative period - recovery and care of the animal after surgery or any procedure requiring anesthesia.

Preoperative period

He should never be underestimated. Any surgical intervention, whether elective or emergency surgery(procedure) carries certain risks to the life and health of the animal. This is due to the fact that operations and some procedures (manipulations) are performed under general anesthesia (anesthesia). The success of surgery and subsequent recovery directly depends on the preoperative preparation of the pet. During this period, the doctor draws up a general picture of the animal’s condition, determines the severity of the underlying disease and the presence of concomitant disorders (for example, cardiac ones). To minimize risks, the necessary examinations are carried out, and sometimes additional therapy is prescribed.

For healthy animals up to 7 years old

Elective surgeries (for example) or procedures under anesthesia ( ultrasonic cleaning teeth, radiography under sedation) are most often performed without additional examinations pets But only if they are under seven years of age and do not have a breed predisposition to heart disease. Such operations are prescribed without first seeing a therapist, and you can sign up for them simply by calling.

For animals over 7 years old or with a history of diseases

Pets in this age category must first see a therapist. This also applies to animals with any diseases (for example, chronic kidney disease or acute liver failure). And in the case of tumor processes, you should make an appointment with an oncologist and surgeon in advance. For such animals, the day of surgery is assigned only after all the necessary examinations.

They must:

• General and biochemical blood test. shows the level of leukocytes, red blood (to exclude anemia), platelet count.
• Biochemistry. It is necessary to assess the functionality of the kidneys and liver in older animals (over 7 years), since many diseases of the liver, kidneys and heart can occur chronically, without clinical signs and symptoms, and during surgery they can lead to complications and even death of the animal.

Additional tests ordered for some animals

Radiography

It is necessarily carried out to exclude lung pathology, if tumor metastasis is suspected, etc.

Ultrasound

The study is carried out to visually assess the abdominal organs. It is prescribed for suspected presence of free fluid in the chest or abdominal cavity, before cesarean section (including calculating the fetal heart rate), suspected tumor metastases or ruptures of abdominal organs, etc.

Electrocardiogram(ECG) should be performed on older animals with a history of loss of consciousness, chronic cough, and periodically blue mucous membranes and tongue. It will help identify cardiac rhythm and conduction disturbances, as well as mass indirect signs disturbances in the functioning of the heart and its structure.

ECHO of the heart used to determine the size of the chambers and muscles of the heart, to assess the function and structure of the valves, to identify regurgitation (reverse reflux of blood), etc. It must be carried out in purebred cats to exclude hereditary pathology - hypertrophic cardiomyopathy (HCM). Surrender of all necessary tests can be done in one or several days.

After examination and research, you can:

• draw conclusions about the need for surgical intervention (or performing one or another manipulation under anesthesia);
• set the time and date of the operation;
• carry out preoperative therapy in cases of abnormal test results.

It is very important that the animal is as stable as possible before anesthesia.

At good analyzes, surgery is scheduled for the near future.

If the operation is emergency, tests are prescribed individually in each case, taking into account the condition of the animal.

At home the day before surgery

A fasting diet is required 10-12 hours before the announced time of surgery. Absolutely any food should be excluded, and water should not be given 3 hours before surgery. This is due to the fact that while feeding the animal, vomiting of feed may occur. If this happens, there is a risk of developing aspiration pneumonia. Therefore, a fasting diet is extremely important.

In the clinic on the day of surgery

On the appointed day, immediately before the operation, the necessary information is collected and the animal is thoroughly examined by an anesthesiologist. Next, the patient is taken to the hospital for the necessary surgical intervention. Pedigree cats undergo cardiac ECHO on the same day (or in advance). After consultations with the anesthesiologist, the pet's owners sign a written consent to give the animal anesthesia and deposit the necessary funds into the balance. The owners' participation is no longer required at this stage; they can leave the clinic.

Surgery

Introductory anesthesia

Just before the start of the operation, premedication is carried out - the installation of intravenous catheters and the administration of an antibiotic. Next, the surgical field is prepared: the hair is shaved into sufficient volume to avoid its entry into the surgical incision and ensure sterility.

Deep anesthesia

The animal is admitted to the operating room, where it is given deeper anesthesia, if necessary, the trachea is intubated and connected to gas anesthesia. At this time, the surgeon completes the preparation of the surgical field. Once the anesthesiologist is completely sure that the animal is sufficiently anesthetized and is in the required stage of sleep, he gives the command to the surgeon to begin the operation.

Operation

This is the period during which the necessary surgery (or procedure under sedation) is performed. Doctors work harmoniously: the surgeon and his assistant carry out the necessary surgical procedures, the anesthesiologist monitors vital important indicators animal. The heart rate, blood pressure (tonometry), respiratory rate (possibly connecting to a ventilator), oxygen saturation of the body are monitored, and in some cases ECG monitoring is carried out.

Postoperative period

After the operation is completed, the animal is placed in a hospital. He is monitored until he fully awakens, and postoperative pain relief is provided. Most often, during anesthesia, a decrease in body temperature occurs; in this case, the animal is placed on a heating pad. As soon as the patient is admitted to the hospital, we call the owners and inform them that the operation is completed and how everything went. The next call to the owners is usually made 2-3 hours later, when the animal has woken up and can already be taken home. In some cases (during operations on the spinal cord, brain, unstable condition of the patient, etc.) it may be necessary to leave the animal in the clinic for a night or more to monitor the condition. We definitely warn the owner about this.

• necessary manipulations (treatment of sutures, external fixation devices, etc.);
• post-operative care (antibiotic therapy, massages, exercises, wearing protective collar and/or blankets, etc.);
• timing of your next doctor's appointment.

Protective collar and blanket

Wearing protective blanket always necessary after abdominal operations: ovariohysterectomy (sterilization), caesarean section, pyometra, diagnostic laparotomy, foreign body removal, suturing of an umbilical hernia, gastric volvulus, mastectomy (removal of mammary tumors), removal of any formations from the skin in the chest, abdomen and groin.

Protective collar necessary after castration (if the animal shows a strong interest in the operated area), osteosynthesis, installation of drains, removal eyeballs, excision of tumors from the skin or after suturing wounds where the defect cannot be hidden with a protective blanket.

In some cases, it is necessary to wear both a collar and a blanket at the same time (for example, in the case of an extensive skin defect after a unilateral mastectomy, when the blanket does not cover all the sutures applied and additional protection is required).

Repeated appointment and additional tests

Repeated appointments after surgery are scheduled individually. If the operation was planned and sutures were placed, then most often the sutures are removed at the next visit. It is prescribed on the 10-14th day.

If the operation was an emergency or was accompanied by any inflammatory process (for example, pyometra, gastric volvulus, foreign body in the intestine), a repeat appointment is scheduled on the 3-4th day after the operation. In this case, carry out:

• blood tests (general analysis, blood biochemistry);
• examination by the attending physician.

All this will help to adjust therapy if necessary.

When performing operations on the spinal cord or brain, the animal is always kept in hospital for the first day (possibly more). In the morning, the patient is examined by a neurologist, and only after that the animal is discharged home. Next appointment prescribed on the 3-4th day.

After osteosynthesis (stabilization of the fracture with an external fixation device), a second appointment with the surgeon and an x-ray are performed on the 14th day.

If the patient is given to the owners on the day of the operation, they must be warned that the animal is still weakened. The anesthesia completely leaves the body after 24 hours, so residual manifestations are possible. The paws may become slightly tangled, the body temperature may be slightly reduced, and mild nausea may occur. During this period, we ask you to ensure that the animal does not fall from anywhere and is in a place without drafts. It is allowed to feed with regular food (if there are no additional notes in the card about dietary nutrition), but the portions should be reduced during the first day.

As our surgeons say, postoperative care is sometimes more important than the operation itself. Its high-quality implementation is the key to a successful outcome and recovery!

As you already understand, the key to your pet’s recovery is the coordinated work of not only the clinic staff, but also your understanding, trust and direct participation in the preparation and recovery of the animal. If you have any questions, it is important not to be shy - call and ask! We are always happy to help and ready to answer any questions!