Term
| What signs can be used to identify resp difficulty? |
|
Definition
-open-mouth breathing
-abducted forelimbs
-labored breathing
-restlessness |
|
|
Term
| What preop management of resp dz patients? |
|
Definition
-minimal restraint
-O2 support
-sedation: butorphanol, acepromazine
-/+ colling esp w/ brachycephalic |
|
|
Term
| Describe anesthetic management of resp dz patients. |
|
Definition
-extreme anesthetic risk
-greatest danger: induction & recovery
-pre-oxygenation
-examine the upper airway at induction
-rapid endotracheal intubation: be prepared for a temporary tracheostomy |
|
|
Term
| Described the signalment of brachycephalic airway syndrome. |
|
Definition
-compressed face
-poorly developed nares
-distorted nasopharynx
-redundant tissues
-often young |
|
|
Term
| Describe what qualifies as brachycephalic airway syndrome. |
|
Definition
-stenotic nares
-soft palate elongation
-laryngeal saccule eversion (part of lining of larynx)
-hypoplastic trachea |
|
|
Term
| What are the clinical signs of brachycephlic airway syndrome? |
|
Definition
-striderous breathing
-coughing, gagging
-exercise intolerance
-restless sleeping pattern
-collapse
-dyspnea |
|
|
Term
| Why are thoracic rads so important w/ brachycephalic airway syndrome? |
|
Definition
| -rule out aspiration pneumonia before surgery |
|
|
Term
| Why are stenotic nares a concern? |
|
Definition
-airway P inc w/ narrowing
-airway tissues will eventually collapse |
|
|
Term
| How do we surgically manage stenotic nares? |
|
Definition
-cartilage resection/suture anastomosis
-cartilage amputation (Trader's technique) |
|
|
Term
| What is an elongated soft palate? Why is it a cncern? |
|
Definition
-palate extends >1-3mm beyond the epiglottis
-laryngeal mucosa becomes inflamed => laryngeal edema => airway obstruction |
|
|
Term
| How do we surgically fix elongated soft palate? |
|
Definition
| -remove elongated portion of the palate => trim to level of tonsils/just past tip of epiglottis |
|
|
Term
| What are the basic methods of surgically fixing an elongated soft palate? |
|
Definition
-scissors & suture
-CO2 laser
-ligasure |
|
|
Term
| What are the common complications of surgically fixing an elongated soft palate? |
|
Definition
-laryngeal edema: airway obstruction, short-term
-hemorrhage
-aspiration |
|
|
Term
| What are everted laryngeal saccules? |
|
Definition
| -prolapse of mucosa lining the laryngeal crypts: response to chronic high upper airway pressures |
|
|
Term
| Why are everted laryngeal saccules a concern? |
|
Definition
-further inhibit airflow & in mucosal irritation
-first stage of laryngeal collapse |
|
|
Term
| Briefly describe the surgical technique of everted laryngeal saccules. |
|
Definition
-extubate the patient temporarily
-grasp & pull w/ forceps
-resect saccule at its base w/ Metzenbaum scissors
-bleeding is controlled w/ direct P |
|
|
Term
| What counts as a hypoplastic trachea? |
|
Definition
| -tracheal diameter <0.2 at thoracic inlet |
|
|
Term
| Can we surgically fix hypoplastic trachea? |
|
Definition
|
|
Term
| What are the three stages of laryngeal collapse? |
|
Definition
-I: everted laryngeal saccules
-II: everted laryngeal saccules + collapsed cunieform cartilages
-III: I + II + collapsed corniculate cartilages |
|
|
Term
| How do we treat laryngeal collapse? |
|
Definition
-laryngectomy
-permanent tracheostomy |
|
|
Term
| What is laryngeal paralysis? Which structures cause the problem? |
|
Definition
-complete or partial fialure of the aryntenoid cartilages
-recurrent laryngeal nerve
-cricoarytenoideus dorsalis muscle |
|
|
Term
| Which dog breeds are affected by congenital laryngeal paralysis? |
|
Definition
-rottweiler
-Dalmattion
-White-coated GSD
-Great Pyrenees
-Leonburger
-Bull-terrier
-Bouvier des Flandres |
|
|
Term
| What are the common causes of acquried laryngeal paralysis? |
|
Definition
-idiopathic ***
-trauma
-systemic dz
-iatrogenic |
|
|
Term
| What is the typical signalment of acquired laryngeal paralysis? |
|
Definition
-large breed dogs > medium/small breed
-Lab, Irish setter, St Bernard |
|
|
Term
| What are the CS of laryngeal paralysis? |
|
Definition
-inspiratory stridor
-voice change
-exercise intolerance
-coughing, gagging
-anxious
-collapse
+/- generalized weakness, muscle atrophy |
|
|
Term
| What do we see on thoracic rads w/ laryngeal paralysis? |
|
Definition
|
|
Term
| Describe the laryngeal exam done for laryngeal paralysis. |
|
Definition
-light plane of anethesia: propofol +/- doxapram
-eval for purposeful movement: abduction of arytenoids & vocal folds on inspiration |
|
|
Term
| What do we see on exam that confirms laryngeal paralysis? |
|
Definition
|
|
Term
| What are the goals of surgically fixing laryngeal paralysisi? |
|
Definition
-reduce obstruction w/in the airway
-reduce airway resistance |
|
|
Term
| What is the most common way to surgically fix laryngeal paralysis? |
|
Definition
| -unilateral arytenoid lateralization |
|
|
Term
| What are the complications that occur w/ surgical correction of laryngeal paralysis? |
|
Definition
-failure of procedure: higher w/ mineralization of cartilages, suture breakage
-aspiration pneumonia |
|
|
Term
| What is the prognosis of surgical correction for laryngeal paralysis? |
|
Definition
| -Good: 90% improvement in CS |
|
|
Term
| What are the life-long risks in laryngeal paralysis patients? |
|
Definition
-aspiration pneumonia
-continued heat/exercise intolerance
-progression of polyneuropathy |
|
|
Term
| How do we fix tracheal collapse? |
|
Definition
-extraluminal stenting!
-prosthetic tracheal ring |
|
|
Term
| What cases of tracheal collapse can be treated w/ prosthetic tracheal rings? Which cannot? |
|
Definition
-ONLY for cervical trachea
-NOT for mainstem bronchi collase |
|
|
Term
| What complications do we see with surgically treated tracheal collapse? |
|
Definition
-laryngeal paralysis
-tracheitis: prolongs recovery
-tracheal necrosis |
|
|
Term
| What does prognosis of surgical correction of tracheal collapse depend on? |
|
Definition
-grade of collapse
-control of concurrent dz
-prognosis same as intraluminal stenting: 80-90% |
|
|
Term
| How much lung can dogs tolerate losing? |
|
Definition
|
|
Term
| How does compensation for lung loss occur? |
|
Definition
-hyperinflation of the remaining lung
-enlargement of the alveolar air spaces
-thinning of the alveolar-capillary tissue barrier |
|
|
Term
| What are the indications of partial lobectomy? |
|
Definition
-focal lesion at peripheral half-third of lung lobe: neoplasia, granuloma, bulla
-biopsy |
|
|
Term
| What are the indications of a complete lobectomy? |
|
Definition
-large amt of purulent material (Abscess)
-lung lobe torsion
-large/multifocal lesion: neoplasia, bulla |
|
|
Term
| How do we perform a partial lobectomy? |
|
Definition
|
|
Term
| How do we perform a complete lobectomy? |
|
Definition
-intercostal thoracotomy or median sternotomy
-remove lung at pedicle: ligate main a, bronchus, v |
|
|
Term
| What is the signalment of a lung torsion? |
|
Definition
|
|
Term
| What are the most common locations of lung torsion? |
|
Definition
|
|
Term
| What problems exist due to lung torsion? |
|
Definition
-venous & bronchus obstruction arterial flow remains
-lobe becomes congested & consolidated |
|
|
Term
| How do we surgically fix lung torsion? |
|
Definition
| -complete lobectomy WITHOUT untwisting the lobe |
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