21 General Laparotomy Reproductive Surgery

Lay on right side

• bc esophagus and rumen is on the left

What side should you have a cow lay on if they have bloat and you need to do a recumbent procedure?

Hypoglycemia

Why can you not withhold feed from calves for 24 hours?

Hold off feed and water for 24 hours

What should you hold off and for how long for regurgitation during recumbent procedures?

1. xylazine (higher doses for wild, recumbent cattle) = IV, IM, SQ

2. detomidine = IM

3. ketamine stun (butorphanol, xylazine, ketamine combo)

Name the options for chemical restrains in cattle?

c. xylazine

d. ketamine

f. butorphanol

name the drugs that are in a ketamine stun in cattle:

a. buprenorphine

b. acepromazine

c. xylazine

d. ketamine

e. dexmedetomidine

f. butorphanol

IV

Which has faster onset and more intense sedation and analgesia when administering xylazine in cattle, IM or IV route?

1. Tolazoline (for ER situations, give slowly IV)

2. Yohimbine (xyalzine)

Name the alpha 2 reversal agents in cattle

a. IV recumbent

For which cattle situation do you use a ketamine stun in two "bumps", where you give 1/2 the initial ketamine dose in bump 1 then the other 1/2 of ketamine and 1/2 xylazine in bump 2:

a. IV recumbent

b. IM/SQ standing

c. unruly cattle

IM & SQ Butorphanol, Xylazine, and Ketamine

What route do you give ketamine stun for cow to remain standing?

IM

What route of administration do you give ketamine stuns to unruly cattle?

1. Paralumbar/Flank laparotomy

   1. Standing

2. Ventral midline/paramedian celiotomy

   1. Recumbent

Where do you often approach cattle for abdominal surgery?

Midline, paramedian celiotomy

What approach is this for cattle abdominal surgery?

T13, L1, L2

What nerves innervate feeling in flank laparotomy (basically what nerves do you have to be aware of)?

1. Line block

2. Inverted L (backwards 7)

3. Paravertebral (which can be either proximal or distal)

What types of regional anesthesia blocks can you do for Laparotomy?

Inverted L

What regional anesthesia technique is this?

Line block

• inject lidocaine INTO incision

What regional anesthesia technique is this? What drug do you use and how?

It may impair wound healing and lead to toxicity because lidocaine is more acidic and causes vasodilation

What is the problem with using Lidocaine for line blocks for regional anesthesia in cattle?

Incomplete analgesia and relaxation of body wall

What is the problem with using inverted L block for regional anesthesia in cattle?

7-10 mg/kg

What is the toxic dose of Lidocaine in cattle?

PROXIMAL: closer to vertebral body right where nerve exits = T13, L1, L2

DISTAL: need to poke in 2 places for every nerve, dorsal and ventral to transverse process = L1, L2, L4

What is the difference between the nerves affected in proximal and distal paravertebral block?

Proximal: use a spinal needle

Which paravertebral block is closer to vertebral body right where nerve exits = T13, L1, L2

Distal

For which paravertebral block do you need to poke in 2 places for every nerve, dorsal and ventral to transverse process = L1, L2, L4

2% lidocaine and 2% mepivacaine

What are the typical medications you use for local anesthesia in cattle?

Do NOT do in:

1. Line block

2. Wound edge

3. LS epidural

To increase the potency and duration of a local block, you can add epinephrine to lidocaine. In what local anesthetic technique/place would you NOT DO THIS?

d. bupivacaine

Which of these local anesthetic options are toxic when administered IV in ruminants?

a. lidocaine

b. procaine

c. mepivacaine

d. bupivacaine

Abdominal explore (cecum, SI, abomasal problem)

Why would you do a RIGHT paralumbar/flank laparotomy in a ruminant?

1. Look at rumen

2. C-section

3. Abdominal explore (rumen and reticulum)

Why would you do a LEFT paralumbar/flank laparotomy in a ruminant?

1. S2/S3-S5

2. Perineum

3. Caudal udder

4. Rectum

Where does it block in a cow if you do a caudal epidural?

2% Lidocaine

• Sometimes morphine and xylazine

What drug is mostly used for caudal epidural?

e. paravertebral block

You are preparing to perform a C-section on a dairy cow. What anesthetic technique are you using?

a. caudal epidural

b. lumbosacral epidural

c. induce with ketamine, maintain on isoflurane

d. induce with detomidine, maintain on triple drip

e. paravertebral block

1. Skin/SQ

2. External abdominal oblique

3. Internal abdominal oblique

4. Transverse abdominis

5. Peritoneum

What are the layers you are incising when doing a flank laparotomy in cattle? (in order)

External abdominal oblique muscle

• Caudoventral muscle fiber direction

Which muscle layer is this that you go through for a cow flank laparotomy?

Internal abdominal oblique muscle

• Cranioventral muscle fiber direction

Which muscle layer is this that you go through for a cow flank laparotomy?

Transverse abdominis muscle

• dorsoventral direction

Which muscle layer is this that you go through for a cow flank laparotomy?

External abdominal oblique

Which muscle HAS a sheath and is the thick muscle layer, where the muscle fibers run in a caudoventral direction?

Caudoventral

What direction do the muscle fibers in the external abdominal oblique muscle run?

Internal abdominal oblique

Which muscle has NO sheath and is a fairly thick muscle layer, where fibers run in a cranioventral direction?

Transverse abdominis

What muscle layer has a sheath + good holding power and thin muscle layer, where muscle fibers are in a dorsoventral (perpendicular) direction?

Dorsoventral

What direction do the muscle fibers in the transverse abdominis muscle run?

Sharp

To incise the peritoneum in cattle, you must do sharp or blunt dissection

Cranioventral

What direction do the muscle fibers in the internal abdominal oblique muscle run?

External oblique

What is 1?

Transverse abdominis

What is 2?

Internal oblique

What is 3?

Rectus abdominis

What is 4?

Ford interlocking with interrupteds on the ventral 5cm

• using S shaped needle

What type of suture pattern closure do you typically do for flank incisions in cattle in skin?

Give epidural

You should always do WHAT before replacing a prolapse in cattle?

Hypertonic solution/sugar and compression

How can you combat edema that is caused by prolapses in order to make reduction easier in cattle?

Buhner's stitch

What type of stitch in cattle helps to retain a vaginal prolapse?

1. Buhner's stitch

2. horizontal mattress

3. prolapse pin/button

Name the methods of repair for bovine urogenital prolapses

Uterine

What type of prolapse is this?

Cervical (see cervical star/folded over)

What type of prolapse is this?

Vaginal

What type of prolapse is this?

Buhner's stitch

What is this prolapse treatment?

Horizontal mattress

What is this prolapse treatment?

Prolapse pin or button

What is this prolapse treatment?

Prolapse pin/button NOT BUHNER

Which type of prolapse treatment do you do when calving is imminent and the cow cannot be closely monitored?

Prolapse pin/button

Inserting the rod thru the rectum, vessel damage/hemorrhage, and pressure necrosis are all complications caused by WHAT prolapse treatment in cattle?

LEFT PARALUMBAR

• blique is most common

• mid flank

Ventral/Recumbent

• midline

• low flank

How do you approach a cow for a c-section?

Oblique

Which approach for a left paralumbar c-section in cows is indicated by the purple line?

Mid flank

Which approach for a left paralumbar c-section in cows is indicated by the blue line?

Low flank

Which approach for a left paralumbar c-section in cows is indicated by the green line?

Ventral midline

Which approach is this for a bovine c-section?

2 layer of inverting (utrecht or cushing) using monofilament to close the uterus.

Must then close body wall

How do you close a bovine c-section?

Episiotomy

What are these red lines the landmarks for?

Up first, then down

• Hold umbilicus to prevent a hernia

Should you move the fetus up or down first when trying to remove a calf from a c-section? What should you be holding onto & why?

Facilitate passage of calf’s head thru vulva

• tearing = trauma

Why would you do an episiotomy in a cow?

10 and 2

If you are looking at the cow's vagina, what are the "numbers on the clock face" for where you should perform an episotomy?

Suture mucosa towards mucocutaneous junction (do NOT let heal by second intention)

To close an episiotomy, you should use an absorbable suture with a continuous pattern to close the mucosa. What should you suture the mucosa towards?

Yes, after the hysterotomy is closed

What are your thoughts about administering oxytocin to your c-section cow?

Non-gravid horn

When performing a C-section in cattle, which horn will the calf’s hind limb be located in?