Lecture 22 - Principles of Thoracic Surgery

thoracotomy

What is the surgical incision of the chest wall?

median sternotomy

What is the name of surgery performed by splitting the sternum?

pulmonary lobectomy

What is removal of a lung lobe or a portion of a lung lobe?

pneumonectomy

What is removal of all lung tissue on one side of the thoracic cavity?

1. patent ductus arteriosus

2. vascular ring anomalies

3. open heart procedures

4. neoplasia

5. pericardiectomy

What are the potential indications of cardiovascular surgery?

1. pulmonary lobectomy - partial or complete

2. tracheal surgery

3. esophageal surgery

4. mediastinal neoplasia

5. thoracic duct ligation

What are the potential indications for thoracic surgery?

1. flail chest

2. acute respiratory impairment

What two injuries occur when trauma imapirs respiration and needs emergency stabilization?

readily available

Equipment for thoracentesis and thoracostomy should be _______

sternal, lateral

In an animal with large neoplastic lesions, you should position in ____ or ____ recumbancy with affected side DOWN with supplemental oxygen

rapid induction and intubation

A thoracic trauma patient should have a prepared anesthetist, preoxygenate for 3-5 minutes and....

thoracic inlet

Intubation of a single bronchus is disastrous in comprised animals so you must be diligent the endotracheal tube is palpated where?

intermittent positive pressure ventilation

Animals with open chest cavities (including diaphragmatic hernia) require...

arterial blood gas

What is the gold standard evaluation method of ventilation and oxygenation?

1. hypoventilation

2. hypotension

3. esophageal intubation

4. airway obstruction

5. ventilator malfunctions

What life-threatening situations can EtCO2 be helpful in identifying?

1. extubation should not be rushed

2. patient is awake and not overly sedated

3. respirations are adequate

4. patient is comfortable prior to extubation

Once thoracic surgery is completed...

increased

Animals with underlying pulmonary disease or trauma at _____ risk of developing pulmonary infections

prophylactic antibiotics

What medication should be given at induction for thoracic surgery?

therapeutic antibiotics

What should be intiated at the first sign of infection after thoracic surgery?

1. ampicillin

2. clindamycin

3. enrofloxacin

Prior to culture and sensitivity results, what antibiotics should we use?

1. length of surgery

2. type of surgery

3. immune status

4. underlying disease process

Appropriate use of prophylactic antibiotics depends on:

prophylactic antibiotics

Debilitated animals undergoing thoractomy for removal of large neoplastic lesion are likely to benefit from...

1. left lateral

2. right lateral

What two lateral (intercostal) approaches to the thorax are there?

median sternotomy

What is another common surgical appraoch to the thorax?

reviewed

Review this chart of recommended intercostal spaces for thoracotomy

just below the vertebral bodies to near the sternum

What should the skin incision of an intercostal thoracotomy extend from?

finochietto retractor

What instrument is this?

one to two spaces

You should place a thoracostomy tube through an intercostal space _________ caudal to the incision prior to closing the thorax

over-the-needle catheter

What is an alternative method to remove residual air from the thoracic cavity?

preplacing

What is an important thing to do with your suture when it comes to closing an intercostal thoracotomy?

Bailey-gibbon rib approximator

What instrument is being used to appose the ribs to tie remaining sutures?

1. preplaced thoracostomy

2. over-the-needle catheter

What are the two most important methods of removing residual air from thoracic cavity?

1. caudal vena cava

2. main pulmonary artery

3. both sides of pericardial sac

What are the structures that can be isolated and manipulated through a median sternotomy?

1. mediastinal tumors

2. pericardiectomy

3. spontaneous pneumothorax

4. trauma

5. exploratory thoracotomy

6. cranial lung lobe tumors

What are the indications for a median sternotomy?

mediastinal tumors

What are shown here?

two or three

_______ sternebrae should be left intact cranially or caudally to reduce postoperative pain and prevent delayed healing by sternebral shifting

xiphoid cartilage cranially to second or third sternebra

If exposure of the lungs or heart is necessary, the sternotomy should extend from...

manubrium caudally to the sixth or seventh sternebra

If exposure of the cranual mediastinum is desired, the steronotomy should extend from...

sternal saw

What instrument is this?

oscillating orthopedic saw

What instrument is this?

on the midline

Transect the sternebrae longitudinally _________ with a sternal saw, bone saw or chisel and osteotome

crushing

In young animals, heavy straight scissors may be adequate to cut the sternum, however, avoid ______ the bone

malleable (ribbon) retractor

Once the xiphoid is split, a __________ can be placed in the thorax underneath the sternum

before

If a thoracostomy tube is to be placed, do so _____ closing the sternotomy

sternebrae

Do not exit the tube from beneath the ______; exit it from between the ribs or through the diaphragm

figure-eight pattern

What pattern should wire or suture be placed around the sternebrae?

large breed dogs

What dogs tend to be more stable with healing using chondral or osteochondral bridging with wire?

double-loop cerclage wire

What wire should be avoided due to high failure rate under load?

remove residual air

What should you always make sure to do in the thoracic surgery, including in the median sternotomy procedure prior to closing?

partial pulmonary lobectomy

What is shown here?

thoracoabdominal (TA) stapler

What instrument is being used in this image of a partial pulmonary lobectomy?

satinsky clamp

What instrument is this?

evaluate thorax to verify residual air was removed

What is something you must do if post-operative respiratory excursions are inadequate?

pulmonary edema

What should you evaluate for in a severe or progressive hypoxemia case?

multimodal analgesia

Median sternotomies are more painful than lateral thoracotomies, so ventilation may decrease from pain...what should we do for all of these patients?

1. pneumothorax

2. hemothorax

3. pulmonary edema

What should we evaluate for in radiographs for post-operative patients experiencing hypoventilation?

hypothermia

What is common for a patient to experience after thoracic surgery?

1. warm water bottles

2. circulating warm water blankets

3. warm air blankets

What should we use to re-warm patients?

pyothorax

In a study of 232 dogs, there was an incidence of _____ found to be 6.5%...with a mortality rate of 67%

1. subcutaneous fluid accumulation at ventral aspect of incision

2. major complication of partial or complete lobectomy is air leakage or hemorrhage

What are the complications of thoracic surgery?

median sternotomy

What specific thoracic surgery can have delayed healing or nonunion of sternebrae if not adequate closure and leaving several sternebrae intact?