Help! Run of post-op complications

Re: Help! Run of post-op complications

Anthony Todd — Sun, 11 Aug 2013 12:50:05 GMT

[quote user="Malcolm Ness"]

[quote user="Anthony Todd"] we changed after a tragedy.... [/quote]

But you don't get complications!!

[/quote]

Sorry never bright on a Sunday [or during the week ,for that matter] so I don't get it.

Re: Help! Run of post-op complications

Mark Holmes — Sun, 11 Aug 2013 12:12:29 GMT

[quote user="Anthony Todd"]

[quote user="Linda Filshie"]I'd call breakdown of the linea alba a pretty serious bloody complication! And how much of that knot failure was due to 'rushing'.[/quote]

So would I, and sometimes it was due to rushing I'm sure, just as it can be now. But to be quicker doesn't necessary mean you are less careful or your results are affected.

Ask Lewis Hamilton.

[/quote] I agree in principle, but bad example - he crashes all the time.

Re: Help! Run of post-op complications

Malcolm Ness — Sun, 11 Aug 2013 11:45:22 GMT

[quote user="Anthony Todd"] we changed after a tragedy.... [/quote]

But you don't get complications!!

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 14:21:19 GMT

[quote user="Francisco Gomez"]If them guys had a few seconds more to put the wheel properly, this wouldn't had happened: http://www.youtube.com/watch?v=kKMIUbPB1Z0[quote [/quote]

Yes, you just can't get the staff these days.....

Re: Help! Run of post-op complications

Francisco Gomez — Sat, 10 Aug 2013 12:17:59 GMT

[quote user="Anthony Todd"]

But to be quicker doesn't necessary mean you are less careful or your results are affected.

Ask Lewis Hamilton.

[/quote]

I believe longer op times can increase the risk of infection. I try to op fast but there is a fine line between fast and careless. And definitely, the same happens in the road: the best way to avoid 'accidents' is to slow down a bit, similar principle can be applied to surgery.

Just because you've been driving for longer it doesn't mean you are allowed to ignore the speed limit.

If them guys had a few seconds more to put the wheel properly, this wouldn't had happened: http://www.youtube.com/watch?v=kKMIUbPB1Z0[quote

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 12:12:00 GMT

[quote user="Hannah Wynne Richards"]

The secret with cats and tubes is :

a) be gentle when inserting

and b) don't be paranoic about theatre gas contamination,and DON'T OVERINFLATE.

I'm old enough to be a dinosaur-but am very glad I'm not!!!!!!!!!!!!!!!

Wynne[/quote]

a) agree totally

b) yes, the irony is that the regs now say that you hang a test kit in the theatre on a day of your choosing and if it's negative it's fine. Of course if you chose the day when the scavenging pipe has fallen off and the smell is soporific it wan't show up on your kit 'cos it wasn't THE day.....

c) OVERINFLATE vital but the idea of a fixed amount is just stupid and dangerous as it depends on the volume of the inflated cuff which is fixed in each individual animal so injecting a set amount of air is a recipe for a rupture sooner of later.

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 12:06:26 GMT

[quote user="Linda Filshie"]I'd call breakdown of the linea alba a pretty serious bloody complication! And how much of that knot failure was due to 'rushing'.[/quote]

So would I, and sometimes it was due to rushing I'm sure, just as it can be now. But to be quicker doesn't necessary mean you are less careful or your results are affected.

Ask Lewis Hamilton.

Re: Help! Run of post-op complications

Hannah Wynne Richards — Sat, 10 Aug 2013 11:30:09 GMT

The secret with cats and tubes is :

a) be gentle when inserting

and b) don't be paranoic about theatre gas contamination,and DON'T OVERINFLATE.

I'm old enough to be a dinosaur-but am very glad I'm not!!!!!!!!!!!!!!!

Wynne

Re: Help! Run of post-op complications

Linda Filshie — Sat, 10 Aug 2013 11:10:15 GMT

[quote user="Anthony Todd"]

Hard to investigate complications if you just don't have them!

Linea alba were always stitched with chromic gut, some single interrupted; some continuous, and there were some breakdowns but almost always the knot had come undone.

Many today don't seem to grasp that surgical success is not the preserve of the modern with all the bells and whistles. Dinosaurs were good too and always quick without trying to be.

[/quote] I'd call breakdown of the linea alba a pretty serious bloody complication! And how much of that knot failure was due to 'rushing'.

I think it's safe to say that if you've got a line of cat spays, castrates or whatever and you're going from one to the next then your patient is not getting the monitoring it deserves (and that their owner no doubt expects)during maintenance and recovery.

And it's all very well decrying the 'unnecessary time wasting' that placing an ET tube and IV catheter takes, but to be perfectly honest if my patients stop breathing or suffer some kind of other intra-operative crisis I would rather have a patent airway and IV access there and ready to go....

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 10:44:24 GMT

[quote user="patrick murphy"]love this stuff.[/quote]

Yes, at my first job we used to mix a bottle of neomycin powder into a bottle of dextrose and flutter it into cattle with salmonella I/V; a cure every time if you got them early enough.

Re: Help! Run of post-op complications

patrick murphy — Sat, 10 Aug 2013 10:26:31 GMT

love this stuff. whilst a student (even better phrase) my mentors used to pour a whole bottle, 500 ml, of a sulpha mixture into any large animal abdominal intervention. I still do stuff that is quackery, but probably more to with luck/superstition than EBM for sure,

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 10:13:52 GMT

[quote user="Martin Atkinson"]person who said there's more complications with tubing should be shot (Anthony?) -[/quote]

Have a glance at this before you do

Scholarly articles for tracheal rupture cats
Tracheal rupture associated with intubation in cats: 20 … - ‎Mitchell - Cited by 49 Tracheal rupture in cats: 16 cases (1983-1998). - ‎Hardie - Cited by 33 Rupture of the thoracic trachea following blunt trauma: … - ‎Palder - Cited by 21

Re: Help! Run of post-op complications

Anthony Todd — Sat, 10 Aug 2013 10:06:36 GMT

[quote user="James Laidlaw"]and try actually timing themselves operating.[/quote]

I've seen many vets doing a line of C/Ss at not more than 5mins per spay skin to skin but not vets trained doing them the last 10 years.

They would do this day after day.

One well known management guru vet proudly told me he could consistently spay a cat in 30 mins [about 15 years ago].

What no adverse poster seems to grasp is that all the dinosaurs used to do them that fast with much lower complications rates than seen now and they weren't doing them "faster" that was there normal speed.

It wasn't a contest it was just the norm. [Not that I ever aspired to their output however hard I tried to piss].

Hard to investigate complications if you just don't have them!

Linea alba were always stitched with chromic gut, some single interrupted; some continuous, and there were some breakdowns but almost always the knot had come undone.

Many today don't seem to grasp that surgical success is not the preserve of the modern with all the bells and whistles. Dinosaurs were good too and always quick without trying to be.

Re: Help! Run of post-op complications

Rob Reid — Sat, 10 Aug 2013 09:07:23 GMT

[quote user="James Laidlaw"] it's about operating efficiently AND effectively.[/quote]

Sums things up perfectly. Don't be hasty for the sake of it but at the same time don't needlessly slow up the procedure by gossiping about what was on TV last night with your nurse!

Re: Help! Run of post-op complications

Rob Reid — Sat, 10 Aug 2013 08:49:51 GMT

[quote user="Anthony Todd"]

Mine was a puff of Aureomycin powder directly into the open abdominal wound, accepted practice, I was told.

[/quote]

There was still a vet that insisted on this in my first job - applied directly onto the ovarian and cervical stumps in bitch spays. Same vet used to also close linea alba with catgut. To be fair I never recall seeing any of his bitch spays back for a wound breakdown.....read into that what you will!

Re: Help! Run of post-op complications

James Laidlaw — Sat, 10 Aug 2013 01:19:01 GMT

I think anyone claiming five minutes might want to stop swinging their privates and try actually timing themselves operating. This isn't a pissing contest, it's about operating efficiently AND effectively. I don't get where the idea that people are seeing lots more complications now from? If you have complications I'd suggest you investigate, rather than just do more ops faster...

Re: Help! Run of post-op complications

karen jones — Fri, 09 Aug 2013 22:26:41 GMT

Mylipen dc with wound sprayed with Terramycin was usual for all ops when I started in practice

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 21:26:22 GMT

[quote user="Anthony Todd"]Quicker isn't necessarily better.[/quote]

The prolongation of operating times does not depend on the complexity of surgery, intraoperative complications or the surgeon's inexperience, but may be the result of the meticulous implementation of procedures and steps taken to prevent complications which, given that they require extreme care and attention, necessarily contribute to increasing the duration of surgery.

This might sum up my view better , the above selectively plucked from a paper which actually seemed to show that an increased surgery time was NOT associated with an increased complication rate [these were very major abdominal surgeries though, not a cat spay] but note the comment on "meticulous etc. ....]

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 21:14:20 GMT

[quote user="Evelyn Barbour-Hill"]When I qualified[/quote]

Mine was a puff of Aureomycin powder directly into the open abdominal wound, accepted practice, I was told.

Others did use intramammary preps.

Re: Help! Run of post-op complications

Evelyn Barbour-Hill — Fri, 09 Aug 2013 20:04:18 GMT

[quote user="Anthony Todd"]

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]What does/did routine A/B achieve?[/quote]

Killed the cat, sometimes. Remember the Streptopen MC story?

[/quote]

No!

Surely there is nothing before my time or Martin's??

Streptopen was used a lot in my early days.

[/quote]

When I qualified (ah, lovely phrase)(and it was before Martin) it was normal procedure to squirt a mastitis tube into the abdomen before closing; indeed you were thought to be chancing it a bit if you didn't. Most people put a bit under the skin too.

Of course the surgeons would just reach for whatever there was a a broken box of on the shelf – Zipcillin, whatever – and quite often it was Streptopen. Then Glaxo brought out Streptopen MC, which was the same stuff but with much higher concentrations of antibiotic. I remember it well, the tubes were orange to make it look exciting and powerful. So, naturally, a surgeon or two reached for tubes of Streptopen MC....... to find that the cat mysteriously died a few days later. Of streptomycin poisoning.

Streptopen injection was great. Then Penbritin arrived and it was new and exciting and expensive so it gave you a warm glow to use it.

Re: Help! Run of post-op complications

Mark Holmes — Fri, 09 Aug 2013 20:03:17 GMT

I would agree that there seems very little benefit taking longer to set up the Ga than perform the proceedure - it makes no sense at all.

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 19:14:04 GMT

[quote user="Robin Grimmer"]

Well put Martin, this is the sort of veterinary care we should be providing in the 21st century. Re Anthony's query re complications with ET tubes - the new silicone ones are safe - the old red rubber Et tubes could cause damage if the cuff is blown up too tight.

http://www.fabcats.org/catfriendlypractice/cat%20friendly%2032pp.pdf page 26 anaesthesia

[/quote]

Your reference talks of tracheal/trauma with the red rubber ones but doesn't mention the killer which is when the rubber ones are blocked with gunk 'cos someone hasn't washed them out or blown through them before tubing you'll have a tragedy which is why we changed.

And by the time all your monitors have registered the drama unfolding and realised what's wrong it's too late. that's why we got Apalerts too!

Do humans tube and attach monitors for a 5 minute procedure [don't think they did when i had a dislocated ankle reduced nor a uretal stone removed?

I venture to suggesat that if you, Martin, just got on with the spay [and I don't doubt 5 mins would be enough] you'd have it done before all the monitoring kit and tube was set up.

None seems to address my supposition that the rate of complications [not success, I add] is proportional to the time under GA [I've modified it ]

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 19:00:53 GMT

[quote user="Robin Grimmer"]

http://www.fabcats.org/catfriendlypractice/cat%20friendly%2032pp.pdf page 26 anaesthesia

[/quote]

Oh dear the silicone ones can be overblown just as easily; their advantage is you can see the gunk in the tube when somehow, someone hasn't cleaned it out which is why we changed after a tragedy....

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 18:49:18 GMT

[quote user="Robin Grimmer"]

Quicker isn't necessarily better. If I was an owner, I would rather have a careful surgeon who takes their time, rather than someone rushing through it as fast as possible.

[/quote]

So slower surgeons get fewer "complications" I think not, in fact I suspect the complication rate is directly proportional to the duration of surgery in routine procedures.

I'm not talking about orthopaedics etc. although, with some, it certainly seemed valid

Re: Help! Run of post-op complications

Anthony Todd — Fri, 09 Aug 2013 18:45:28 GMT

[quote user="Evelyn Barbour-Hill"]

[quote user="Anthony Todd"]What does/did routine A/B achieve?[/quote]

Killed the cat, sometimes. Remember the Streptopen MC story?

[/quote]

No!

Surely there is nothing before my time or Martin's??

Streptopen was used a lot in my early days.

Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Scholarly articles for tracheal rupture cats

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications

Re: Help! Run of post-op complications