Watch video: Introduction
Welcome to the 5th month of the Mentorship Program!
This month we will be discussing a surgical topic and an anesthesia-related topic; but before we discuss any of these subjects, be sure to note the date of the Webinar in your calendar. The webinar is an informative discussion, or what we like to call and ”Ask Me Anything-AMA” session. Come prepared to ask questions or maybe even discuss a case.
Lumpectomies are probably one of the most common type of surgery that is performed in a small clinic. Skin and subcutaneous masses are varied in shape, size and etiology. The excision of a small dermal benign mass is considered a simple surgery (which it is). Unfortunately, it seems the ‘simpler’ a procedure is, the less training or education we actually get on this topic.
So no worries, in this month we are going to actually look at all of those details that your teachers, mentors, and senior clinicians all assume you already know!
Let’s establish for you a strong and solid foundation of knowledge on dealing with lumps.
Often when lumpectomies are being considered, the issue of sedation VS general anesthesia arises. So it is fitting that we delve further into the pros and cons of each option. We will also explore maximizing patient safety during sedation of both cats and dogs.
Watch video: Introduction (4)
Hi All,
I apologize that I have not monitored this page as much as I usually do. I have had some medical issues but I am getting back into healthy mode now. Thank you for your patience.
Emerald, I will alert Dr Brock that you have another question. I believe she is back from her ski vacation this week.
Nicole, thank you for making that comment. So yes 2mm in between ligatures can be enough and, in my opinion, it is better to have 2 ligatures a bit close together than just one, most of the time. Regarding the "flashing". We 'flash' when a clamp is on the pedicle because the nature of the clamp will tend to 'spread' the tissues out, so by flashing (releasing the clamp) we allow the ligature to fully strangulate the tissues without the tissues being held 'spread out'. The flashing is needed because of the hemostat. One ligature close to another will not cause the tissues to be held spread out because the ligature circumferentially encloses the pedicle. I hope this explanation makes sense and that I understood your comment correctly. I know you are in a different time zone but hopefully you can join us for the webinar next week in case I did not adequately clarify this question.
Have an amazing day!
Thankyou Dr Sylvestre
Yes I wil continue to pursue a cat gut alternative , thanku for the monocryl tip.
As I was religating the ovarian pedicles post bitch spey bleed I only managed to get 1 ligature on he ovarian pedicles due to there not being much tissue , if I was to put 2 on this particular case there would have only been a couple of mm between the 2 ligatures , is that still better than 1, I always allow more space between ligatures due to the need for " flashing ' u talk about ?
Thanks 😊
Hi Emerald
I saw your question for Dr Brock. I know she was heading to BC today for a ski holiday. I will alert her to your question but she may not get back to you for a few days. I do not know what her computer/work availability is like while away. Just an FYI.
Thanks and have an amazing day!
Hi Nicole
Great questions, difficult case. I do believe that the spaniel had some sort of bleeding disorder, or an adverse reaction to something that might have caused the odd clotting issue. Going back in the second time certainly could have caused you to go through muscle which would lead to bruising at the incision line. I am very cautious with ligating pedicles, especially in bigger patients. I had one patient, a large mixed breed dog on which we did a hindlimb disarticulation amputation. 2 weeks post op his entire incision fell open and he was bleeding from his femoral artery. Thank goodness the owner was the veterinarian also! But it made me realize that large vessels do take a long time to clot securely closed. So I would not be using catgut on such pedicles (I used it for many years but with everything I have learnt in the past 40 years, I would not touch it anymore). PDS is a good choice but that extra strength and duration is not necessary within the abdomen so I would simply use monocryl or biosyn, or something equivalent. I do certainly embrace the Modified Miller's knot (new to me for the past few years!) as those knots do stay on securely; others, if using the surgeon's knot or slip knot (as I used to) then I would transfixed when ligating an organ/pedicle like the body of the uterus in a larger patient as these knots can slip and I would always place 2 ligatures (large patient again). I hope this helps a bit. Welcome to the program.
Questions & Answers (1)
Hi Dr. Brock,
I was wondering if I could ask a question about a reply you had given last month to a colleague's question about a feline neuter anesthetic protocol for a cat with a heart murmur. You had mentioned at the end: "Listen carefully for upper respiratory noises such as gurgling both before and also in the half hour or so after extubation and treat with IM glycopyrrolate at 0.01mg/kg." I do sometimes hear this in feline patients after extubation during neuter procedures, (does not occur in patients we do IM sedation for other procedures and are not intubated). I was told or assumed it may be due to the lidocaine spray upon intubation and we tell clients this should resolve within 24-48h. Should I be treating this with glycopyrrolate and is the lidocaine spray the actual reason for this??
A question for Dr. Sylvestre also: I was just looking for the spay and neuter workshop to see if I could watch the cryptorchid videos, do we still have access to this?
Thank you very much,
Tina
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