TEACHING MANUAL

ON
GENERAL VETERINARY SURGERY, ANAESTHESIOLOGY
AND DIAGNOSTIC IMAGING (VSR 411)

Prepared by
Dr.R.UMA RANI.Ph.D.
Dr.S.KATHIRVEL.Ph.D.
Dr.A.R. NINU.Ph.D.
Dr.S. KOKILA.M.V.Sc.
Dr.D. VISHNUGURUBARAN.M.V.Sc
Dr.K.JAYAKUMAR.Ph.D.
Dr.M. SHIJU SIMON.Ph.D.

Department of Veterinary Surgery and Radiology

Veterinary College and Research Institute,
Tirunelveli – 627358

TAMIL NADU VETERINARY AND ANIMAL SCIENCES UNIVERSITY

2016

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 THEORY - SYLLABUS
GENERAL VETERINARY SURGERY

Introduction, history, classification, surgical terminology and development of veterinary

surgery, Asepsis-antisepsis, their application in veterinary surgery, surgical risk and
judgment. Shock and its management, Haemorrhage and its management, Principles of fluid
therapy in surgical patients, Differential diagnosis and surgical treatment of abscess, tumors,
cyst and haematoma, Differential diagnosis and surgical treatment of necrosis, gangrene and
burn, Wound: classification, symptoms, diagnosis and treatment, complications of wound,
their treatment and prevention

ANAESTHESIOLOGY

Preanaesthetic considerations and preanaesthetic, Local analgesia /anaesthesia, General

anaesthesia and anaesthetic agents, Inhalation anaesthesia and agents, Maintenance and
monitoring of general anaesthesia, Anaesthetic emergencies and their management,
Awareness of neuroleptanalgesia, electroanaesthesia, acupuncture, hypothermia and muscle
relaxants, Postoperative pain management, General principles of chemical restraint of wild /
zoo animals, General principles of anaesthesia of lab animals

DIAGNOSTIC IMAGING

Production and properties of X-rays.Factors influencing production of X-ray. Principles of

viewing and interpreting X-ray films, classification of radiographic lesions, Contrast
radiography: classification, materials, uses, indications and contra indications. Biological
effects of radiation, radiation hazards and their prevention by adoption of safety
measures.Principles of ultrasonography and its applications in veterinary practice. Awareness
on principles of radiation therapy, Isotopes and their uses in diagnosis and therapy; Principles
and application of CT scan, MRI, echocardiography, scintigraphy, gamma camera,
xeroradiography and Doppler.

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 PRACTICAL - SYLLABUS
GENERAL VETERINARY SURGERY

Surgical instruments and equipment.Operation theatre routines. Surgical pack: Preparation,

sterilization and handling. Familiarization with suture materials, surgical knots, suture
patterns and their use.Familiarization to live surgical haemostasis.

ANAESTHESIOLOGY
Familiarization with anaesthetic, apparatus, endotracheal tubes.Laryngoscope, gadgets for
monitoring preanaesthetic preparation, induction of general anaesthesia, in small and large
animals and endotracheal intubations in dogs.Demonstration of inhalant anaesthesia
monitoring of general anaesthesia, and the management of anaesthestic emergencies.Use of
artificial / assisted respiration.Various methods of local infiltration anaesthesia, and regional
block, for surgical procedures of different regions of body in large and small
animals.Chemical restraint of lab animals. (Visit of a wild animal facility and audiovisual
aids)

DIAGNOSTIC IMAGING

Familiarization with operation of the X-ray equipment, X-ray accessories and adoption of
safety measures in radiography. Dark room equipments, X-ray film and its
processing.Intensifying screen and its uses.Radiographic technique-positioning of small and
large animals.Handling, viewing and interpretation of X-ray films. Familiarization with film
contrasts, density and detail, common defects of X-ray films. Radiographic anatomy and
interpretation of radiographic lesions.Demonstration of contrast technique in small
animals.Familiarization with ultrasonography of small and large animals (demonstration).

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 GENERAL VETERINARY SURGERY
LESSON -1
HISTORY

1. HISTORY OF VETERINARY SURGERY

Veterinary Surgery is old as the civilization itself. It is one of the oldest forms of medicine. A
veterinarian must know the events that brought the profession its present day status.

 300 BC Domestic animals have been treated by ancient Egyptians

 250 BC King Ashoka erected first Veterinary Hospital in India
 Later on Arabian surgeon made suture material from sun dried sheepintestine
 In the 1st century A.D -- Celsus has introduced the use of suture materials
 1590 Ambroise Pare, French Barber Surgeon was called as Father of Surgery.
 1711 - 1761 About 200 million cattle died from Rinderpest in Europe
 1762- Establishment of first Veterinary College in Lyon, France by Claude Bourgelat
 1765 - National Veterinary School of Alfort, Paris
 1806 - Dr. Philip has developed absorbable suture materials
 1850- George Dadd was the first veterinarian to use general anaesthesia
 1852- 1922 - Halstead laid down the " Principles of Modern Surgery "
 1852 - United states - first Veterinary College at Philadelphia
 1862 – First Army Veterinary School at Pune, India
 1867 - Pean - Popularized forceps to control bleeding
 1869 - Joseph Lister has introduced sterilization of suture materials
 1894 - Dollars Veterinary Surgery published
 1895 - Wilham Conrad Rontgen discovered X-Ray
 1895 - Laparo-enterotomy for the removal of enterolith
 1910 - Text book of Veterinary Anatomy by Septimus Sisson
 1933 - American Animal Hospital Association was founded
 1934 - Babcock has developed stainless steel (metal) as a suture material.
 1939 - 1st Edition of Canine Surgery by Lacroix and Hoskins
 1940 - Aseptic principles widely applied in veterinary surgery
 1960 - Gaseous anaesthesia replacing parenteral anaesthesia for major surgeries
 1970 - Journal of Veterinary Surgery started
 As time passes, Veterinary Surgery became wider in its scope and moresophisticated
 The improvements in anaesthesia, blocking of nerves, pinning and screwing of
fracture of bones, dehorning of cattle, sheep and goat and radiologicaldiagnosis have
played crucial role for the development of veterinary surgery.

Father of Ancient Indian Surgery – Sushruta had written book on Surgery called as
Susrutha samhita

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 Father of modern Surgery : Joseph Lister

2. HISTORY OF ANAESTHESIA

 300 B.C. Juice of mandrake plant was used during Alexandrian period. Egyptians
induced unconsciousness by compression of the carotid arteries. In following centuries
various plants containing opium and atropine like compounds were used.
 1540, Paracelsus administered ether to chickens.
 1771, Joseph Priestley isolated and identified depholgisticated air-oxygen and
depholgisticated Nitrous oxide.
 1825, Hentry Hill Hickman performed surgeries on experimental animals by
inducing asphyxiation using carbon dioxide.
 1831, Chloroform was discovered independently by Von Liebig, Souberian and
Guthrie.
 1846 William Thomas Green Morton (1819-1868) demonstrated the use of ether as
anaesthetic for the removal of tumor in humans. Later ether was patented as Lethon.
Morton deserves the chief credit for the introduction of ether as anaesthetic agent.
 1846, Chloroform was used first in animals by Flourens.
 1847, Horace Wells (1815-1848) though lived only a for short duration, published
valuable information through his newsletter “A History of the discovery of the
application of Nitrous oxide gas, Ether and other vapours to surgical operations”.
 1857, John Snow administered chloroform to Queen Victoria during the delivery of
her eighth son Prince Leopold and later it became popular.
 Sir William Macewen (1847-1924) Pioneer of oral and nasolaryngeal intubation in
diphtheria patients as an alternative to tracheotomy using rubber, gum elastic catheters
and metal and flexometallic tubes. Later he administered chloroform and air through the
tubes for induction of anaesthesia.
 William Stewart Halsted (1852-1922) Famous surgeon who proposed the
“Principles of Surgery” and developed nerve block techniques like blocking of brachial
plexus, nerves of the face, internal pudental nerve and posterior tibial nerve using
cocaine in 1886.

3. DEFINITION
 Surgery: Surgery is the art and practice of treating injuries, deformities and other
disorders by manual and instrumental operations. In Latin ‘chirurgia’ refers to
surgery, cheir means hand and ergon means to work.
 A Surgeon must be a clinician trained in surgical skills with adequate knowledge of
allied sciences viz., anatomy, physiology, pathology, pharmacology, medicine and
gynecology and obstetrics. He must have good knowledge of anesthesiology,

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 radiology, microbiology, sterilization, shock management, fluid therapy,
chemotherapy and nutrition.
 Veterinary surgery is surgery practiced on animals.

CLASSIFICATION OF SURGERY
Surgery can be classified according to:

 Nature of surgery
 Region or system involved
 Instruments and appliances used.
I. According to the Nature of Surgery: this encompasses the following:

1. General surgery is carried to restore the normal functions of the body or a part
without substituting or discarding any part of the body E.g. Rumenotomy.

2. Plastic surgery is done on aesthetic grounds or to restore disturbed function and

includes reconstructive and cosmetic surgery.

a. Reconstructive surgery is surgery done for correction of deformities e.g. surgery for
cleft palate.

b. Cosmetic surgery isdone either to improve the appearance or to satisfy the fancy and
sentiments of the owner E.g. Ear cropping, tail docking, etc.

3. Elective surgery: In this case the operation is performed when circumstances are
favourable in terms of time as well as in terms of the patient. e.g. Spaying, castration,
etc

4. Emergency surgery: It requires immediate intervention without spending time. It is

performed and recommended in case of profuse hemorrhage, perforation of visceral
organs, tympany of the rumen.

5. Major surgery is surgery which is relatively more difficult to perform, time

consuming, involves risk on the life of the patient and requires the help of an assistant.
E.g. Caesarean section, thoracic surgery, etc.

6. Minor surgery is surgery which is relatively simple to perform, having no risk on the
life of the animal and does not require the services of an assistant E.g. Lancing an
abscess.

7. Radical surgery is surgery by which the root cause or source of a disease condition is
removed or rectified. E.g. Hernial repair, Enucleation of a tumor, etc.

8. Exploratory surgery is done to arrive at a diagnosis or for the confirmation of a

diagnosis. E.g. Exploratory laparotomy, paracentesis, etc

II. According to region or system involved: Advancement in surgery has led to this
classification and surgeons specialize on a particular region or system E.g. Orthopedic
surgery, ophthalmic surgery, thoracic surgery, cardiovascular surgery, neurosurgery, etc.
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III.According to Instruments and appliances used for Surgery

1. The term General surgery is used when only the common surgical instruments
are used in the procedure. e.g. Castration.
2. In Microsurgery magnification facilities are used for specialized surgical
procedures. e.g. Vascular anastomosis
3. Cryosurgery involves controlled use of substances like liquid nitrogen which
produces freezing temperatures to destroy abnormal tissues. e.g. Removal of
warts.
4. In Electrosurgery,electricity is converted to heat to incise a tissue. e.g. Excision
of small tumors using electrocautery.
5. In Laser surgery,laser beams are used to cut or destroy the diseased tissue.

REASONS FOR SURGERY/ GOALS AND OBJECTIVES OF SURGERY

 To save life of an animal.
 To prolong life of an animal.
 To hasten recovery from an injury.
 For elimination of disease process. Example: removal of a benign tumour.
 For cosmetic reasons.
 For correction of deformities.
 For replacement of a part by an artificial one.
 To make an animal sociality acceptable. Example: Castration in a male cat.
 To aid in diagnosis. Example: Exploratory laparotomy.
 For investigation in research work. Example: Rumen fistulation.

TENETS OF HALSTED

 Gentle handling of tissues

 Aseptic surgery

 Anatomical dissection

 Control of haemorrhage

 Obliteration of dead space

 Use of minimum quantity of suture material

 Avoidance of suture tension

 Immobilization

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 G A A C O M T I - acronym

LESSON 2

ASEPSIS AND ANTISEPSIS

Surgical asepsis (sterile technique)

Aseptic technique is defined as methods and practices that prevent cross contamination in
surgery. Microorganisms have access to the inner tissues, whenever dermal integrity is
disrupted, such as during surgery. The bacteria that contaminate surgical wounds generally
originate from the operating room personnel, and from the environment. Rules of aseptic
technique must be followed to prevent wound contamination.
The sterile field
1. Sterile field is a microorganism andspore free area
2. To maintain an area free of microorganisms, sterile gloves, gowns and drapes are used
to create a barrier between the environment (including members of the team) and the
client.
3. Established by using the innermost side of a sterile wrapper or by a sterile drape.
Sterile supplies and solutions may be placed on it.

Principles and practices of surgical asepsis

Start with sterile equipment and set up the sterile field

1. All objects used in a sterile field must be sterile.
2. Confirm sterility of the package. – Check expiration date and ensure package is clean
and dry.
3. Open the package – place in the center of table; top flap should be opened away from
you; touch only outside of wrapper; side flaps are opened with each hand; 4th flap is
opened towards you making sure it does not touch your uniform. If the inner surface
touches any unsterile article it is contaminated.
4. Opening a wrapped package while holding it: same as above.
5. Using a drape to establish a field; with one hand pluck the corner of the drape that is
folded back on the top.
o Lift the drape out of the cover and allow it to open freely without touching any
objects.
o Lay the drape on a clean dry surface, placing the freely hanging side farthest
from you (nurse should not lean over sterile field).
6. If there is any doubt about the sterility of an object consider it unsterile. Eg, the
package falls on the floor or has evidence of damage or moisture, even dried moisture.

Maintain the sterile field from start to finish.

1. The skin cannot be sterilized and is unsterile.
2. Sterile persons and items contact only sterile areas, unsterile persons and items
contact only unsterile areas.
3. Sterile objects become unsterile when touched by unsterile objects.
4. Sterile objects can become unsterile by prolonged exposure to airborne
microorganisms. Do not cough, sneeze, or talk excessively over a sterile field.

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 5. Use a sterile package immediately once it has been opened. Leftover sterile solutions
are no longer sterile and should be discarded.
6. Sterile items that are out of vision or below the waist level of the nurse are considered
unsterile. Sterile areas are continuously kept in view.
7. Always face a sterile field. If you turn your back on a sterile field, you cannot
guarantee its sterility.
8. Movement within and around a sterile field must be such as not to cause
contamination of that sterile field.
9. Fluids flow in the direction of gravity. Moisture that passes through a sterile object
draws microorganisms from unsterile surfaces above or below to the sterile surface by
capillary action.
10. The edges of sterile containers are not considered sterile once the package is open.
The one inch margin around the edge of the sterile field is considered contaminated.
11. Sterile gowns are considered sterile in front, shoulder to table level. The sleeves are
also sterile.
12. Tables are sterile only at table top level.
13. Whenever bacterial barriers are permeated, contamination occurs.
14. Articles of doubtful sterility are considered unsterile.
15. Conscientiousness, alertness and honesty are essential qualities in maintaining
surgical asepsis.

Sterile Supplies
1. Open each wrapped package as describe above.
2. With free hand, grasp the corners of the wrapper and hold them against the wrist of
the other hand (the unsterile hand is now covered by the sterile wrapper).
3. Place the sterile item on the field by approaching from an angle rather than holding
the arm over the field.
4. Commercially packaged supplies: Hold the package above the field and allow
contents to drop on center of the field.
5. Sterile solutions: Read label to confirm solution. Outside of container is unsterile;
inside sterile. Once it is opened, its sterility cannot be ensured for future use.
Remove cap and inert before placing it on a table. Hold the bottle of fluid at a height
of about 4-6” and to the side of the sterile field; discard a little solution before
pouring; avoid splashing which will cause the field to be contaminated.
6. Use of sterile forceps: Keep the tips of wet forceps lower than the wrist at all times.
Hold sterile forceps above waist level and in sight.

Sterile Gloves

May be donned by open or closed method. Closed method requires a sterile gown so in
the general care area, the open method is used.Gloves may be latex or vinyl and come in
different sizes.

Procedure for donning gloves:

o Remove rings, especially those with stones.
o Wash hands.
o Place package on clean, dry surface.
o Open outer package, then the inner package.
o 1st glove (dominant hand): grasp by its cuff with thumb and 1st finger of non-
dominant hand, touching only the inside of the glove. Insert the hand.

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 o 2nd glove: Pick up the other glove with the sterile gloved hand, inserting the
gloved fingers under the cuff and holding the gloved thumb close to the
gloved palm. Pull on the 2nd glove carefully. Adjust each glove so that it fits
smoothly and pull the cuffs up.

The Surgical Team

1. Team members are categorized as sterile or nonsterile in relation to the sterile surgical
field.
2. Sterile team members are those who scrub their hands and arms, done sterile attire,
use sterile instruments and supplies and work in the sterile surgical field. This
includes the surgeon, physician assistant and RN first assistant and the scrub person
who may be a RN or a surgical technician.
o The RNFA (registered nurse first assistant) replaces an assisting surgeon and
has had additional training. The duties include handling tissue and organs
with instruments, providing exposure of the surgical site, suturing, etc.
o The scrub nurse (or surgical scrub technician) sets up and maintains the sterile
field, hands supplies, and instruments to the surgeon, keeps accurate count of
instruments, sponges and sharps, and monitors aseptic technique.
3. Nonsterile team members have responsibilities outside the sterile field and do not
wear sterile attire.
o The nonsterile team members include the anaesthesiologist, the nurse
anaesthetist, and the circulating nurse.
o The circulating nurse must be an RN and she coordinates the care of the client
and manages activities outside the sterile field.

Nosocomial (Iatrogenic) Infections

Infections that are acquired by patients during the course of hospitalization are known as
nosocomial infections. It may develop preoperatively, postoperatively or even after the
patient has been discharged.

The surgical asepsis can be effectively enforced by proper

i. Preparation of surgical pack
ii. Preparation of surgical patient
iii. Preparation of operation theatre
iv. Preparation of surgical team

RULES REASONS

1. Surgical team members remain within the sterile Movement out of the sterile area
area. may encourage cross
contamination.
2. Talking is kept to a minimum. Talking release moisture droplets
laden with bacteria.
3. Movement in the operating room (OR) by all Movement in the OR may
personnel is kept to a minimum; only necessary encourage turbulent airflow and
personnel should enter the OR. result in cross contamination.
4. Non-scrubbed personnel do not reach over sterile Dust, lint, or other vehicles of
fields. bacterial contamination may fall
on the sterile field.

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5. Scrubbed team members face each other and the A team member’s back is not
sterile field at all times. considered sterile even if wearing a
wraparound gown.
6. Equipment used during surgery must be sterilized. Unsterile instrument may be a
source of cross contamination.
7. Scrubbed personnel handle only sterile instruments; Non-scrubbed personnel and non-
non-scrubbed personnel handle only non-sterile sterile instruments may be a source
instruments. of cross contamination.
8. If the sterility of an item is questioned, it is Non-sterile, contaminated
considered contaminated. equipment may be a source of
cross contamination.
9. Sterile tables are only sterile at table height. Items hanging over the table edge
are considered non-sterile because
they are out of the surgeon’s
vision.
10. Gowns are sterile from midchest to waist and from The back of the gown is not
gloved hand to 2 inches above the elbow. considered sterile even if it is a
wraparound gown.
11. Drapes covering instrument tables or the patient Moisture carries bacteria from a
should be moisture proof. non-sterile surface to a sterile
surface (strike-through
contamination).
12. If a sterile object touches the sealing edge of the Once opened, sealed edges of
pouch that holds it during opening, it is considered pouches are not sterile.
contaminated.
13. Sterile items within a damaged or wet wrapper are Contamination can occur from
considered contaminated. perforated wrappers or from strike-
through from moisture transport.
14. Hands may not be folded into the axillary region; The axillary region of the gown is
rather, they are clasped in front of the body above the not considered sterile.
waist.
15. The instrument assistant during surgery should give The surgeon can use the instrument
handle side of the instruments to the surgeon. easily and the chance of any injury
by the instrument is avoided.
16. If the surgical team begins the surgery seated, they The surgical field is sterile only
should remain seated until the surgery has been from table height to the chest;
completed. movement from seating to standing
during surgery may increase cross
contamination.

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 LESSON 3

SURGICAL RISK AND JUDGEMENT

CLASSIFICATION OF PHYSICAL STATUS

 It reflects an attempt to define the condition of the animal and thereby surgeon
becomes alert to problems which may occur during anaesthesia and surgery.
 Physical status may be of
o Good
o Fair
o Poor
o Extremely poor
o Emergency good
o Emergency poor
o Moribund condition

SURGICAL RISK
 The term risk is used to describe the animal’s potentiality for surviving anaesthesia
and surgery.
 To reduce the risk to minimum is of surgeons concern and alert to problems that may
arise during anaesthesia and surgery.

FACTORS INFLUENCING SURGICAL RISK

 Haemorrhage and shock
 Fluid and electrolyte imbalances
 Acidosis and alkalosis
 Anaemia and hypovolaemia
 Malnutrition and hypoproteinaemia
 Pulmonary and cardiovascular complication
 Hepatic insufficiency
 Renal and adrenal diseases
 Obesity of the patient
 Extreme of age - complication in both very old and very young animals

HOW SURGICAL RISK IS DETERMINED

 Detailed history of animals
 Physical status and condition of animal
 Individuality
 Clinical examination of the patient including general, systemic and special
examination
 Essential laboratory examination including routine examination of stool, urine and
blood (clotting time, bleeding time, total count, differential leukocyte count,
haemoglobin %, packed cell volume)
 On the basis of magnitude of operation, nature of ailment with foresaid findings, the
risk of patient is evaluated

ADJUNCTS AND SAFEGAURDS

These are
 Evaluation of operative risk
 Recognition and correction of preoperative deficits

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  Prevention of intra-operative and postoperative complication before they develop
 Resuscitation and after care of surgical patient

SURGICAL JUDGEMENT
 Surgical judgment is something that can be developed only over a period of time, the
length of time depending on the surgeon’s exposure to many and varied cases.
 A Surgeon who continuously makes the same errors can never develop sound
judgment.
 When examination and diagnosis favours or indicates for surgical treatment then
decision must be made about:
o Feasibility of performing surgery in consideration to the animal’s condition.
o When to undertake surgery
 Feasibility of performing surgery entirely depends on the evaluation of the patientand
proper timing of operation as arrived from clinical judgment
 The decision to perform surgery must be based on the circumstances and the optimum
condition of the patient for surgery.
 Such type of decision as to whether and when to undertake surgery is applicable both
for emergency and elective surgery.
 In elective surgery certain preoperative schedule should be carefully followed and
evaluated.
o Careful recorded history
o Detailed physical examination
o Essential laboratory test
o Radiographic study where necessary
 Other diagnostic test like ultrasonography, computed tomography, Doppler study,
magnetic resonance imaging etc., wherever required
 Emergency surgical operations are those where there is serious injury or massive
internal haemorrhage which may endanger the life of the patient.
 It is never justified to omit the details of a carefully recorded history and careful
physical examination during preoperative preparation of emergency cases.
 Resuscitation, emptying of stomach, empting of bladder by catheterization should be
considered as general rule, if necessary.

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 LESSON 4

SHOCK AND ITS MANAGEMENT

DEFINITION OF SHOCK

 "The clinical state resulting from an inadequate supply of oxygen to the tissues or an
inability of the tissues to properly use oxygen." This deprives the organs and tissues of
oxygen (carried in the blood) and allows the building up of waste products.
 Shock can result in serious damage or even death.

CLASSIFICATION

There are four general categories of shock: hypovolemic, cardiogenic, septic and
vasogenic shock.

 Hypovolemic shock is the result of inadequate intravascular circulatory volume

commonly resulting from haemorrhage, fluid loss in excess of intake, or third spacing
of body fluids.
o Acute blood loss: - Major laceration, ruptured abdominal or thoracic organs,
surgical procedures.
o Fluid loss:- Severe vomiting, diarrhoea, burns
o Fluid sequestration: - Massive tissue trauma, especially crushing injuries.
 Cardiogenic shock occurs from cardiac insufficiency with lowered cardiac output.It
may result from:
o Inherent heart diseases such as arrhythmias, myocardial trauma etc.
o Extracardiac diseases such as cardiac tamponade, tension pneumothorax.
o The circulatory failure is central in origin.
 Septic or endotoxic shock occurs from massive infection caused by gram negative
microbes. Various diseases which can cause this type of shock are peritonitis,
pyometra, haemorrhagic gastroenteritis, intestinal strangulation, or volvulus,
pericarditis, mastitis, osteomyelitis etc.
 Vasogenic shock occurs either due to extensive vasoconstriction or extensive
vasodilatation. Direct action of toxic substance on blood vessels produces dilatation of
blood vessels. It leads to decreased resistance and increased capacity of vascular bed.
o Pain or extensive handling and traction of the viscera – massive vasoconstriction
o Deep anaesthesia or spinal injury – extensive vasodilatation
 Anaphylactic shock occurs due to antigen-antibody reaction and resultant histamine
release. Histamine leads to increased permeability and massive vasodilatation.

PATHOPHYSIOLOGY OF SHOCK
Although the nature of shock varies, the fundamental sequence of events is essentially
the same in all forms of shock:

 Some precipitating cause decreases cardiac output and blood pressure

 Stimulation of sympatho-adrenal system leads to peripheral vasoconstriction and
shunting of blood away from the skin and intestinal viscera
 Heart rate and myocardial contractility increases, leading to increase in cardiac output

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  Simultaneously there is increased release of ADH, activation of rennin-angiotensin
system and release of aldosterone which ultimately helps to conserve water and sodium
through the kidneys.
 In micro vascular level certain compensatory changes become less reversible as shock
persists and provide a positive feedback.
o There is lowered oxygen delivery to tissue due to sympathetic constriction
of arteriole and pre-capillary sphincters.
o Development of cellular anoxia with release of lactic acid.
o Permeability of cell membrane increases with release of lysozymes
o Capillary stasis and decreased capillary pH triggers vascular pulling and
decreased venous return to heart.
o Hypercoagulability also occurs, which may leads to disseminated
intravascular coagulopathy (DIC).
 The end result in all forms of shock is cardiac failure ultimately leading to death.

SYMPTOMS OF SHOCK
 It is easy to recognize fully established shock; but it is difficult in early or
compensated shock.
 Shock is dynamic and not a static process.
 Physical examination findings associated with hypovolemic and cardiogenic shock
include:
o Tachycardia
o Tachypnea
o Pallor of mucous membrane
o Prolongation of the capillary refill time and decrease pulse quality
o Heart murmurs or arrhythmias (not absolute)
 Laboratory findings during shock shows lowered red blood cells, haematocrit and
plasma proteins; and elevated blood urea nitrogen (BUN).
 Other signs include weakness, restlessness, and depression, reduced urine output,
coma and dilation of pupils.

TREATMENT

 The most important goals in the treatment of shock include:

o Quickly diagnose the patient's state of shock;
o Quickly intervene to halt the underlying condition (stopping bleeding, re-
starting the heart, giving antibiotics to combat an infection, etc.);
o Treat the effects of shock (low oxygen, increased acid in the blood,
activation of the blood clotting system)
o Supportvital functions (blood pressure, urine flow, heart function).
 Patent airway should be ensured by intubating animal if collapsed or comatose.
Oxygen should be delivered via musk, cannula or endotracheal tube.
 Haemorrhage, if any, should be controlled by direct pressure, bandages, tourniquet
or ligation.
 Fluid therapy: A multi electrolyte, sodium containing crystalloid replacement
solution is usually the fluid of choice; plasma and whole blood have obvious
advantages

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 Types of intravenous fluids

- Crystalloid: Dextrose or electrolyte solutions increase intravascular and interstitial

fluid volume: Isotonic 0.9% NaCl, lactated Ringers Hypotonic (5% dextrose in water,
45% NaCl).
- Colloids: Do not diffuse easily through capillary walls Fluids stay in vascular
compartment; increase osmotic pressure: albumin, plasma protein and dextran.
- Blood and blood products: Treatment of haemorrhage and to restore coagulation
properties.

 Glucocorticoid: the role of glucocorticoid in shock state has remained debatable even
in man and small animal. Beneficial effects (dexamethasone @10mg/kg,
prednisolone @ 30mg/kg) include: increase in cardiac output, decrease in
peripheral resistance, increase in metabolism of lactic acid, improved efficiency of
glycolytic enzymes, stabilization of lysosomal enzymes and interference with
endotoxin- induced immune reaction.
 Vasoactive drugs are used to modify sympathetic and adrenal responses. Dopamine
is most popular vasoactive drugs used in shock.
 Sodium bicarbonate is indicated to counteract metabolic acidosis caused by
accumulation of lactic acid in shock state.
 Broad spectrum antibiotics are indicated to combat wide-ranging secondary
bacterial infection and diuretics for over dehydration or poor urine output.
 Drugs acting on cardiovascular system are also indicated to improve blood pressure
and to stimulate blood flow. Digitalis and adrenaline are drug of choice in this case.
 The animal should be kept in a warm and well ventilated room without exposing
direct heat.
 Thrombolytic therapy (drugs that dissolve clots as they form) may be considered in
the case of myocardial infarction or pulmonary embolism.
 Treatment with antioxidants that help rid the body of free radicals (harmful by-
products of the oxidative process) may protect against some types of shock.
o Carnitine may be helpful in treating cardiogenic, septic, and hypovolemic
shock.
o Coenzyme Q10 (CoQ10), an antioxidant, may be beneficial in treating
hypovolemic and septic shock.
o Glutamine added to parenteral nutrition may protect the intestines and
prevent complications from septic shock.
o N-acetylcysteine (NAC) improved the immune system response in septic
shock caused by endotoxins (toxins released from bacterial cells).
o Omega-3 fatty acids compared with omega-6 fatty acids may protect
against the harmful effects of septic shock.
o Vitamins B3 and B12may help protect against bacterial endotoxin that
causes septic shock.

17
 LESSON 5

HAEMORRHAGE AND ITS MANAGEMENT

HAEMORRHAGE

 Haemorrhage means escape of blood from an artery, vein or capillary to

extravascular space.
 The complete loss of blood is referred to as exsanguination.

CLASSIFICATION

 External haemorrhage
 Internal haemorrhage
 Depending on the time of occurrence
 Depending on the source of haemorrhage

- External haemorrhageoccurs from open wounds or cut wounds that is visible on the
outside of the body

o Example
 Epistaxis – bleeding from nose.
 Haematuria: Blood in urine.
 Haematemesis- vomiting fresh blood.
 Haemoptysis – coughing up blood from the lungs.
 Melena - presence of blood in faeces.

- Internal haemorrhageis bleeding occurring inside the body. It may be caused by

high blood pressure (by causing blood vessel rupture) or other forms of injury,
especially high speed deceleration occurring during an automobile accident, which
can cause organ rupture. When blood is collected in a newly formed cavity, it is called
as haematoma.

o Example:
 Haemometra - haemorrhage into uterus
 Haemopleura - haemorrhage into pleural cavity
 Haemoperitoneum - haemorrhage into peritoneal cavity
 Haematocele - haemorrhage in to tunica vaginalis
 Haemarthrosis - haemorrhage into a joint
 Haematomyelia - haemorrhage into spinal cord
 Petechiae - Pinpoint haemorrhages on skin and subcutis
 Ecchymosis - haemorrhagic spots on skin and subcutis.

- Depending on the time of occurrencehaemorrhage is classified as:

 Primary haemorrhage occurs immediately after injury.

 Reactionary haemorrhage occurs within 24hours after the primary bleeding has been
arrested due to mechanical disturbance of clot in vessel or due to slipping of the
ligature.

18
  Secondary haemorrhage occurs after about a week or more due to septic disintegration
of clot or due to sloughing of portion of vessel because of a septic or gangrenous
lesion.

- Depending on the source of haemorrhage: Arterial, Venous and Capillary

Characteristics Arterial Venous Capillary

Colour Bright red Dark red Red
Flow Jets (Jerks) Continuous slow and steady oozing
Spurting / flows freely
pulsating
Of force cardiac side peripheral side (distal) wound

ETIOLOGY

 Trauma - blunt trauma (e.g. fall, motor vehicle accident), laceration, or penetrating
trauma (e.g. knife or gun).
 Necrosis and ulcerations of blood vessel wall
 Infection and subsequent release of toxins of microorganism
 Aneurysm ( weaknesses in blood vessels )
 Increased blood pressure
 Lack of oxygen and nutrition.
 Anaphylactic shock
 Deficiencies of coagulation factors.
 Deficiency diseases
o Haemophilia
o Thrombocytopenia
o Deficiency of vitamin C, vitamin K
o Plant toxins (sweat Clover)

SYMPTOMS

 Bleeding from injured blood vessel

 Skin and mucous membrane become pale, cold and moist
 Patient feels thirsty
 Air hunger
 Thready pulse
 Hypotension
 Low haemoglobin and red blood cells
 Severe bleeding leads to shock

HAEMOSTATIC TECHNIQUES

The important methods used to control local haemorrhage include; application of pressure,
instruments, ligatures, thermal cauterization and haemostatic agents to aid coagulation.

1. Digital Pressure: Pressure applied to a vessel proximal to the bleeding site by the fingers
of an assistant. The digital compression is less traumatic to the intima of the vessel wall, than
instruments.

19
2. Forcipressure: Forcipressure consists of applying an Artery forceps (Haemostatic
forceps) to the bleeding end of the vessel and leaving it in position, until it is convenient to
apply a ligature. Haemostatic forceps allow more precise compression of haemorrhaging
vessels and are available in various lengths, shapes, and types. They are; Halstead mosquito
forceps, Kelly forceps, Crile forceps, Oschner forceps, Carmelt forceps.

When a vessel is crushed, the endothelial and muscular coats of the vessel rupture first and
they retract slightly into the lumen of the vessel and the tough areolar coat forms a cap over
this. A clot is soon formed inside the vessel, adjoining the ruptured ends of the coats.

Basic principles for application of haemostatic forceps are:

 The smallest forceps capable of accomplishing haemostasis should be used.

 Curved hemostats facilitate improved visibility and preferred to straight hemostats.
 For occluding a small superficial bleeder, the tip of the hemostat is used to grasp the
smallest amount of tissue possible, preferably only the bleeding vessel itself.
 When surgical assistant is not available and hemostats are applied in succession, time
can be saved, by carrying multiple hemostats with the third finger and palm
 For occluding deep bleeders and vascular pedicles; the hemostatic forceps are applied
with the concave surface of the tip facing the transected end of the vessel to facilitate
ligation.
 Larger pedicles are clamped with Carmalt forceps to reduce slippage or laceration of
the pedicle.

3. Ligation is the use of suture materials and surgical knots to occlude the blood vessels. It is
a haemostatic method most commonly used. For larger vessels, definitive haemostasis and
increased security provided by ligatures, compensates time spent on application.

As a rule ligatures are tied with square knots, which are the least likely to loosen or untie.

Surgeon’s knot can be used with advantage for ligation of vascular pedicles with synthetic
sutures.

A surgeon’s knot is not recommended when using surgical gut, because increased friction
tends to weaken it at the knot.

The increased bulk and asymmetry of the surgeon’s knot make less suitable for general
ligation than the square knot.

Double ligatures are recommended for large isolated vessels, especially arteries.

For large pulsating arteries transfixation ligatures are used.

4. Ligating clips are ‘V’ shaped stainless steel clips widely used to control bleeding during
surgery. They have minimal reactivity in tissues and often offer, improved efficiency
compared to ligation.

20
Advantages

 Ease of application in areas of difficult accessibility.

 High strength
 Structural stability
 Improved security.
Metallic clips (stainless steel) are widely used and have minimal reactivity in tissues.
Currently absorbable clips are available. The absorbable clips (Polygalactin 910 and PDS)
have an integral locking mechanism to prevent re-opening.

The metallic vascular clips can be easily applied to vessels, using an applicator similar to
needle holder. Disadvantage of metal vascular clip, is they persist in the wound as foreign
material, which interferes with subsequent radiographic studies.

5. Pressure Pad Haemostasis is compressing the bleeding site with gauze sponges and it
controls low pressure bleeding from multiple small vessels. Tissues should be gently blotted
or mopped with the pressure pads rather than wiped; wiping abrades tissues and dislodges
blood clots that were formed. Use of pressure pad haemostasis on larger vessels is temporary.
Once the bleeding has been controlled in this fashion, the offending vessels may be identified
and ligation may be applied.

6. Pressure Bandages are the most common type of bandages used to hold the soft tissues
together. They function to control haemorrhage, prevent oedema, obliterate dead space and
prevent excessive granulation tissue. Inadvertent vascular and peripheral nerve pressure
should be avoided. The pressure generated must be distributed evenly across the bandage
surface. A patient’s intolerance is often the first sign of significant problem. When bandages
are used to prevent haemorrhage, they should be left in place for a relatively short time of 12
to 24 hours only.

7. Tourniquet is a cord tied around an extremity (like limb and tail) so as to control bleeding.
Diffuse bleeding from multiple vessels is best controlled by placing a tourniquet. It should
not be applied very tightly because it may completely arrest blood supply to the part and
cause tissue damage. It should not be kept continuously for more than 15 minutes.

8. Esmarch’s Bandage is an elastic bandage applied completely covering, from the distal
part of an extremity up to a point above the site of operation, so as to compress the vessels
and drive blood from the area into the body. A tourniquet is then applied, close to the upper
limit of the bandage, to prevent return of blood and then the bandage is removed. The
tourniquet is removed after the surgery is completed. This method is employed, while doing
surgery on limb or tail so as to minimize bleeding during the course of surgery.

9. Crushing: Crushing can be practiced for haemostasis in larger structures like spermatic
cord using Emasculator / Ecraseur.

10. Torsion: Torsion is securing the bleeding end of the vessel with an artery forceps and
drawing out slightly and twisting on its long axis several times for occluding it. It is
sufficient to arrest haemorrhage from small vessels.

21
11. Tearing: Tearing of tissues often practiced in the removal of tumors (mammary tumors)
loosely attached and situated in the vicinity of vessels. This minimizes bleeding.

12. Blunt Dissection: It is performed by rupturing the tissues by pressure of blunt

instruments. This method is employed for isolation of large vessels like jugular vein and
carotid artery.

13. Electrocautery: It may be used to control haemorrhage from arteries up to 1.0mm and
veins up to 2.0mm in diameter. Electrocautery achieves haemostasis through heat induced
protein denaturation and tissue coagulation. The basic electrosurgical instrumentation unit
may have either monopolar mode or bipolar mode and a patient ground plate. With either
method, tissue trauma is minimized by using the lowest amplitude setting and shortest
duration of application.

14. Electroscalpel is an attachment to the electrosurgical unit and is used to make

electroincision or to coagulate small vessels. The surgeon should hold the electro scalpel
perpendicular to the tissue and minimize the contact area at the point of incision.

15. Heated Filaments: Battery powered heated filaments effectively coagulate blood vessels
in ophthalmic surgery.

16. Cryoprobes applied at a temperature of -20o C or below, cause cryogenic necrosis of

capillaries and venules and controls bleeding.

17. LASER: The acronym LASER stands for Light Amplification by Stimulated Emission
of Radiation. Lasers may be used to control haemorrhage. Laser energy ruptures RBCs,
damages platelets and activates clotting cascades with thrombus formation. Haemostasis is
achieved by laser induced endothelial damage, protein denaturation and oedema.

18. Topical Haemostatic Agents

 Gelatin sponge
 Oxidized cellulose
 Microfibrillar collagen
 Fibrin glue
 Absorbable collagen
 Cyanoacrylate tissue adhesive.

These are used to enhance normal clotting. These can be applied topically to control diffuse
haemorrhage that is not amenable to other haemostatic methods.

19. Silver Nitrate Chemical agents like silver nitrate have an astringent action on tissues are
capable of producing haemostasis.

20. Adrenalin: Hypodermic injection of adrenalin is capable of preventing capillary

haemorrhage.

22
21. Vitamin K: Injection of vitamin-K in doses of 0.5 to 1.0ml for dogs and 10 to 20ml in
cattle also helps haemostasis.

22. Calcium: Injection of calcium borogluconate can bring about coagulation of blood.

Doses: Dog 5 to 10ml i/v, Cattle 100 to 300ml i/v.

Commercially available haemostatic agents:

Inj.Botropase

Inj.Thrombokinas, USP.

Inj.Thrombin, USP.

Inj.Tranexamic acid (Texableed)

Inj.Adrenochrome monosemicalbazone

Inj.Calcium alginate

Inj.Ethamsylate

Inj.Ephinephrine

Absorbable gelatine sponge (Abgel)

Chitosan powder

Protamine sulphate

Botroclot liquid

23. Other methods: The other means of controlling diffuse haemorrhages are:

 Umbilical tape packing in the nasal cavity bleeding

 Gauze tampons in the vaginal region
 Wound closure techniques

23
 LESSON 6

ABSCESS, TUMOUR, CYST

ABSCESS

 Abscesses are circumscribed collections of purulent material (pus) in a cavity, found

in several species of animals in a variety of locations.
 This purulent inflammation is usually caused by one of four pyogenic (pus
producing) bacteria: Corynebacterium, Pseudomonas, Streptococcus and
Staphylococcus.

Parts of abscess
 Abscess consists of a wall, pyogenic membrane and pus (Liquor puris).
 The pyogenic membrane that lies between the wall and pus, controls spread of
infection, and helps in phagocytosis and granulation tissue formation.
Pus
 Pus contains necrosed tissue, dead bacteria, leukocytes and proteins of blood and
tissues.
 Pus cells mainly consist of polymorphonuclear leukocytes along with a few
mononuclear cells.
 Pus is alkaline in nature and yellow in colour.
 Pus serum will not clot, since the fibrin of exudates is digested by the proteolytic
enzymes of the leukocytes.

Abscess classification

Abscess may be classified as:

 Acute Abscess (Hot abscess): Inflammatory symptoms are more active.

 Chronic Abscess (Cold abscess): Inflammatory symptoms are less active.

Chronic abscess may be:

 Hard with inspissated pus,or
 Soft with liquid pus and thin abscess wall.
 Superficial or deep abscess: based on location.

Etiology

 Pyogenic organisms like Staphylococci, Streptococci, Escherichia coli and

Pseudomonas aeruginosa.
 Specific organisms like Corynebacterium pyogenes, Actinomyces bovis etc.
 Chemicals like mercuric chloride and Zinc chloride.

Common seats of abscess

 Cattle: Yoke, udder and prominences

 Horses: Shoulders, sub-maxillary and post pharyngeal lymph nodes.
 Dogs: Anal region, and mammary glands.

24
Acute abscess
 Acute abscess forms in 3 to 5 days following infection.
 In long duration abscess, the liquid part is absorbed and the solid part is left. This is
called inspissated pus.

Symptoms
 Acute superficial abscess appears as a local painful swelling.
 The dead tissues and dead inflammatory cells are continuously thrown into the cavity
which leads to a gradual increase in the amount of pus.
 Thus the abscess enlarges till it reaches the surface of skin or mucous membrane.
 The center of abscess becomes soft (pointing) and later ruptures, discharging pus.
 Local acute inflammatory symptoms without fever are observed in superficial
abscess.
 Deep abscess has no local symptoms, but fever and pain on manipulation of the part
are evident.

Chronic abscess
 A chronic abscess develops slowly without any inflammatory symptoms.
 It may be painless or slightly painful.
 Primary chronic abscess usually occurs from repeated injuries and observed on the
prominences of limbs and ribs due to bed sores.
 Secondary chronic abscess develops in the course of various local affections.
 Chronic abscess may be hard in consistency surrounded by fibrous tissue and
containing small amount of pus or it may be soft and thin walled with
comparatively larger amount of pus.

Treatment
Treatment should correspond to the stage of development of an abscess. In time,
abscess may become inactive or enclosed (sterile) when the body defences have killed
all of the causative bacteria. The accumulated pus, with no route of escape, will slowly
become liquefied and absorbed.

 Measures to accelerate maturation of abscess by using liniments, fomentations and

mild blisters.
 Once mature, abscess must be early cleared up of pus by aspiration and subsequent
washing of the purulent cavity.
 The abscess should be opened by syme’s abscess knife or a scalpel at the place of
pointing. The pus should be drained and the cavity is to be irrigated with a mild
antiseptic lotion. In cases where the pointing of abscess is not at a dependent Part,
then drainage will not be perfect. A counter opening is made at the most ventral part
(dependent Part) of the abscess.
 Tincture of Iodine soaked gauge is be packed to keep the openings patent. This should
be changed once in 24 hours. The quantity of gauze used to pack the abscess cavity
has to be reduced daily as the cavity is being filled up by granulation tissue. Gauze
soaked with 0.5% silver nitrate is best against most of the micro-organisms.
 Further therapy is the same as that of a granulating wound.
 A chronic abscess is converted into an acute abscess by applying blisters, and then
treated as acute abscess. Sometimes the chronic abscess is enucleated under local
infiltration analgesia, and the skin is sutured.

25
Common Terms Related to Abscess

 Cellulitis or Phlegmon is diffuse, suppurative spreading inflammation of loose

connective tissue, with predominance of necrotic events over suppurative.
 Pustuleis a circumscribed cavity with pus, situated in epidermis.
 Furuncle or Boil is suppurative inflammation of hair follicle or a sebaceous gland
due to Staphylococcus aureus. A group of furuncles is called Furunculosis.
 Carbuncleis small boil, which drains to outside by multiple small openings. It is
caused by Streptococci and Staphylococci.
 Acneis an abscess of sebaceous gland. It appears as single or multiple pustules
containing grayish white pus. Antiseptic ointments externally and systemic penicillin
gives good relief.
 Empyemais collection of pus in a body cavity. Example: Empyema of frontal sinus,
empyema of joint.
 Antibiomais a clinical condition resulting from improper treatment of an abscess.

TUMOUR

 The term neoplasm is a Greek word used primarily for new formations or new
growths.
 Tumour may be defined as “an abnormal mass of tissue, the growth of which extends
uncontrolled, in comparison to the normal tissue and persists in the same excess even
after cessation of the stimuli which evoked the change.”

Classification

Benign Malignant
Grow slowly Grow rapidly
Locally grow to great size Create metastases
Don’t invade the neighbouring tissue Invade and destroy neighbouring
tissues.
Usually do not return after surgical Recurrence after surgical removal
removal

Incidence

Tumours are more common in canines.

 Skin - Common in older dogs (often benign) but much less common in cats
(malignant).
 Breast- Fifty percent of all breast tumors in dogs and 85% of all breast tumors in cats
are malignant.
 Testicles - Testicular tumors are rare in cats and common in dogs, especially those
with retained testes.
 Bone - Bone tumors are most commonly observed in large breed dogs and rarely in
cats. The most common sites are leg bones, near joints.
 Head and Neck - Cancer of the mouth is common in dogs and less common in cats. A
mass on the gums, bleeding, odour, or difficulty in eating are signs to watch for.

26
  Horse and cattle are more often affected than sheep, pig and goat.

- Fibropapillomatosis of the skin, mucosa of mouth, esophagus and urogenital

organs are often seen in domestic animals. Fibroma is more common in
horses, cattle and dogs.

 Old animals are affected more commonly than young ones.

Varieties of tumour

Tissue of origin Name of tumor Cell type

Mesenchymal Fibroma Fibrous connective
tumors tissue
Chondroma Cartilaginous tissue
Osteoma Bony tissue
Odontoma Tooth substances
Myoma muscular tissue
Myxoma Cardiac skeleton
Lipoma Adipose tissue
Neuroma Nerve cells and fibres
Leiomyoma Smooth muscle
Rhabdomyoma Skeletal tissue
Haemangioma Blood vessels
Meningioma Meninges
Teratoma Germ cells
Epithelial tumors Papilloma Skin or mucous
membrane
Adenoma Glandular epithelium
Basal cell tumour Basal cell of skin
Hepatocellur adenoma Hepatocytes
Glomus tumour Melanocytes
Blood cells Non-Hodgkin lymphoma and Hodgkin Lymphoid cells
lymphoma
Leukemia Hematopoietic cells

27
Diagnosis
 Clinical examination – location, size and consistency
 Radiography – bones and vascular organs.
 Biopsy – exploratory cytology

Treatment
 Prophylactic treatment is undertaken either to reduce the anticipated incidence rate
of a particular tumor type or the rate of recurrence of a neoplastic disease after
therapy.
o Mammary tumors in bitch – Spaying between 6 and 12 months of age will
greatly reduce the risk of breast cancer. Surgery is the treatment of choice
for this type of cancer.
o Benign vaginal tumor – ovariotomy
o Testicular tumors (Seminoma and sertole cell tumour) - Castration
 Definitive excision refers to use of surgery as the sole treatment procedure without
adjunctive radiotherapy or chemotherapy.
o Local excision: The removal of a neoplastic mass with the minimal amount
of surrounding normal tissue.
o Wide local excision: Removal of a significant predetermined margin of
surrounding tissues together with the primary mass.
o Radical local excision: Removal of a tumour with anatomically extensive
margins of tissue extending into fascial planes which are undisturbed by the
primary growth of the tumouris termed radical local excision or
compartmental excision. Eg: sarcomas.
 Palliative treatment: A procedure that remarkably improves an animal’s quality of
life by providing pain relief, or relieving poor function, despite the presence of
unsolved systemic neoplastic disease.
o Eg: Limb amputation – osteosarcoma
o Spleenectomy – Bleeding haemorrhage of sarcoma
 Apart from surgery and chemotherapy, radiation, cryosurgery (freezing),
hyperthermia (heating) or immunotherapy can be effectively used to treat cancers.
Combination therapy is commonly employed.

CYST

 A cyst is a closed sac having a distinct inner lining of secreting membrane.

 They may contain air, fluids, or semi-solid material.
 Cyst may contain a solid structure like tooth (dentigerous cyst) or hair (dermoid cyst)
also.
 The outer wall of a cyst is called as ‘capsule’.
 Most of the cysts are benign in nature, but some may produce symptoms due to their
size and /or location.
 Size of a cyst may vary from a small grape to a football.
 Cysts can arise anywhere in the body,

Common examples are listed below:

 Chalazion cyst (eyelid)

 Retention Cyst (gland like salivary cyst)
 Dentigerous Cyst (associated with the crowns of non-erupted teeth)

28
  Exudation Cyst (Hydrocoele).
 Dermoid (misplaced embryonic tissue).
 Encapsulation cyst (around foreign bodies and parasites. Eg: Cysticercosis)
 Neoplastic (Cyst adenoma).
 Ganglion cyst (hand/foot joints and tendons)
 Glial Cyst (in the brain)
 Distension cyst: (Follicular cyst of ovary, cystic distension of a joint bursa).
 Meibomian cyst (eyelid)
 Ovarian cyst (ovaries, functional and pathological)
 Renal cyst (kidneys)
 Sebaceous cyst (sac below skin)

Diagnosis

 Cysts are generally non-inflammatory in nature and develop slowly with well defined
periphery.
 On palpation fluid filled cyst fluctuates uniformly while cysts with solid mass
fluctuates en-masse.

Treatment

 Puncture and evacuate the contents of cyst and inject an irritant solution like Tr.
iodine to destroy the smooth lining membrane and setting up inflammation.
 Use of seton to drain cyst is a good practice.
 Surgical excision of the cyst is the preferred option. Intact cyst is carefully dissected
and removed from the surrounding tissue in possible cases.

Differential diagnosis

An abscess must be differentiated from the following conditions:

 Cyst
o
Slow in development as compared to an abscess.
o
Soft and fluctuates uniformly, but not hard at periphery.
o
No inflammatory symptoms.
o
No pain sensation.
 Haematoma
o Forms due to coagulation of blood or serum.
o Doughy on palpation and forms immediately following an injury.
o Does not point like an abscess.
o No pain sensation.
 Hernia
o History of recent injury and swelling.
o Hernial ring can be palpated.
 Tumour
o Uniformly hard in consistency.
o Exploratory puncture with needle may reveal blood.
o No pain sensation.
o Does not point like an abscess.

29
 LESSON 7

NECROSIS, GANGRENE, BURN AND SCALD, FROST BITE

NECROSIS
 Necrosis means death of tissues in the body. This occurs when enough blood is not
supplied to the tissue, whether from injury, radiation, or chemicals.
 Necrosis is not reversible.

Classification
 Avascular necrosis is a disease resulting from the temporary or permanent loss of the
blood supply to the bones. Without blood, the bone tissue dies and causes the bone to
collapse. This disease also is known as osteonecrosis, aseptic necrosis, and ischemic
bone necrosis
 Coagulative necrosis is typically seen in hypoxic environments (e.g. myocardial
infarction, infarct of the spleen).
 Liquefactive necrosis is usually associated with cellular destruction and pus
formation (e.g. pneumonia).
 Haemorrhagic necrosis is due to blockage of the venous drainage of an organ or
tissue (e.g. in testicular torsion).
 Caseous necrosis is a specific form of coagulation necrosis typically caused by
mycobacteria (e.g. tuberculosis).
 Fatty necrosis results from the action of lipases on fatty tissues (e.g. acute
pancreatitis, mammary tissue necrosis).
 Fibrinoid necrosis is caused by immune -mediated vascular damage. It is marked by
deposition of fibrin -like proteinaceous material in arterial walls.
 There are many causes of necrosis including injury, infection, cancer, infarction,
toxins and inflammation.
 Severe damage to one essential system in the cell leads to secondary damage to other
systems, a so-called "cascade of effects".

Etiology
Necrosis can arise from lack of proper care to a wound site.
 Physical agents like excessive heat or cold.
 Mechanical injuries that crush or cut off blood supply.
 Loss of blood supply cuts off oxygendue to passive hyperaemia with sluggish flow of
nutrients and deficient oxygenation (volvulus, strangulated hernia) and ischemia (
decreased blood supply to a part) due to thrombus or embolism; compression of an
artery, and ergot poisoning.

GANGRENE
 Gangrene is necrosis and subsequent decay of body tissues caused by infection or
thrombosis or lack of blood flow.
 It is usually the result of critically insufficient blood supply sometimes caused by
injury and subsequent contamination with bacteria. This condition is most common
in the extremities.

Etiology
 The main factors in gangrene are loss of blood supply, and later invasion of the part
by micro-organisms.

30
Gangrene may be caused by:
 Direct damage to tissues which include:
o Mechanical compression or interference with blood and nerve supply to a part of the
body or an organ while lying on a hard floor. Example: bed-sores; sit-fast.
o Physical agents like application of heat and cold. Example: burns, frost-bite.
o Action of acids, alkali and other chemicals producing dry gangrene and moist gangrene.
o Impaction of intestine in the hernial ring and infestation with pathogenic microbes
especially with anaerobic infection.
 Indirect changes in tissues due to cardiac, venous, arterial or nervous affections like:
o Ergot intoxication, which causes spasmodic narrowing of arterioles and leads to dry
gangrene of extremities. It is commonly seen in feet of cattle.
o Diabetic gangrene narrows arteries and sugar in tissues, favours bacterial growth.
o Senile gangrene i.e. arteriosclerosis in old age, which narrows lumen of blood vessels.

Common sites of affection

 Extremities like legs, ears, tail, wattle and combs. It is mostly due to freezing or ergot
poisoning.
 Mammary gland: Staphylococcal mastitis produces necrosis due to toxins or thrombosis
of mammary vessels.
 Involvement of lung due to wrong drenching of medicines, improper passage of
stomach tube or severe lung infection.
 Intestines in equines are commonly involved either with infarction due to verminous
thrombosis of anterior mesenteric artery; or due to acute, local passive hyperaemia
produced by intestinal torsion, volvulus or intussusceptions.

CLASSIFICATION, ETIOLOGY AND SIGNS OF GANGRENE

Type Etiology Characteristic signs

Wet gangrene Sudden interruption of blood flow  Affected tissue may appear
or such as due to burns, freezing, badly bruised, swollen or
moist injury or blood clot. Wet gangrene blistered.
gangrene spreads very quickly and can be  May also become infected.
fatal.  No clear line between
healthy and affected tissue.
Dry gangrene Insufficient blood flow through the  Affected tissue becomes
arteries such as due to shrivelled, dry and blackish or
atherosclerosis or blood clots. It greenish colour.
usually doesn't involve bacterial  Cold to touch
infection.

Gas gangrene Infection with certain types of
bacteria, such as clostridium. It
typically occurs at the site of a
recent injury or surgery. The
bacteria rapidly destroy muscle and
surrounding tissue.
 Swelling around skin due to
exudates and gas formation.
 Skin initially looks pale and
then turns dark red or purple in
colour.
 Offensive odour of exudates.

31
Diagnosis
Diagnosis of gangrene will be based on a combination of

 History (recent trauma, surgery, cancer, or chronic disease).

 Physical examination
 Results of blood and other laboratory tests (presence and extent of infection).

Treatment
Treatment should be directed to:

 Prevention of cause and extension of gangrene.

 Debridement: Removal of dead, damaged, or infected tissue to improve the healing
potential of the remaining healthy tissue.
 Application of warm antiseptic fomentations to relieve pain.
 Surgical excision or amputation of a limb or organ.
 Antibiotics alone are not effective because they do not penetrate ischemic muscles
sufficiently. However, penicillin is given as an adjuvant treatment to surgery.
 In addition to surgery and antibiotics, hyperbaric oxygen therapy (HBOT) is used
that inhibit the growth and kill the anaerobic organisms.

ULCER

 An ulcer is a localised defect in the continuity of an epithelial surface without any

tendency to heal.
 It is usually associated with an inflamed base of granulation tissue with or without
necrotic slough.
 The majority is chronically inflamed; the slough at their base represents inadequate
drainage.
 Acutely inflamed ulcers may have an outer rim of cellulitis.
 Ulcer must be differentiated from erosion which is an epithelial defect with loss of
superficial layers, but the basal layers are intact.

Classification
 Iatrogenic ulcers: wound breakdown post-operatively and results in extravasation of
irritant fluid.
 Non-specific ulcers:eg; Traumatic ulcers including secondary stress ulcers.
 Specific ulcers: as observed in tuberculosis, ulcerative lymphangitis, and glanders.
 Malignant ulcers: observed in skin and gastrointestinal tract.
 Ischemic ulcers or Decubitus ulcers: These are due to continuous pressure which
interferes with supply of nutrition to local tissues leading to pressure or bed sores.
 Infective ulcers: primary e.g. viral, tuberculosis, and secondary e.g. due to drainage of
deep foci.
 Neuropathic ulcer e.g. in diabetes

Etiology
 Repeated and continuous irritation of wound. Example: Traumatic ulcer, bed sore.
 Secondary infection of the site by bacteria, fungus or virus with which the tissues
cannot effectively combat.
 Insufficiency of nerve and blood supply to the part.
 Presence of necrotic tissue or foreign body in a wound.

32
  Specific diseases like tuberculosis, glanders, and ulcerative lymphangitis.
 Presence of neoplasm. Example: Rodent ulcer.

Common sites
 Cattle: yoke
 Horse: saddle place, elbow, limbs.
 Dog: root of tail, tip of ears, and cornea of eye.

Symptoms
 The edge of ulcer may be raised or in level with the surrounding skin and rugged.
 The center of the lesion may be flat or concave, and may show necrotic spots.
 Granulations are pale or blue in colour depending upon the form.
 The discharge may be serous, purulent or grayish.

Treatment
The specific treatment of an ulcer is dependent on the subtype.

 Elimination of the cause adversely affecting the course of ulcerative disease and
stimulation of regenerative processes at the affected site.
 Astringent or caustic applications for ulcers with excessive or unhealthy granulations.
E.g. copper sulphate, silver nitrate, carbolic acid.
 Thermo-cautery with red hot iron to destroy unhealthy tissue which promotes
granulation and cicatrisation.
 Bier’s hyperaemic treatment.
 Antibiotics are only indicated for infected ulcers in which there is evidence of spread
around the margin e.g. a cellulitic rim and there may be ongoing systemic infection
e.g. tuberculosis.
 Exposure to ultra – violet rays to stimulate circulation and to destroy micro-
organisms.
 For large deficits or prolonged ulcers with little evidence of healing, further surgical
intervention may be indicated e.g. skin grafts and rotational flaps.

BURN AND SCALD

 Burn is an injury of integuments and underlying tissues, occurring due to high

temperature or chemical substances.
 Burn may be defined as tissue changes that occur on excessive absorption of heat by
skin.
 Scald is an injury caused by hot liquids or steam.
 Scald is likely to be more injurious than because of the hot liquid may penetrate into
the deeper part of tissues.

Classification
According to the depth and severity of burn:
 First Degree (Superficial): epidermis is affected and transient erythema, sometimes
vesicle formation and desquamation of the epidermis occurs. Epidermal burns look
red, are painful and heal rapidly.
 Second degree burn (partial thickness burn): Here, depth extends to the mid dermis.
Loss of epidermis is complete. Capillaries and venules in the dermis is dilated,
congested and exude plasma. There is erythema, coagulative necrosis of epidermal

33
 cells and vesicle formation. Healing is rapid and complete by the regeneration of
epithelium unless there is involvement of secondary infection.
 Third degree burn (Full thickness): is characterized by coagulation of epidermis and
dermis. Severe edema of the sub cutis develops and dry gangrene of the damaged
tissue occurs. The epidermis is desiccated and charred with presence of black layer
in skin. Permanent scarring occurs due to healing by granulation. Full thickness
burn is insensitive to pain because of damage of cutaneous nerve endings.
 Fourth degree: Here, subcutaneous fascia and deeper tissue like muscles, bones etc are
involved. The clinical features are similar to those described in third degree burn.
Repair is by scar formation preceded by sloughing of the necrotic tissue.

Etiology

The following may cause burn:

 Thermal injuries
o Direct heat
o Flame
o Scalding
 Electrical burns
o Electrical cord exposure
o Lightning
 Chemical burns
o Injuries caused by chemicals like strong acids and alkalis, solvents, petroleum
distillates and hot tars are referred to as chemical burns.
o The chemical produces localized necrosis of skin and deeper tissues with which it
comes in contact.
o The degree of tissue destruction depends on the strength of the chemical and the
duration of contact.
o Chemical causes local coagulation of proteins and necrosis.

Clinical signs
Thermal burns
 Superficial-hyperaemia, desquamation and pain.
 Partial thickness- exudation, pain, decreased sensitivity.
 Full thickness- White, black or brown, leathery eschar, subcutaneous oedema and
little or no pain.

Electrical burns
 No pain
 Well-circumscribed cold, blood less, pale yellow lesion.

Chemical burns
 Line of demarcation between dead and healthy tissue
 Devitalized tissues may get infected
 Formation of ulcer which heals gradually

Treatment

 The therapeutic measures must be aimed at

34
 o Termination of painful stimuli and improvement of the nervous system function
for avoiding shock;
o Reduction of autointoxication;
o Prevention of infection;
o Promotion of rejection of coagulated Skin and tissues;
o Creation of favourable conditions for regeneration of skin
 Anti-shock measures are to be provided to prevent shock that may arise as burn
complication.
 Burn may lead to renal failure and fatty infiltration of liver thus appropriate care
should be extended to combat the complication.
 Local treatment of burns should include:
o Application of ice (3-17ºc) pack wrapped in a soft towel and cold water for 30
minutes or covers it with wet towels. This also helps to remove caustic substances
(acid or alkali) if these are the cause.
o Hair should be removed and gently clean from the site. Necrotic tissue should be
debrided. The area should be swabbed with weak vinegar (half water, half
vinegar) using cotton wool or cloth.
o Topical antibacterial ointments may be applied to prevent the animal from post
burn sepsis. Several topical commercial products like Aloevera cream, Silver
sulphadiazine cream (Indo-Pharma), Silver nitrate 0.5% Solution, chlorhexidine
0.5% Solution, gentamycin sulphate 0.1% cream, povidone iodine cream can be
used. Soothing and protective preparations like Badional gel (Bayer), Caladryl
cream (Park Davis), Burnol (Knoll) may be used as burn dressing.
o Drugs like gentian violet, picric acid, acriflavin and tannic acid should not be
used as far as possible as they delay the healing process by damaging the living
cells.
o Analgesic should be given to reduce pain.
o Hypovolemic shock and acidosis are to be prevented by supplementation of large
quantities of fluid (Dextrose 5%) including 4% sodium bicarbonate.
o The treatment in chemical burns should include washing with lots of plain water
and neutralization of the offending chemicals. Acids can be neutralized with 2-
3% solution of sodium carbonate or milk, while alkali with 2% vinegar, citric or
boric acid. Finally soothing ointment like olive oil may be applied. If shock
occurs, keep the animal warm with heating pads or hot water bottles and a blanket
of heavy coat. A burn patient (pet) should be provided with ample warm fluids to
drink and this may be given in the form of milk or glucose water.

FROST BITE

 Frost bite is injury of tissues due to the action of a low temperature on them.
 The condition is rare in animals because they can withstand cold temperature due to
their hairy coats and will instinctively seek shelter from inclement weather.
 Udder and teats are commonly frozen in cows during exercise on frosty winter days.
Besides the prepuce, penis and scrotum in horses, snout of pig, comb and wattles of
birds, tip of the ear and scrotum of dogs, tail and distal extremities in other animals
are commonly affected.
 It usually occurs in a low temperature but it can also ensue in prolonged action of wet
moderate above zero temperature (3-7ºc) since heat conductance of the skin is
increased and heat emission is intensified by it.

35
Causes
 Exposure to cold or chilling environment.
 Contact with cold metal, glass, and liquids.
 Iatrogenic freezing with cryogens like liquid nitrogen and nitrous oxide etc.

Classification and Pathophysiology

 Various degrees of frost bite recognized are:
o Mild: contraction of blood vessels (parts appear white) —> paralytic dilatation of
blood vessels —> engorgement of vessels —> parts appear red and swollen —>
thawing —> severe pain
o Moderately severe: Below 0oC temperature for longer period than mild —>
injury of Blood vessels —> inflammation of the tissues —> redness of epidermis
together with certain amount of necrosis and blister formation —> desquamation
o Severe: Temperature falls for lower than freezing point —> impaired circulation
of blood and lymph —> parts undergoes necrosis and gangrene may ensure

Clinical signs
 Loss of sensation in the affected part.
 Cyanotic or pale appearance of frozen part.
 Moderate oedemas, pain and very cold to touch.
 Shivering.
 In neglected cases, necrosis and sloughing of skin.

Treatment
 Withdrawal from cold

 Warming of frost bitten extremities, and restoration of blood and lymph circulation:
Frozen animals must be immediately put in a warm housing to restore body core
temperature. Hot water bag or hot pad may be used for warming; frozen parts
should be bathed in increasingly warm water until pink colour is restored.

36
 LESSON 8

WOUND

Wound is a break in the continuity of soft tissue caused by physical, chemical or biological
insult. Disruption in the continuity of soft tissue is called as wound.
Wound Classification- I: According to the openness of the wound

Wound
Classification-I

Closed Wound Open Wound

Bruise Abrasion
Hematoma Avulsion
Contusion Bite Wound
Lacerated Wound
Punctured Wound
Penetrating Wound
Gunshot Wound
Incised Wound

Classification- II: According to the cleanliness of the wound. This classification is the most
widely accepted system today.

1. Clean Wounds: are surgically created under aseptic precautions.

2. Clean contaminated wounds: have minimal contamination which can be effectively
removed.
3. Contaminated wounds: have gross contamination with foreign derbies. e.g. Dog bite
wound.
4. Dirty and Infected wounds: are characterized by an existing infectious process.

I. CLOSED WOUNDS (Internal or Interstitial Wound)

It is a wound in which there is no break in the continuity of the skin, but, the underlying
tissues are damaged to a varying degree.

1. Bruise: It is a mild degree of contusion characterized by rupture of capillaries in the skin

giving rise to reddish blue coloration of the skin (ecchymosis).
2. Contusion is produced by the blunt objects. There is damage to subcutaneous tissues,
without breaking the continuity of the skin surface.

Depending upon the extent of injury; it can be further subdivided into three categories.
(a) First-degree contusion: there is rupture of capillary vessels of the skin and subcutaneous
tissue.
(b) Second degree contusion; there is rupture of larger vessels leading to hematoma.

37
(c) Third degree contusion: the tissues are considerably damage and gangrene may set in.

3. Haematoma is the collection of blood in an abnormal cavity. It is frequently seen

subcutaneously or submucously.

Examples
Cow - mammary vein hematoma- butting by calf
- Vaginal mucous membrane hematoma- coital
Bull - penile haematoma- coital
Horse - spur vein haematoma – rider (external thoracic vein)
Dog - haematoma ear- self mutilation; vaginal mucous membrane hematoma –post
coital

II. OPEN WOUNDS (EXTERNAL WOUND)

It is a wound in which there is discontinuity in the skin or other covering tissues to a

varying depth. They are further sub-divided into different categories as per their etiology.

1. Abrasion: In abrasion there is damage to the skin, consisting of loss of the epidermis
and portions of the dermis.
2. Avulsion: It is a wound characterized by tearing of the tissue from its attachments.
3. Incised wound: It is wound created by sharp objects. The edges of the wound are
smooth, with minimal tissue trauma to the surrounding tissues.
4. Lacerated wound: It is an irregular wound created by tearing up tissues, causing
variable damage to both superficial and underlying tissues.
5. Punctured Wound: It is caused by sharp pointed objects like nails. They have
relatively small opening, but, damage to deeper structures may be substantial.
Contamination and subsequent infection is a common problem.
6. Penetrating Wound: These are deep wounds communicating with cavities like
abdomen, thorax, trachea, joints etc.
7. Gunshot wound: Such wounds are caused by firearms. The point of entry is marked by
a small opening on the skin, but, the exit will have a larger wound depending upon the
velocity of the firearm.
8. Bite wounds: These wounds result from snake, dog or wild animal’s bite. There is
significant degree of tissue damage.
9. Virulent wounds are caused by bacteria or virus leading to formation of pustules or
vesicles e.g.: FMD, anthrax.
10. Granulating wound is one in which there is a tendency to heal within expected time.
11. Aseptic wound is surgical wound made under aseptic conditions where chances of
bacterial contamination are negligible.
12. Contaminated wound is one where there is presence of microorganisms.
13. Infected/ septic wound: A contaminated wound may become infected after a period of
6 to8 hours where bacterial multiplication may occur and liberation of their toxin.

Symptoms of wound
 Localized pain and bleeding.
 Gaping of the lips of wound.
 Weakness, paralysis or a loss of function in a dependent portion.
 Febrile disturbances in severe septic wound.
 Neuritis extending along the course of the nerve involved in the wound.

38
Phases of wound healing
 Wound healing involves a complex series of interactions between different cell types,
cytokine mediators, and the extracellular matrix.
 The phases of normal wound healing include haemostasis, inflammation,
proliferation, and remodelling.
 Each phase of wound healing is distinct, although the wound healing process is
continuous, with each phase overlapping the next.
 Before the advent of modern veterinary practice, many soft tissue injuries healed with
time.
 The difference that the modern veterinary practice has made is that the more severe
injuries that would have killed the animal are now manageable; the deformity and
infection that often accompanies natural unaided tissue healing can be avoided or
minimized.

The four phases of wound healing are

 Haemostasis
 Inflammatory phase
 Proliferative phase
 Wound remodelling

Haemostasis
 Tissue injury initiates a response that first clears the wound of devitalized tissue and
foreign material, setting the stage for subsequent tissue healing and regeneration.
 The initial vascular response involves a brief and transient period of vasoconstriction
and haemostasis.
 5-10 minutes of intense vasoconstriction is followed by active vasodilatation
accompanied by an increase in capillary permeability.
 Platelets aggregated within a fibrin clot secrete a variety of growth factors and
cytokines that set the stage for an orderly series of events leading to tissue repair.

Inflammatory phase
 The second phase of wound healing i.e. the inflammatory phase lasts for 1-3 days in
uninfected wounds.

Classic signs include the following:

 Redness (rubor)
 Swelling (tumor)
 Pain ( dolor)
 Heat (calor)
 Loss of function (function laesa)

Process

 The inflammatory response increases vascular permeability, resulting in migration of

neutrophils and monocytes into the surrounding tissue. The neutrophils engulf debris
and microorganisms, providing the first line of defense against infection. Neutrophil
migration ceases after the first few days post-injury if the wound is not contaminated.
If this acute inflammatory phase persists, due to wound hypoxia, infection, nutritional

39
 deficiencies, medication use, or other factors related to the patient’s immune response,
it can interfere with the late inflammatory phase.
 In the late inflammatory phase, monocytes are converted in the tissue to macrophages,
which digest and kill bacterial pathogens, scavenge tissue debris and destroy
remaining neutrophils. Macrophages begin the transition from wound inflammation to
wound repair by secreting a variety of chemotactic and growth factors that stimulate
cell migration, proliferation, and formation of the tissue matrix.

Proliferative phase
The subsequent proliferative phase is dominated by the formation of granulation tissue and
epithelialization.

 Its duration is dependent on the size of the wound.

 Chemotactic and growth factors released from platelets and macrophages stimulate
the migration and activation of wound fibroblasts that produce a variety of substances
essential to wound repair, including glycosaminoglycans (mainly hyaluronic acid,
chondroitin-4-sulfate, dermatan sulfate, and heparan sulfate) and collagen.
 These form an amorphous, gel-like connective tissue matrix necessary for cell
migration.
 New capillary growth must accompany the advancing fibroblasts into the wound to
provide metabolic needs.
 Collagen synthesis and cross-linkage is responsible for vascular integrity and strength
of new capillary beds.
 Improper cross-linkage of collagen fibers has been responsible for nonspecific post-
operative bleeding in patients with normal coagulation parameters.
 Early in the proliferation phase fibroblast activity is limited to cellular replication and
migration.
 Around the third day after wounding the growing mass of fibroblast cells begin to
synthesize and secrete measurable amounts of collagen.
 Collagen levels rise continually for approximately three weeks.
 The amount of collagen secreted during this period determines the tensile strength of
the wound.

Remodelling phase
 The final phase of wound healing i.e. remodelling develops 3 weeks following injury
and continues up to two years, achieving 40-70 percent of the strength of undamaged
tissue at four weeks.
 This phase is characterized by reorganization of new collagen fibers, forming a more
organized lattice structure that progressively continues to increase wound tensile
strength.
 The strength of scar tissue formed in this phase is less than the surrounding normal
tissue.

Old type of Wound Healing process

(1) First Intention wound healing (Primary union)

 Healing completed in about 5 to 14 days.
 Scar formed is very little.
 Sufficient tensile strength in14 days.
 Surgical wound heal by this type.

40
(2) Second Intention Healing (Healing by granulation)
 Healing by replacement of tissue.
 Extensive loss of tissue.
 Wound edges are widely separated.
 Granulation tissue consisting of budding capillaries and fibroblasts fills the gap. It is
highly vascular, velvety, soft, moist and pink in colour.
 Healing takes 14 to 20 days.
(3)Third Intention Healing (Healing by Secondary suture)
 Granulation tissue of an extensive wound united by sutures at a later date.
 Granulation tissue does not have any nerve supply.
 Granulation tissue is resistant to infection.
Complications of wound
 Wound dehiscence is the splitting and separation of previously closed wound layers.
Evisceration is protrusion of viscera through the wound. Eventration is protrusion of
the bowels from the abdomen. The main causes responsible for these conditions
include improper surgical technique and the local and systemic factors described
below. Dehiscence usually occurs 3-5 days after surgery before collagen deposition.
The characteristics features include incisional swelling, discolouration, necrosis and
unusual exudation.
 Haemorrhage due to rupture of blood vessels can lead to development of
haemorrhagic shock and ultimately death.
 Traumatic neuralgia is the pain perceived at or around the vicinity of wound.
Primary traumatic neuralgia persist for prolong period whereas secondary one appear
during cicatrisation.
 Septicaemia and pyaemia are the common complications of wound healing cause by
the bacterial toxins due to massive infection and may lead to endotoxic shock.
 Traumatic fever is the resultant of pyrogen release from neutrophils and injured
body tissue.
 Haematoma(accumulation of blood in the subcutis) or seroma (accumulation of
serum in the dead space) may occur due to rupture of blood vessels following injury.
 Sinus(draining tract from a suppurative cavity to the surface) may develop due to
presence of necrotic tissue debris and foreign bodies.
 Fistula (abnormal passage between two internal organs) may develop due to paucity
of drainage from a purulent cavity.
 Cellulitis is inflammation of the connective tissues presenting as oedema, redness,
pain and heat often with hardness.
 Exuberant granulation tissue (proud flesh) is granulation tissue which grows above
the level of the surrounding skin (overgranulation), preventing epithelial cells from
growing across the wound.
 Tetanus may develop due to Clostridium tetani infection particularly in deep
penetrating and punctured wound. Caprine, equine and camelidae are more
susceptible to tetanus.
 Adhesions are the major post-operative complication following abdominal surgery
due to rough handling of viscera.
 Traumatic emphysema arises due to punctured wounds of the respiratory or
gastrointestinal tract where gas or air accumulate in and around the wound area.
 Venous thrombosis and embolism may occur when fat tissue accidentally entered in
the circulation.
 Gas gangrene may develop.

41
Factors affecting wound healing

i) Local factors
 Good surgical technique is warranted for proper wound healing if Halsted’s principles
are followed. The principles include:
o Gentle handling of tissue.
o Aseptic surgical technique
o Perfect haemostasis and preservation of blood supply to the wound area.
o Close tissue approximation and obliteration of dead space
o Removal of necrotic and devitalized tissue.
 Tissue vascularity ensures oxygenation and nutrients which is essential for wound
healing. Oxygen influences angiogenesis, epithelialization and resistance to
infection.
 Infection is one of the major factors which retard the wound healing significantly as it
prolongs the inflammatory phase, disrupts the normal clotting mechanisms,
promotes disordered leukocyte function and ultimately prevents the development of
new blood vessels and formation of granulation tissue.
 Topical medications promote wound healing by minimizing bacterial infection.
However, certain antimicrobial agents and local anaesthetics delay the healing
process by destroying cellular elements of wound.
 Lavage and dressings accelerate wound healing by protecting healing tissue. Lavage
with sterile isotonic solutions like normal saline decreases the concentration of the
microorganisms mechanically and aids in healing process. Nonadherent, moist
dressing triggers epithelisation whereas adherent gauge dressing mechanically
debride the contaminated wound.
 Presence of foreign bodies such as tissue debris, dirt, soil, sequestrum, or
nonabsorbable braided suture materials delay the healing process by exacerbating
the inflammatory response and inciting infection.
 Obliteration of dead spaceand prevention of fluid accumulation promote migration
of reparative cells and minimizing the risk of infection during wound healing.
 Ionizing radiation retards wound healing by decreasing fibroblast formation,
collagen synthesis and neovascularisation within fortnight of surgery.
 Movement of the wound site prolongs the healing process as movement can disrupt
cell migration, neovascularisation and formation of early ground substances of the
wound.
 Mutilationof the wound not only disturbs the healing but also complicate by creating
evisceration like condition.

ii) Systemic factors

 Advanced age retards healing because of reduced skin elasticity and collagen
replacement. The immune system also declines with age making patients more
susceptible to infection. Older animals are also susceptible to other chronic diseases,
which affect their circulation and oxygenation to the wound bed as compared to
young.
 Nutrition plays a pivotal role in wound healing process.
 Protein is required for all the phases of wound healing, particularly important for
collagen synthesis. Hypoproteinaemia slows healing by decreasing wound tensile
strength, delaying fibroplasia and producing oedema.

42
 Glucosebalance is essential for wound healing. Hyperglycaemia delay wound
healing.
 Ironis required to transport oxygen.
 Minerals like zinc, copper are important for enzyme systems and immune systems.
Zinc deficiency contributes to delay epithelisation and disruption in granulation
tissue formation by inhibiting fibroblastic cellular proliferation.
 Vitamins A and B complex are responsible for supporting epithelialization and
collagen formation. It is also important for the inflammatory phase of wound
healing.
 Vitamin C is essential for formation of intercellular cementing substances as it is
needed for hydroxylation of the lysine and proline moieties of collagen.
 Carbohydrates and fats: These provide the energy required for cell function. When
the patient does not have enough, the body breaks down protein to meet the energy
needs. Fatty acids are essential for wound healing.
iii) Medications
Anti-inflammatory, cytotoxic, immunosuppressive and anticoagulant drugs all reduce
healing rates.
Anti-inflammatory drugs like corticosteroids if used in long term and at higher doses
impair the inflammatory phase, decrease fibroplasia, collagen synthesis and
neovascularisation.
Chemotherapeutic agents like methotrexate, doxorubicin and cyclophosphamide
delay the wound healing process by inhibiting cell division or collagen synthesis. In
addition, healing process is adversely affected by depressing immune function,
epithelialization and contraction.
Anticoagulant drugs retard the healing by interrupting clotting mechanism and thus
making a wound more prone to infection due to presence of blood clots.
Most NSAIDslower resistance to infection and ultimately delay healing.
iv) Systemic diseases
Systemic diseases like malignancy, uncontrolled diabetes, renal and hepatic
disturbances delay healing process.
 A malignancy in the body retards wound healing by altering metabolism,
producingcachexia and minimizing inflammatory cell division.
 Uraemia delays fibroblastic proliferation, granulation tissue formation, epithelial
proliferation and subsequently strength of healing wound.
 In patients with uncontrolled diabetes, there is delayed healing as hyperglycaemia
impairs collagen formation, neovascularisation, granulocytes cell functions and
ultimately leading to wound dehiscence.

WOUND INFECTION
Signs of wound infection
 Local pain/tenderness
 Local swelling/oedema
 Increased exudate
 Frank pus
 Wound breakdown
 Pyrexia
 Delayed healing
 Change in appearance of granulation tissue
 Bridging of epithelial tissue
 Abnormal smell

43
WOUND TREATMENT

Topical antimicrobials and Antibiotics

Antimicrobial agents and antibiotics eliminate or reduce the number of
microorganisms in a wound that destroy tissue. Topical rather than systemic antibiotics are
preferred for open wounds. Combined topical and systemic antibiotic therapy is advantageous
in heavily contaminated wounds but not in mildly or moderately contaminated wounds.
Antibiotics applied within 1-3 hrs of contamination often prevent infection. Benefits of
topical drugs should outweigh their cytotoxic effects. Antibiotics used effectively as topical
ointments or added to lavage solutions are penicillin, ampicillin, tetracycline, kanamycin,
neomycin, bacitracin, polymyxin, and cephalosporins.

Once infection is established, topical and systemic antibiotics have no beneficial

effect in preventing suppuration of wounds undergoing closure. Wound coagulum prevents
topical antibiotics from reaching effective levels in tissues deep in the wound and also
prevents systemic antibiotics from reaching superficial bacteria. These wounds must be
debrided to allow antimicrobial access to bacteria.

Topical steroids may inhibit epithelialization, wound contraction, and angiogenesis.

Production of exuberant granulation tissue may be reduced by the one or two application of
corticosteroids. Topical anaesthetics may be used to reduce traumatic and postoperative pain.

In wound management topical antibiotics have got both advantage and disadvantage
compared to antiseptics

Advantages: Selective bacterial toxicity, efficacy in the presence of organic material, and
combined efficacy with systemic antibiotics.

Disadvantages: expense, narrower antimicrobial spectrum, potential for bacterial resistance,

creation of “super infections”, systemic or local toxicity, hypersensitivity, and increased
nosocomial infections.

Drugs used:

1. Triple antibiotic ointment: Triple antibiotic ointment consists of bacitracin, neomycin,

and polymyxin and is effective against a broad spectrum of pathogenic bacteria commonly
infecting superficial skin wounds. It is more effective for preventing infection than for
treating them.

2. Silver sulfadiazine: It is a 1% water miscible cream and is effective against most gram-
positive and gram-negative bacteria most fungi. It also serves as an antimicrobial barrier, can
penetrate necrotic tissue, and enhances wound epithelialization. It is the drug of choice to
treat burn wounds. Wound retardant effects have been reported in vitro studies in human.
These effects are reversed when it is combined with aloevera.

3. Nitrofurazone: Nitrofurazone (Furacin) has broad spectrum antibacterial and hydrophilic

properties, the later enabling it to draw body fluid from wound tissue, which helps dilute

44
tenacious exudates so they can be absorbed into bandages. It delays wound epithelialization
and loses some of its antimicrobial effects in the presence of organic matter.

4. Gentamicin sulfate: It is available as a 1% ointment or powder (Garamycin), but solutions

are preferred. It is especially effective in controlling gram-negative bacterial growth
(Pseudomonas spp., Escherichia coli, Proteus organisms). It is often used for wounds that do
not responded to triple antibiotic ointment.

5. Cefazolin: Cefazolin is effective against gram-positive and some gram-negative

organisms. Topically administered cefazolin is 95% bioavilable and rapidly absorbed;
therefore systemic levels equal wound fluid levels within 1 hour.

6. Mafenide: Mafenide (hydrochloride or acetate) is a topical sulfa compound available as an

aqueous spray. It has a spectrum against gram-negative bacteria, including Pseudomonas and
Clostridium, and is particularly useful on severely contaminated wounds.

Other Topical Agents

1. Aloe vera: Aloe vera gel is extracted from the aloe leaf and contains 75 potentially active
constituents. It has antimicrobial and antifungal activity. It is used on burns because of its
antimicrobial effect on Pseudomonasaeruginosa. The antiprostaglandin and antithromboxane
properties of aloevera medications are beneficial in maintaining vascular patency and thus
avert dermal ischemia. It has so many other activities on wound like stimulation of
fibroblastic replication, penetration and anesthetizing tissue, promoting wound healing,
stimulating tissue repair in suppurating wounds and resistant ulcers by promoting epithelial
growth. Aloe vera counteracts the inhibitory effects of silver sulfadiazine when the two are
combined.

2. Tripeptide-copper complex: Tripeptide-copper complex stimulates wound healing and is

a chemoattractant for mast cells, monocytes, and macrophages, which stimulate debridement,
angiogenesis, collagen synthesis, and epithelialization. The best time to begin tripeptide-
copper complex application is the late inflammatory and early repair phases, with treatment
continuing into later repair phase. Its greatest effect is in the first 7 days of its use. Exuberant
granulation tissue may be a problem with this agent.

3. Honey and sugar: Honey is an old agent that has seen renewed interest. Its benefits
include enhancing wound debridement, reducing edema and inflammation, promoting
granulation tissue formation and epithelialization, and improving wound nutrition. It has an
antimicrobial and a deodorizing effect. Like honey, sugar has similar hypertonic effects.
Sugar is applied in a 1cm thick layer, and the wound is bandaged after debridement and
lavage. Honey is applied by impregnating sterile gauze, which is then positioned on the
wound and covered with a thick, absorbent bandage. They are indicated in the inflammatory
and early repair phases of healing.

45
WOUND CLEANSING SOLUTIONS

Wound cleansing solution should have ideal antiseptic properties with minimal cytotoxicity.
They are used primarily in the initial phases of wound management to decrease bacterial load
and rid wounds of necrotic tissue and debris. Once the wound is clean, balanced electrolyte or
physiologic saline solutions are ideal for cleansing it. Tap water is not an ideal wound
cleanser, but is acceptable to initially remove dirt and debris when there is severe
contamination. Its hypotonicity causes cell swelling, which can cause significant cell
destruction and delay wound healing with prolonged use. Antiseptic solutions are
contraindicated in clean wounds because all antiseptics have some cytotoxic effects and may
do more harm than good.

1. Chlorhexidine Diacetate: The preferred wound lavage and wetting solution is 0.05%
chlorhexidine diacetate because of its wide spectrum of antimicrobial activity and sustained
residual activity. It has antibacterial activity in the presence of blood and other organic debris,
has minimal systemic absorption and toxicity, and promotes rapid healing. Residual activity
may last as long as 2 day, and effectiveness increases with repeat application. Potential
drawbacks of chlorhexidine include resistance to Proteus, Pseudomonas, and Candida, and
corneal toxicity.

2. Povidone-Iodine: A 1% or 0.1% povidone-iodine is used frequently for wound lavage

because of its wide spectrum of antimicrobial activity. Iodine compounds are active against
vegetative and sporulated bacteria, fungi, viruses, protozoa, and yeasts. A 0.1% solution is
recommended. This concentration kills bacteria within 15 seconds, and there is no known
bacterial resistance. Residual activity lasts only 4 to 8 hours and organic matter inactivates
the free iodine in povidone-iodine. It is absorbed to the system through the skin and mucus
thus excess systemic concentration causes transient thyroid dysfunction. Its low pH can cause
or intensify metabolic acidosis when it is absorbed. Scrubbing wounds with povidone-iodine
detergents damages tissues and potentiate infection.

Other Solutions: Acetic acid at 0.25% or 0.5% occasionally is used as lavage solution. Its
antibacterial effect is achieved by lowering wound pH. It is more cytotoxic to fibroblasts than
to bacteria. Hydrogen peroxide and Dakin’s solution should not be used as wound lavage
solutions.

1. Hydrogen peroxide, even in low concentrations, damages tissue and is poor antiseptic. It
is an effective sporicide.

2. Dakin’s solution is a 5% solution of sodium hypochlorite (1:10 dilution of laundry

bleach). It is detrimental to neutrophils, fibroblasts, and endothelial cells and therefore should
not be used as a wound lavage solution.

3. Sterile normal saline 0.9% - used for irrigation

4. Hyper tonic saline 2.5% - Cleaning and antibacterial activity

5. Biological dressings - Skin grafts, cartilage powder and amnioticfluid.

46
TYPES OF WOUND MANAGEMENT

Wound healing is a natural and inherent biological process. The healing of a wound has got
a high priority among various body functions. It is the major concern of a surgeon because it
plays a very useful role in the life and survival of the animal. The aim of the surgeon is to
accelerate the healing process and avoid the factors that delay it. He tries to accomplish this,
with minimum scar formation and minimum deformity of the part without any complications.
Basic Principles of wound Treatment

1. Maintenance of aseptic conditions

2. Careful debridement
3. Proper irrigation of wound
4. Gentle handling of tissues
5. Layer by layer closure avoiding tissue tension.
6. Careful haemostasis.
7. Avoiding the use of irritant materials.
8. Application of protective bandage.
9. Proper drainage

Golden Period of a wound is the first 6 to 8 hours between wound contamination at injury
and bacterial multiplication. A wound is classified as infected rather than contaminated when
bacterial numbers exceed 105 organisms per gram of tissue. Cardinal sign of wound infection
is the presence of discoloured foul smelling exudates.

Wound Therapy
I. Surgical or aseptic wound treatment.
II. Contaminated and septic wound treatment.
III. Accidental or traumatic wound treatment
IV. Treating as open wound:
V. Maggot Wound
VI. Exuberant granulations

I. Surgical or Aseptic wound treatment: (Clean and clean contaminated wound)

A surgical wound made with all aseptic precautions; in a non-infected tissue is an aseptic
wound. No open wound is absolutely aseptic as slight infection may exist, however, it will
have very little inhibitory effect on wound repair. Wounds less than 6 to 8 hours with minimal
trauma and contamination are treated by lavage, debridement and primary closure. Anesthesia
is often required for initial wound inspection and care. The objective of open wound care is to
convert the clean contaminated wound into a surgically clean wound that can be given a
primary closure.

 Prophylaxis against tetanus should be considered, especially in equines, camels, sheep

and goat.
 While doing surgery, the surgeon should observe all Tenets of Halstead, to lower the
wound infection.
 Drainage should be provided, if haematoma or seroma formation is expected.
 Systemic use of specific antibiotic is more beneficial.
 In hot summer months local application of fly repellants is useful to avoid maggot
infestation.
 The patient must be kept at rest at least till the removal of sutures.

47
II. Contaminated and septic wound therapy: (Contaminated, Dirty and Infected wounds).
The contaminated or infected wound should be cultured. Wound is classified as infected,
when the time lapse is more than 8 hours and the bacterial numbers exceed 10 5 organisms, per
gram of tissue. Infected wounds are often dirty and covered with thick, viscous exudates.
Wound infection is the most important cause of morbidity and mortality in injured animals.
After initial inspection, the wound should be cultured.
The area surrounding the wound should be clipped and prepared. The wound may be
protected from clipped hairs and detergents by applying saline soaked sponges.
Alternatively, the wound may be temporarily closed with sutures, towel clamps or staples.
Povidone iodine or chlorhexidine scrubs can be used to prepare the skin and cleaned with tap
water. Alcohol kills and fixes the exposed tissues on contact and should be used only on intact
skin.
Wound debridement, wound lavage and fixing of surgical drains are other special techniques.

III. Accidental traumatic wounds

 The haemorrhage should be checked, and the shock is treated by fluids.
 Clean the contamination and dress the wound.
 Prophylaxis against tetanus must be done.
 Follow-up is done on similar line of the open wound management.

IV. Treating as open wound: In case wound edges cannot be brought into apposition by
sutures, open wound healing by granulation tissue formation, should be allowed. With
medications both topical and parental the wound should be protected by bandage. If defect is
considerable, skin grafts may be considered.

V. Maggot wound: In case of maggot infestation, the wound is cleaned and initially irrigated
with a combination of chloroform and turpentine oil for easy removal of maggots.

VI. Exuberant granulations (proud flesh) can be surgically excised up to the level of
epidermis and dressed for healing.

SPECIAL WOUND THERAPY

I. Wound lavage: Copious Lavage and thorough debridement are most essential to manage
contaminated or infected wounds. Initial wound management begins with copious lavage
using warm, sterile saline or balanced electrolyte solution is preferred lavage solutions.
Wound lavage reduces bacterial numbers mechanically, by loosening and flushing away
bacteria and associated necrotic debris. Antibiotics or antiseptics like povidone iodine or
chlorhexidine, added to the lavage solution, reduces the bacterial numbers. Lavaging is
preferred to scrubbing the wound with sponges, since they inflict tissue damage and
subsequent infection.
Bacteria are effectively removed from the wound surface by high-pressure lavage using 50 ml
syringe and 18 gauge needle, which generates approximately 7 to 8 psi of pressure. The
irrigation by jet or bulb lavage has shown good results.
II. Wound debridement
Debridement is the process of removing devitalized tissue from a wound. The objective is to
convert the wounds to a clean status, containing tissue with adequate blood supply for normal
healing

48
1. Surgical debridement:The layered debridement begins on the surface and progress to the
deeper aspects of the wound. Extensive tissue damage may require aggressive debridement.
Complete wound excision is removal of wound, resulting in surgical margins suitable for
immediate closure.
2. Mechanical wound debridement: this accomplished by the use of bandage after surgical
debridement or gross debris (wet to dry).
3. Enzymatic wound debridement: Trypsin and chymotrpsin are used topically for this
purpose. It is used in places where important healthy structures (nerves) are present. It is
expensive.

III. Surgical drains

Surgical drains are implants placed, usually on temporary basis, to channel away-unwanted
fluid or gas from the wound or body cavity. They facilitate the healing process. They are used
to eliminate dead space. They may however increase the risk of ascending infection. Drains
can be passive or active.
1. Passive drains: they are constructed of either soft latex (Penrose drain) or more rigid
materials. They rely on gravity to evacuate and hence should be placed in a dependant
position and are fixed by penetrating sutures on the outside of the skin.

2. Active drains: the active drains remove fluid by applying negative pressure to the tube
drains. This is most efficient for removing large quantity of fluid from the wound cavity,
usually removed with 24hours.

IV. Wound excision: The entire wound can be excised en block, if there is sufficient healthy
tissue in the surrounding area. The danger of surgical debridement is removal of excessive
amounts of potentially viable tissue. After surgical debridement, wounds are often treated as
open wounds with medications and wet-dry bandages. The wound should be closed when it
appears healthy or when a bed of granulation tissue has formed.

V. Bandages

Bandage is a piece of cloth material, in the form of a pad or strip, applied to a wound or used
to bind around an injured or diseased part of the body. It has the following functions:

 Control of haemorrhages
 Provide vehicle for topical medications
 Debriding action
 Protect from secondary infections
 Decrease pain
 Immobilizing injured tissue
 Obliteration of dead space
 Decrease the oedema
 Wound cleanliness
 Control of wound environment
 Minimize scar tissue
 Provide comfort
 Absorb wound secretions

49
  Give aesthetic appearance
 Keep wounds warm
 Remove exudates and toxins
 Allow gaseous exchange

Components of bandages

 Primary layer orContact layer, directly contacts the wound or lesion.

 Secondary or Intermediate layer-Covers the primary layer, serves to absorb wound
fluids.
 Tertiary layer or Outer layer; provides additional support and pressure

The primary layer of the bandage may be adherent or non-adherent, and should remain in
contact with the wound during movement.

Treatment of Septic wound and infected wound

Basic principles of infected wound treatment strategies

 Debridement: Thorough debridement is most essential to manage septic wounds which

will provide easy access to the wound depth.
o All necrotic tissue debris and foreign materials should be removed until clean,
healthy tissue margin of the wound are achieved.
o Infected wound should not be plugged or closed unless infection is well controlled
for primary healing but should be left to heal by secondary healing.
 Lavage: after removal of the necrotic debris, the wound and its periphery should be
copiously irrigated with warm normal saline or water and soap or 2% hydrogen per
oxide.
o Volume and nature of lavage fluid depends on the degree of gross contamination
and size of the wound.
o Addition of antibiotics or antiseptics is not required when large volume of fluid is
used as improper concentrations of such drugs may have deleterious effect to the
wound healing process.
 Wound drainage can be achieved by using Penrose drains, plastic or rubber tubes or
open drainage with bandage support. The aim is to reduce fluid accumulation, dead
space, hematoma and seroma. The following guidelines should be observed:
o Dependent drainage of wound exudate should be provided if possible so that
gravity will aid drainage of the exudate.
o The incision for drainage should be placed in the most direct route possible and
away from anastomotic sites, tendon and major vessels. They may cause pressure
necrosis.
o Soft, petrolatum based antiseptic gauze should be used to keep the wound edges
apart.
o Incision to place the drain should be made within the zone of reaction; avoid
cutting into non-infected areas. The drain exit site should be prepared in an aseptic
manner and should be covered with sterile bandages to prevent premature removal
or loss of the drain and to access the nature of the exudate.
o Through and through drainage should not be used.
o Usually drain should be removed after 24-48 hrs.

50
 Antimicrobial therapy:Selection of the antimicrobial agent should be based on culture
and antibiotic sensitivity test. However, empirical antimicrobial agents should be
advocated in life–threatening infections that exists or develops while awaiting culture
and sensitivity results (48-72 hrs). In most cases, animals with existing wound infection
are treated initially with loading dose of intravenous medication. Antimicrobial therapy
should be continued for 10-14 days.
 Sterile protective bandaging is a good practice to avoid hospital infection,
colonization of the wound by opportunistic organisms and to prevent environmental
contamination with the infective agent.

51
 FOR EXTRA READING
PRE-SURGICAL CONSIDERATIONS
A surgeon must keep certain considerations related to the owner, the patient and the
surgeon himself in mind before undertaking surgery.

A. The Owner

 The owner is the custodian and provider of the animal’s needs and therefore has a legal
right over his/her animal.
 A veterinarian is legally answerable to the owner and must inform him/her the disease,
proposed surgical treatment and the possible outcome.
 The owner must be convinced that everything is being done in the interest of the patient.
 Therefore, owner-patient-surgeon relationship becomes very important in veterinary
profession to maintain a good rapport.
 A surgeon must also consider economic aspects of the case, surgical risk involved, ethics
and sentiments of the owner.
 After weighing each aspect carefully, the surgeon should make a decision and
communicate the same to the owner in a confident and convincing tone.
 Being unable to communicate and reason, the animal patient submits itself to the surgeon.
Therefore, it is the duty of the surgeon to make sure that his patient gets maximum
possible attention.
 The veterinarian must remember that both animal and human communities expect
him/her to be compassionate and considerate; therefore, he/she should live up to their
expectations.
 He should inform the surgical risk involved. Surgical risk is a subtle line between the
good and bad outcome of surgery.
 In case of poor risk, chances of complications or death are more, while in good surgical
risk, the chances are less. Surgical risk can be minimized and cannot be entirely
eliminated.
 Unforeseen incidences can lead to untoward results. Therefore, while communicating
with the owner, overzealousness must be avoided. A word of caution should always be
passed on to the owner and a surgical risk note should be obtained well before hand.
 Nevertheless, a surgeon should not have a pessimistic attitude to unnecessarily put doubts
in the mind of the owner.

B. The Patient

Identification: It is imperative to properly record the;

o Identification of the patient with name of the owner
o Surgery to be performed
o Exact part to be operated.
o Operating wrong patient or performing surgery on a wrong leg in the open yard
system will lead to lot of confusion.

History of the patient:

Since the animal cannot describe the ailment, the information provided by the owner
may prove more beneficial. We should gather full information on the history of the animal.
This may help us to screen out whether the animal is fit or not for the operation to be

52
performed e.g. In the last half of pregnancy surgery is contraindicated, in heat period
particularly in small animals, surgery is also contraindicated.

 Information provided by the owner may prove highly beneficial since an animal
cannot describe the ailment.
 A surgeon should have experience and analytical power to extract valuable
information as an owner may provide misleading history.
 A simple language without technical terms should be used while extracting
information.
 An approach of through questioning with tact and generation without irritating the
owner may provide better results.
 Clinical signs recorded by owner, probable duration of the disease, status of
pregnancy , date of last parturition and status of milk yield should be recorded.
 Information should also be gained regarding the treatment previously received by the
animal
 The conflicting points of history should be sorted out logically to gather reliable
information.
 Even though history provided by the owner may be useful it is not a substitute for
careful clinical examination.
 If history and clinical examination are at variance, it is better to depend upon the
examination.

Body condition of the patient: The patient must be carefully examined to ascertain whether
it is a fit subject for operation, whether it is debilitated or affected with some condition which
renders the operation risk greater than usual

Parameters - Temperature, Pulse rate and respiratory rate are recorded. If the animal is
febrile, we should postpone the surgical manipulation.

Laboratory examination: Special attention should be given for zoonotic diseases. Some
diseases may remain in sub clinical forms. E.g. Chronic anthrax, Leptospirosis and
Brucellosis. In the case of neoplastic diseases, before diagnosing whether the neoplasia is
malignant or benign surgical manipulation should not be performed.

Economics of the surgical situation should also be considered. If the cost of the surgical
manipulation exceeds the cost of the animal, surgery may not be performed.

Pre-operative preparations: Starvation of the animal for 24 hours for major surgeries and
12 hours for minor surgeries. Water should be withheld for 12 hours in ruminants.

PREPARATION OF PATIENT

 Make the patient an indoor one to accustom with the environment of ward In
ruminants rest for couple of hours lowers the stress (Travel of animal long
distances on feet) Emergency case should be attempted immediately General
physical examinations should be carried to assess prognosis.

53
  Severe dehydration and debilitation with prominent ribs indicate poor prognosis if
general anaesthesia or major surgery is indicated.
 Rough and hard coat.
 Sunken eyes
 Prolonged lateral recumbency
o Colour of the mucous membrane and capillary refill time are the
o useful aids in dealing seriously ill patients
 Rectal temperature, pulse and respirations should be recorded
 Palpation, percussion and auscultation help to arrive diagnosis
 In a febrile state surgery should be postponed
 Paracentesis of swelling and cavities for differential diagnosis
 Laboratory procedures – Pathological tests and their correction for treatment
 Radiography
 Fluid therapy particularly in case of dehydrated and worm infested animals.
 With holding of feed and water
 Large animals: 24 - 48 Hrs ; 12 - 24 hrs
 Small animals : 12 Hrs ; 4 - 6 hrs
 Administration of laxative, purgative or enema for 2-3 days before operation to
evacuate the bowels and fit for general anaesthesia (not recommended in
Ruminants)

C. The Surgeon
 A surgeon must develop his surgical skills and learn from each and every surgical
procedure which forms a basis for sound judgment. Judgment means rational analysis
for a good decision, whether to operate or not and when to operate, form a part of a
surgical judgment.
 A surgeon who recognizes his short comings, learns from failures of his own and of
others, develops a better judgment
 A surgeon has to be bold. He must have the eyes of an eagle, fingers of ladies and the
heart of a lion.
 He must know the difference between a planned and emergency surgery.
Location
 It is always preferable to do surgery in an operation theatre, where professional and
manual help is adequately available.
 Open field surgery is a common practice in most developing countries.
Planning
 A surgeon must be familiar with the surgical anatomy of the part and the surgical
procedure. In case of doubt, referring the book will give guidance and confidence.
 He must ensure that all equipments, drugs and other items have been arranged
properly.
 A better approach is to mentally visualize the operation to be done and to make a
check list of all items required.
Records
 A surgeon must keep records of each and every aspects of a case, which will be useful
for the future planning and expansion of the clinic.
 The case sheets should be such that there can be stored for future reference and use.
 Description of the patient identification marks, owners name and address, history of
the case clinical findings type of surgical and postoperative treatment and the
outcome should be recorded.

54
  Records can be analyzed to work out incidence of various diseases in an area and also
to judge the efficiency of the treatment measures adopted.
 Records will help to identity the technical areas of difficulty.

POST OPERATIVE CARE AND MANAGEMENT

Shifting of patient in the ward

 Immediately after major operation, the patient should be gently removed from
operation table.
 Unconscious patient should be placed in the bed of surgical ward with slightly
lowered down the head except in brain surgery operation cases.
 It prevents cerebral ischemia, vomition and helps to remove tracheobronchial
secretion.

Post-operative medication

 According to severity of pain, analgesic drugs should be given to control pain which
may originate from the operation site.
 Restlessness can be controlled by the application of sedative or tranquilizer.
 Routine broad or narrow spectrum antibiotic should be given.
 Antiemetics may be given to prevent vomition.
 Supportive therapy with fluid and vitamins should be resorted too.
o Oral intake of food and fluid is restricted for 12-24 hours after major
operation.
o Liquid diet should be given at second day.
o Semisolid food should be given from forth day.
o Solid food should be given after 8th day of operation.
o Food must be free from fat and some vitamins, enzymes should be added.

Post-operative diet

 Oral intake of food and fluid is restricted for 12-24 hours after major operation.
 Liquid diet should be given at second day.
 Semisolid food should be given from forth day.
 Solid food should be given after 8th day of operation.
 Food must be free from fat and some vitamins, enzymes should be added.

Post-operative exercise

 Exercise means walking which should be accomplished for 2-3 hours per day.
 The time and distance of walking depend upon the severity of patient.

Post-operative dressing

 Dressing should be done on 3rd, 5th and 7th post-operative days to visualize the
condition of operative site.
 The area should be washed with antiseptic lotion and rebandaged for proper healing.

Release from the ward

55
  Skin sutures should be removed between 8-10th day of post-operative days according
to the condition.
 Operative site should be treated with topical antibiotics and covered by light
bandages.

Check up

 The surgeon advised the attendants that the patients must be checked by him for a
certain days.

ANAESTHESIOLOGY
LESSON 1
INTRODUCTION TO COMMON TERMS, PREANAESTHETICS AND
PREANAESTHETIC CONSIDERATIONS

Anaesthesia:

56
 Word derived from Greek word ““anaisthesia”” meaning insensibility.

 The word was coined by OLIVER WENDELL HOMES in 1846

 Reversible lack of awareness
 Pharmacologically induced reversible state of amnesia, analgesia, loss of
responsiveness, loss of skeletal muscle reflexes and decreased stress response.

Anaesthesiology is the branch of medicine that deals with anaesthesia and anaesthetics

Anaesthetic protocol

Use of anaesthetic technique and agents to achieve general anaesthesia.

General anaesthesia: Is a state of controlled and reversible loss of consciousness

characterized by analgesia (lack of pain), amnesia (lack of memory), muscle relaxation and
immobilization (relatively depressed reflex responses).

Basal Anaesthesia:

The state of CNS depression produced by pre-anaesthetic agents that serves as a basis for
general anaesthesia.

Balanced Anaesthesia:

Surgical anaesthesia produced by combining two or more drugs

(preanaesthetics/anaesthetics) so as to reduce the dose of individual drugs and thereby their
adverse effects.

“To effect vs pre calculated dose administration”:

The anaesthetics which produce anaesthesia in one or two injection site to brain
circulation time are called as “Rapidly acting drugs”

Eg: Thiopentone, thiamylal, methohexitone etc.

Because of their quick onset of action, I/V administration of these agents can be easily
titrated to the depth of anaesthesia required and so are most suitable for induction of general
anaesthesia.

Agents like pentobarbitone, ketamine, chloral hydrate etc. have slow onset of action
even after I/V administration. Therefore such agents cannot be administered “to effect” and a
precalculated dose is required to be administered.

Dissociative anaesthesia – is that type of anaesthesia brought about by drugs like

ketamine/tiletamine, in which there is interruption of information flow from unconscious to
conscious parts of brain due to stimulation of the brain centers. It is characterized by
catalepsy, somatic analgesia and presence of all ocular reflexes. In Dissociative anaesthesia,

57
the animal appears awake (eyes remain open) but unaware of its surroundings. Dissociation
of thalamocortical and limbic systems occurs with dissociative anaesthesia.

Catalepsy:

A state in which there is malleable rigidity of limbs. The patient is unresponsive to

aural, visual or minor painful stimuli.

Chemical Restraint:

Drug induced state that produces favourable behaviour modification, sedation, and
analgesia or muscle relaxation.

Eg: tranquilizer, sedatives, non-opioid analgesics, opioid analgesics and

neuroleptanalgesics.

Tranquilization (Ataxia, neurolepsis)

A state of tranquility and calmness in which the patient is awake, relaxed and
unconcerned with its surrounding.

Sufficient stimulation will arouse the patient from tranquilizers. The tranquilizers act
by depressing the hypothalamus and reticular activating systems. Eg: phenothiazines and
butyrophenones.

Sedation:

A mild degree of central depression in which the patient awake but calm. Sufficient
stimulation will arouse the patient from sedation. Sedatives act by a dose dependent
depression of the cerebral cortex. Eg. Benzodiazepines

Neuroleptanalgesia:

A state of profound sedation and analgesia achieved by administering an opioid and a

tranquilizing agent.

E.g: Acepromazine – meperidine

Acepromazine – oxymorphone

Droperidol – fentanyl

Xylazine – oxymorphone

Diazepam – morphine

Diazepam – oxymorphone

Diazepam – fentanyl

Glucose effect:

58
 Glucose causes a decrease in activity of the components of the microsomal electron
chain resulting in decreased microsomal metabolism and hence a reanaesthetizing effect is
observed in animals recovering from barbiturate anaesthesia given glucose which is termed as
glucose effect.The glucose effect presumably occurs with most barbiburates and thio
barbiturates but not with inhalation or other anaesthetics.

MAC:

MAC is defined as the Minimum Alveolar Concentration of an inhalant anaesthetic at

one atmosphere that produces immobility in 50% of subjects (patients) exposed to a
supramaximal stimuli.

Minimum alveolar concentration of an anaesthetic required to keep a patient from

gross movement in response to a painful stimulus.

End tidal anaesthetic concentration midway between that allowing movement and that
preventing it is minimum alveolar concentration.

MAC is equivalent to ED50.

MAC for different inhalant anaesthetics

Nitrous oxide – 104%

Halothane – 0.87%

Isoflurane – 1.28%

Methoxyflurane – 0.24%

Sevoflurane – 2%

Desflurane – 6%

Solubility co-efficient:

It is the measure of ability of a gas to dissolve in a solvent. For inhalation anaesthetics

it is measured and expressed as a “partition co-efficient”.

Partition co-efficient:

It is the concentration ratio of an anaesthetic in the solvent and the gas phases (Blood
gas partition co-efficient) or between two tissue solvents (brain and blood).

Blood Gas partition co-efficient:

It is the concentration ratio of an anaesthetic in the blood and the gas phases. It
provides a means of predicting the speed of anaesthetic induction, recovery and change of

59
anaesthetic depth. Lower the blood gas partition co-efficient faster will be the induction and
recovery. Blood gas partition co-efficient

Nitrous oxide – 0.47

Isoflurane – 1.46

Halothane – 2.54

Methoxyflurane – 1.5

Oil gas partition co-efficient:

It is the concentration ratio of an anaesthetic ion in oil (brain cells) and gas phase at
equilibrium. It correlates inversely with anaesthetic potency. Very potent anaesthetics have
low MAC and high oil gas partition co-efficient.

IPPV – Intermittent Positive Pressure Ventilation:

Application of positive pressure during the inspiratory phase when the patient has an
artificial airway in place and is connected to a ventilation.

Indications for IPPV

 Apnea
 Significant ventilation during anaesthesia
 Using of neuromuscular blocking agents
 Intra thoracic surgery
 General anaesthesia lasting more than 90 minutes
 To facilitate inhalant anaesthesia
 To eliminate oscillations between deep and light anaesthesia associated with
depression of spontaneous ventilation.
 To maintain normal carbondioxide tension in arterial blood (ECAPNIA) (Pco2 = 35-
45 mmHg)
PEEP- Positive End Expiratory Pressure:

It improves the alveolar ventilation by increasing the functional residual capacity.

High levels of PEEP however decrease cardiac return and lowers cardiac output.

Second Gas Effect:

Applies to the situation in inhalant anaesthesia where a gas such as nitrous oxide
given in a high enough concentration leads to its rapid uptake from the alveolus resulting in
an increase in the concentration of the other/second gas.

60
 When soluble gases (such as N2O) are breathed in large quantities, can be dissolved in
body fluids rapidly. This can lead to a temporary increase in the concentration of oxygen and
CO2 in the alveolus causing an increase in their respective partial pressures. When patient is
recovering from N2O anaesthesia, large quantities of this gas move from the blood to the
alveolus (down its concentration gradient) and so for a short period of time the oxygen and
CO2 in the alveolus are diluted by this gas.

This could cause the partial pressure of O2 to decrease and could lead to hypoxia. The
decrease in CO2 could also potentiate this effect as ventilation would be suppressed leading to
potential hypoxaemia.

Hypoxia can be avoided by increasing the O2 when recovering from N2Oanaesthesia.

Diffusion hypoxia is the phenomenon in which a patient recovering from N2O anaesthesia
experiences hypoxia due to diffusion of large quantities of nitrous oxide gas from the blood
to the alveolus leading to the dilution of alveolar oxygen and a decrease in the partial pressure
of oxygen.

GENERAL CONSIDERATIONS FOR SELECTION OF AN ANAESTHETIC AGENT

Selection of an anaesthetic agent depends on the following factors:

1. Metabolic rate

As the basal metabolic rate increases, the requirement of anaesthetic also increases and
vice versa. Small animals have a higher basal metabolic rate per unit of surface area than
large animals. So smaller the animal, the larger is the dose per unit of body weight
necessary for anaesthesia. Animals with large quantities of fat, which is a relatively inactive
nonmetabolizing tissue, have a lower basal metabolic rate per unit of body weight and usually
require less anesthetic than lean muscular animals in good condition. The basal metabolic rate
(bmr) of males is approximately 7% higher than that of females. In females, bmr rises during
pregnancy due to the metabolic activity of the fetuses.

2. Species
Procaine is lethal for parakeets. In high doses, morphine can cause excitation in cats. In
horses and cattle, anaesthetics should be selected to provide rapid recovery with minimal
emergence struggling. Endotracheal intubation is mandatory if general anaesthesia is used.
General anaesthesia in ruminants is associated with hazards of rumen tympany, regurgitation,
and aspiration. These latter complications necessitate the use of regional anaesthesia
whenever possible. Regional anaesthesia with the patient in the standing position can prevent
compression of abdominal viscera and is therefore will not affect respiratory and
cardiovascular function.

3. Breed
Pendulous soft palate and restricted respiratory passages predisposes brachycephalic dogs
to respiratory tract obstruction unless a patent airway is maintained via endotracheal
intubation. So use agents that are rapidly eliminated (e.g., propofol) to enable rapid recovery.

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 4. Age
In very young animals, limited muscular and fat tissue limits redistribution of
anaesthetics. Also immature metabolic and excretory mechanisms increase the anaesthetic
risk. Hence the use of barbiturates in very young patients is not recommended. Aged animals
and those inpoor physical condition are often poor anesthetic risks because of decreased
vitality and the possibility of decreased cardiac, hepatic, and renal function. Drugs and doses
that minimally depress these systems, easily metabolized and eliminated or reversed with
specific antagonists should be chosen.

5. Physical status of the animal

Avoid general anaesthesia in animals with renal failure. Protein binding of organic acids
is reduced in uremic patients, causing increased pharmacological activity (sensitivity) eg.
Pentobarbital. Limited excretion prolongs the activity of muscle relaxants. Short-acting
anesthetic (propofol/etomidate), a potent opioid, or very low doses of a thiobarbiturate and
inhalant anesthetic may be used for induction if general anaesthesia is to be used.
In hepatocellular disease decreased albumin production in liver limits protein binding
of drugs like thiopental and propofol leading to unexpected sensitivity. Liver disease also
reduces detoxification of anaesthetics. Eg. Pseudocholinesterase production may be impaired,
with consequent increased duration of action of succinylcholine.
General anaesthesia is contraindicated in patients with cardiovascular disease together
with exercise intolerance. If unavoidable, balanced anaesthesia with dissociatives, opioids,
etomidate and isoflurane are preferred.
Fever increases anaesthetic requirement as metabolic rate increases by 7 % for each
degree increase in temperature (°F).
In shock metabolic rate decreases and so the anaesthetic dose also decreases. Impaired
distribution necessitates use of inhalation anaesthesia with positive pressure ventilation
Pregnant animals require a reduced dose per kilogram of body weight of the local
anesthetic for satisfactory epidural and subarachnoid anesthesia. This is due to the reduced
volume of epidural space caused by the engorged epidural veins, increased neural tissue
sensitivity due to hormonal changes and faulty overestimation of lean body mass.

6. Time required for surgery

Depends on the experience and degree of complication involved in the procedure. For short
procedures, short acting agents like propofol may be used and longer procedures with
balanced anaesthesia.
7. Type of surgery
Never use barbiturates for caesarean section. Propofol is preferred over other injectable
anaesthetics.

8. Availability of equipment and personnel

Experienced personnel and equipment are needed for administering inhalant anaesthetic
agents.

Other important considerations for general anaesthesia:

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 Anaesthetic drugs depress the respirations, cardio vascular and nervous system at
therapeutic doses.
 During anaesthesia, the patient’s oxygenation, ventilation, circulation and temperature
shall be continually evaluated.
 Oxygenation (arterial O2 saturation SaO2SPO2) is measured employed a pulse
oximeter.
 Normal SPO2 is greater than 90%- 95%.
 Ventilation status is assessed by capnometry,which is measurement of end tidal co2.
 Normal end tidal co2 is 35-45mmHg.
 Hypoxia may develop during anaesthesia due to apnea and airway obstruction during
induction.
 Brachycephalic breeds (pug) are prone to airway obstruction due to the redundant
(unnecessary) pharyngeal tissue they have.
 Endotracheal intubations prevents aspiration, facilitates 02 and anaesthetic
administration and controls ventilation.
 Airway implement involves the nasal passage and hence oral pathway must be kept
open during anaesthetic, if endotracheal intubations is not performed in dogs (horses
are obligate nasal breathers).
 Anticholinergics and dissociative anaesthetics cause tachycardia.
 Atropine is effective in controlling salivation.
 Atropine can be used in the management of bradycardia caused by halothane,
narcotics and neuroleptanalgesics.
 Glycopyrrolate do not cross blood brain barrier unlike atropine.
 Elimination of anaesthetics depends upon metabolic rate.
 Narcotics have minimal effect on myocardium.
 Acepromazine produce minimal direct myocardial depression but decreases peripheral
vascular existence causing arterial hypotension.
 Acepromazine produces minimal respiratory depression.
 Alpha 2 agonists produce dysarrhythmics, that is sinus bradycardia, SA and AV nodal
block and are avoided in patients with impaired cardiac output. Ketamine, tiletamine
and nitrous oxide cause catecholamine release.
 Halothane increases the sensitization of myocardium to catecholamine. Barbiturates
cause spleenic congestion.
 Xylazine inhibits small intestinal and caecal motility in horses and ponies for upto
two hours after a dose of 1.1 mg/kg body weight.
 Nitrous oxide should not be used in patients with pneumothorax. Acepromazine has
antiemetic, antiarrhythmic and antihistamine property.
 Acepromazine is avoided in animals that are positive to allergic testing, it lowers the
seizure threshold and should not be used in patients with hepatic encephalitis.
 Acepromazine alters the metabolism of procaine and succinylcholine.
 Acepromazine may cause paraphimosis in stallions and may be avoided.
 Opioids have little or no effects on liver. Barbiturates are used with caution in

63
patients with significant hepatic diseases.
 Ketamine is metabolized in liver of dog, whereas it is excreted unchanged form in
urine of cats.
 Diazepam is highly protein bound and is used with caution in hyperglobulinemic
patients. It absorbs on to plastics.
 Diazepam is synergistic with thiobarbiturates, opioids and possibly alpha 2 agonists.
Midazolam is water soluble, more potent than diazepam but has shorter duration of
action.
 Elimination of injectable anaesthetics depends upon redistribution within the tissues,
detoxification principally in the liver and excretion via the kidneys.
 Morphine is eliminated via the G.I. tract.
 Haemorrhage during surgery, significantly increase the sleeping time.
 Animals showing a period of excitement during induction always require more
anaesthetic, hence pre anaesthetic sedation is advised.
 Dissociative anaesthetics do not induce ocular signs of CNS depression.
 Higher dose of general anaesthesia is to be avoided in patients with renal failure.
Maintenance of potent airways via endotracheal intubation is mandatory in
brachycephalic breeds of dogs during anaesthesia.
 Emergence struggling is usually more of a problem in equine anaesthesia.
 Ruminants have a different temperament than horse and seldom make premature
attempts to rise after anaesthesia.
 Decompensated heart disease is a contraindication for general anaesthesia. Mild state
of diuersis should be established with i/v fluids in hepatitis patients prior to the
administration of anaesthetic drugs.
 Opioids are incorporated in the anaesthetic protocol of ear surgeries as they are
painful.
 Hypotension and seizures are the contraindications for acepromazine.
 Dobutamine or dopamine (2-10mg/kg.i/v) may be given during surgery for
ionotrophic support. Hyperventilation may cause a significant decrease in portal blood
flow. Halothane and isoflurane decreases the portal blood flow. Halothane may cause
post anaesthetic hepatic dysfunction (halothane hepatitis).

PREANAESTHETICS

I. Anticholinergics / parasympatholytics:

1. Atropine

 Decrease the oral, pharyngeal and respiratory tract secretions

 Dilates bronchi and increase both anatomic and physiologic dead space.
 Decreases G.I motor and secretary activity.
 It suppresses the vagal influence on the heart, relaxes the sphincter muscle of iris,
dilating the pupil.

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  Decreases tear formation in both awake and anaesthetized dogs.
 It can be given S/C, I/M and I/V
 Atropine when given I/V, there is an increase in vagal tone both centrally and
peripherally, initially. The classic parasympatholytic action occurs secondarily.
 Contraindicated in patients with preexisting tachycardia (fever and the thyrotoxicosis)
 Cat, rat and rabbit can destroy large quantities of atropine because they have the
atropine esterase enzyme in the liver.
 Dose 0.02 – 0.04 mg/kg – dog
0.7 mg/kg – sheep and goat

 Atropine 1ml amp. and 10 ml vial. Each ml contains 0.6mg atropine.

2. Glycopyrolate:

 Synthetic quartenary ammonium anticholinergic.

 Duration of action longer than atropine.
 Blocks vagal reflexes during induction of anaesthesia and intubation
 Dose: 0.01mg/kg, s/c,i/m, i/v.
 Pyrolate:Concentration - 0.02mg/ml, 1ml amp. and 10 ml vial.

65
 Chemical restraints

Tranquilizers

1.Phenothiazines 2.Butyrophenones

Ex. 1 Acepromazine Ex1.Droperidol

2. Triflupromazine 2.Lenperone
3.Azaperone
4.Fluanisone
Sedatives

Benzodiazepines Benzodiazepine
antagonist
Ex : Diazepam, Ex : Flumazenil

Midazolam.

Lorazepam

Zolazepam.

Non opioid analgesics

Alpha 2 agonists:
Ex. Xylazine
Detomidine
Dexamedetomidine,
Romifidine
Azepoxole

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 OPIOIDS

1.agonist 2.agonist/antagonist 3.antagonist

Ex. morphine Ex. butyrophénone Eg. naloxone

Pethidine/meperidine Pentazocine. naltroxone

Oxymorphone Buprenorphine

Fentanyl, methedone Nalbuphine

Dextromethorphone

Neuroleptanalgesics

Ex.acepromazine-meperidine

Acepromazine-oxymorphone

Droperidol-fentanyl

Diazepam-morphine

Xylazine-oxymorphone

Diazepam- 0xymorphone

Diazepam-fentanyl.

INNOVAR VET ®:

Fentanyl 0.4mg/ml, dogs 1ml for 7- 10 kg i/m

Droperidol 20mg/ml, dogs 1ml for 12-20kg, i/v

IMMOBILON LA®:

Etrophine 2.45mg/ml

Acepromazine 10mg/ml.

IMMOBILON SA ®:

Etrophine 0.074mg/ml.

Methotrimeprazine 18mg/ml.

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HYPNORM®:

Fluanisone 10mg/ml.

Fentanyl 0.345mg/ml.

METHOTRIMEPRAZINE® :

*** Phenothiazine with analgesic property.

EQUITHESIN®:

Mixture of phenobarbital, chloral hydrate and magnesium sulphate commonly used in horses

SAFFAN®:

Alphaxalone 9mg/ml

Alphadolone 3mg/ml

Both are progesterone like steroids/steroid anaesthetics

CHLORAL HYDRATE®:

Sedative hypnotic

Metabolized to 2,2,2 trichloro ethanol, which is the active ingredient

Poor analgesia

Low margin of safety

ETOMIDATE®:

Carboxylated imidazole derivative

No analgesia

Low cardiovascular risk profile.

M-99®:

Etorphine hydrochloride

Oripamine derivative and chemically related to morphine

80-1000 times more potent than morphine.

Used extensively in wild animals.

Elephants, hippopotamus, rhinoceros, bear, primates are more sensitive to etorphine.

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69
TRANQUILIZERS

Phenothiazines:

 Relative anxiety and calms the patients.

 May potentiate toxicity of OPC and activity of procaine hydrochloride.
 Decrease arterial blood pressure.
 Induce hypothermia.
 Has antiemetic effect.
 Has antiarrhythmic effect. They abolish halothane sensation to catecholamines.
 Has antihistaminic effect. Not to be used in animals, that are to undergo allergic test.
 Causes peripheral vasodilation due to alpha 1 adrenergic blocking effect resulting
hypotension and hypothermia. Not used in animals in shock.
 Causes paraphimosis and permanent penile prolapse/paralysis in stallions.
 Prevent/decreases the severity of the malignant hyperthermia in susceptible pigs
exposed to halothane.
 Drug interaction with thiamylal was reported.
 Half the recommended dose in geriatric neonatal and animals with liver dysfunction.
 Decrease seizure threshold.
 Ex. Acepril 1% that is 10mg/ml.
 Decreases PCV by spleenic sequestration of RBCs.

SEDATIVES

BENZODIAZEPINES:

 Diazepam, midozolam, lorazepam,zolazepam.

 Unlike phenothiazines they do not sedate or tranquilize the animal.
 No anaesthesia.
 Minimal adverse effect on cardiovascular and respiratory system.
 Used in high risk and geriatric patients.
 Administered prior to Ketamine to prevent seizures and muscle hypertonus.
 Injected slowly to prevent versus thrombosis.
 I/M administration, not recommended.
 Rapidly crosses blood brain barrier and placental barriers.
 Synergistic with thiobarbiturates, opioids and possibly alpha 2 agonist.
 Propylene glycol, the diluent used in diazepam on rapid i/v administration causes
bradycardia hypotension and transient cardiac arrest.
 Diazepam-physical incompatibility with most drugs except Ketamine.
 Midazolam is water soluble more potent than diazepam and has a shorter duration
of action in some animals.
 Diazepam gets absorbed to plastics and hence to be stored in glass vials or
ampules or syringes.

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  Benzodiazepine antagonist – flumazenil
 Dose: 1 part flumazenil to 13 parts of diazepam, Midazolam.
 Calmpose: 2ml amp.
 Each ml contains 5 mg diazepam
 Mezolam: 5 and 10ml vial contains 1mg/ml Midazolam.
 1ml amp. contains 5mg/ml Midazolam.

NON OPIOID ANALGESICS ALPHA 2 AGONIST

XYLAZINE:

 Sedative analgesic and sedative hypnotic

 Xylazine has predictable sedative analgesic and muscle relaxant action.
 Eliminates muscular hypertonicity in drugs and cats given lactamine.
 Most commonly administered sedative analgesia are improved when Xylazine is
combined with Ketamine.
 Xylazine can be combined with butorphanol, guaifanesin and benzodiazepine.
 Major effect develop in approximately 10-15min. after i/m and within 3-5 min
following i/v administration.
 A dose dependent sleep like state is usually maintained for 1-3 hr, but the duration
of analgesia lasts only for about 15-30min.
 It causes bradycardia, arrhythmias, decreases cardiac output and B.P.
 Anticholinergics are routinely recommended prior to Xylazine in all animals
except horses and large ruminants.
 It decreases the respiratory tract. ‘
 Drooling of saliva is commonly observed in ruminants.
 The decreased gastro-oesophageal sphincter pressure may result in gastric reflex
in dogs.
 S/C and I/M administration induces vomiting in both dogs and cats during the
early onset of sedation.
 It prolongs the G.I. transit time.
 Unfasted cattle develops tympany.
 In horses, Xylazine causes minimal effect on small intestine, caecum and colon.
The large intestine motor responses are inhibited, relaxation of large intestine
coupled with alpha 2 mediated analgesia results in alleviation of visceral pain.
 Acute abdominal distension is caused by aerophagia or may be due to
parasympatholytic action causing G.I. atony with accumulation of gas and hence
Xylazine is not suitable for upper G.I. radiography.
 It increases urinary output.
 It causes transient hypoinsulinaemia and hyperglycemia.
 It has oxytocin like effect and indiscriminate use in pregnant animals is not
advised.

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  It causes mydriasis and decreases intraocular pressure.
 Painful procedures should be carried out within 10-15min. after onset of sedation
continued painful manipulations will shorter the period of sedation and faster
recovery.
 Xylazine can be administered epidurally and will have longer duration of
analgesia in cattle.
 Dose:
 Cattle: 0.05mg/kg. and 0.1mg/kg i/m
 Horses: 1.1mg/kg wt
 Dogs: 1mg/kg, i./m
 Xylazine 2ml and 10 ml vials.
 Each ml contains 20mg Xylazine.
Opioids

 Refers to exogenous and synthetic compounds that bind to specific subpopulation of

opioid receptor.
 The analgesic action of opioids are not accompanied by loss of proprioception or
consciousness unless excessive doses are given
 Mu, kappa and phencyclidine or sigma are the opioid receptor subtypes
 Mu receptor
o Supraspinal analgesia
o Respiratory depression
o Physical dependence
 Kappa receptors
o Spinal analgesia
o Miosis, sedation and respiratory depression
 Sigma receptors
o Psychomimetic activity
o Hallucinations, respiratory and vasomotor stimulation
 Opioid agonist – antagonist
o Butorphanol, buprenorphine, pentazocine.
Butorphanol

 Synthetic opioid analgesic.

 Analgesic potency is 3-5 times that of morphine
 Respiratory depressant effects of butorphanol is less than those of morphine and has a
“ceiling effect”
 The sedation achieved with butorphanol in dogs are mild.
 Butorphanol is 115 times more effective than codeine or dextromethorphan in
suppressing cough in dogs.
 Butorphanol at 0.22 mg/kg I/M and 0.1 mg/kg I/V provided visceral analgesia in
horses suffering with colic for 4 hrs and 30 min respectively.

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  A combination of butorphanol (0.1 mg) plus Xylazine (1.1 mg/kg I/V) will allow
standing surgical procedure in horses for approximately 30 min.
 Readily crosses placental barrier
 Excretion occurs primarily in urine (70%) with some biliary elimination (11-14%)
 Butorphanol is an excellent analgesic to combine with xylazine or detomidine
 Dose : Dogs: 0.1 – 0.3 mg/kg b.wt
Cattle: 8 – 10 mg Butorphanol

8 – 10 mg xylazine I/V

 BUTRUM ® : 1 and 2 ml Amp

 Each ml contains 2 mg butorphanol
Buprenorphine

 Partial Mu opioid agonist – antogonist

 30 times potent than morphine
 Onset of action is relatively slow requiring 20-30 min to reach full effect
 Analgesic action may last as long as 8-12 hrs
 Causes respiratory depression and can be reversed by naloxone or naltrexone
 Buprenorphine is best used with a tranquilizer in horses
 4-6 micro gram /kg I/V buprenorphine
 0.04 – 0.05 mg/kg I/V acepromazine
Dose

 Dogs: 6 – 10 mcg/kg b.wt I/M or I/V administration gives analgesia for 6 – 8 hrs.
 Epidural buprenorphine – analgesia for 18 – 24 hrs suited for real limb orthopaedic
procedure
 When it is placed in epidural space, the high lipid solubility and affinity of
buprenorphine for Mu receptors limits its cranial spread and the likelihood of
respiratory depression.
 Inj: buprigesic ® 2ml Amp
 Each ml contains 300 mcg buprenorphine.
Pentazocine

 1/3rd potency as morphine in humans

 Has minimal effect of cardiovascular system and is mild respiratory depressant.
 Effective analgesic in horses, dogs, pigs, primates, rabbits and rats.
 Effects are observed within 15 min. and last up to 2 hrs.
 Dose
o Horses : 0.5 – 3 mg/kg I/V
0.5 – 6 mg/kg I/M

o Dogs and pigs : 2 mg/kg I/M

o Inj : Fortwin ® 1 ml Amp ( each ml contains 30 mg of pentazocine)

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Tramadol

 Centrally acting analgesic

 Chemically not of the opioid drugs
 Dual mode of action
1. M. agonism – mild and developed M. agonist activity
2. Monoamine and serotonergic systems
 Analgesia even when naloxone is administered
 Tramadol is excreted via liver and kidney
 Adverse effects include constipation, stomach upset and decreased heart rate.
 Over dosage causes mental alteration, pin point pupil and seizures
 Dog : 1 -2 mg/kg I/M or I/V, PO
 Cats : 0.5 – 1 mg/kg
 Each ml contains 50 mg tramadol

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 LESSON 2

LOCAL ANAESTHESIA/ANALGESIA

Introduction

• Local anaesthesia/analgesia
– Loss of sensation in circumscribed body area
• Regional anaesthesia/analgesia
– Loss of sensation in larger but limited body area
Mechanism of Action of LA (local anaesthetic)

They act on cell membrane of nerve fibre and bind with the gate of the sodium
selective ionic channels in nerves and inhibit sodium movement. Thereby preventing
depolarization of nerve cell membrane.
Metabolism and Excretion

Amide linked LA

• Metabolism exclusively in liver

• Requires glucuronic acid conjugation for its excretion
– Cats more prone to develop toxic side effects with amide LA as glucuronidate
conjugation pathway is less developed
– eg. Lidocaine, Bupivacaine, Ropivacaine, Articaine
Ester linked LA

• Hydrolysis occurs in plasma by non-specific pseudocholine esterases

• Clearance of ester linked LA is prolonged during pregnancy and long term choline
esterase inhibiting poisoning
– Choline esterase activity is decreased in pregnancy
Eg. Cocaine, Procaine, Tetracaine, Benzocaine

Methods of Local Anaesthesia

• Surface anaesthesia
• Infiltration anaesthesia
• Field block
• Conductional/ Regional nerve block
– Perineural
– Spinal Analgesia
• Intrasynovial anaesthesia
• Intravenous regional anaesthesia
Surface Anaesthesia

• Also known as topical anaesthesia

• Useful in anaesthetising mucosal surface and cornea

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 • Onset of action is longer, pain relief is lesser than in infiltration
• Repeated instillations are needed after 1 minute
• Peak effect in 5 minutes
• Spraying/splashing, instilling into eyes, infusing into urethra
• Drug of choice for topical analgesia of the cornea is proxymetacaine hydrochloride
– With single drop analgesia starts in 15 s and persists for 15 minutes
• Topical anaesthetics: butacaine, proparacaine, ethyl chloride spray, 4% procaine, 10
% lignocaine hydrochloride spray, 4 % lignocaine hcl
Infiltration anaesthesia

• Blocks nerve endings at the site of infiltration

• Facilitated by creating skin bleb followed by layer by layer tissue in filtration
• Never infiltrate infected or inflamed tissues
eg. Linear infiltration for skin incision- line block, Inverted -7 or inverted L block
Continuous infiltration anaesthesia

 Indicated for pain management in amputation and total ear canal ablation
Field Block

 Anaesthesia is produced in a larger area than infiltration

 Fanwise, diamond shaped, 'cone‘ or 'cup' or ring of tissue infiltration
 Eg. Ring block
Conductional/ Regional Nerve Block

 Blocks conduction in nerves supplying the surgical site

 Perineural Injection
– LA is injected around nerves or nerve trunks
 Spinal analgesia
It is a technique of regional nerve blockade by injecting local anaesthetic agent into
the subarachnoid space, which contains cerebrospinal fluid, to desensitize the nerves
emerging from the vertebral column.

 Subarchnoid injection- LA injected into cerebrospinal fluid by penetrating duramater

and arachnoid
 Extradural- LA injected over duramater inside the spinal canal
 Anterior or high and posterior or low epidural blocks may be induced from the
same site, by increasing/decreasing the volume of the local anaesthetic agent
Intrasynovial Anaesthesia:

Local anaesthetic is injected into the joint cavity

• Relieves pain involving the joints and tendon sheaths

• Drain the synovial fluid and inject the local anaesthetic
• Onset in 5 minutes and lasts for 1 hour

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Intravenous Regional Anaesthesia/IVRA/BIER Block

It is the technique of providing analgesia to an extremity of the body by administering

local analgesia into a distal vein after applying a tourniquet to prevent its distribution to other
parts of the body.

Technique

• Catheter is inserted into a vein at the distal extremity of a limb

• Exsanguinate the limb with an Esmarch bandage
• Apply tourniquet to occlude the arterial supply at the top of the limb
• Inject the local analgesic solution via the catheter
• Analgesia up to the lower limit of the tourniquet ensues
• Analgesia wears off rapidly on removing the tourniquet
• Tourniquet should not be left beyond 1.5 hours
• Never use bupivacaine as the duration of action will be prolonged and can enter into
the systemic circulation once the tourniquet is removed
Factors influencing efficacy of local anaesthesia

• Dose of local anaesthetic

• Volume
– Irrespective of volume Articaine penetrates tissues and produce anaesthesia in
2 minutes
• Concentration
• Injection site
– s/c or intrathecal: onset-3-5 minutes, duration: 1 hour
– Minor nerve blocks: 5-10 mts, Major nerve blocks and epidural:10-20 minutes
• Additives
– Hyaluronidase increases penetration of tissues and enables wide spread
distribution of LA
– Epinephrine causes vasoconstriction and prolongs the duration of LA action.
But it should never be injected in extremities.
• Temperature
• Pregnancy
Local Anaesthetic Toxicity

• In dogs, the dose of lignocaine should not exceed 10mg/kg

• In cats, not more than 4mg/kg
• Reduce total dose by 30-40% in old, sick and cachectic animals
• Toxic doses damage nerves, skeletal muscles and delay wound healing
• Salivation, vomition, hypothermia, seizures are also noticed in toxicity
• Decreased heart rate, BP, CO, unconsciousness and coma, respiratory arrest and CVS
collapse

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 Treatment of Adverse Reactions

• Seizures: oxygen supplementation and Diazepam @ 0.5-1 mg/kg b. wt.

• Low BP: i/v fluids – 10mL/kg/h
– Phenylephrine-5mcg/kg/min
• Heart failure: epinephrine @ 1-15mcg/kgb. wt.

Local Anaesthesia in Horses

Auriculopalpebral Nerve Block

• Blocks the motor supply to orbicularis occuli, hence prevents the closure of eyelid
• Inject 2 % 5ml lidocaine subfacially into the depression dorsal to highest point of
zygomatic arch or into the depression just anterior to the base of the ear
• Onset :4 to 6 minutes and a duration of 60 to 90 minutes
• Examination of eye will be easy as closure of eyelid is prevented
• Helps in relieving spasm of eyelid
Supraorbital/Frontal Nerve block

• Supraorbital foramen is located 5-7 cm above the medial canthus in the supraorbital
process of frontal bone
• Through this foramen the supraorbital nerve emerges. This nerve is the terminal
branch of the ophthalmic division of the trigeminal nerve
• Inject 5ml 2 % Lignocaine upto 1.5-2cm depth into the supraorbital foramen using a
22 G needle to desensitize the upper eyelid
• Indicated for suturing wounds in the upper eyelid

Infraorbital Nerve Block

• Desensitization of upper lip, nostril, roof of nasal cavity, skin upto infraorbital
foramen is facilitated by injecting near the infraorbital foramen
• First molar, the maxillary sinus, and skin upto the medial canthus of the eye by
injecting 3.5 cm deep into the infraorbital canal
• Site: 2.5 cm dorsal to the middle of a line connecting the nasomaxillary notch and the
rostral end of the facial crest
• Inject 5mL 2 % lidocaine into or near the foramen after pushing the levator labii
superioris muscle upward.
• To be repeated on the other side for desensitizing the nerves on that side also
• Indicated for suturing wounds in the upper lip, nares, extraction of first molar tooth
Mental Nerve block

 Lower lip desensitization

 Depressor labii inferioris tendon is dorsally displaced
 Inject 2mL 2 % lidocaine with a 22-25 G 2.5 cm long needle at the middle of the
interdental space in the horizontal ramus of mandible

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Caudal Epidural Anaesthesia

Surgical procedures in which caudal epidural anaesthesia is indicated in horses:

• Caslick’s procedure
• Rectovaginal fistula repair
• Repair of prolapsed rectum
• Urethrostomy
• Tail amputation
Area blocked:

• Tail, perineum, anus, rectum, vulva vagina, urethra, bladder

Nerves blocked

• Coccygeal and last three pairs of sacral nerves

Site: inject 6-10 ml of 2 % lignocaine using 18 G 5-7 cm spinal needle at first intercoccygeal
space after inserting at right angle to the croup

NERVE BLOCKS IN DOGS

Infraorbital Nerve Block

• Area desensitized: upper lip, nose, the roof of nasal cavity, and the surrounding skin
up to the infraorbital foramen of the side injected
• Site: the dorsal border of the zygomatic process and the gum of the upper canine tooth
• Inject 2ml 2 % lidocaine using 2-5 cm 25 G needle

Mandibular Nerve Block

 Nerve blocked: Inferior alveolar branch of mandibular nerve

• Mandible and all teeth, chin and lower lip skin and mucosa are desensitized
• Site: Near mandibular foramen on medial surface of ramus
• Insert a 22 G 2.5 cm long needle at the lower angle of jaw 0.5 cm rostral to angular
process
• Inject 2-4ml 2 % lidocaine to block the nerve of that side
Mental Nerve block

 Nerve blocked: Mental Nerve

 Lower lip desensitization
 Site: Mental foramen at the level of second premolar tooth
 2mL 2 % lidocaine is injected with a 22-25 G 2.5 cm long needle
Lumbar Epidural Anaesthesia

• Surgical Procedures in which lumbar epidural anaesthesia is indicated

– Caesarean section in dogs (to be combined with sedation)

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 • Site: L7-S1 is palpated by placing middle and thumb on iliac prominences and index
on the spinous process of L7 and 22 G 5cm needle placed in the midline behind the
L7 spinous process until it penetrates interarcuate ligament
• Dose: 1ml/kg over 1 minute period

LOCAL ANAESTHESIA IN RUMINANTS AND PIG

Local Anaesthesia for Dehorning in Cattle

Nerve blocked: Cornual Nerve –CLOT (Cornual N is a branch of Lacrymal N which is a

branch of ophthalmic division of trigeminal nerve.

Area blocked: horn and horn base

Site and Method:

• Lateral to upper third of temporal ridge at 0.7-1 cm depth

• 5-10 ml 2 % lidocaine injected with 18 G needle
• Inject posterior to horns if they are well developed
• Blocks cutaneous branches of cervical nerves
• Note: In fracture of horn with frontal bone or sinus involvement, Peterson’s eye block
is also performed.
Local Anaesthesia for Dehorning in Goat

Nerves blocked: Cornual branch of lacrimal nerve and cornual branch of infratrochlear nerve
Area blocked: horn and horn base
Site and method:
Cornual branch of lacrimal nerve:
Midway between lateral canthus of eye and lateral horn base caudal to ridge of
supraorbital process
Cornual branch of infratrochlear nerve:
Linear infiltration dorsal and parallel to dorsomedial margin of orbit midway
between medial canthus and medial horn base
Inject 2-3 ml 2 % lidocaine 1-1.5 cm deep with 22 G needle
Kids of 7-14 days: ring block at horn base with 0.5mL 2 % lidocaine
Retrobulbar Nerve Block in Ruminants

Nerves blocked: optic nerve, oculomotor nerve, trochlear nerve, trigeminal nerve,
abducens, facial nerve

Area blocked: Sensory and motor blockade of eye, Sensory blockade of eyelid

Site and Method:

 Eyelid penetrated at superior/ inferior/medial/lateral orbital rim

Medial canthus approach:
 Feel the medial wall of the bony orbit
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  Deflect the globe with index finger
 Insert needle in the fornix of the conjunctiva cranial to the nictitans and dorsomedial
to the operator's finger
 Inject into the apex of orbit
 Indications: Surgery of eye and orbit except eyelid
 Small ruminants: 3.75-cm, 22-gauge needle, 5-7 mL 2 % lidocaine
 Adult cattle: 15-cm, 18-gauge needle with a fairly large bend , 15 mL 2 % lidocaine
Peterson Eye Block

Nerves blocked: oculomotor, trochlear, abducens, branches of trigeminal-ophthalmic,

maxillary and mandibular

Area blocked: eye and orbit, except eyelid

Indications: Enucleation of eye, surgery of cornea

Site and Method: Foramen orbitorotundum

 Head should be fully extended with nasal bone parallel to ground

 5 mL lignocaine injected subcutaneously
 14 G, 2.54 cm long cannula is placed in the notch formed by supraorbital process of
frontal bone cranially, zygomatic arch ventrally and coronoid process of mandible
caudally
 Curved 18 G 12cm long needle passed through this cannula such that it passes to the
medial side of coronoid process
 Advance needle posteriorly and ventrally to strike the bony plate at 7.6-10.2 cm
depth
 Inject 15 mL of 2 % lidocaine anterior to foramen in pterygopalatine fossa
Adverse effects

• Injection into subarachnoid can cause brain stem anaesthesia and respiratory arrest
• Bradycardia, hypotension, asystole,
• Perforation of the globe
• Intraorbital or retrobulbar venous haemorrhage
Differentiate between
Peterson nerve block Retrobulbar nerve block
• Requires more skill to perform • Less skill
• Less oedema and inflammation • More oedema and inflammation
• Orbital haemorrhage less • More orbital haemorrhage
• Direct pressure on the globe isless • More pressure on globe
• Penetration of the globe is less • Penetration of the globe is more
• Damage to the optic nerve is less • Damage to the optic nerve is more
• Lesser peribulbar distribution of LA • Greater peribulbar spread of LA

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Auriculopalpebral Nerve Block in Cattle

Indications: Along with topical anaesthesia:

– Removing foreign bodies from the cornea and conjunctival sac
– Subconjunctival injection of medicines
Nerve blocked: Auriculopalpebral nerve
Area blocked: Motor blockade of eyelid/prevents blinking
Site: Notch on the zygomatic arch anterior to the base of the auricular muscles
Method
• 5 to 10 mL of local anaesthetic is subcutaneously injected using 20-gauge needle
Nasal Anaesthesia in Cattle

Indications:
• Repair of nasal lacerations
• Insertion of a nose ring in bulls
Nerve blocked: Infraorbital nerve
Site and Method:
• Infraorbital foramen is located rostral to the facial tuberosity on a line extending from
the nasomaxillary notch to the second upper molar (P2)
• In adult animals , 5 cm dorsal to P2
• 20 to 30 mL of a 2% lidocaine hydrochloride solution is injected

Anaesthesia for Laparotomy

• Proximal Paravertebral Nerve Block
• Distal Paravertebral Nerve Block
• Line block
• Inverted -L Infiltration
• Segmental Dorsolumbar Epidural Block

Paravertebral Nerve Block

• Proximal Paravertebral Nerve Block

– Synonym: Farquharson/Hall/Cambridge technique
• Distal Paravertebral Nerve Block
– Magda/Cakala/Cornell technique
• Analgesia is developed from the 13th rib and caudally up to the tuber coxae and
ventrally to the fold of the flank on the side performed in both techniques
• In addition in proximal, caudal migration of local anaesthetic cause hind limb ataxia

Proximal Paravertebral Nerve Block in Cattle

Nerves blocked: The dorsal and ventral branches of the last thoracic (T13) and first and
second lumbar (LI and L2) spinal nerves are desensitized

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Site and Method: 2.5 to 5.0 cm lateral from the dorsal midline cranial to transverse process
of L1, L2, and L3
• Desensitize skin with 2 to 3 mL of a 2% lidocaine using 2.5-cm, 20-gauge needle
• Introduce 1.25-cm, 14-gauge needle as cannula right angle to skin
• 4.25- to 15-cm, 18-gauge spinal needle passed ventrally
• Walk off the needle from the cranial edge of the transverse process
• Advanced 1 cm ventrally to pass through the intertransverse fascia
• 10 to 15 mL of a 2% lidocaine hydrochloride solution is injected to desensitize the
ventral branch
• Withdraw needle 1 to 2.5 cm to above the fascia and dorsal surface of the transverse
process.
• 5 mL of the anaesthetic is injected to desensitize the dorsal branch
• L3 and L4 lumbar spinal nerves desensitized for analgesia of the caudal most part of the
paralumbar fossa
• Pelvic limb weakness is noticed in L3-L4 block (L3 spinal nerve block)

Proximal Paravertebral Nerve Blockin Sheep and Goats

• Nerves blocked: T13, L I , and L2 are desensitized

• Site and Method: 2.5 to 3.0 cm lateral to the midline cranial to transverse process of L I ,
L2, and L3
• Inject 2 % lidocaine 2 to 3 mL/site
Signs of successful nerve blockade

• Loss of sensation of skin

• Increased skin temperature
– Hyperaemia after paralysis of cutaneous vasomotor nerves
• Scoliosis toward the desensitized side by paralysis of paravertebral muscles
DistalParavertebral Nerve Block in Cattle

Nerves blocked: dorsal and ventral rami of T13, L1 and L2 nerves

Site and Method:

• Inject 10 to 20 mL of a 2% lidocaine in a fan-shaped infiltration pattern ventral to and

parallel to the distal ends of LI, L2 and L4 transverse processes using 7.5-cm, 18-
gauge needle
• Withdraw and reinsert the needle dorsal and caudal to the transverse process
• Inject 5 mL of the anaesthetic to desensitize the cutaneous branch of the dorsolateral
branches
Distal verses Proximal Paravertebral Nerve Block

• Advantages over proximal

• Lack of scoliosis in distal
• Risk of penetrating a major blood vessel is less
• Minimal hind limb weakness

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 • Disadvantages of distal
• Larger volume needed
• Efficiency varies
Line Block

• Infiltration of the incision line

• Subcutaneous injection of 0.5 to 1.0 mL 2% lidocaine hydrochloride 1 to 2 cm apart
using 20G needle
• Successive layers infiltrated with 10-15 mL LA using 18 G 10 cm long needle
• 450 kg cattle tolerate 250 mL of a 2% lidocaine
• hydrochloride solution
• Adult goats tolerate 10 mL of a 2% lidocaine hydrochloride solution

Inverted –L Infiltration in Cattle

Nerves blocked: Ventral branches of T13, L1-L4 are blocked

Site:

• The dorso-caudal aspect of the last rib and ventrolateral aspect of the lumbar
transverse processes
• Inverted L pattern of infiltration of skin, subcut, muscles and parietal peritoneum with
upto 100 mL of 2 % lidocaine
• Desensitization occurs in 10-15 minutes

Infiltration verse Paravertebral Nerve Block

Paravertebral Nerve Block

• A wide and uniform area of analgesia and muscle relaxation

• The incision site is not disrupted
• Desensitize larger area at faster rate

Infiltration Anaesthesia

• Area of analgesia and muscle relaxation is not uniform

• Incision site disruption may occur
Desensitize larger area at slower rate than Paravertebral Nerve Block

Epidural Anaesthesia

Site of choice:

• Adult cattle and bulls: sacrococcygeal or first intercoccygeal

• Calves, sheep ,goat and pig: lumbosacral space

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Anterior/High and Posterior or low epiduralbocks may be induced from the same site, by
increasing/decreasing the volume of the local anaesthetic agent

Area desensitized:
• Perineal region, inguinal region, the flanks, the abdominal wall up to the umbilicus
• Hind limb ataxia to complete paralysis depending on cranial spread and involvement
of S1, S2, L6, L5
Reduce epidural dose in the following:

• Aged animals:
– More permeable dura
– Progressive increase in the size and number of arachnoid villi increasing
surface area of absorption
– Occluded intervertebral foramina
• Full term pregnancy :
– Distended epidural veins decreases epidural space
– Enhanced migration of epidural anaesthetics
• Obese animals
– Increased quantities of fat in obesity enhances epidural anaesthetic migration

Epidural Anaesthesia in Small Ruminants

Site - between L6-S1

Indications:
• Caesarean section
• Intra-abdominal surgery
• Hindlimb surgery
• Udder surgery
Method

• Insert 6-7 cm long 20 G needle at 90° to skin

• Inject 2 % lidocaine at 1mL/4.5 kg bwt on the midline just caudal to a line joining the
anterior border of the ilium into the epidural space

EpiduralAnaesthesia inPigs

Site:

 Between L6-S1
 0.5 to 2.5 cm caudal to a transverse line between the iliac crest
 2-3 cm caudal to a vertical line through the patella
Indications:

• Caesarean section
• Repair of rectal/uterine/ vaginal prolapse

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 • Umbilical, inguinal, or scrotal herniorrhaphy
• Surgery of the prepuce/penis/rear limb
Method:

• Use 20G (< 20 kg) -18G (> 100 kg) needle at an angle of 20° caudal to the vertical
with the bevel of the needle directed cranially
• Penetrate to a depth of 2-4 cm (< 20 kg), 4-10 cm (20-100kg), 10-15 cm (> 100 kg)
• Inject 2% lidocaine hydrochloride solution at 1 mL per 4.5 kg body weight at a rate
of 1 mL/2 to 3 s
• Advantages: minimal CNS depression, rapid recovery
• Overdose: unconsciousness, convulsions, collapse

Posterior/Low epidural block in Cattle

Site: S5-Co1 or Co1-Co2

Nerves blocked:

Coccygeal nerves and posterior sacral nerves

Area blocked: Anus, perineum, tail, vulva and vagina

Indications: Tail amputation, vaginal prolapse

Advantage: Hind limb ataxia not encountered in usual doses

Method:

• Site is located by moving tail up and down

• Insert 18 G needle at 10 ° to vertical
• Push to a depth of 2-4 cm to penetrate interarcuate ligament
• If cerebrospinal fluid comes on withdrawal of syringe, needle withdrawn slightly
• Inject 5 to 6 mL of 2 % lidocaine if no resistance is felt

Internal Pudendal Nerve Block in Cattle

Site: Lesser sciatic foramen

Nerves blocked:Internal pudendal, caudal rectal, pelvic splanchnic nerves

Indications:

 Examination of penis
 Relieve straining in vaginal and uterine prolapse

Advantage:

• Sciatic nerve function and tail tone are maintained

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Method:

• Locate the site per rectally by the aid of pulsation in internal pudental artery
• Internal pudendal nerve is located a finger’s width dorsal to the artery in the site
• Approach the site with a 18 G spinal needle in a downward direction upto a depth of
6-8cm
• Deposit 25 mL 2 % lidocaine
• Withdraw needle caudodorsally 2-3 cm
• 10 mL 2 % lidocaine deposited to desensitize caudal rectal nerve
• Repeat on the other side also
• Anaesthesia starts in 30 minutes and lasts 2-4 hours
• No hind limb ataxia or loss of tail tone
Teat Anaesthesia in Cattle

• Infusion block
– Milk out the teat cistern and apply alcohol swab at the teat orifice
– Desensitize mucosa of teat by infusing 5-10 ml of lidocaine hcl
– Anaesthesia develop in 5-10 minutes
• Ring block
– LA injected into subcutaneously at the teat base after applying a tourniquet
above
– 4-6 ml of 2 % lidocaine is deposited in a direction transverse to the teat using
25 G 1.5 cm long needle
– Analgesia develops in 10 minutes and lasts for up to 2 hours.
• Inverted V block
– Infiltration of skin and muscular tissue enclosing the defect with 4-6 ml of
lidocaine using 1.5 cm long 25 G needle

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 LESSON 3

GENERAL ANAESTHESIA AND ANAESTHETIC AGENTS

General anaesthesia is defined as the state of controlled and reversible loss of consciousness,
characterized by loss of pain (analgesia), amnesia, muscle relaxation and relatively depressed
reflex responses.

STAGES OF GENERAL ANAESTHESIA

Inhalant anaesthetics such as ether, chloroform when used to induce and maintain anaesthesia
typically exhibit the following four stage of anaesthesia.

Stage 1: Stage of voluntary movement or excitement.

Stage 2: Stage of involuntary movement or delirium.

Stage 3: Stage of surgical anaesthesia.

Stage 4: Stage of medullary paralysis and death.

Newer injectable anaesthetics do not exhibit all four stages.

Stage1: Lasts from initial administration of anaesthetic drugs to loss of consciousness,

characterized by epinephrine release resulting in increased heart rate and pupillary dilation.
Voluntary breaths holding.

Stage2: Lasts from loss of consciousness to the onset of a regular pattern of breathing. Loss
of all voluntary control.Violent reflex struggling to external stimuli.Nystagmus in horses.
Vocalization may occur in all animals. Excessive salivation is observed in ruminants and
cats. Vomiting may occur in dogs and cats. Presence of jaw tone is another sign.

Stage3:Characterized by unconsciousness with progressive depression of reflexes. Muscular

relaxation develops and ventilation become slow and regular.

Three planes - light surgical anaesthesia, medium surgical anaesthesia and deep surgical
anaesthesia.

 Plane 1 or plane of light anaesthesia: persists until eyeball movement ceases.

 Plane 2 or plane of medium anaesthesia is characterized by progressive intercostal
muscle paralysis and strong corneal reflex.
 Plane 3 or deep anaesthesia is characterized by diaphragmatic depression, weak
corneal reflexes, centered and dilated pupil.
Stage 4 is characterised by the following signs:

 Extreme CNS depression

 Apnoea
 CRT (markedly delayed)
 Anal and bladder sphincter relaxes

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 Anaesthetic Agents

Injectable agents Inhalation agents

1. Diethyl ether
2. Ethyl chloride
3. Chloroform
Dissociative Anaesthetics General anaesthetics 4. Cyclopropane
1. Ketamine 5. Nitrous oxide
2. Tiletamine 6. Halothane
7. Isofluorane
8. Methoxy fluorane
Barbiturates Imidazoles Alkyl phenols 9. Sevofluorane
1. Etomidate 1. Propofol 10 Desfluorane

Ultra short Short acting

acting 1. Pentobarbital
2. Phenobarbital

Thiobarbiturates Methylated oxybarbiturates

1. Thiopental 1. Methohexital
2. Thiamylal

Barbiturates

General anaesthetic action is by GABA mimetic effects

 They are derivatives of barbiturates which is a combination of malonic acid and urea.
 Barbituric acid lacks CNS depression effect
 Substitution at position 5 of barbituric acid renders it CNS effects.
 Thiobarbiturates have sulfur atom at carbon 2 on the barbituric acid ring, this
markedly increases the lipid solubility resulting in rapid onset and short duration of
action.
 Methohexital sodium is an oxybarbiturate having oxygen atom at carbon 2. It has
methyl group at 8th nitrogen which markedly increases its lipid solubility and shorter
its duration of action.
 The sodium salts as barbituric acid derivatives dissolve easily in water resulting in a
relatively unstable, pharmacologically inactive solution that has a strong alkaline pH
of 11 or 12. The alkalinity is caused by the addition of sodium carbonate.
 After I/V injection, thiopental and thiamylal are converted to nonionized acidic forms
and bind to plasma proteins particularly albumin.

89
  The protein bound ultrashort acting barbiturates can be displaced by various other
drugs, resulting in prolongation of anaesthetic sleepe.g:
Phenylbutazone/chloramphenicol
 Recovery from barbiturate anaesthesia begins with redistribution of the anaesthetic to
various parts of the body. On injection major portion is rapidly delivered to highly
perfused tissues of the body such as brain, causing initial unconsciousness, the drug is
then redistributed from the vessel rich organs to moderately perfused tissues such as
muscle and vessel poor areas such as fat and skin. Once the redistribution takes place
and the concentration of anaesthetic in the brain drops and recovery begins.
 The initial recovery phase of thiobarbiturates is primarily the result of redistribution
of the drug with the body and is not a consequences of active metabolism and
elimination. For total recovery the drug must be metabolized in liver and excreted via
the renal system.
 The short acting of methohexital and ultrashort acting methylated oxybarbiturate, is
due to rapid metabolism and not of redistribution.
Pentobarbital (I/V)

 Available as sterile 6.5% solution containing propylene glycol/as a powder in gelatine

capsules / non-sterile 20 % solutions
 Weak analgesic action
 Depress cerebral cortex and respiration
 Decrease stroke volume
 Metabolism in liver and excretion in urine
 No effect on GIT
 Glucose effect is seen especially in rabbits and guinea pigs but not in dogs, cats, mice
or rats
Dose
 Dogs – 10 – 33 mg/kg
 Cats : 25 mg/kg
 Cattle: 15 -30 mg/kg
 Pigs: 10 – 30 mg/kg
Half the dose is given rapidly for induction and rest is given slowly ‘to effect’.
Phenobarbital(I/V,PO)

 long acting barbiturate not used as an anaesthetic

 used in the treatment of convulsive disorders (Distemper encephalitis)
 Hepatic microsomal enzyme inducer
 In strychnine poisoning I/V to effect
 An oral loading dose should be administered followed by a daily maintenance dose of
6 mg/kg initially followed by 1.5 mg/kg three times a day.
Ultrashort acting Barbiturates

1. Thiopental sodium
2. Thiamylal sodium

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 3. Methohexital sodium
Thiopental sodium (I/V)

 1.25 %, 2.5% and 5% solutions are used

 Not recommended in neonatal foals/calf
 Dogs [2.5 %- 5%] and cats [1.25 %]
 For rapid induction of anaesthesia of short duration the dose is 10-12 mg/kg
 20 – 30 mg/kg will provide 10 – 20 min of surgical anaesthesia
 1/3rd of calculated dose is injected rapidly within 15 sec and the remainder is
administered slowly “to effect”
 after preanaesthetic sedation (with xylazine) dose is 6 – 10 mg/kg is administered
I/V)
 Horses: 6-15 mg/kg [with premedication]
 Cattle: 5-10 mg/kg
 Pigs: 5.5-11mg/kg
 Small ruminants: 8-30 mg/kg
Thiamylal (I/V)

 17.5 mg/kg is produces surgical anaesthesia for approximately 15 min

Methohexital (I/V)

 Twice or thrice potent than thiopentone

 Dose in dogs: 6 – 10 mg/kg I/V (1 % Solution)
 Cats: 5 mg/kg I/V (0.5 % solution)
 ½ of calculated dose is injected I/V rapidly and the remainder is administered slowly
“to effect”
Barbiturate slough

Barbiturates have a pH of 11 and above. If injected perivascularly, concentrated solutions

causes necrosis. So infiltrate the area with normal saline/ 1-2 ml 2% lidocaine/use hot
packs. Vasodilator effect of lidocaine aids dilution and absorption of barbiturate. Also
lidocaine is broken down by alkaline medium. Hence barbiturate is neutralized.

Dissociative Anaesthetic agents

Ketamine

 NMDA receptor antagonists

 NMDA receptor is an ionotropic receptor that allows the transfer of electrical
signals between neurons in the brain and in spinal cord.
 (NMDA agonists: Glutamate and Glycine).
 Ketamine also binds to opioid N receptors and sigma receptors
 Ketamine produces a loss of sensory perception of response and a state of altered
consciousness (coma like) often referred to as CATALEPTOID ANAESTHESIA,

91
 which differ markedly from the classic signs of anaesthesia produced by volatile
gases anaesthetics and barbiturates
 In ketamine anaesthesia, the eyes remain open with active corneal and pupillary
light reflexes suggesting that the mechanisms involved in dissociative anaesthesia
are different from those of inhalant anaesthetics
 Ketamine appears to alter the reactivity of the CNS to various sensory impulses
without blocking the sensory input at spinal or brain stem levels. The input may
reach cortical receiving areas, but it fails to be perceived because of the associated
areas during anaesthesia.
 Ketamine is a clear colourless, odourless solution soluble in water and
commercially available as a 1% (10 mg/ml) and 5% (50 mg/ml) solution in India.
 The solution has a pH of 3.7 and is an irritant when given intramuscularly
 Ketamine is a potent convulsant and may induce seizures when used alone.
 Ketamine increases intracranial and intraocular pressure.
 Ketamine increases the respiratory rate but the tidal volume is decreased
 Ketamine produce apneutic pattern of breathing.
 Xylazine in combination with ketamine improve muscle relaxation, the degree of
visceral analgesia and recovery.
 Dosage of Ketamine
o Dogs : 5 – 10 mg/kg b.wt I/M or I/V
o Horses : 2.2 mg/kg b.wt I/V
o Cats : 11 – 44 mg/kg b.wt I/M , I/V
o Cattle : 2 – 4 mg/kg b.wt I/V
Alkyl Phenols
Propofol
• Active ingredient is 2,6 diisopropylphenol
• It is an oil in water in emulsion with the following ingredients:
Soyabean oil, purified egg phosphatide, glycerol
• Cardiovascular and respiratory effects are similar to thiopentone
• Perivascular or intra-arterial injection does not damage tissue
• No effects on bronchomotor tone or gastrointestinal motility
• A brief period of apnoea may occur after induction
• Propofol reduces the risk for catecholamine induced cardiac arrhythmias
• Rapid excitement free recovery is the peculiarity
• In cats recovery may be slightly prolonged than in dogs as they are unable to
conjugate phenols
• It does not trigger malignant hyperthermia in pigs
• Minimal foetal depression after use in c-section
• Recovery is prolonged in grey hounds
Dose:
Unpremedicated dogs and cats: 6 – 8 mg/kg I/V
Premedicated dogs, cats,horse: 2-4 mg/kg I/V

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 LESSON 4

INHALANT ANAESTHETICS

Nitrous oxide: (N2O)

 Laughing gas
 Oxide of nitrogen
 Possesses analgesic property
 Non inflammable gas with sweat odour and taste
 MAC : 80%
 Blood – gas partition coefficient : 0.46
 Vapour pressure : 38628 mmHg at 00C
41457 mmHg at 200C

Halothane: (C2HBrF3)

Halogenated hydrocarbon (not an ether)

Only inhalant anaesthetic having Bromine
2 – bromo – 2 – chloro 1,1,1 trifluro ethane
Colourless and pleasant smelling
Unstable and decomposes when exposed to UV light (contains 0.01% thymol as a
stabilizing agent). Halothane is stored in dark coloured bottle since it is sensitive to
light exposure,
 Halothane increases the cardiac sensitization to catecholamines
 Catecholamines causes cardiac depression at high levels (bradycardia)
 Halothane causes bronchial relaxation
 Lacks airway irritation and used as inhalant induction agent.
 Contraindicated in patients with cardiac failure, arrhythmiasis and high
catecholamines (phaeochromocytoma)
 Repeated exposure to halothane causes “halothane hepatitis”
 MAC : 0.75%
 Blood – gas partition coefficient : 2.5
 Oil – gas partition coefficient : 224
 Vapour pressure : 244 mmHg at 200C
Methoxy flurane (C3H4Cl2F4O)

 Halogenated hydrocarbon/halogenated ether

 Vapour is pleasant and of fruity aroma
 Potent analgesic
 Very slow is onset and offset
 Hepatotoxic and nephrotoxic
 Concurrent use of oxytetracyclines and methoxyflurane results in fatal renal toxicity
 Used as an emergency analgesic

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  MAC : 0.2%
 Blood – gas partition coefficient : 15
 Oil – gas partition coefficient : 950 (extremely potent)
 Vapour pressure : 23 mmHg at 200C
Isoflurane (C3H2ClF5O)

 Halogenated ether
 Vapour – pungent and irritate respiratory passage
 Has analgesia and possess muscle relaxing property
 Binds to GABA, Glutamate and Glycine receptors
 Isoflurane is stable when exposed to UV light
 MAC : 1.15%
 Blood – gas partition coefficient : 1.4
 Oil – gas partition coefficient : 98 (extremely potent)
 Vapour pressure : 238 mmHg at 200C
Sevoflurane (C4H3F7O)

 Highly fluorinated methyl isopropyl ether (used for induction and maintenance)
 Sweat smelling and preferred for mask induction
 Block NMDA receptors, binds to GABA receptors
 To degradation products are produced when sevoflurane comes in contact with
sodalime, compound A and B compound A is nephrotoxic
 MAC : 2%
 Blood – gas partition coefficient : 0.68
 Oil – gas partition coefficient : 47
 Vapour pressure : 157 mmHg at 200C
 After desflurane, sevoflurane has the fastest onset and offset.

Anaesthetic Machines
Helps in delivering anaesthetic gasesprecisely to the patient. MAC is considered while
maintaining anaesthesia.
Anaesthetic machines mainly consists of basic components and breathing systems.
If the oxygen flow rate is equal to the patient’s metabolic oxygen consumption rate, it is a
closed circuit. In a semi-closed circuit, the oxygen flow rate will be greater than the patient’s
metabolic oxygen consumption rate
Basic components
It includes the following:
1. Sources for medical gases
2. Pressure regulator
3. Flowmeters
4. Vapourizer

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Breathing systems

 Supply oxygen and anaesthetic gas/vapour to the patient and eliminate carbondioxide
from exhaled gases.
 It includes
1. Y piece
2. Breathing tubes (inspiratory and expiratory)
3. One way/unidirectional valve
4. Fresh gas inlet
5. Pop off value or APL valve
6. Reservoir bag
7. Manometer
8. CO2 absorber
Pressure areas:

High pressure areas

 Gas cylinders
 Hanger yokes
 Yoke blocks
 Pressure gauges
 Regulator (pressure may as high as 2200 Psi)
Intermediate pressure

 Pipeline from regulator to flush valved and flowmeters

 Flow meter assembly
 O2 Flush apparatus (37 – 50 Psi)
Low pressure area

 Pipeline from between the flow meter to common gas outlet

 Vapourizer
 Pipeline from common gas outlet to breathing system (0 – 30 cm H2O)
Sources for medical gas

 Oxygen is commonly used carrier gas

 O2 is supplied in pressurized cylinders at 2000 – 2200 Psi
 O2 cylinder colour code in India is black with white shoulders
 1 atmospheric pressure = 14,693 Psi (2200Psi = 150 atm p)
 The pressure within O2 cylinder will be as high as 150 times the atmospheric pressure
 The pressure within the pneumatic tube of a bus tyre is 3 – 4 times the atmospheric
pressure
 O2 cylinder break a concrete wall and move like a rocket if accidental breakage of
valve occurs
 “E” type O2 cylinders are designed to be fitted with anaesthetic machine. The volume
of O2 in the cylinder can be calculated as pressure withincylinder (Psi) X 0.3

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  “G” or “H” type cylinders are bigger in size and are commonly used for centralized
O2 supply. The volume of O2 in litres in bulk cylinders can be calculated as,
Pressure within cylinder (in Psi) X 3
Pressure Regulators


The pressure regulators reduce the cylinder pressure and supplies O2 at 50 – 60 Psi
(the working pressure of most anaesthetic machines).
Flow meters

 Flow meters regulate the volume of O2 or nitrous oxide delivered to the breathing
system
 The float in the flow meters are of two types- rotor type and ball type
 For rotor type, the top reading of the float should be used
 For ball type, the center reading should be used
Vaporizers

Vaporizers are the apparatus which vaporizes the volatile anaesthetic agents and an
O2 anaesthetic vapour mixture is supplied to the patient.
 Vaporizers are of two types
1. Precision vaporizer’s
2. Non precision vaporizer’s
 Precision vaporizers are the one which delivers precise concentration of anaesthetic
vapour irrespective of the flow, temperature and atmospheric pressure.
 Based on the location of the vaporizer, they can be called as vaporizer out of circle
and vaporizer in the circle
 Vaporizer located out of breathing systems are called Vaporizer out of circle and
they offer least resistance to the respiratory effort of the patient.
Flush Valves

 The flush valves delivers a high but unmetered flow of oxygen (35 to 75 lit/min) to
the common gas outlet or to the breathing system
Breathing system:

“Y” piece

 The ‘Y’ piece unites the endotracheal tube connector and the inspiratory and
expiratory breathing tubes
 The ‘Y’ piece contributes to the system’s mechanical dead space
Breathing tubes


Breathing tubes are usually made of rubber, plastic or silicone and serve as
flexible, low resistance conducts between the ‘Y’ piece and the one way values.
 The breathing tubes are corrugated to reduce the likelihood of kinking and
breakage
One way (unidirectional) valves

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  These paired valves direct gas flow away from the patient on expiration and towards
the patient on inspiration, preventing rebreathing of exhaled gases before they pass
through the CO2 absorbent canister
Fresh gas inlet

 The fresh gas inlet is the location at which gases from the common gas outlet of the
anaesthesia machine enter the circle system
Pop – off valves: (Adjustable pressure limiting value)

 The pop off valve vents gases to the scavenger system to prevent the building up of
excessive pressure within the circle and it allows rapid elimination of anaesthetic
gases from the circle when 100% O2 is indicated.
Reservoir Bag

 The reservoir bag meets the patients peak inspiratory flow demands and provides
compliance in the system during exhalation
 The bag can be used for providing assisted ventilation
 Excursions of the bag during spontaneous ventilation allow the anaesthetist to assess
respiratory rate and to roughly estimate the ideal volume
 The minimum size of the reservoir bag should be six times the patients tidal volume
Manometer

 A manometer is a pressure gauge attached to the absorber assembly to assess

pressures during assisted or controlled ventilation
CO2 Absorber

 The absorber assembly contains the canister for the chemical absorbent ( soda lime or
Baralime) for carbondioxide
 It is located between the two unidirectional valves
The size of the CO2 absorber considered should be twice the patient’s tidal volume.
 Soda lime
o Ca(OH) 2 – 94%
o NaOH – 5%
o KOH – 1%
 Bara lime
o Ca(OH) 2 – 80%
o Ba(OH) 2 – 20%

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 LESSON 5

MONITORING GENERAL ANAESTHESIA

Monitoring the central nervous system

This is possible by carefully observing the signs of anaesthesia.

I. MONITORING THE CIRCULATION

The heart rate, tissue perfusion and blood pressure are to be analysed at different intervals
in an animal undergoing anaesthesia

1. Measurement of heart rate

The lowest acceptable heart rates during anaesthesia are as follows:

Large dogs: 55 beats/minute

Adult cats: 65 beats/minute

Horses: 26 beats/minute

Cattle: 50 beats/minute

Heart rate can be indirectly counted from the peripheral arterial pulse. In dogs, lingual
artery or femoral artery can be palpated. In cats, femoral artery; horses,
facial/median/metatarsal artery and in ruminants and pig, femoral/median/auricular
arteries can be palpated. In dogs and cats, the heart rate and rhythm can be monitored
with an oesophageal stethoscope. This is passed into the oesophagus till the balloon end
at the tip is in level with the heart. The other end is connected to a head piece of an
ordinary stethoscope/ amplifier. Bradycardia is to be treated if blood pressure and
peripheral perfusion are also decreased.

2. Electrocardiography
Heart rate and rhythm can be monitored by connecting standard ECG leads. Error in
ECG values can result if there is poor contact of electrode to skin or proximity of ECG
apparatus to another electrical apparatus. Base apex lead is a commonly used monitor
lead in cattle and horses. The right arm electrode is clipped on the neck in the right
jugular furrow and the left arm electrode is passed between the forelimbs and clipped at
the apex of the heart over the left 5th intercostal space several inches from the midline.
The left leg electrode is clipped on the neck or on the shoulder. Good electrical contact is
achieved with alcohol or electrode paste. The normal configuration in lead I in equines
includes a negative R wave. It is also normal to find a bifid P wave in equine ECG. If AV
block is seen during anaesthesia in conditions other than when giving detomidine or
intravenous xylazine premedication the chance of progression to cardiac arrest is more.

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3. Tissue perfusion
Tissue perfusion can be evaluated by gum or lip mucous membrane colour, the
capillary refill time, and the blood pressure. Pale gums, CRT of greater than 1.5 seconds
and mean arterial pressure of less than 60 mm Hg are indications of reduced tissue
perfusion.

4. Arterial blood pressure

Normal systolic arterial pressure (SAP) in healthy awake animals is 140-160 mm Hg,
MAP is 100-110 mm Hg and diastolic arterial pressure is 85-95 mm Hg. Most of the
times anaesthesia leads to a decrease in these values except in certain circumstances.This
include the preanaesthetic use of medetomidine or detomidine and the use of
ketamine/tiletamine as induction agents. In paediatric patient the arterial pressure will be
still lower. A mean arterial pressure of less than 65 mm Hg is termed as hypotension and
needs appropriate treatments like decreasing the depth of anaesthesia, increasing the
intravenous fluid administration or administration of drugs like dobutamine. Blindness or
renal failure after recovery are the possible outcomes of an untreated prolonged
hypotension. In horses in addition to the above postanaesthetic myopathy also may be
encountered. It is important to monitor blood pressure as the heart rate may be in a
normal range when the blood pressure is low. Indirect measurement of blood pressure is
possible by using Doppler ultrasound technique in dogs and cats, and direct blood
pressure measurement using an anaeroid manometer in horses. For direct measurement
a catheter is introduced into a peripheral artery which is connected by saline filled tubing
to an anaeroid manometer.

5. Central Venous Pressure

Central venous pressure can be monitored by introducing a catheter into the jugular
vein till its tip lies in cranial venacava. Then the catheter is connected to a manometer by
a three way stopcock. Oncethe catheter is in venacava, the level of fluid in the manometer
tube moves in time with the respiratory movements of the animal. The CVP is read off
when the fluid fall stops. The zero of the manometer scale should be in level with the
sternal manubrium. CVP indicates whether the blood volume is adequate or not. Normal
CVP in small animals ranges from 0-5 cm of H2O. A value less than 0 indicates
hypovolaemia and above 12 indicates heart failure or fluid overload.

6. Left Atrial Pressure/Pulmonary Artery Wedge Pressure

It is a measure of left atrial filling pressure. A balloon tipped catheter is advanced into
the pulmonary artery via the jugular vein. Once inside the pulmonary artery the catheter
tip is advanced further so that it wedges in a small pulmonary vessel. A manometer is
connected to the catheter and the reading is noted. Balloon should only be inflated when
measurements are being made.

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7. Cardiac Output
Measured by invasive techniques like direct/indirect Fick estimations, dye
(indocyanine green) or thermal dilution. Non-invasive method involves Doppler shift
measurements.

8. Measurement of blood loss

Usually 20 % of the blood volume may be lost without signs of hypotension. In
animals which are healthy, well ventilated, maintained in light plane of anaesthesia with
intravenous balanced electrolyte solutions and vasoactive drugs, even a blood loss of 40
percent can be well afforded without causing any hypotension/ hypoxia. Blood loss
during surgery can be estimated from the following formula:

Weight of n no: of blood soaked gauze swabs-weight of n no: of dry gauze swabs =
weight in gram,

1 gm = 1mL blood

Total blood volume in healthy adult animals are as follows:

Dogs: 86 ml/kg body weight

Cats: 56 ml/kg

Draught horses and ponies: 72 ml/kg

Thoroughbreds and Arabian horses: 100ml/kg

Sheep: 60 ml/kg

II. MONITORING RESPIRATORY SYSTEM

1. Respiratory Rate Monitors and Apnoea Monitors

They count only respiration rate. They do not evaluate whether the respiration is
providing adequate oxygenation to the tissues. They are kept in front of the nose or
connected to an endotracheal tube. The temperature difference between the inspired and
expired gas is counted these rate monitors by means of thermistor connected to a digital
rate meter. If no temperature difference is noticed in the gas, then the alarm rings.

2. Tidal and Minute Volume Monitors

They monitor the volume of each breath and the volume of gas exhaled/inhaled per
minute. The equipment used is called respirometer and is connected within the
anaesthetic circle circuit or to the endotracheal tube.

3. Measurement of Arterial PH and Blood Gas Tensions

Measurement of the partial pressure of carbon dioxide (PaCO2) in a sample of arterial
bloodbyblood gas analysis is the best monitor of ventilation. Arterial blood may be

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 collected from anyperipheral artery used for blood pressure measurement. pH and Blood
gas analyzers measure pH, PCO2, PO2. PaCO2 values exceeding 60mmHg are indicative
of significant respiratory depression. A decrease in PaCO2 (hypocapnia) is due to
increased ventilation. A PaO2 less than 20 mmHg causes cerebral vasoconstriction and
cerebral hypoxia.

4. Pulse oxymeter
Detects inadequate oxygenation of blood and not tissue oxygenation. In presence of
hypotension, though the blood may be adequately oxygenated, the tissues may not be
perfused adequately. The principles of measurement are based on the different light
absorption spectra of oxyhaemoglobin and reduced haemoglobin, and the detection of a
pulsatile signal. Reflectance pulse oxymeters detect changes in absorption of light
reflected from tissues.

5. Anaesthetic gas analyser

It measures the concentration of inhalation anaesthetic agent in inspired and expired
gases. To assess the depth of anaesthesia, the end-tidal concentration of inhalation agent
is measured (alveolar concentration is measured at the end of exhalation) and compared
with the MAC value for that inhalant anaesthetic and species. Usually 1.2 to 1.5 times
MAC value is needed for surgical anaesthesia.

6. Capnography
Capnography indirectly estimates PaCO2 by measuring the concentration of CO2 in
expired gas. Capnography is also useful for diagnosis of mechanical problems in
anaesthetic circuits, airway obstructions, and cardiogenic shock.

III. MONITORING BODY TEMPERATURE

It is important to monitor body temperature either rectal or oesophageal before and

during anaesthesia. Cold operating room conditions, skin preparation with cold solutions,
abdominal surgical exposure and administration of unwarmed intravenous fluids
contribute to hypothermia. Furthermore, anaesthetics inhibit thermoregulation,
vasoconstriction, and shivering, thereby decreasing the threshold for cold responses. A
decrease of 1 to 3° C from normal prevents cerebral ischaemia and hypoxaemia, but
below 32.8 ° C (91 ° F), irreversible cardiovascular depression may develop.

Hypothermia can be prevented by plastic covered foam pads and hot water circulating
pads to lie on, wrapping of extremities with towels or plastic insulation and administering
warm fluids. Heat loss from the respiratory tract may be minimized by employing
rebreathing circuits and low flow administration. Heat loss in small cats and dogs is
effectively limited by insertion of a low-volume passive humidifier.

Hyperthermia during intraoperative period results from excessive application of heat

in anattempt to prevent hypothermia or by a pyrogenic reaction to a bacterial infection, a

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contaminant in intravenous fluids, or drugs. Other causes are loss of central nervous
system temperature regulation, thyrotoxicosis, or phaeochromocytoma.

IV. MONITORING URINE VOLUME

Urine volume is a sensitive indicator of circulating blood volume during anaesthesia.

Measurement is advised in renal diseases and circulatory failure from non-renal causes.
Catheterise the bladder and connect it to a plastic bag prior to induction of anaesthesia.
Urine output of less than 1ml/kg/hour is inadequate and requires treatment.

V. MONITORING BLOOD GLUCOSE

Monitoring of blood glucose is important as the consequences of hypoglycaemia are

coma, hypotension, or prolonged recovery from anaesthesia with depression, weakness,
or even seizures. Pediatric animals, diabetics, liver diseases etc are of concern. 5 %
dextrose in water at a rate of 2 to 5 ml/kg/hour is given in high risk patients to maintain
blood glucose level along with balanced electrolyte solutions at 5 to 10 mg/kg/hour.

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 LESSON 6

ANAESTHETIC EMERGENCIES AND THEIR MANAGEMENT

The most commonly encountered anaesthetic emergencies and their treatments are given
below:

Anaesthetic emergencies affecting respiratory system

• Apnoea
– Cessation of breathing
– Seen on induction with thiopentone/propofol
– Cardiac arrest can lead to stoppage of respiration
– Muscle relaxants will relax all the muscles including respiratory muscles
• Hypopnoea
– Decrease in the rate and depth of respiration
Causes:
– Increased abdominal pressure
– Deep plane of gas/barbiturates
– Narcotic/sedative overdosage
• Tracheal tug
– Jerky respiration
– Seen in cases of intercostal and diaphragmatic paralysis
• Apneustic breathing
– Series of slow deep inspirations
– Seen during deep plane of barbiturate and chloral hydrate anaesthesia in
horses and also during ketamine anaesthesia in cattle
• Gasping
– Seen prior to respiratory arrest
– Cardiac arrest
• Hyperpnoea and tachypnea
– Hyperpnoea is the increase in depth of respiration
– Tachypnoea is the increase in rate of respiration
– Usually seen during surgical stimulation in light plane or because of
hypercapnoea/hypoxia
– High halothane concentration causes tachypnea in cattle, horse, cat and dog
• Respiratory obstruction
Causes may be:
– Improper patient positioning
– Occlusion of mouth and external nares
– Elongated soft palate and eversion of lateral ventricles
– Kinking of endotracheal tube
• Laryngeal spasms
– Intubation in light plane can induce spasms of larynx
– Common in cats, sheep, goats, swine, rabbits if high concentration of inhalants

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 • Broncheal spasms
– Common in ruminants
– Increased respiratory tract secretions and anaesthetic vapours can cause
bronchial spasms
– If intubation is causing stimulation of carina there will be bronchial spasms

Treatment for respiratory emergencies:

• Lidocaine spray for laryngeal spasms

• Deepen the anaesthesia to reduce spasms during intubation and apply proper
technique of intubation
• Decrease the anaesthetic depth in hypopnea and oxygen flushing may be given
• Administer respiratory stimulants and reduce anaesthetic depth in apnoea
• Cardiac resuscitation and inotropic drugs for cardiac failure

Emergencies of Cardiovascular System

Shock
Causes:
• Preanaesthetic and anaesthetic effects, haemorrhage, rough handling of
viscera/tissues, cooling of abdominal cavity and contents
Treatment

• Maintain ventilation
• Blood volume should be maintained with crystalloids / colloids
– CVP (central venous pressure): above 12 cm H2O indicates fluid overload
– PWP (pulmonary wedge pressure): should be in the range of 10-12 mm Hg
during fluid administration. This will prevent pulmonary oedema
– PCV< 30 %: whole blood is to be administered
– Buffered Ringer Lactate: dose is 8 times the lost blood
• Pumping of heart
– Can be maintained with drugs like dobutamine/digoxin
• Supportive therapy with antibiotics and analgesics
Cardiac arrhythmia

Causes:

• Thiobarbiturates, halothane, xylazine, succinyl choline, morphine

• Electrolyte imbalance, hypercapnoea/hypoxia
• Stimulation of pharynx/trachea, manipulation of eye
• Traction on intrathoracic/abdominal structures
Treatment

• Prior to anaesthesia: give antiarrhythmic drugs like acepromazine/ chlorpromazine

• Bradycardia: atropine i/v, Tachycardia: i/v propranolol
• Ventricular ectopic beats: i/v lidocaine, diazepam

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 • Rising CVP: dobutamine/isoproterenol
• Maintain proper ventilation
Cardiac arrest

Causes:
– Hypoxia/hypercapnia, electrolyte changes
– Anaesthetic drugs, cardiac diseases
– Electrocution
Treatment: CPR (cardiopulmonary resuscitation)

– ABCDD (Acronymn)
– Airway patent
– Breathing support
– Cardiac compression (100/ minute in dogs)
– Drug therapy for maintaining heart rate and rhythm
– Defibrillation if other treatments are not effective
Emergencies Affecting Nervous System
Cerebral oedema
Cause
• Hypoxia
Treatment

• Diuretics
– Mannitol: 1.5 g /kg i/v over 1 hour
– Furosemide: 5 mg/kg i/v
• Dexamethasone: 2-4 mg/kg i/v
• Lidocaine: 1.5 mg/kg i/v
• Preferred anaesthetics: thiopental, etomidate, fentanyl-droperidol
• Contraindicated: ketamine, halothane, enflurane, methoxyflurane
• Premedication with glycopyrrolate to prevent vomition/regurgitation which may
increase the intracerebral pressure
• Proper positioning
– Sternal recumbency with head down
– Chest higher than head and abdomen
• Remove the contents from respiratory tract
• Intubate and inflate the cuff of endotracheal tube
• Administer oxygen
Aspiration Pneumonitis

• Aspiration of regurgitated contents from stomach (gastric juice has acidic pH) to
respiratory tract is the cause
• Leads to tachypnoea, apnoea, cyanosis, patchy atelectasis

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Treatment

• Bronchial lavage with saline

• Hydrocortisone and antibiotics: intratracheally
• 100 percent O2
• Expectorants
• Inhalation of detergent aerosol
Anaesthetic Overdosage

• Absolute overdosage : more than calculated dose is administered

• Relative overdosage: normal calculated dose is administered but adverse effects are
seen
Treatment:

• Stop administration of anaesthetics

• Administer antagonist for reducing depression of respiratory center
• Eliminate the anaesthetics from the system by flushing oxygen ( in case of inhalalnt
anaesthetics) and increasing fluid administration rate in case of injectable anaesthetics
Barbiturate overdosage

• Hyperventilate
• Sodium bicarbonate i/v
• Phenothiazines i/v
• i/v saline only without any glucose
• Diuretics
• Peritoneal dialysis
• Maintain normal body temperature
Anaphylactoid Reaction

• Results from histamine release due to allergy to certain drugs like

• Morphine, succinyl choline,atropine, phenothiazine, saffan
• Arrhythmia and cardiac arrest may result
• High levels of epinephrine and glucose blocks histamine and hence suggested for the
treatment
Drug Interactions

Drug interactions are seen with the following combinations:

• Thiopentone-meperidone
• Thiopentone-pancuronium
• Narcotic analgesics-inhalant anaesthetics
Hypothermia

Cause

• Cool environment
• Anaesthesia can lower the body temperature

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 • Administration of unwarmed intravenous fluids
Treatment: heating pads/warm fluids

Hyperthermia
Cause
• Infectious agents/thyrotoxicosis/susceptibility to drugs as in malignant hyperthermia
• Malignant hyperthermia is common in landrace breed of pigs
Treatment

• Antibiotics
• Dantrolene (3.5-5 mg/kg) is the drug of choice for malignant hyperthermia
Perivascular Injection
Treatment
• Dilute with normal saline
• Injections to neutralize the drug
• Hot packs
• Hydrotherapy

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 LESSON 7

ELECTROANAESTHESIA, ACUPUNCTURE, NEUROLEPTANALGESIA,

MUSCLE RELAXANTS AND HYPOTHERMIA

Electroanaesthesia/Electronarcosis

• Principle: electrical stimulation of brain activates opiate/non-opiate pain control

pathways
• It is important to administer atropine and muscle relaxant before induction to prevent
salivation and convulsions respectively
• Intubate with endotracheal tube
• Direct current/alternating current (AC: 700 cycles, 35-50 mA, 40 V) is delivered
through needle electrodes applied to head
• Depth of anaesthesia is assessed from photomotor reflex
• This technique provides analgesia, but hyperthermia, increased blood pressure,
epinephrine, norepinephrine and blood glucose are reported
• Rapid arousal will occur once current is cut off
• This technique is used for performing painful procedures in research purpose where
use of other drugs need to be kept minimum
• Rapid recovery and less cost involved are the advantages
Acupuncture
 Acupuncture – is the technique of providing analgesia by needle placement alone or
needle placement combined with electrical stimulation of certain acupuncture points
(xue) in the body
 Acupuncture enables pain control by inhibition of pain perception and transmission at
peripheral, spinal and central levels and activation of descending pain inhibition
 Electrostimulation is given through acupuncture needles inserted into specific
acupuncture points
 26-34G needles are used in large animals, whereas, 28- 36G in small animals
 A frequency of <5 Hz ʋ activates Aδ fibres and release of enkephalins.
 A frequency of 100-200 Hz activates C- fibers and release of dynorphin
 A frequency of > 200 Hz: secretes serotonin and norepinephrine
 Induction is initiated in 10-40 minutes and duration of analgesia lasts for 20 minutes
 In addition to pain relief, stimulation of GV 26 (Renzhong), an acupoint in the
midline of the nasal philtrum, can resuscitate an animal from depression of
cardiovascular system due to opioids or volatile anaesthetics
• Disadvantages: inadequate muscle relaxation, cannot perform intrathoracic surgery
Neuroleptanalgesia
– Hypnosis and analgesia by combining a tranquilizer and analgesic
– Fentanyl- droperidol (Innovar vet)
– Etorphine-acepromazine (Immobilon LA)
– Etorphine-methotrimeprazine (Immobilon SA)

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 • Antagonist:
– Revivon LA- (Diprenorphine 3 mg/mL)
– Revivon SM – (Diprenorphine 0.272 mg/mL)
Muscle relaxants
1. Peripherally acting muscle relaxants

1a. Depolarizing muscle relaxants

– Act like Ach causing persistent depolarization due to Na++ inactivation

– Effect terminated by metabolism of drug by pseudocholinesterase
– eg. Succinylcholine (1-3 mts duration)
1b. Non depolarizing muscle relaxants

• Compete with Ach for post synaptic receptors and reduce depolarization caused by
Ach
• Effects can be reversed by anticholineesterase drugs like neostigmine or
edrophonium
Eg. Pancuronium, Mivacurium – (> 30 minutes: duration of action), Atracurium (10 to 30
minutes)

2. Centrally acting muscle relaxants

2a. Guaifenesin (Glycerol guaiacolate)

 Depress the nerve impulse transmission through spinal polysynaptic pathways that
maintain normal skeletal muscle tone
 Mild sedation and analgesia
 Do not cause respiratory paralysis
 Relaxes the pharyngeal and laryngeal muscles facilitating intubation.
 Administered as a 10% solution at 160mg/kg in horse to induce recumbency
 Administered as 5 % solution, 50 to 100 mg/kg to produce ataxic effect as i/v infusion

Hypothermia
• Principle: Fall in body temperature in warm blooded animal decreases metabolism
and oxygen need
• First administer phenothiazines/ general anaesthetics to prevent increase in
temperature by shivering
• Body cooling can be facilitated by
– Surface cooling
– Body cavity cooling
– Extracorporeal cooling
• Monitor temperature and remove from cold water before the desired body temperature
is reached
• Indicated in surgery of brain, spinal cord, heart and great vessels

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 LESSON 8

PAIN MANAGEMENT

Introduction

• Pain: unpleasant sensory and emotional experience associated with potential tissue
damage
• Acute pain: begins suddenly due to trauma/surgery/infection and is brief as alleviated
by analgesics
• Chronic pain:
– Persists for year, rarely diminishes with analgesics alone
– Instead a combination of analgesics,tranquilizers, physical therapy,
behavioural conditioning and environmental manipulation works
• Agology
– The science that deals with study of pain phenomena
• Noxious stimulus
– A potentially damaging stimulus to body tissue
• Nociceptive pain
– Transient pain in response to noxious stimuli
• Allodynia
– Pain caused by a stimulus that normally does not provoke pain
• Hyperalgesia
– An increased response to a painful stimulus
• Hypoalgesia
– A diminished sensitivity to pain
• Radiculalgia
– Pain along the distribution of one or more sensory nerve roots
• Wind up
– Temporal summation of painful stimuli in the spinal cord
– Mediated by C-fibers
– Second/delayed pain
• Preemptive analgesia
– Administration of analgesics before painful stimulation to prevent the
sensitization of neurons or wind up
The following are the pain pathways:
 Peripheral pain receptors
• Peripheral nerves

• Dorsal horn gray matter

• Spinothalamic tract nerves
• Thalamus
• Reticular activating system

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 Physiological process associated with pain perception:

Transduction (pain perceived by receptors are converted into electrical impulses),

transmission (these electrical impulses are conducted along the peripheral nerves to
dorsal horn of spinal cord and higher centers of brain), modulation (occurs in the
peripheral receptors, higher centers of brain and dorsal horn of spinal cord- here mild pain
is taken up as exaggerated pain by peripheral receptors due to activation of previous silent
nociceptors in presence of inflammatory mediators, winding up of pain occurs in the
dorsal horn, nociceptive stimulation of higher centers of brain releases pain alleviating
substances like enkephalins, endorphins and dynorphins in the dorsal horn), perception
(sense of pain by the individual).

Signs of pain

• Decreased appetite, altered gait, abnormal posture, decreased grooming, vocalization

• Pain during surgery is manifested as movement, tachycardia/tachypnea, increased
blood pressure, increase in circulating levels of ACTH, glucose, catecholamines,
lactic acid, free fatty acids, endorphins and enkephalins

Classification of Pain

Nociceptive/physiological pain
• It is non-tissue damaging stimuli that gives early warning
• Localized, transient and high threshold pain
Inflammatory pain
• Peripheral tissue damage initiates adaptive and protective pain
• Allodynia will be evident
• Hyperalgesia
• Poorly localized pain
Neuropathic pain
• Maladaptive pain due to damage to nervous system
• Low threshold spontaneous pain
Dysfunctional pain
• Low threshold spontaneous pain
• Abnormal pain processing
• No neural lesions/inflammation
Clinical pain
• Combination of inflammatory and neuropathic pain
• Arises due to pathologic hypersensitivity
Modes of Pain Management

• Surgical pain
- Can be prevented by administering inhalant anaesthetics, hypnotics, dissociative
anaesthetics, local anaesthetics, opioids, α2 agonists, NSAIDS
• Converting clinical pain to physiologic pain

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 – Opioids, α2 agonists, NSAIDS
• Preventing establishment of pain
– Pre-emptive analgesia
• Multimodal analgesia
– NSAIDS – Opioids
– Opioids - α2 agonists
– Morphine-lidocaine-ketamine
Drugs for Pain Management
NSAIDs

– Mode of action: inhibit COX

– They act in periphery to decrease production of algogenic substances
• Non selective COX inhibitors: Aspirin, phenylbutazone, ketoprofen, ketorolac,
flunixin meglumin
• Preferrential COX2 inhibitor with weak COX1 inhibition: Meloxicam, Carprofen,
Etodolac, Tolfenamic Acid
• Exclusive COX2 inhibitors: deracoxib, firocoxib, rofecoxib
• Preferrential COX3 inhibitor with weak COX1, COX2 inhibition: Acetaminophen
Ketoprofen: Dogs and cats – 2 mg/kg s/c once
- 1 mg/kg q 24 hrs

Ruminants: 1- 3.3 mg/kg i/v, i/m q 24 hours

Horses: 2.2 mg/kg i/v, i/m q 12-24 hrs

Meloxicam: Dogs and cats – 0.2 mg/kg i/v once

- 0.1 mg/kg i/v q 24 hrs

Tolfenamic acid: Dogs and cats: 4 mg/kg SC, PO q 24 hours for 3 days, 4 days off
Flunixin meglumine: Dogs – 1 mg /kg i/v once
Cats – 0.25 mg/kg s/c q 12-24 hrs
Cattle and horses: 1.1 mg/kg i/v 12 hours

Phenylbutazone: Horses: 2.2 to 4.4 mg/kg i/v, PO BID

Contraindications for using NSAIDS

• COX1 preferential contraindicated in spinal trauma

• Gastric ulcers
• Shock, haemorrhage, asthma, pulmonary disease (may give COX2 specific)
• Pregnancy, breeding , lactating animals

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Narcotic Analgesics/Opioids

• Mechanism of action
– Inhibit pain transmission in dorsal horn
– Activate descending inhibitory pathways
– Inhibit somato-sensory afferents at supraspinal level
• Bind with specific receptors in CNS to provide sedation, analgesia, respiratory
depression, excitement
• Stimulates vomiting center
• Elevates intracranial pressure and cause bradycardia
• Antagonist: naloxone, naltrexone
 Morphine
• Full opioid agonist
• s/c, i/m
• Histamine release after i/v administration
• Crosses placental barrier and depress foetal respiration
• Dogs:0.05-1mg/kg i/m,i/v, s/c q 1 to 4 hour
• Narcotic Analgesics
 Fentanyl
• Full opioid agonist
• i/v, transdermal patch
• Dogs: 1-2 µg/kg i/v cats: 1-3 µg/kg i/v q 25 to 50 minutes
• 2-5 µg/kg/hr transdermal for 2-4 days
• Narcotic Analgesics
 Butorphanol
• Agonist-antagonist
• 3-5 times more potent than morphine
• Good analgesic and fair sedative
• Bradycardia and respiratory depressant
• Dose
– Dogs and cat: 0.1-0.5 mg/kgi/v, i/m, s/c q 25 minutes – 2 hrs
– Cattle: 0.05-0.2 mg/kg i/v, i/m q 4 to 6 hrs
– Horses: 0.01 to 0.02 mg/kg i/v q 2 to 4 hour
 Pentazocine
• Agonist-antagonist
• Minimal CNS, respiratory and CVS depression
• Used for colic in horses
• Duration of action : 2 hours
• Dose
– Dogs: 1-3 mg/kg i/v , i/m
– Horses:0.3 mg/kg i/v
 Buprenorphine
• Partial agonist
• More respiratory depression than butorphanol

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 • Duration of action: 6-12hours
• Dose: Dogs - 0.01-0.04 mg/kg i/v, i/m
• Horse , cat: 0.001- 0.005 mg/kg i/v, i/m
• Ruminants: 0.005-0.01 mg/kg i/v, i/m, s/c
 Etorphine –M-99
• Used to immobilize wild game animals
– Dose
• 2µg/kg
– Immobilon LA: Etorphine + Acepromazine
– Immobilon SA: Etorphine + Methotrimeprazine
– Antagonist: Diprenorhine hcl - Revivon
Local Anaesthetics

• Bupivacaine
Dose:
– Dogs: 1.5 to 3.0 mg/kg locally/intrapleural q 2-6 hrs
– Cats: 2 mg/kg local anaesthetic block q 4-5 hrs
– Horses: 2 mg/kg infiltration q 6-8 hrs
• Lidocaine
Dose
– Dogs: 1-2 mg/kg q 1-2hrs
– Cats: 2-4 mg/kg q 1-2 hrs
Other analgesic drugs

• Ketamine
– Dogs and cats: 0.5 mg/kg i/v loading dose
0.1-0.5 mg/kg/hour i/v CRI (continuous rate infusion)

• Gabapentin
– Antiepileptic drug
– Central inhibition, reduce glutamate synthesis
– Neuropathic pain, arthritis
– Side effects: drowsiness, fatigue, weight gain
– Dose: Dogs and cats 2-10 mg/kg PO q 8-12 hr
• Tramadol (Not an opioid drug)
– Synthetic codeine analogue
– Weak µ receptor agonist (similar to opioids)
– Inhibits neuronal reuptake of norepinephrine and serotonine
– Neuropathic pain, osteoarthritis
– Contraindicated in seizures
– Dose: Dogs: 2-10 mg/kg PO q 12 hr
– Cats : 2-4 mg/kg PO q 6 hr- preemptive

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 LESSON 9

PRINCIPLES OF WILD ANIMAL ANAESTHESIA

Precapture Plan

• Decide whether physical/chemical restraint or a combination of both is to be used

• Be ready with all equipments
• Keep 50 % more drug than needed to compensate for target failures during darting
• Locate and estimate the weight of the animal from a safe distance
• Decide the drug to be used and calculate the dose
• Temperament of the animal should also be considered while calculating the dose
• Never preload metal darts for more than 12 hours
• Approach within 30-40 m distance to dart
• Chase should be limited to 2-5 minutes and should not be resumed within one day if
attempt fails
• Most important determinant of induction time is darting site
• Neck, shoulder and hindquarter muscle ensure quick absorption of anaesthetic drug
• Record time after dart placement
• If medetomidine-ketamine, xylazine-tiletamine-zolazepam are given, no movement of
animal’s limb or head should be there prior to approach
• If narcotics or tiletamine-zolazepam is used involuntary movements may be present
even while approaching
• After approaching the darted animal examine for the vital signs like rectal
temperature, respiratory rate, heart rate
• Apply hobbles for ungulates and ophthalmic gels if eyes are remaining open for long
• Carnivores should be resrtrained in lateral/sternal recumbency and ruminants in
sternal recumbency
• Pulse oximeter: hypoxemia
• Ungulates prone to hyperthermia
• Tiletamine-zolazepam recovery signs: spontaneous blinking; in carnivores: chewing
and paw movements
• Top up if more than 30 minutes needed
• Intramuscular antagonists for recovery
• Firearm back up for protection from dangerous animals
• Attack from other family members possible in lions and bears
• Captured animals should not be handled for 6 weeks
Complications of Capture

• Physical trauma
• Hyperthermia
• Hypothermia
• Bloat
• Exertional myopathy

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 - Acute death syndrome: death in 2-3 hrs
- Delayed peracute death syndrome: death in one day after capture if animals
are stressed
- Ataxic myoglobinuric syndrome: death within hrs-days
- Muscle rupture syndrome: death within 2-3 weeks
• Respiratory depression and hypoxaemia

Drugs for Wild Animal Anaesthesia

• Hellabrunn mixture: xylazine (125 mg/mL) + ketamine (100 mg/mL)

• Medetomidine
• Azaperone
• Etorphine
• Carfentanil
• Innovar Vet
• Immobilon SA
• Immobilon LA
Anaesthetic Protocols

Cheetah (adult-39-65 kg)

• Medetomidine (70 µg/kg) + ketamine (3 mg/kg)

• Reversal with 5 mg atipamezole/1 mg medetomidine
Asian Elephant (2000-5000 kg)

• Weight in kg= 18(heart girth in cm) – 3336

• For standing sedation: 0.3-0.7mg/kg ketamine + 0.1 mg/kg xylaxine i/m
African Elephant (4000-6500 kg)

• Drug of choice: Etorphine: 14-20 mg in bulls, 10-15 mg for cows i/m at

rump/shoulder
• Reversal with diprenorphine i/v (3 to 4 mg for every 1 mg etorphine)
• Anaesthetic Protocols
Lion (M: 150 – 240 kg, F: 120-180 kg)

• Medetomidine: 70 µg/kg + 2.5 mg/kg ketamine i/m

• Telazol: 0.8 mg/kg + medetomidine 50 µg /kg 1 ½ hr anaesthesia
Tiger (M: 180-260 kg, F: 100-160 kg)

• Medetomidine (70 µg/k) + ketamine (3 mg/kg) i/m

• Reversal with 5 mg atipamezole/1 mg medetomidine
• 0.8 mg/kg xylazine + ketamine: 11 mg/kg i/m
• Reversal with 0.125 mg/kg Yohimbine
• Telazol to be used with caution as reports of adverse effects
• Anaesthetic Protocols

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Giraffe (M: 1800 kg, F: 1180 kg)

• Adult bulls: 10 to 12 mg of etorphine + 40 to 60 mg of azaperone

• Adult cows: 8 to 10 mg of etorphine + 40 mg of azaperone for adult cows
• Reversal: Diprenorphine at 2.4 mg per 1mg etorphine
Rhinoceros (M: 850 - 1000 kg, F: 880 kg)

• Etorphine 2-4 mg + 50-150 mg azaperone

 Reversal: Diprenorphine at 2.4 mg per 1mg etorphine

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 LESSON 10

PRINCIPLES OF LAB ANIMAL ANAESTHESIA

General Considerations

• Acclimatize the animals to handling and restraint for 1-2 weeks

• Adult body weight: mouse: 25-40 g, rat: 300-500 g, rabbit: 2-6 kg, guinea pig: 700g to
1.2 kg
• Blood volume: 70 mL/kg body weight
• No food/ water withholding is needed prior to anaesthesia in rodents, guinea pigs and
rabbits
• Non-human primates: withdraw food for 8 hours and water for 2-3 hrs pre-operatively
• Pre-emptive analgesia should be given if surgical/painful procedures are to be
performed
• Preanaesthetic medication:
• Not needed in rodents
• Rabbits: sedatives/tranquilizers/glycopyrrolate should be given
• Nonhuman primates: ketamine is used alone for restraint, medetomidine-
ketamine combinations may also be used
• Guinea pigs: if isoflurane is to be given, prior preanaesthetics administration is
needed as isoflurane increases respiratory tract secretions
• Maintain body temperature using heating pads at 37 to 39 ° C
Commonly used anaesthetics and doses in various lab animals:
Rabbits
Ketamine/xylazine: 35 – 60 mg/kg + 5-6 mg/kg i/m
Propofol: 10 mg/kg i/v (Light anaesthesia)
Thiopentone: 30 mg/kg i/v
Nonhuman primates
• Alphaxolone-alphadolone: 12-18 mg/kg i/v, i/m
• Ketamine/diazepam: 15 mg/kg i/m + 1 mg/kg i/m
• Ketamine/xylazine: 10 mg/kg i/m + 0.5 mg/kg i/m
• Propofol: 7.5-12.5 mg/kg i/v
Mice
• Ketamine/xylazine: 80 mg/kg + 10 mg/kg intraperitoneally
Rats
• Ketamine-xylazine: 75 mg/kg + 10 mg/kg intraperitoneally
Guinea pigs
• Ketamine-xylazine: 40 mg/kg + 5 mg/kg intraperitoneally
• Inhalation agent of choice: methoxyflurane (1 to 2 mL for mask induction)
Hamsters
• Ketamine-xylazine: 100 – 200 mg/kg +10 mg/kg intraperitoneally

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 DIAGNOSTIC IMAGING

LESSON 1

PRODUCTION AND PROPERTIES OF X-RAYS

X- rays: Electromagnetic radiations of high energy and low wavelength produced by the
conversion of Kinetic energy of electrons into electromagnetic radiations.

Physical properties of X-rays

1. These are Electro Magnetic radiations and behave as waves.

2. Their wavelength ranges from 0.1 – 0.5˚ A with energy levels of 25 – 125 KeV.
3. These are high-energy radiations with high frequency. Energy is inversely related
to wavelength.
4. Because of their high energy, X-ray can able to penetrate materials, which readily
absorb and reflect visible light.
5. X- rays travel in a straight line with the speed of light. (3 x10 10 cm/sec).
6. X- rays cannot be focused by a lens.
7. X- rays do not possess mass or charge and thus are unaffected by electrical or
magnetic fields.
8. X- rays interact with matter, are absorbed or scattered and liberate minute heat on
passing through it. Thicker and denser the material more is the absorption and
scattering.
9. X- rays affect phosphorescence or fluorescence in certain crystalline materials like
calcium tungstate and Zinc Cadmium sulphide.
10. X-rays affect photographic film by a chemical reaction initiated in a way similar
to that of visible light.
11. X-rays are able to produce indirect ionizing effect on gases because of their ability
to remove electrons from atoms.
X- ray Production:

1. A source of electron for producing X-ray

2. A Method of accelerating electron
3. An Obstacle free path for passage of high speed electron.
4. Target in which electrons can interact, releasing energy in the form of X-rays.
5. An envelope (tube) to provide a vacuum environment, eliminating air molecules
which are obstacles for electron stream and preventing rapid Oxidation of
elements.
Basically X- ray tube consists of cathode (-ve ) side and anode (+ve) side, encased
in a glass envelope which is evacuated to form a vacuum.

The production of x-rays occurs as a result of a sequence of events. The evacuated x-

ray tube is a device for producing free electrons from heated tungsten filament; the process is
called thermionic emission. The electrons remain in a constant agitated motion and their
number increases as the temperature of the filament increased. The electrons are focused
towards the anode with the help of focusing cup made up of Molybdenum. Now, the filament
or the cathode is given a very high negative electric potential and the target or the anode is
given an equally high positive electric potential. The resulting strong electrical field causes the

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cloud of electrons near the filament to rush up at a high speed through the vacuum tube and
bombard the target at the focal spot. The movement of electron from cathode to anode is called
as Tube current. This results in several types of interactions with the target material in the x-
ray tube. More than 99% of the kinetic energy of electrons is converted into thermal energy.
Approximately less than 1% of the remaining kinetic energy is irradiated as X-RAYS.
When the exposure is terminated, x-rays are no longer present in the room or in the
patient since, the x-rays travel at the speed of light. X-rays produced are traveling in all
directions. The lead housing surrounding the x-ray tube will absorb most of the x-radiation.
The useful x-rays are those x-rays that pass through the tube window and help to produce the
radiograph. The useful x-rays that leave the tube housing are called the ‘primary x-ray
beam’.

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 LESSON 2

FACTORS INFLUENCING PRODUCTION OF X-RAY

1. Kilovoltage (kVp) is the force that accelerates the electrons from the cathode to the anode. .
kVp means the kilovoltage peak or the crest of waveform representing x-ray photon energy.
The kVp is the force behind the stream of electrons that determines the speed at which the
electrons ‘slam’ or ‘bombard’ into the focal spot. It is the most significant factor in the
production of x-rays and radiographs. The stream of electrons is called the Tube current or
Cathode rays.
‘Kilo’ means one thousand. So, a kV setting of 80 means - 80,000 volts will be produced to
push the electrons across the x-ray tube at the time of exposure. The energy of the x-ray beam
is determined by the kilovoltage selection.
Increase in kVp increases the radiographic density
2. Milliampere (mA) is defined as the current that flow through the cathode filament at the
time of exposure. It is the second important technical factor.
An increase in milliampere will increase the number of x-ray photons in the x-ray beam. A
doubling of the milliampere will double the amount of blackening in the film.
“Milliampere” is the important ‘factor of choice’ to control the blackening of the film.
3. Exposure time(S) is the technical factor that controls the time of exposure. It is also a
quantitative factor (s), when combined with milliampere (mA) it determines the exposure rate
(mAs).
Milliampere x Time = Milliamperesecond, i.e. mA x s =mAs.
An increase in the mAs increases the x-ray photons exposing the film.
The mA and time relationship is inversely proportional and hence an increase in mA requires a
decrease in the exposure time.
4. Focal Spot
The focal spot on the target surface of the anode is the area which is bombarded, by the
electrons from the cathode during an exposure. The rotating target produces a focal track that
runs the circumference of the rotating disk. Umbra is the true object recorded on the film.
Penumbra is the thin blurred area around the umbra. Penumbra is unsharpness.
5. Focal – Film Distance (FFD) is measured from the focal spot to the recording medium (x-
ray film in the cassette). In veterinary radiography, 90-100cm FFD is considered a good
compromise between the distance and exposure factors.
Increase in FFD decreases the total number of x-rays available to expose the film.

Geometric factors:

I. Image magnification:
Magnification of some degree is usually present in every clinical radiograph because
the image formed is a two dimensional representation of a three dimensional structure.

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Magnification has to be kept as low as possible except in vascular radiography, to reduce the
magnification, part to be examined should be as close as possible to the film called as part
film Distance (PFD) should be always ‘zero’.

FFD/Source Image Distance - Between 90 – 100 cm will be a compromise between

magnification effect and increased exposure factors.

II. Image Distortion

A radiograph is not an exact picture of the structure being examined and differences
of varying degrees are present in the shape and size and such misrepresentation of shape and
size is called as Image Distortion. Distortion means unequal magnification of different
portions of the same object. The Distortion of image depends on shape of the object and
position of the object.

Elongation – Distortion of anatomic structure when the image appears longer than actual size
owing to the x-ray beam not being directed perpendicular to the film surface.

Fore shortening - Distortion of anatomic structure when the image appears shorter than actual
size due to the plane of interest not being parallel to the film surface.

Spatial Distortion - It can occur when objects of same size are positioned at different
distances from the film.

III. Image Unsharpness

Loss of detail due to geometric distortion.

a. Penumbra /edge gradient often called as geometric unsharpness which refers to partial
outer shadow of an object being imaged byillumination.
b. Motion Unsharpness - refers to loss of radiographic quality due to movement of either
the patient or the X-ray tube or the film during X-ray exposure.
c. Absorption Unsharpness- this type of unsharpness arise from gradual change in X-ray
absorption across the boundary or periphery or center of the object. This leads to
unsharp edges.
d. Screen Unsharpness - Unsharpness is caused by light diffusion in the screen phosphor
layer. This can be avoided by maintaining a good film-screen contact and by using a
fine grain screen. Use of intensifying screens with high intensification factors reduces
exposure factors but cause image unsharpness.

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 LESSION 3
PRINCIPLES OF VIEWING AND INTERPRETING X-RAY FILMS AND
CLASSIFICATION OF RADIOGRAPHIC LESIONS

Veterinary students should learn how to apply diagnostic imaging investigation and
how to recognize basic radiological signs, by the time they graduate and become hospital
doctors. Quality radiographs, detection knowledge and correlation of significant radiographic
findings with clinical data are essential. Radiography is not an absolute diagnostic tool but only
an adjunct to clinical diagnosis.
It is important to relate the changes seen to known behavior of tissues under
consideration, rather than relating radiographic appearance to a clinical condition seen before.
It is important to remember that each radiograph can only represent a fraction of a second in
the life of a patient, and the development of disease process. The x-ray picture is a static image
of a dynamic process. All the changes from the normal, should be used to build up an
impression which can be related to disease process known to occur in that region.
In order to interpret a radiograph for pathological lesion, it is essential that radiographic
appearance of normal structures are known. The radiograph should be interpreted without any
preconceived idea. Radiography is an aid to diagnosis and not the ultimate diagnosis itself.
For a given site, adequate evaluation usually requires a minimum of two views, to be
made at 90o to each other (orthogonal views). To evaluate fractures and postoperative fracture
repairs radiographs of the long bones must include the joints above and below the bone of
interest. Serial radiographs are necessary for correct interpretation of dynamic process e.g.
fracture healing and growth of bone tumors.
Radiographic interpretation should be done when the film is dry. The emulsion swells
when wet and details cannot be appreciated on wet films. It is helpful if the radiographs are
always viewed using the same orientation, i.e. with the animal facing the viewer's left.
Satisfactory radiographic interpretation is dependent on complete and systematic evaluation
of all the information that is found on the film. Close attention should be paid to the variations
in the outline and densities of the images in the film. Fine details of the radiograph should be
examined minutely.
The following points must be considered for effective interpretation of radiograph.
1. Important Factors for Accurate Interpretation
 The period of time during which the clinical signs have been present.
 The age, sex and breed
 The validity of history
 Possible complicating factors.
2. Viewing Box
X-ray should be viewed only on a viewing box with subdued light. This optimizes the
ability of the reader to differentiate the structures and to obtain the maximum information from
the film. The darker the film, the more important is to read the film under ideal conditions.

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Radiograph has variable grey shades. Black areas indicate areas or structures of low density
e.g. Air in Lungs. White areas indicate structures that have relatively high density e.g. Bone.
3. Distant Evaluation of X-ray
Prior to closer view, initially the film should be evaluated from a distance of several feet, in
order to get an overall impression before concentrating on details. Then start assessing the
radiograph itself for:
 Quality of the film
 Processing artifacts and other artifacts
 Exposure factors and penetration of the part of interest
 Sufficient radiographic density and contrast
 Elimination of motion during exposure
 Approximate age of the patient
 Soft tissue abnormalities
 Bone outline and internal structures.
4. Asses the Identified Abnormality
 Ensure that it is real and confirm it on another view.
 Asses the possibilities due to overlapping of bones or soft tissues.
 Differentiate normal variations and real abnormalities e.g. Nutrient foramen.
 Explain the radiolucent zone - whether due to introduction of air during injection of
local analgesics.
5. Describe the radiographic lesion in radiographic terms.
 Terms like smooth, regular, well defined etc. It will lead towards a conclusion of
normal, benign or long standing lesion.
 Other terms such as roughened, irregular, sharp, poorly demarcated or destructive, lead
to conclusions of active disease.
 Other pathological lesions also should be considered.
6. Assessment of the duration of the lesion
 Osteophyte formation less than three weeks
 Incomplete fracture takes 2 weeks to become visible
 Active bone lesions have irregular margins and less opaque than parent bone
 Inactive bone changes appear generally smooth, regular and uniformly opaque
 Scars in bone, as in other tissue, do not model.
The purpose of x-ray in facture is to asses:
 The type and severity of fracture
 The degree of displacement
 The damage to adjacent joint
 The damage to soft tissue
 The degree of reduction achieved.
7. For interpretation of skeletal X-rays
 For detection of fractures and dislocations, one x-ray is not enough
 For correct assessment of fracture at times more than one view is required
 Obtain minimum two views at right angles for all suspected fractures and dislocations
 The films must show the joint above and below any suspected fracture of the limbs

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  The tendon or vascular damage cannot be seen on routine x-rays
 Fractures of the shaft of bones are easily seen when there is break in the thick cortex
 When an obvious injury is seen, continue searching, as there may be other
abnormalities
 In non-union, the fracture line persists, the broken ends of the bone appear whiter
 For best visualization of a fracture, the x-ray beam must be parallel with the plane of
fracture
 All the changes from the normal should be used to build up an impression, which can
be related to disease process known to occur in that region
 Serial radiographs are necessary for correct interpretation of dynamic process e.g.
fracture healing and growth of bone tumors.
A working diagnosis can then be formed, which will complement any laboratory findings and
other imaging techniques and to help to confirm a clinical diagnosis.
There is no substitute for a good clinical diagnosis and examination, and radiograph should
only be used as an aid to clinical diagnosis.
The Radiographic Features of a few Specific Conditions
Serial radiographs are needed for correct interpretation of dynamic process fracture healing.
1. Fracture – Evaluation of normal healing pattern
 A lucent line or lines noticed at the beginning
 Osteocalcis along the fracture line within 5 days
 Bridging calcified periosteal callous formation
 Remodeling of callus with restoration of continuity of the medullary cavity and cortex
 Reformation of the normal trabecular pattern from one fragment to another
2. Fracture - Non-union
 The irregular translucent fracture line present
 The broken ends of the bone appear whiter (sclerotic)
 There is often thick new bone around the fracture
 There may be movement clinically
 Obliteration of the medullary cavity.
3. Dislocation
 Malalignment and displacement of the apposing articular surfaces
 Disruption of adjacent fascial plane
 Periarticular soft tissue swelling.
4. Septic Arthritis
 Periarticular soft tissue swelling and distension of joint capsule
 In early stages – increase in joint space due to synovial effusion
 As the disease progresses – Narrowing of the joint space due to destruction of the
articular surface
 In Advanced cases – Widening of joint space due to subchondral bone destruction.
5. Degenerative Joint Diseases
 Spurs or osteophyte formation along the articular margins of the bones (Lipping)
 Increased density of the articular ends the bones

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  Narrowing or collapse of the joint space
 Intra-articular and /or Periarticular calcification may also be present.
6. Lungs – Pneumonia
 Lung markings increased in both in size and number
 Increased patchy densities with irregular and indistinct borders
 In aspiration pneumonia – Irregular poorly defined areas of increased density noticed.
7. Pericarditis
 Cardiac shadow appears rounded and enlarged
 If traumatic in origin – Foreign body embedded in the pericardium may be visible.

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 LESSON 4

CONTRAST RADIOGRAPHY
When the radiodensity of the tissue itself or its surrounding tissues is deliberately
altered to obtain a radiograph with enhanced visualization and demarcation it is called as
contrastradiography. The substance used for this purpose is called as contrast medium. The
substances used for this purpose are called as contrast medium.

Contrast medium:

It is a substance which is either radio opaque or radiolucent, which can be

administered to the animal to increase radiographic contrast within an organ or a system.

Mainly classified as

1. Positive contrast agent- Those materials which increases the radiodensity of the
structure or tissue in relation to surrounding tissue. Atomic number more than 50.
2. Negative contrast agent- Those materials which relatively decrease the
radiodensity of the tissue or structure.

An ideal positive contrast agent possess the following properties

1. They should have desired atomic number.

2. They should be inert and its metabolic byproducts should not be toxic. Atomic
number of uranium is 92 and of Lead is 82 but they are toxic.
3. It should be retained in the area of interest only for a desired period.
4. Agents used for outlining the excretory organs must specifically be excreted
through that route in sufficient concentration so as to produce radiodensity of
diagnostic value eg. Barium sulphate for alimentary canal, Meglumine
iodopamide for biliary system.

A. Positive Contrast Agents:

1. Barium sulphate preparations

They are used mainly outlining alimentary tract. It is insoluble and is not absorbed in
the body. If perforations are suspected in the tract they should not be used. Because it enters
the peritoneal or pleural cavity and remains permanently inside and produce granulomatous
reactions. They are available as powder, paste and suspensions. They are used for
oesophagraphy, gastrography and reticulography. Barium meal is administered upto small
intestine but whereas Barium enema is used for rectum and colon. Trade name: Micropaque,
Baritop.

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 2. Water soluble Iodine Preparations

These form the largest single group of contrast medium. They are opaque to X-rays,
chemically inert, low in viscosity for rapid IV and low in toxicity, rapidly excreted in kidney
and chemically stable so no iodine is released in the body.

Tri-iodinated compounds are widely accepted because they are well tolerated by the
body and provide excellent contrast. They are supplied as sodium or meglumine salts of
iothalamic diatrizoic or metrizoic acids or as a mixture of these two salts.

E.g: Meglumine iothalamate called asconray 280

Sodium iothalamate called asconray 420.
Iohexol called as omnipaque 140, 180, 300, 350 etc.

These are indicated in angiography, osteomedullography, myelography, sialography,

cystography, arthrography, etc.

3. Cholecystopaques

These are water soluble organic Iodine preparations but exclusively excreted through
biliary system and gall bladder. They are used for outlining biliary system and gall bladder.

Eg: Iopanoic acid - Telepaque used in cholecystography

Sodium iopodate - Biliptin
Meglumine Iodipamide - Biligrafin forte I/V
Meglumine iodoxamate - Endobil
Meglumine iodipamide - Chrografin, Biligrafin

4. Viscous and Oily Preparations:

The oily contrast materials consists of iodised oils. The oil contains a suspension of
propyliodone in either water or arachidic oils. Because of viscous nature and insolubility in
water they are not reabsorbed in the body and produce fat embolism. Their uses are limited to
lymphangiography or lymphography, dacrocystorhinography, and hysterosalphingography,
sialography, myelography and bronchiography.

Eg: i) Propyliodone - Dinosil aqueous 280 and dinosil oily 340

ii) Iodised poppy seed oil - Lipidol (Ultrafluid 480)
iii) Iophhendylate - Myodil-300

B. Negative contrast agents:

They are gases that are more radiolucent to X-rays than that of soft tissues and have a
black appearance on a radiograph.

E.g. - Air, 02, N2, N2O and CO2.

Air, O2 and CO2 are commonly used. CO2has an advantage over room air as it is
better absorbed into body in hollow organs where room air cause air emboli.

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Contrast Techniques
There are many contrast techniques and the following are some of the important
contrast techniques.
1. Barium Series
This procedure is indicated to evaluate the structural and functional status of the
gastrointestinal tract in small animals. It should be avoided if rupture of the stomach or
intestine is suspected.
Technique (Calves, Sheep and Goat)
 Keep the animal off feed for 36 hours and off water for 12 hours.
 Administer 0.5kg. Magnesium sulphate orally 24 hours before the study.
 100gms.of activated charcoal given orally 12 hours before, to clear the gas in GI.tract.
 Give warm soap-water enema to clear the bowel.
 Administer 70% solution of barium sulphate @ 25-30ml/kg orally.
 Obtain lateral and ventrodorsal projections at various intervals.
The entire course of intestine is not visualized at one time. Most organs upto cecum are
visualized at 4 hours, while colon gets demarcated between 6-8 hours, after administration. In
case of dogs, the barium sulphate 15- 20% is used @ 6-12ml / kg and the laxatives are not
used.

2. Barium Enema
Barium enema is indicated to outline the colon and rectum to rule out intramural or
extraluminal obstructions. It should not be used if perforation is suspected.
Technique
 Keep the animal off feed for 36 hours and off water off water for 12hours.
 Give magnesium sulphate orally before 12 hours as a laxative.
 Give warm soap- water enema 2hours before.
 Sedate the animal deeply after controlling it in lateral recumbency.
 Raise the hind quarters for retention of contrast agent in the gut.
 Insert cuffed lubricated catheter into the rectum and inflate it.
 Administer micropulvarised barium sulphate 15-20% @15-20ml / kg.
 Obtain right lateral and ventrodorsal projections.
 Evacuate the contrast materials from the gut by elevating the cranial part of the abdomen
3. Barium Swallow (Oesophagography)
The technique is used to evaluate both structural and functional status of the
oesophagus after introduction of positive contrast agent.
The indications are:
 Oesophageal obstruction
 Oesophageal stenosis
 Oesophageal diverticulum
 Oesophageal perforations
 Oesophageal mucosal diseases
It should not be used if rupture of the thoracic part of oesophagus is suspected.

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Technique
 First obtain a survey radiograph of the area.
 Prepare barium suspension in water with the viscosity of light cream.
 Administer orally the barium swallow slowly (1-2ml / kg.).
 Make lateral radiograph of oesophagus at the last swallow.
Appearance
In the absence of obstruction, the mucosal folds appear as linear streaks. In case of
obstruction, barium gets accumulated cranial to the obstruction site. Diverticulum is identified
as an oesophageal out pouch filled with contrast agent.
4. Reticulography
It is indicated to diagnose, reticular hernia in bovines.
Technique:
 Keep the animal off feed for 24 hours and off water for 12 hours.
 Administer orally thick barium suspension (1 – 2kg.).
 Restrain the animal in lateral recumbency.
 Take a lateral radiograph after 40minutes.
It helps to differentially diagnose diaphragmatic hernia from pleurisy and phrenic abscess.
5. Pneumoperitoneography
Pneumoperitoneography is the radiographic study of the peritoneal cavity and its
contents after introduction of a negative contrast agent. If barium series and
pneumoperitoneum are combined it is called double contrast peritoneography. These are
indicated to visualize outline of various abdominal organs. It should not be used if
diaphragmatic hernia is suspected because of the risk of pneumothorax.
6. Arthrography
Arthrography is used to visualize structures of a diarthrodial joint after injecting a
positive or negative contrast medium or a combination of both. It is indicated to diagnose
various joint abnormalities.
7. Intravenous Pyelography
Intravenous pyelography refers to the contrast radiographic examination of the kidneys
and ureters after intravenous introduction of a positive contrast agent like iothalmate. It will
also give a rough index of kidney function. It is contraindicated in severely dehydrated
patients.
8. Myelography
This technique refers to the contrast radiographic examination of the spinal cord and
emerging spinal roots after injecting the contrast material, the metrizamide into the
subarachinoid space. It is indicated for the diagnosis of intervertebral disc protrusion,
intraspinal lesions and spinal cord oedema.

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Double contrast radiography
It is radiographic contrast study technique, which uses the combination of positive
and negative contrast media simultaneously. The positive contrast material is administered
initially followed by negative contrast material.
Triple contrast radiography
Infusing air into peritoneal cavity and obtaining pneumoperitoneum and then
administering double contrast to Rectum and colon obtain triple contrast radiography.
Indications for contrast radiography:
1.Structures or organs can be evaluated more effectively for theirsize, shape and position
2. Valuable information can be gained regarding serosal and mucosal surfaces of hollow
organs or their contents which otherwise not apparent on plain radiography
3. In some instances some idea on function of organ can be formed.
Contraindications.
1. They are chemotaxic or local reaction -The allergic responses, urticaria, head jerks,
muscle fasciculation etc. Hyper osmolarity of tri-iodinated compounds is the major
contributing factor.
2. Systemic or hypersensitive reaction - These may occur even in small dose of contrast
agent but increasing the dose increases the incidence. Mediator release or Histamine
release, antigen-antibody reaction or due to involvement of acute activation system.
Patients with pre-existing cardiac or renal abnormalities, diabetes mellitus and
dehydration are at high risk. Premeditation with steroids reduces the adverse effects.

Common Terminology used in contrast radiography:

1. Nephrography - Positive contrast radiography of kidneys.

2. Myelography -Subarachnoid space surrounding spinal cord.
3. Hysterography -Uterus
4. Fistulography - Fistula
5. Cystography - Bladder
6. Sialography - Salivary glands and ducts
7. Cholecystography - Gall bladder Bile duct
8. Reticulography - Reticulum (with barium)
9. Pneumocystography -Urinarybladder(Negative contrast study)
10. Vaginography -Female reproductive organs
11. Urethrography -Urethra in male
12. Oesophagography - Oesophagus
13. Intravenons pyelography - Kidney and ureter
14. Arthrography - Articular cartilage, joint space
15. Angiocardiography - Chamber of heart
16. Renal angiography - Renal vascular architecture and assessment of cortex
to medulla ratio.
17. Fasciagraphy - Tendons and associated structures.
18. Osteomedullography or intraosseous phlebography - to visualize intraosseous and
extraosseous venous channels of long bones.
19. Peritoneography - peritoneal cavity and its contents.

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 LESSON 5
BIOLOGICAL EFFECTS OF RADIATION, RADIATION HAZARDS AND
PREVENTION

"Radiation should be respected not feared"

Radiation or Radiant energy is energy emitted or transferred or propagated through the

matter (space).

Ionising Radiation is any type of energy or matter-energy combination capable of removing

one or more orbital electrons from the atom after interaction. The process is called as
Ionisation.

Once absorbed by tissue, all types of radiation produce changes within the living
tissue. The X-ray beam while traversing the tissues forces the electron to be ejected from the
atomic lattice. The atom is thus left with surplus positive electric charge. The cells within
the tissue come to a state of high chemical reactivity, which can initiate biological effects.

The cellular injury causes pathological and physiological changes leading to

"radiation sickness" and other manifestation of radiation damage to the body.

The radiation effects may be somatic or genetic. The somatic effects are harmful to a
person in his lifetime whereas genetic effects affects after generations.

Example for somatic damage is Leukaemia and Malignant tumour

Biological Effects of radiation are Direct and Indirect effects

After the transfer of radiant energy to the atoms and molecules in the form of
excitation and ionization, the resultant chemical changes in the molecules can be produced by
direct and indirect effects of radiation. The direct effects appear due to absorption of energy
by the molecules. Indirect effects are caused by the products of radiation decomposition
(Radiolysis) of water and other solutes of the body.

After radiolysis of water in the cells, there is formation of free radicals with unpaired
electrons. Hº and OHº are the free radicals and H2O2 formed by them are highly reactive and
mutagenic. The various types of damage produced by the radiation in a DNA molecule are
change of base called Deamination, loss of base, H+ bond breakage between chains, single
strand break, double strand break, cross linking with helix and cross linking with other DNA
molecules and proteins.

Radiation Sensitivity of Different Body cells:

All living tissues are susceptible to ionizing radiation damage. Affected cells may be
damaged or killed. Cells that are most sensitive to radiation are rapidly dividing cells i.e.
gonadal cells, neoplastic cells, growth cells and metabolically active cells.

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 Therefore persons under the age of 18 years and pregnant women should not be
involved in radiographic procedures.

Other tissues that are readily sensitive to radiation include bone, lymphatic, dermis,
leukopoietic and haemopoietic(blood forming) and epithelial cells.

Radiation Hazards:
Two types of biological damage can occur from over exposure to radiation

1. Somatic damage:
It is the term that describes damage to the body that become manifest within the
lifetime of the recipient. Radiation can produce immediate changes in the cell. The damage
may not be apparent for some time because body has ability to repair itself. Cell damage may
never be appreciated or visible. Damage is more extensive when the body is exposed to a
single massive dose of radiation than to smaller cumulatively equivalent repeated exposures.

Example: Cataract, Cancer, Aplastic anaemia, and sterility.

2. Genetic Damage:
Genetic damage from radiation occurs as a result of injury to the genes(DNA) of
reproductive cells. Ionising radiation can damage chromosomal materials within any cell. The
result of damage is determined by the cell type i.e. somatic cell or reproductive cell. Damage
to reproductive cell can result in the effect known as gene mutation. Genetic damage is not
detectable until future generations are produced. The offspring of irradiated persons may be
abnormally formed because of changes in the hereditary material resulting in alteration of
individual phenotype (physical appearance). The mutation may be lethal / only may visible
anomaly. The gene mutation may also lay latent or recessive until the second or third
generation.

Mortality from radiation is caused by exposure to extremely high levels of radiation.

Exposure to a large, single dose of radiation, as a form of hydrogen bomb is necessary to
cause rapid death.

A single exposure to a dose of 300 rad (radiation absorbed dose) or more has been
shown lethal to humans. The exposure received by any individual should never exceed the
maximum permissible dose (MPD)

The maximum permissible dose(MPD) is the maximum dose of radiation that a

person may receive in a given period.

Measurement of radiation or Radiation Exposure units:

1. Absorbed Dose:
It is the quantity of energy imparted by ionising radiation to matter per unit mass of
matter. The unit of Absorbed Dose is gray (Gy) previously called as rad (1 Gy = 100rad).
2. Dose Equivalent:
It is the quantity obtained by multiplying the absorbed dose in tissue by the quality factor.
This equation accounts for the differing biological effectiveness of equal absorbed doses and

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other modifying factors. The unit of dose equivalent is Sivert (Sv). Recently called as Rem
(Roentgen Equivalent Men) 1 Rem = rad X quality factor (ie. Biological effectiveness
of given radiation. The Quality factor for X-ray and Gamma rays is one and for alpha
particles 20).

Personal Monitoring Devices:-

The actual amount of irradiation received by those engaged in radiography can be monitored,
called as dosimetry.

Personal exposure monitoring devices called as dosimeters should be worn by personnel at all
times during radiographic procedures. These monitors are sent regularly to federally
approved laboratories where they are processed and dosage received is reported.In India it is
sent to Bhabha Atomic Research Centre (BARC), Trombay of Bombay.

1. Film Badge:
It is a method of dosimetry consisting of a plastic holder with a radiation sensitive film in
a light proof package. At 3 months of periodic intervals, these can be sent and radiation
exposed is monitored.

2. Pocket Ionisation Chamber

A method of dosimetry consisting of a charged ion chamber and electrometer, which can
be read immediately to determine the amount of exposure.

3. Thermoluminescent Dosimeter (TLD)

A method of dosimetry consisting of a chamber containing special compound that
become electrically altered by ionising radiation.

Prevention of radiation by adoption of safety measures:

1. By increasing the distance between radiation source and personnel. Doubling the
distance from the source will reduce the radiation exposure by a factor of four.

i. Remove all unnecessary personnel from the radiographic suit during exposure.
ii. Never permit patients under age of 18 or pregnant women in the radiographic suit
while in use.
iii. Rotate the personnel who assist radiographic procedures to minimize exposure.
iv. Use mechanical restraints whenever possible. e.g sand bag
v. Use of chemical restraints eg: tranqulizer, sedatives etc.
vi. Operator should be in a shielding booth or behind a shielding screen or atleast 6 feet away
from the X-ray source.

2. Use of protective barriers or X- ray protective apparels.

These barriers are used to seek protection against scattered radiation and not against
the primary beam.

i. Lead Apron - should have minimum thickness of 0.25mm to 1.0mm of lead

equivalent for voltages up to 100 kV. Rubber material impregnated in a plastic metallic

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lead.Usually 0.5 mm lead equivalent is present in the apron. The apron should never be
folded but kept flat, since lead shielding material tends to separate after repeated bending.

ii. Gloves and Goggles - lead equivalent should be not less than 0.33mm, voltage upto
100 volts. Goggles should be used during fluoroscopic examination.
3. X-ray room and equipment:

The X-ray room should be located away from traffic place and in those places where
public is likely to inadvertently exposed. The wall thickness should be 22cm thick concrete
wall or lead lining sandwiched between plywood in the wall.

4. Reduction of exposure factors and unnecessary radiograph

Correct exposure factor, correct positioning should be adopted. Avoid repetition of the
process. Unnecessary exposure should be avoided.

Radiation Safety Rules:

1. Remove all unnecessary personnel’s during exposure.

2. Never hold the X-ray cassette with hands during an exposure.
3. Never allow patients below age of 18 year and pregnant women.
4. Lead apron and gloves should be used.
5. Rotate personnel assisting in radiography to minimize exposure.
6. Use of Mechanical and Chemical restraints whenever possible.
7. Primary beam restricting device and Filter should be used.
8. Never permit any part of the body to be within the primary beam.
9. Do not direct X- ray beam directly at any personnel.
10. Fast speed screens may be used to reduce exposure factors.
11. Never hold the X-ray tube
12. Radiation monitoring devices should be used.
13. Plan the radiographic procedures to avoid retake.
14. Maintain Dark room chemicals in good operative conditions.
15. Have X-ray machines calibrated annually
16. Notice should be posted prominently near the X-ray unit indicatingpotential hazards
and need to wear protective apparels.
17. Warning light should be placed in the radiology unit during exposure.

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 LESSON 6
PRINCIPLES OF ULTRASONOGRAPHY AND ITS APPLICATIONS
IN VETERINARY PRACTICE

Ultrasonography has evolved as a very important non-invasive tool in veterinary

practice and an alternative diagnostic aid. Ultrasound (US) is a sound of frequency above
that perceived by the human ear. Normal human ear can hear about 20 to 20000 hertz,
ultra sound lies in 1to 10 Mega hertz region.

Normally a sound waves travel in a pulse and when it is reflected back it becomes an
echo. Based on the pulse echo principle, it is used for ultrasound imaging.

A pulse is generated by one or more piezo electric crystals in the transducer (scan
head). When this crystal is stimulated electrically, it changes its shape and produces
sound waves of a particular frequency. The frequency of a transducer determined by the
times the crystal expands and contracts per second.

The pulse travels through the body until it reaches a reflecting surface, at which time
a portion of the ultrasound pulse (the echo) is reflected back towards the transducer.

The transducer emits pulse less than 0.1 % of the time, allowing it to spend the
remaining time more than 99.9% for listening the returning echoes. The time needed for
the pulse to travel is directly proportional to the distance it has travelled and this allows
the determination of the reflecting surface position, which will be displayed as a dot on a
ultrasound screen at the appropriate depth. The brightness of the dot is determined by the
amount of ultrasound pulse that is reflected. As ultrasound travels through tissue, it
becomes weaker; this phenomenon is called as attenuation.

Like audible sound, ultrasound cannot be propagated in a vacuum and in gas, the
transmission is poor and so a coupling agent is needed to bridge the small gap between
the transducer space and the patient. This agent is a coupling gel applied to the contact
area of the patient. Since hairs traps air, it is important to clip the hairy parts of the patient
and shave closely prior to applying gel.

Advantages:

1. It has the advantage of being safe, non-invasive procedure that can be performed
quickly and easily with proper knowledge of the equipment.
2. It is used as a complementary method after clinical examination; laboratory
examination and radiography have been performed.
3. It is used as primary diagnostic technique in pregnancy diagnosis.
4. Ultrasound is often closest thing, one can offer to exploratory surgery.
5. With the use of appropriate equipment and training, almost any soft tissue structures
can be viewed.
6. Ultrasonography is commonly used for examination of pleural and peritoneal
effusions, prostatic disease, urinary tract diseases, Cystocentesis, cardiac disease,

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 mass lesions and ultrasonic guided aspiration and biopsy and pregnancy diagnosis and
evaluation of female genital tract.
7. Doppler technique allows measuring of velocity and flow pattern of blood within the
heart and vessels. Transducer is displaced after processing by the computer either in
A or B or M mode.

When the transducer is placed in close contact with the body surface through a
coupling medium, it undergoes continuous modification which occurs through three
processes.

i. Absorption - It occurs when the energy in the sound beam is absorbed by the tissues
thereby converting it in to heat. It is basis for the therapeutic ultrasound.
ii. Reflection - It is the redirection of the portion of the ultrasound beam back towards
the source. The reflection gives rise to different echoes. These echoes are converted
by peizoelectric effect in to electrical signals and displayed in to oscilloscope screen.
iii. Scattering - It occurs when the beam encounters an interface that is irregular and
smaller than the sound beam. The portion of beam that interacts with this interface is
scattered in all directions.
There are two other closely related phenomena, refraction and refraction of which
refraction is common cause of artefacts. Larger echoes leave very little of the beam to
produce echoes from another interface deeper in the tissues. This is the reason that bowel gas
or bone does not allow the scanning of tissues deeper to these.

Echo Quantification (EQ)

Once the echoes are converted into electrical signals, these are processed and
transformed into a visual display of measure of the amplitude of the echo. This is called echo
quantification. For displaying this echo amplitude information three modes A, B and M mode
are used.

A mode (Amplitude) - It is the simplest form of display. It displays two parameters

of the echoes in the form of spike. The distance from the transducer and the amplitude or
reflected strength and is rarely used.

M mode (Motion) - Similar to ‘A’ Mode but can record the motion and position of
echo, used in heart valve and cardiac valve movement.

B mode (Brightness) - Most commonly used display mode, yields two dimensional
picture composed of lines per grey dots. The position of the dot is directly proportional to the
actual distance the sound wave travelled through tissue. The brightness of the dot is
determined by the amount of ultrasound pulse that is reflected. A cross sectional view
covered by the transducer is displayed.

TRANSDUCERS:

The frequency of the transducer is determined by the times the crystals expand and
contracts in one second. Transducers are in linear array, convex and sector.

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Linear array: Thin rectangular clip lined up side by side producing sound waves. Beam is
rectangular in shape and it permits good visualization of shape of the structure.

Convex array: Crystals are placed in curvilinear fashion. Imaging of greater area can be
effected.

Sector type: This contains single crystal which oscillates or rotates to produce a fan shaped
beam. The small size gives it to access more of the thoracic and abdominal organs through a
small contact area.

Real time Ultrasound:

When the images displayed in B mode scan are formed rapidly and presented in
sequence, the movement of organs will be viewed in real time. In order to form the sequential
images, it is necessary to sweep the ultrasound beam over the tissues by either mechanical or
electronic means.

The sound beam can be swept either in a arc or in a linear fashion, when it is in a form
of arc, it is called sector scan.

Interpretation:

1. The structures are evaluated on the basis of their position, size, shape and
Echogenicity. Unlike radiography, ultrasound images must be interpreted as they are
acquired and hard copies are made only for further documentation.
2. Hyper-echoic/Echogenic e.g: Bone and air. Bighter echoes and appear in white on
conventional scans.
3. Hypoechoic - Grey images or dark screen. eg. soft tissues (moderate reflection)
4. Anechoic / Echolucent - Absence of echo, the image is black. E.g. fluids. There is
often a normal bright area immediately deeper to fluid, this phenomenon is called
Acoustic enhancement. Similarly bone or gas or mineral deposits reflect sound
waves totally and image seen is bright with no visible structure beneath it. This
phenomenon is called Acoustic shadowing. This helps in detection of urinary or
biliary stones. Soft tissues present an image of mixed shades of grey depending upon
their proportion of fat, fibrous tissue and fluid.
5. Artifacts - Interaction between sound waves and tissues such that there is no true
representation of the underlying structure is called artifacts.
Common artifacts are

i. Acoustic shadow
ii. Distant enhancement
iii.Refraction
iv. Reverberation - largest source of artifacts that are not real. The echo bounces
back to the transducer and is again reflected through the patient and back to
transducer. This process of echo bouncing back and forth between the two
interfaces is known as reverberation.
v. Mirror image
vi. Comet tail - air-fluid interface.

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Cardiac Ultrasonography (Echocardiography):

It is a useful non-invasive tool for imaging the heart and surrounding structures. It is
used to evaluate chamber size, wall thickness, wall motion, valve configuration and motion
and the movement of the great vessels of heart.

For performing echocardiography in dogs, they should be restraint in lateral

recumbency on a table with a cut out for probe placement. The different windows for
approaching the heart are as follows:

Parasternal window is on the right side of the thorax between sternal border and
costo-chondral junction from 3rd to 6th intercostal space. There are two windows on the left
side of the thorax. One is between 5th and 7th intercostal space adjacent to the sternal border
and another between sternum and costo-chondral junction at the 3rd/4th intercostal space.

Different echocardiographic imaging modalities are there.

Doppler imaging allows evaluation of blood flow patterns and velocity.‘M’ mode
helps in quantification of left ventricular diameter and wall thickness at end-diastole and end-
systole. Two dimensional (2D real time) imaging helps to detect pericardial effusion and
cardiac mass. It also helps in estimating cardiac chamber size and systolic function of
ventricles.

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 LESSON 7

PRINCIPLES OF RADIATION THERAPY, AWARENESS ON

ISOTOPES AND THEIR USES IN DIAGNOSIS AND THERAPY

Radiation therapy is the use of X-rays or radioisotopes for the treatment of Neoplasms
of domestic animal. First reported by Dr. R.Eberlin of Berlin Veterinary School (1906-1912).

Radiosensitivity:
Refers to the susceptibility of the cells or tissue to the killing effect of absorbed
radiation.

Radioresponse:
It is the degree to which a normal or neoplastic tissue visibility changes during or
after radiotherapy.

Radiocurability:
In vet practice, radiocurability is a two-year patient survival after radiotherapy
without further progress of the neoplasm and subsequent metastasis.

Radio isotope (or) radionuclide:

Unstable nuclides undergo the process of spontaneous decay to form stable nuclides
by the process of radioactive decay. During this process of decay, there is emission of
radiation energy from the isotopes. Such isotopes are called as radioisotopes (or)
radionuclides. Isotopes are those nuclides, which have same atomic number but different
mass number. ie. Isotopes of a given atom have same number of protons but different number
of neutrons.

Isotopes of iron and carbon are stable whereas isotopes of cobalt, cesium etc. are
unstable. Naturally occurring radioisotopes are radium, thorium etc.

Radioactivity:

It is an exponential decay artificially produced by irradiation of stable nuclides by

subatomic particles such as neutrons in a nuclear reactor. In this process nucleus of
bombarded atom captures a neutron and thus becoming unstable and exhibiting the properties
of spontaneous breakdown.

Radioactive half-life:

The length of time required for one half of the atom to be decayed in a given amount
of radionuclide that ranges from 10 –9 sec. to 1010 years.

Eg.Uranium - 4.5 Million years and Radium -1622 years. Radioactive half-life is constant
for any given radionuclide.

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Application of radionuclide in medicine:

1. Nuclear medicine - the field of medical science, which employs radioactive materials
for diagnosis, and treatment of cases.
2. Radionuclides are also used in biological research and sterilization of surgical
instrument, syringes and dressing especially disposables.
3. Radio nuclides are also used for diagnostic application (Scintigraphy) have a short
physical half-life as use of such materials reduces radiation dose to patients in wide
variety of diagnostic examination.
4. Number of radionuclide is used for the treatment of Neoplasms.

Mechanism of action of radiation:

1. Direct or Target theory: The DNA molecule is the most important target of radiation
in the cells, especially linkages and bonds within the DNA molecule.
Depending on the radiosensitivity of the tissue, dose and duration of radiation there
are three principle effects on the DNA molecule.

i. Genetic damage- If damage occurs in the germ cells, response is observed in the
next generation.
ii. Cancer production - If proper dose is not used upto a particular period there will
be derangement of DNA resulting in abnormal metabolic activity causing
malignant disease.
iii. Cell Death - DNA plays an important role in cell division and is also important
for maintaining life of the cell. When radiation damages DNA, cell division is
interfered. This explains the death of cancerous cells by ionising radiation.
2. Indirect theory: Radiant energy exerts its effect by production of free 'hot' radicals,
such as peroxides, within the cell that damage the specific target. The major
component of the cell i.e. water molecule gets ionized into H+, OH- and other
unstable particles such as H2O and H2 O2. Since these solutes are unstable, they react
rapidly among themselves and other solutes within the solution producing a crucial
biological change in the cell which leads to the cell death.

Effects of radiation on biological tissue:

The factors which make the tissue more susceptible to this energy are

1. Linear Energy Transfer (LET):

It is a measure of rate at which energy is transferred from ionizing radiation to the
exposed tissue. Biological damage increases as linear Energy transfer increases.

2. Oxygen effect:
Radiation therapy is more effective in Oxygenated cells. Hyperbaric oxygen and
hyperthermia are recommended to increase oxygenation of tissue.

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 3. Metabolic effects :
Radio sensitivity is a function of the metabolic state of the tissue. Radio sensitivity is
directly proportional to the mitotic activity of cell and indirectly proportional to their level of
specialisation. So, permanent cells such as neutrons, skeletal and cardiac muscles are
radioresistant and dividing cells such as germ cells, marrow cells, lymphoid and respiratory
cells are radio sensitive.

Tissue tolerance to radiotherapy:

Neoplasm's radio sensitivity is based on three factors.

1. Neoplasm Lethal Dose: It is the dose of radiation, which in vivo produces lethal
effects on the neoplasm.
2. Normal Tissue Tolerance Dose: It is the dose of radiation which normal tissue can
absorb without any pathological effects.
E.g Eye lens - 200 rads, Kidney and lungs - 2000 rad/2 weeks and Brain - 4000
rads/4 weeks

3. Therapeutic ratio: It is the ratio of normal tissue tolerance dose to the neoplasm lethal
dose.
Divided into three categories:

Sensitive category - Squamous cell carcinoma

Moderate sensitive - Mast cell neoplasm
Resistant - Fibrosarcoma

INDICATION FOR RADIOTHERAPY

1. Indicated for localized, solid neoplasm that can’t be excised completely.

2. When surgery is expected to do or already failed
3. When regional or distant metastasis has not occurred.
4. When Radical surgery is unable to remove whole neoplasm.
5. When bulk of the neoplasm needs reduction in size so that it can be subsequently
removed surgically.

METHODS OF RADIO THERAPY:

A patient can acquire life-threatening complications during radiation therapy due to

destruction of healthy cells. The injuries, which normal cells undergo, are compensated for
the cells by shortening the cell division time and by increasing their relative number. This is
done by four R's of radio therapy.

i) Reoxygenation
ii) Repopulation
iii) Redistribution and
iv) Repair.
Radiotherapy is done by multiple treatments given over a period of time termed as Fractioned
therapy. In animals, they are giving 10 –12 fractions of radiation dose of 4 –5Gy for 3 times
per week. In humans 1.8 - 2.00 Gy with a total dose of 60 –70 Gy over a period of 6-7 weeks.

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A. Teletherapy:

Radiation source is kept at a distance from the lesion which consists of four types

1. Superficial X-ray therapy - with X- ray machine of 60 –100 keV

2. Deep X-ray therapy – 200 – 300 keV
3. Super Voltage therapy- it can be provided through
i. X-ray machine with linear accelerator
( 1 MeV to 20 MeV or cyclotron or betatron (20 MeV to 100 MeV)
ii. Through isotopic X-ray machine with cobalt or cesium in a sealedform.
2. Particulate beam therapy - Beam of Electron, Proton or Neutron used as a mode of
teletherapy.

B. Brachytherapy:
It is the therapeutic use of radio isotopes either within the interstitium or on the
surface of the neoplasm. Brachytherapy sources are usually in the form of surface
applicators, needles, seeds or grains etc., Permanently implanted isotopes in the body are
222
Rn(Radon), 198 AU (Aurum), 125K (Potassium). Removable isotopes are 192Ir (Iridium),
60
Co (Cobalt) and 135Cs (Caesium).

Brachytherapy is done with four types -

1. Interstital brachtheraphy - when the source of brachytherapy are within the

interstitum of the neoplasm. eg. 198 Au, 60Co etc.
2. Pliesotherapy or Surface brachytherapy use of 90Sr (strontium) for superficial
therapy.
3. Systemic brachytherapy: use of 131I and 32P administered systemically.

COMPLICATIONS OF RADIOTHERAPY:

1. Immediate - observed within minutes or days after irradiation.

Eg.Epilation (loss of hair), desquation of skin, skin erythema, chromosome aberration,
haematological depression etc.
2. Latent effect - Complications are not observed within month or years and occur after
the long gap of time.
Eg.Leukemia, cancer, life span shortening and lethal genes.
3. Complications depend on the area to be irradiated
Eg. In case of ophthalmic neoplasm irradiations, the effects can be in the form of
conjunctivitis, keratitis, cataract etc. In case of radiotherapy of bone complications are
fractures, septicosteoradionecrosis and sarcoma formation.

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 LESSON 8
PRINCIPLES AND APPLICATION OF CT SCAN, MRI

In computed tomography (CT) the x-ray tube revolves around the patient and the
emergent beam is picked by electric detectors. This information is conveyed to a computer,
which makes the pictorial arrangement. “Slices” are obtained at predetermined intervals. The
images produced show cross–sectional slices of the body. Another improved version in this is
Computed Axial Tomography (CAT SCAN).
The differences between plain radiographs and CT are:
 In plain radiographs superimposition shadow grams are produced and the images of all
superimposed structures appear on the film.
 The computed tomography gives focused radiographic information about one cross-
sectional slice of the patient only, without any confusing superimposed images.
The CT should be considered as a sophisticated study, for special problems.
Contrast media may be used during CT scanning to enhance the difference in density of
various structures.

Magnetic Resonance Imaging (MRI)

Magnetic resonance imaging (MRI), like ultrasound does not use ionizing radiation as
diagnostic radiography and CT do. The rapid development of MRI makes it essential to have
some idea of its uses in clinical medicine as well as the exquisite visualization of anatomic
structures in the living patients.
The technique for imaging places the patient, within a bore of a powerful magnet and
passes radio waves through the body in a particular sequence of very short pulses. Each pulse
causes responding pulse of radio waves to be emitted from the patient’s tissues and is recorded
by a computer which then produces a two-dimensional picture as a slice of the patient.
In addition to the transverse sections of the body, the magnetic resonance imaging can
be carried out in the sagittal and coronal planes as well as in various degrees of obliquity.
Tissues which emit strong MR signals appear white in MR scans, whereas those
emitting little or no signal appear black. In general, air and cortical bone as well as rapidly
moving fluid (blood) will appear black, whereas fat will appear white.

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 LESSON 9
SCINTIGRAPHY, GAMMA CAMERA, XERORADIOGRAPHY AND DOPPLER

SCINTIGRAPHY

 Scintigraphy is a branch of nuclear medicine. It is an imaging technique in

which radionuclides (radioactive elements emitting gamma rays) are administered to
a subject.
 The radionuclides are attached to chemicals to form radiopharmaceuticals that
accumulate in the tissue of interest. Most radiopharmaceuticals are analogues of
physiologic substances or biologic organic molecules. Their presence, and their
concentration, can be detected by gamma-ray detection equipment—usually a gamma
ray camera.
 The gamma rays are converted by the camera into signals from which a computer
produces a digital format that is used to construct an image of the area under
examination. Nuclear medicine images are described in terms of uptake of the
radiopharmaceutical.
 The degree of uptake is subjectively assessed in some techniques, while in others
quantitative analysis is performed. In this way normal and abnormal tissues can be
identified by the selective accumulation of the radioactive substances within them.

GAMMA CAMERA

The gamma camera is an imaging technique used to carry out functional scans of the
brain, thyroid, lungs, liver, gallbladder, kidneys and skeleton.

Gamma cameras image the radiation from a tracer introduced into the patient’s
body. The most commonly used tracer is technetium-99m, a metastable nuclear isomer
chosen for its relatively long half-life of six hours and its ability to be incorporated into a
variety of molecules in order to target different systems within the body. As it travels through
the body and emits radiation the tracer’s progress is tracked by a crystal that scintillates in
response to gamma-rays.

The crystal is mounted in front of an array of light sensors that convert the resulting flash of
light into an electrical signal. Gamma cameras differ from X-ray imaging techniques in one
very important respect; rather than anatomy and structure, gamma cameras map the function
and processes of the body.

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XERORADIOGRAPHY

It is the technology in which an invisible electrostatic pattern produced on a

photoconductor plate is made visible by a powder cloud technique rather than the
photochemical process employed in conventional radiography. It is useful for imaging soft
tissues like muscle, tendon and ligaments.

Technique:

The photoconductor plate/xeroradiography plate consists of a thin layer of selenium

coated on the surface of aluminium plate with an insulating interface of aluminium oxide.
Plate is charged to a uniform surface potential of 1000 volts in darkness by passing under a
stationary charging device. This induces uniform positive charge on the selenium surface and
negative charge on the aluminium and the charge neutralization is prevented by aluminium
oxide layer. The charged plate is enclosed in a light-tight cassette and placed beneath the part
to be radiographed. Depending on the intensity of x-rays reaching the plate after penetrating
the patient, electron hole pairs are formed. Electrons and holes move towards electrically
opposite charges on selenium and aluminium surface respectively and neutralize them. The
amount of positive charge discharged from selenium surface is proportional to the intensity of
x-rays which penetrate the patient. Thus an invisible residual electrostatic pattern which is a
shadow of the object being radiographed is formed on the plate. This pattern is made visible
by a powder cloud technique.

The powder cloud technique is a process by which the invisible electrostatic pattern
produced on a photoconductor plate is made visible by exposing the surface of the selenium
to fine charged powder particle called toner. Toner is a thermoplastic material of dark blue
colour and its size is very few microns only. Toner particles are sprayed through a nozzle that
induce positive and negative charge in equal numbers by friction between the toner and wall
of nozzle. This process is termed as triboelectrification or contact electrification. These toner
particles are attracted to the selenium plate surface in proportion to the intensity of the
residual charge. The uncharged areas appear black and charged areas appear in shades of
blue. Then the image is transferred to a polyethylene coated paper and fixed into a permanent
image by heat fusing at a temperature of 475OF.

Advantages:

i) Edge enhancement which provides sharp demarcation between tissues of different

densities
ii) Long scale of contrast enabling differentiation of soft tissues
iii) Dry process.

Disadvantage: High exposure is needed for thick parts.

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DOPPLER ULTRASONOGRAPHY

It helps to detect the presence, direction, speed and character of blood flow. It works
on the principle of Doppler effect. Doppler effect in turn depends on the relative change in
the returning ultrasound wave frequency which is termed as Doppler shift. Doppler shift is
directly proportional to the blood velocity and frequency of transmitted ultrasound beam.
Doppler shift is also dependent on the angle between the incident ultrasound beam and the
moving reflectors. Doppler shift increases as the beam is in the same direction as the flow
direction. If the angle of the beam is 90° to the flow direction, it cannot be detected.

Continuous wave Doppler and pulsed wave Doppler are the two different types of
Doppler system.

In continuous wave Doppler, a double crystal transducer enables continuous

transmission and simultaneous reception of ultrasound waves. It gives information regarding
velocity and flow direction. It can accurately measure high blood velocities but cannot
determine specific location of the reflector within the beam. It also doesn’t help in estimating
the depth or location of abnormal flow.

In pulsed wave Doppler, a single crystal transducer alternates between transmission

and reception of ultrasound waves. As the echoes return to the transducer during a specific
time interval the reflector depth and frequency shift can be determined. It can accurately
assess the depth from which the returning echoes originate but it cannot accurately measure
the high flow velocities that may be seen in conditions like valvular stenosis. This limitation
is termed as aliasing.

The various display modes available in Doppler Ultrasonography are as follows:

1. Spectral Doppler: used for examining the flow waveform within specific part of a blood
vessel. Here the image is graphically displayed with time on x axis and flow velocity
spectrum on y axis. Flow away from transducer is displayed on bottom of baseline and
towards transducer is displayed on the bottom of baseline. The location can be provided
if this mode is combined with real time and B modes.
2. Colour Doppler: it provides a map of flow superimposed over an organ or structure. It
provides information on direction of flow and velocity of flow. Here Doppler shift is
encoded as a colour and displayed as a map on top of B-mode image. Echoes
representing flow towards the transducer are seen as shades of red and flow away from
transducer are seen as shades of blue. Helps to identify gross circulation anomalies.
3. Power Doppler/Energy Doppler/Amplitude Doppler/Doppler Angiography
It works on the principles of pulsed wave Doppler. The signal strength is determined by
the number of moving cells and not the velocity or frequency of flow. It doesn’t
provide information on direction of velocity of flow but can detect even low flow and
smaller vessels.

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