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CONTRIBUTORS

1) Dr. Hamad Bin Rasheed 2) Dr. Hamid Akbar

Associate Professor Assistant Professor
Department of Clinical Medicine & Surgery Department of Clinical Medicine & Surgery
UVAS Lahore UVAS Lahore

3) Dr. Ayesha Safder Chaudhry 4) Dr. Naveed ul Hassan

Assistant Professor Lecturer
Department of Clinical Medicine & Surgery Department of Clinical Medicine & Surgery
UVAS Lahore (Ravi Campus) UVAS Lahore

5) Mr. Imran Ahmed 6) Mr. Nasir Iqbal

Ph.D. Scholar (Vet. Surgery)
7) Mr. Sohaib Safder
M.Phil. Scholar (Vet. Surgery)
Teaching Assistant
Department of Clinical Medicine & Surgery
UVAS Lahore (Ravi Campus)

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TABLE OF CONTENTS

Chapters Description Page No.

1. Surgery and its branches 4

2. Pre-requisites of surgery 6
3. Preoperative Patient Assessment 10
4. Sterilization, Autoclaving & Surgical pack 12
5. Surgical instruments 15
6. Suture material 21
7. Suture pattern 27
8. Fluid therapy 30
9. General and regional anesthetic techniques 35
10. Surgical Procedures 44
a. Tracheotomy/Tracheostomy 46
b. Oesophagotomy 47
c. Opening of frontal sinuses 50
d. Correction of Entropion 53
e. Correction of Ectropion 54
f. Enucleation of the eye ball 55
g. Disbudding and Dehorning 57
h. Large animal orchiectomy 60
i. Penile Amputation/phallectomy 63
j. Amputation of Tail 65
k. Post-operative care in Large Animals 67

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CHAPTER 1
SURGERY AND ITS BRANCHES
Surgery:
A Veterinary surgery is a surgery on animal and it is a branch of medicine that deals with the diagnosis
and treatment of injury deformity and disease by the instruments a person who perform all this are
called veterinary surgeon The word surgery has been originated from Greek words “Cheir” meaning
hand and “Ergon” means work.
Branches of Surgery
Neurosurgery
Neurosurgery or neurological surgery is the branch of surgery that concerned with the prevention,
diagnosis, surgical treatment, and rehabilitation of disorders which affect any portion of the nervous
system including the brain, spinal cord, peripheral nerves, and extra-cranial cerebrovascular system.
Orthopedic surgery
Orthopedic surgeons use both surgical and nonsurgical means to treat musculoskeletal trauma, spine
diseases, sports injuries, degenerative diseases, infections, tumors, and congenital disorders.
Cardiac surgery
Cardiac surgery, or cardiovascular surgery, is surgery on the heart or great vessels performed by cardiac
surgeons
Ocular surgery
Eye surgery, also known as ocular surgery, that is performed on the eye or its adnexa, typically by an
ophthalmologist
ENT Surgery
ENT Surgery is the branch of surgery that concerned with the medical and surgical treatment of the
ears, nose, and throat. ENT Surgeons skills include diagnosing and managing diseases of the sinuses,
larynx (voice box), oral cavity, and upper pharynx (mouth and throat) and adjacent structures of the
head and neck.
Gynecological surgery
Gynecological surgery refers to surgery on the female reproductive system. Gynecological surgeryis
usually performed by gynecologists. It includes procedures for benign conditions, cancer, infertility, and
incontinence. Gynecological surgery may occasionally be performed for elective or cosmetic purposes.
Types of Surgery:
 Aseptic surgery: It is performed in an environment free from microorganism that significant
infection or suppuration does not supervene.
 Elective surgery: Surgery that is subjective to choose. The choice may be made by the patient
or doctor. For example, the time when a surgical procedure is performed may be elective.
 Emergency Surgery: Surgery that is done without any delay, done in life threatening
conditions.
 General Surgery: It deals with surgical problems of all kinds, rather than those in a restricted
area as in a surgical especially such as neurosurgery.
 Minimal invasive surgery: Surgery done with only a small incision or no incision at all such as
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through a cannula with a laparoscope or endoscope.

 Major surgery: Surgery involves the more important difficult and hazardous operation.
 Minor Surgery: Surgery restricted to management of minor problems and injuries.
 Plastic Surgery: Surgery concerned with restoration, reconstruction, correction or improvement in
shape and appearance of body structures that are defective damaged or misshapen by injury disease
or growth and development.
 Radical Surgery: Radical surgery refers to the removal of blood supply, lymph nodes and
sometimes adjacent structures of a diseased organ or tumor during surgery. In surgical oncology,
radical surgery (or dissection) typically describes the removal of a tumor or mass and ancillary
lymph nodes that may drain the mass for diagnostic and/or treatment purposes, as in radical
mastectomy.
 Experimental Surgery: That carried out as part of a planned experimental protocol usually on
animals selected specifically for the purpose of experiment and research. Increasingly use of
animals in this way is under the control of institutional or governmental authorities.
 Replacement surgery: Transplanting tissue or organs from another host. Not commonly
undertaken in veterinary surgery.
 Chemosurgery: Destruction of tissue by chemical means for therapeutic purpose.
 Reconstructive surgery: Surgery concerned with therapeutic or cosmetic reformation of tissue.
 Prosthetic surgery: Surgery that an artificial substitute for a missing body part, such as an arm, leg,
eye, tooth used for functional or cosmetic reasons or both.
 Electro surgery: The surgical use of a high frequency electric current for cutting or destroying
tissue as in cauterization.
 Cryosurgery: The selective exposure of tissue to extreme cold often by applying a probe containing
liquid nitrogen to bring about the destruction or elimination of abnormal cell.
 Laser surgery: Surgery using modern laser technology for breaking of kidney stones.
 Soft tissue surgery: Surgery that is performed on soft tissue like muscles and organs.
 Hard tissue surgery: Surgery that is performed on hard tissue like bones.

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CHAPTER 2
PRE-REQUISITES OF SURGERY/PRE-OPERATIVE CONSIDERATIONS
The principle intent of aseptic surgery is to prevent contamination of the wound inflicted by the surgeon
so that is the primary goal-healing will result without infection. The sources of contamination are the
patient, the environment, surgical materials and instruments and the operating room tea
Preparation of patient:
 Special care aids the well-being of the animal and contributes to the success of the operation.
 Food may be withheld before surgery (6–8 hours, depending on the species) to reduce the salivation
when patient is anesthetized.
 Sometimes an enema or laxative will be given, in addition to withholding food, to empty the
contents of the lower intestinal tract prior to intestinal surgery.
 Perform physical exam before surgery. Temperature, Pulse and Respiration must be normal.
 Specimens of blood and urine may be taken to help determine the animal’s state of health.
 Hydration status of the animal should be checked.
 The animal should be weigh before the surgery.
Preparation of Operative site:
The purpose of site preparation is 1) to remove soil and transient microorganism from the skin.2) to
inhibit the rapid rebound growth of microorganism’s 3) discard sponges after reaching the periphery
Patient preparation includes the following steps:
 Clip a broad area around site being careful not to cut the skin.
 Scrub area with surgical soap for five min.
 Start at center of the site and work outward in larger and larger circles. Every time you go
back to the center, use a new piece of gauze and start again.
 Wipe area with sterile gauze sponge, starting at the center of the site, until all the surgical
scrub material is gone.
 Some surgeons follow the scrub with 70 percent ethyl alcohol.
 Sterile surgical drapes are placed around the incision site; only people wearing sterile surgical
gloves should touch the site.
 Particularly dirty animals require bathing prior to surgical prep.
Preparation of Surgeon:
Preparation of surgeon includes following steps:
Scrubbing:
 Wear a mask and cap.
 Scrubbing is done with a surgical hand brush and soap.
 Scrubbing is 2 to 7 minutes procedure
A. Clean under your fingernail with nail pick
B. Wet your arm and hands.
C. Dispense the appropriate amount of solution in to the palm of your hand by the depressing of foot
pump.
D. Insert and twist of your fingertips of your opposite hand into the solution for several seconds.
E. Transfer the solution to your opposite hand and repeat this step with the fingers of other hand.
F. Rub your hand together, moving up the forearm to slightly past the elbow.
G. Add the water throughout the wash to create additional lather.
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H. Rinse thoroughly and repeat step B through F.

Each finger > 10 strokes on each surface (40 strokes / finger)
 Fingernails and both surfaces of hands= 20 strokes each
 Each arms surface = 10 strokes
 Rinse in warm water, allowing the water to drip from the elbows.
 Repeat entire scrubbing procedure twice
Pictorial description of scrubbing steps

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Antimicrobial Soap Mechanism of Action Properties

Chlorhexidine Disruption of cell wall Broad spectrum (More effective
gluconate and precipitation of cell against Gram positive than Gram
(CHG) proteins negative bacteria or fungi.
Residual activity because it bind to
keratin
Not inactivated by organic material
May be less irritating to skin than
iodophors
Hexachlorphene Disruption of cell wall Bacteriostatic for Gram positive
and precipitation of cell cocci
proteins Minimal activity against negative
bacteria fungi or viruses
Oidophors( Cell wall penetration Broad spectrum (Gram positive and
e.g.,Povidine-iodine .oxidation .,replaces Gram negative bacteria ,fungi
PVI) microbial contents with ,viruses)
free iodine Some activity against spores
Inactivated by organic materials
Requires minimum of 2 minutes of
skin contct

Gowning:
Gown serves as barrier between the skin of surgical team member and patient. They should consist of
a material that eliminate the passage of microorganism between the sterile nonsterile area. They
should be resistant to fluid, stretch, pressure, friction and should be comfortable, economical, and fire
resistant.
 Grasp the gown firmly and gently lift it away from the table.
 Step bake from the sterile table to allow room for gowning.
 Hold the gown at the shoulders and allow in to gently unfolding.
 Do not shake the gown this increase the risk of contamination.
 Once the gown is open, find the armhole and guide each arm through the sleeves.
 Keep your hand in the cuffs of the gown.
 Have an assistant pull the gown up over your shoulder and secure by closing the neck fasteners and
tying the inside waist tie.
 Non-scrubbed assistant opens gown pack outer wrapping.
 Scrubbed surgeon grasps folded gown at the shoulder.
 Places the left arm into the sleeve, right arm into the sleeve.
 Assistant grasps inside of gown and pull the sleeves into place.
 Grasps the inside of the gown and pull down to straighten the front ties the neck and waist
 Assistant opens glove pack

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Gloving:
There are three techniques of gloving
Close gloving technique: it prefers over the open gloving technique. It performs initially after the
sterile gowning. In this technique, the person’s hands remain inside the sleeves and should not touch
the cuffs. The hands are pushed through cuff openings as gloves are pulled into place.
Pictorial description of close gloving

Open gloving technique: The closed glove technique should not be used when changing one or both
gloves because once the hand has been passed through the cuffs, they are contaminated. When a
glove must be changed without assistance during a surgical procedure, the open- glove technique is
used
Assisted gloving:
1. Have the assistant pick up one glove and place his finger and thumb under the cuff of the glove.
2. With the thumb of glove facing you, slip your hand into glove then have the assistant bring the
cuff of the glove up and over the cuff of your gown and gently let it go.
3. Have the assistant pick up the other glove. Assist by the holding the cuff of the glove open with
fingers of your sterile hand while putting your ungloved hand into open glove
4. The assistant’s thumb is kept under the cuff while your thrust your hand into it.

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CHAPTER 3
PREOPERATIVE PATIENT ASSESSMENT
Successful surgical outcomes not only rely on operative procedures themselves. They also depend on
patient health preparation of the patient, surgical suite, owner; anticipation and prevention of
perioperative complications. Surgical procedure begins with, a physical examination in both emergency
and elective surgery. Following laboratory tests that are generally indicated based upon animal age and
systemic status at our clinic:
 Hematology:
o Total protein
o Complete blood count (CBC)
o Packed cell volume (PCV)
o Chemistry
 Electrolyte measurement for RDA
 Urinalysis (e.g. ketosis)
o Measurement of blood urea nitrogen (BUN) and creatinine
o Analysis of peritoneal fluid (prior to laparotomy for horses with colic)
o Full chemistry panels when there are age or systemic considerations
Team Communication:
Effective communication throughout the veterinary team is vital to ensure a successful surgical
outcome.
Before Admission
 Record the complete patient history.
 The client should be asked about any concurrent health issues, previous anesthetic episodes or
surgeries, prior and current medications, any episodes of allergies or adverse reactions to
medications, past or recent infections, unexpected bleeding, difficulty breathing or exercise
intolerance, and vaccination and preventive health care status.
 The owner must be properly guided about the surgical procedure and associated potential risks.
 Gathering information about the patient’s environment (e.g. does the animal live outdoors, are
there other pets at home) helps the veterinary surgeon outline appropriate instructions for
postsurgical care.
 The appropriate fasting instructions to owners are important before surgery, as some patients
that are diabetic, hypoglycaemic, or paediatric, need special feeding instructions.
At Admission
Diagnostic Tests
 Diagnostic blood tests are determined by the surgeon.
 the venipuncture site should not compromise the surgical field.
o For example, blood should not be collected from a jugular vein in a patient undergoing
thyroidectomy or parathyroidectomy because hematoma formation in that area may
distort normal tissue architecture.
o a peripheral catheter should be avoided in the affected limb in patients undergoing
orthopaedic procedures or digit or limb amputation.
 All patients should undergo a complete physical examination on the day of surgery.
o Each patient’s record should contain current weight, temperature, heart rate, respiratory
rate, pain score, body condition score, mucous membrane colour, capillary refill time,
and results of heart and lung auscultation.
Surgical Consideration for the patient:
• Draping:
– Drapes help to maintain a sterile field and preserve body heat.

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– The decision to drape depends on the nature of the procedure being done.
– Faulty draping technique may increase contamination.
– Drapes must cover the animal and table.
• Heat loss:
– Animals should always be kept warm with a hot water blanket.
– Loss of heat also occurs from open body cavity and evaporation of body fluids. As
anesthesia alters thermoregulation and reduces metabolism which significantly prolong
the duration of anesthesia which results in increasing the risk of complications.
• Fluid loss:
– Animals can experience extensive fluid loss during surgery because of evaporation from
body cavities and due to blood loss.
– Reduce intra-operative fluid loss by irrigating the operative field with warmed sterile
saline, and by administration of warm, sterile isotonic fluids parenterally during the
surgery.
– Control blood loss during surgery by cauterizing or ligating potential bleeders. Monitor
water and food intake, body condition and animal weight post-surgically.
PRE-SURGICAL GRADING ACCORDING TO HEALTH STATUS OF ANIMAL
UNDERGOING DIFFERENT SURGICAL PROCEDURES
GRADE DEFINITION POSSIBLE EXAMPLES

No discernible disease; animals undergoing

I Normal, healthy patient ovariohysterectomy, ear trim, castration

Skin tumor, fracture without shock, uncomplicated hernia,

cryptorchidectomy, localized infection, compensated cardiac
II Mild systemic disease disease

III Severe systemic disease Fever, dehydration, anemia, cachexia, moderate hypovolemia

Severe systemic disease that is a constant Uremia, toxemia, severe dehydration and hypovolemia,
IV threat to life anemia, cardiac decompensation, emaciation, high fever

Moribund patient not expected to survive Extreme shock and dehydration, terminal malignancy or
V without surgery infection, severe trauma

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CHAPTER 4
STERILIZATION AND AUTOCLAVING OF SURGICAL INSTRUMENTS & GENERAL
SURGICAL PACK
Keeping the instruments free from infection, all surgical instruments must be sterilized.
Instrument Preparation and Sterilization
All instruments and other equipment used to perform surgery must be sterilized prior to use.
Instrument Preparation
Prior to surgery, instruments and other supplies that requires sterilization are cleaned and wrapped or
packaged to facilitate handling.
Types of Instrument Packs
 Instruments, with or without an instrument tray, may be packed inside a folded cloth or paper wrap
and sealed with autoclave tape for steam sterilization. A sterilization indicator is placed inside the
pack.
 Alternatively, instruments may be packed in a self-sealing sterilization envelope. Sometimes
referred to as 'peel packs', these may be used for steam or gas sterilization. A sterilization indicator
is located on the outside of the envelope.
ITEM, MINIMUM TIME REQUIRED, MIN, 250° F–254° F (121° C–123° C)
 Scrub brushes (in dispensers, cans, individually wrapped) 30 Minutes
 Dressings (wrapped in muslin or paper) 30 Minutes
 Glassware (empty, inverted) 15 Minutes
 Instruments (wrapped in double-thickness muslin) 30 Minutes
 Instruments combined with suture, tubing, porous materials (wrapped in muslin or paper) 30
Minutes
 Metal instruments only (unwrapped) 15 Minutes
 Linen maximum size 12 × 12 × 20 inches (6 kg wrapped) 30 Minutes
 Needles (individually packaged in glass vials or paper, lumens moist) 30 Minutes
 Needles (unwrapped, lumens moist) 15 Minutes
 Rubber catheters, drains, tubing (wrapped in muslin or paper, lumens moist) 30 Minutes
 Rubber catheters, drains, tubing (unwrapped, lumens moist) 20 Minutes
 Utensils (wrapped in muslin or paper, on edge) 20 Minutes
 Utensils (unwrapped, on edge) 15 Minutes
 Syringes (unassembled, individually packaged in muslin or paper) 30 Minutes
 Syringes (unassembled, unwrapped) 15 Minutes
 Suture—silk, cotton, nylon (wrapped in paper or muslin) 30 Minutes
 Solutions:
 75 to 250 ml 20 Minutes (slow exhaust)
 500 to 1000 ml 30 Minutes (slow exhaust)
 1500 to 2000 ml 40 Minutes (slow exhaust)
What to Include (in the pack)
Surgical instruments and other sterile material intended to be used during the procedure should be
included within the surgical pack. This may include wound clips and applicators, gauze or cotton-tipped
swabs and draping material. If pre-packaged (sterile) suture material or other equipment is used this
may be aseptically placed onto the open surgical pack prior to the start of surgery.

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General Surgery Pack

1. Scalpel handle No. 3 and 4 1 each
2. Scalpel Blade 2 for each
3. Curved Mayo scissors 1
4. Straight Mayo scissors 1
5. Operating scissors (sharp/sharp) 1
6. Operating scissors (sharp/blunt) 1
7. Curved Metzenbaum scissors 1
8. Straight Metzenbaum scissors 1
9. Straight Mayo scissors 1
10. Curved Mayo scissors 1
11. Towel forceps 4
12. Curved mosquito hemostats 8
13. Straight mosquito hemostats 4
14. Curved Kelly/Crile hemostatic forceps 2
15. Straight Kelly/Crile hemostatic forceps 2
16. Allis tissue forceps 2
17. Needle holders (Mayo-Hegar/Olsen-Hegar) 1
18. Right-angle forceps 2
19. Curved 6″ Ochsner forceps 2
20. Straight 6″ Ochsner forceps 2
21. 3″ × 4″ thumb tissue forceps 2
22. 1″ × 2″ Adson tissue forceps 2
23. Sponge forceps (curved or straight) 2
24. Surgical needles(All type) 2 each
25. Surgical gloves 4 Pairs
26. Surgical gowns, masks, caps 2 each
27. Surgical shrouds with slits 1
28. Surgical shrouds without slits 1-4
29. Surgicals towels 20x30cm 2
30. Gauze sponge 1
31. Surgical pack wrapper 1
Note: Special instruments needed for any operation should be sterilized along with general surgical
pack or sterilized separately
Keeping the Instruments Sterile During Surgery
Place the opened surgery pack to one side of the surgery field so that the surgeon's arms do not cross
over the surgery field to reach the pack. An extra piece of sterile drape material or the inside of the
sterile pack wrap can be used as a place to set instruments on when they are not in use. One of the most
common errors for an inexperienced surgeon is setting instruments down on an unsterile surface.
In addition, sterile suture material must not be allowed to drag over unsterile areas during use.
Sterilization Methods
Surgical instruments and other material or equipment that will contact the surgical site must be
sterilized prior to use. In general, investigators are expected to sterilize instruments via autoclave (steam
sterilization). Other methods of instrument sterilization like ethylene oxide (gas) sterilization; chemical
(cold) sterilization and dry heat sterilization (glass bead sterilizers) are occasionally used under specific
circumstances.
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Steam Sterilization (Autoclaving)

Steam or autoclave sterilization is the most common method of
instrument sterilization. Instruments are placed in a pack and
exposed to steam under pressure. A sterilization indicator
(required such as autoclave tape or an indicator strip is used to
identify which instrument packs have been sterilized.
Ethylene Oxide
Ethylene oxide is a chemical that in gaseous form; used to sterilize items that cannot withstand the high
temperature and/or moisture produced in an autoclave. Because ethylene oxide is toxic to humans and
other animals, items sterilized with it must be aerated before use to allow the gas to dissipate. Most peel
packs have a built-in indicator for both steam and gas sterilization.
Glass Bead Sterilizers
Glass bead sterilizers have a central well filled with glass beads which are maintained at high
temperature (approximately 500 degrees F). Glass bead sterilizers may be used to sterilize instrument
tips when using a single pack for multiple animals. The tips of
surgical instruments are placed into the hot glass beads for
approximately 5-10 seconds. Blood and tissue should be removed from
the instrument tips using alcohol or sterile water prior to placement in
the glass bead sterilizer. Only the tips of the instruments are sterilized.
The instrument tips become extremely hot and must be cooled before
use. One set of surgical instruments may be used on up to five times
during the same surgical session if the instrument tips are sterilized
between each animal using a glass bead sterilizer.

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CHAPTER 5
SURGICAL INSTRUMENTS
Each type of surgical instrument is designed for a particular use and should be used only for that
purpose using instrument for procedure which they are not designed results in dull or broken
instrument.
Scalpel Handles:
Scalpels are the primary cutting instrument use to incise the tissue. Disposable handle and Reusable
handle are most common types, however later is mostly used in veterinary medicine blade are
available in various sizes and shapes depending upon task for which they are intended. Scalpel
handles come in two numbers that is No.3 and No.4.
Surgical Blades: Blades #10, 11, 12, 15 fit the #3 handle.

Blades #22, #23,#24 fit the #4 handle and are commonly used for large animals

Use: to give incision over tissue.

Scissors:
Scissors are used for sharp cutting and blunt dissection. Scissors are generally classified according to
the type of tip (Blunt-blunt, Sharp-sharp, Sharp-blunt), Shape of Blade (straight, curved), Cutting edge
(plain, serrated)

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1. Metzenbaum Scissor:
This type of scissor has a longer handle to blade ratio and is used to cut delicate tissue. It is
constructed of stainless steel and may have tungsten carbide cutting surface inserts. Blades can be
curved or straight.

2. Mayo Scissor:
This type of scissor has almost equal handle to blade ratio It is most common and is used for cutting
heavy tissue and fasciae.

3. Littauer Suture cutting scissor:

It is used to cut the sutures. It has concavity on one blade that prevent the suture from being lifted
excessive during removal.

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4. Bandage cutting scissor:

Bandage scissor has blunt tip which reduce the risk of cutting skin when the scissor is introduced under
the bandage.

Needle holder:
It is used to grasp and manipulate curved needles. Larger needles require wider heavier jawed
needle holder. There are two types of needle holder.
1. Myo-hegar needle holder:
Myo-hegar needle holder is commonly used in veterinary surgery for medium to coarse needles.

2. Olsen-hegar needle holder:

They are used similarly but have scissor blades which allow suture to be tied and cut with same
instrument.

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Forceps
1, Tissue Forcep:
Tissue Forcep is tweezer like non-locking instrument used to grasp tissue. The tips are pointed or
serrated or may have small or large teeth. Tissue Forcep is used to stabilize tissue, expose tissue
layers during suturing or both.

2. Dressing Forcep:
The tips are round and have serration. It is used in dressing of the wound or operated area.

Hemostat forceps:
Hemostat forceps are crushing instruments used to clamp blood vessels. They are available with
straight or curved tips and vary in size from smaller to larger. The serrations on the larger hemostat
may be transverse, longitudinal, diagonal or combination of these.

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There are different types of hemostat forceps which are as follow:

1. Halsted mosquito forceps:
It is popular, fine-pointed, ratcheted hemostats used to crush very small vessels.

2. Kelly forceps:
Kelly forceps have transverse serrations extend only over the distal portion of jaws.

3. Crile forceps:
Crile forceps also have transverse serrations but extend the entire length of jaw.

4. Rochester-Carmalt forceps:
These are larger crushing forceps that often are used to control large tissue bundles. They have
longitudinal grooves with cross grooves at the tip ends to prevent tissue slippage.

Retractors:
Retractors are used to retract the tissue
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and improve exposure. There are two types of retractors

1. Hand held retractors:
The ends of hand held retractors may be hooked, curved, spatula-shaped or toothed.

2. Self-retaining retractors:
Self-retaining retractors maintain tensions on tissues and are held open with a box lock

Drape clamps / Towel Clamp:

A clamp used for fixing drapes to the skin of anesthetized patients. A scissor action with ratchet fixation
at the finger loops and sharp, incurving, needle-like blades.

Sponge holder:
Sponge Holder, suitable for holding swabs when 'prepping' a patient or used to grip and manipulate
cervical tissue during gynecological procedures.

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CHAPTER 6
SUTURE MATERIAL
Definition of Suturing:
The process of joining two surfaces or edges together along a line surgically by a material called suture
material such as thread, gut or wire.
Sutures are the stitches used to hold together the skin and internal organs that have been damaged by
injury or surgery. The word suture came with little change from the Latin sutura, "a sewn seam." In
Latin, the verb suere is "to sew, stitch, or tack together.
Two important functions of suture material are
 Wound repair
 Ligate blood vessels
Characteristic of Ideal Suture Material:
The ideal suture has the following characteristics:
 Sterile
 All-purpose (composed of material that can be used in any surgical procedure)
 Causes minimal tissue injury or tissue reaction (i.e.non-electrolytic, noncapillary, nonallergenic,
noncarcinogenic)
 Easy to handle
 Holds securely when knotted
 High tensile strength
 Favorable absorption profile
 Resistant to infection
 Inexpensive and readily available
Selection of Suture Material:
Suture materials are chosen on the basis of suture characteristics, and suture tissue reaction.
There is no any ideal suture for every possible indication.
Principles are considered in selecting a suture material.
 Sutures should be atleast as strong as normal tissue through which they are placed.
 Skin and fascia are the strongest tissue. The relative rate at which suture loses its strength and
wound gain strength should also know. E.g. visceral wound heals rapidly attaining strength within
14 to 21 days so absorbable suture material is best.
 Fascia heals slowly so synthetic absorbable suture material is best choice.
 The ability of suture to resist the infection should also be considered in selection of material. For
example, synthetic c suture is superior to natural because these have lowest incidence of infection
with use in contaminated tissue.
Classification of Suture Material:
Suture materials are classified on the basis of
a) Biological properties (Absorbable, Non-absorbable)
b) Physical properties (Natural, synthetics)
c) Formation of suture material (Synthetic polymers, Metallic fibers)

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SYNTHETIC
(Monocril,vicryl,PDS)
ABSORBABLE
NATURAL(Collagens)
SUTURE
SYNTHETIC(Ethilon,Prolene)
NONABSORBABLE
NATURAL
(Surgical cotton,Surgicalsilk)
Biological Properties:
Suture materials are classified as
 Absorbable: It undergoes degradation and rapid loss of tensile strength within 60 days. Absorption
occurs either by enzymatic degradation and subsequent phagocytosis or hydrolysis, a process by
which suture is broken down by the addition of water and is then completely metabolized. It might
have natural or synthetic origin.
Examples Surgical catgut, collagen, polyglycolic acid and polyglactin 910
 Non-absorbable: It retains the tensile strength for longer than 60 days. Tensile strength is as
measure of how much pull a suture can withstand before it will break. It might have natural or
synthetic origin.
Example: Silk, cotton, nylon, stainless steel, skin stapling devices.
 Natural : Made of natural fibers (e.g. silk or catgut). They are less frequently used, as they tend to
provoke a greater tissue reaction. However, suturing silk is still utilized regularly in the securing of
surgical drains.
 Synthetic: Comprised of man-made materials (e.g. PDS or nylon). They tend to be more predictable
than the natural sutures, particularly in their loss of tensile strength and absorption.
 Monofilament suture: A single stranded filament suture (e.g. nylon, PDS or proline). They have a
lower infection risk but also have a poor knot security and ease of handling.
 Multifilament suture: Made of several filaments that are twisted together (e.g. braided silk or
vicryl).
Physical properties:
Suture material is either made of following:
 Natural Substance: Natural sutures are made from natural materials such as collagen derived from
the gastrointestinal track of animals, woven cotton, raw silk, linen, or steel. Coating agents are often
used to help reduce tissue reactivity and to help reduce friction. It may have absorbable or non-
absorbable property.
Formation of suture material
 Synthetic polymers: Synthetic sutures are made from synthetic collagen derived from polymers.
Synthetic sutures are broken down by hydrolysis as opposite to enzymatic degradation (natural sutures),
causing less tissue reaction.
 Metallic fibers: They are made up of metallic material like stainless steel.
It is worth noting that regardless of suture composition, the body will react to any suture as a foreign
body, producing a foreign body reaction to varying degrees.
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The duration of absorption of suture material on different body tissues is given below
Days: Muscle, subcutaneous tissue or skin
Weeks to Months: Fascia or tendon
Months to Never: Vascular prosthesis
Suture Type Absorbable Non- Monofilament Multifilament
absorbable

Vicryl ✓ ✓

PDS ✓ ✓

Monocryl ✓ ✓

Nylon ✓ ✓

Prolene ✓ ✓

Silk ✓ ✓

Suture type and structure

Suture Size:
The diameter of the suture will affect its handling properties and tensile strength. The larger the size of
the suture material the smaller the diameter will be. For example, a 7-0 suture is smaller than a 4-0
suture.
While choosing size of suture material, the smallest size possible should be chosen, taking into account
the natural strength of the tissue.

Detailed pictorial description of the suture material

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Surgical Needles:
The surgical needle allows the placement of the suture within
the tissue, carrying the material through with minimal residual
trauma. Ideal surgical needle should have following properties
 Rigid enough to resist distortion
 Flexible enough to bend before breaking
 Be as slim as possible to minimize trauma
 Sharp enough to penetrate tissue with minimal resistance
 Stable within a needle holder to permit accurate placement.
Commonly, surgical needles are made from stainless steel.
They are composed of: The swaged end connects the needle to
the suture. The needle body or shaft is the region grasped by the needle holder. Needle bodies can be
round, cutting, or reverse cutting:
Types of Needles:
There are three types of needles
 Tapered Needle
Gradually taper to the point and cross-section reveals a round, smooth shaft
Used for tissue that is easy to penetrate, such as bowel or blood vessels
 Conventional Cutting Needle
Triangular tip with the apex forming a cutting surface
Used for tough tissue, such as skin (use of a tapered needle with skin causes excess trauma because of
difficulty in penetration)
 Reverse cutting needle
Similar to a conventional cutting needle except the cutting edge faces down instead of up
This may decrease the likelihood of sutures pulling through soft tissue
 Round bodied needles are used in friable tissue such as liver and kidney
 Cutting needles are triangular in shape, and have 3 cutting edges to penetrate tough tissue such as
the skin and sternum, and have a cutting surface on the concave edge
 Blunt needles are used for abdominal wall closure, and in friable tissue, and can potentially reduce
the risk of blood borne virus infection from needle stick injuries.
 Sharp needles pierce and spread tissues with minimal cutting, and are used in areas where leakage
must be prevented.

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The needles shape varies in their curvature are described as the proportion of a circle complete ¼, ⅜, ½,
and ⅝ are the most common curvatures used. Different curvatures are required depending on the access
to the area to suture.

Suture knots:
The following are several important principles of knots and ligatures that the surgeon should consider:
• The amount of friction between the strands of suture determines knot security.
• Suture size and type impact the amount of friction between strands and thus knot security; the smallest
size suture and knot that will not jeopardize wound strength should be used.
• Monofilaments create less friction against one another and the tissue. They have been designed to
deform when tied to provide increased knot security. The length to which the suture ends should be cut
depends on the security of the knot. For example, catgut suture tends to swell and untie when exposed
to moisture, so the surgeon should leave the suture ends slightly longer than other sutures.
• Studies show that regardless of suture type, maximum knot security is reached at a maximum of two
additional throws to the starting square knot (four throws total). Additional throws will exacerbate
tissue irritation and impede healing. They should be used when a surgeon’s knot or slipknot is used.
• If instruments such as clamps are to be applied to the suture, as in herniorrhaphy in foals and calves,
they should not be applied to those parts of the suture material that will remain in situ.
Knotting Techniques
1. Square knot:
This knot commonly used. The knot is usually tied with needle holders, which should remain parallel to
the wound, whereas all movements are made perpendicular to the wound. Uniform tension to the ends
of the suture ensures that the knot ends up as a square.

2. Granny knot:
Knots that tighten when the Second throw is pressed home, as well as knots that end a continuous suture
in which two strands are tied to one, are also prone to slippage Knots stay tied because of the friction of

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one component against another. The granny knot is a slip knot that will not hold, especially if the strain
on the ends is unequal; its use is not recommended.

3. Surgeon Knot:
It is used when there is excessive tension on wound edges Knot just like the square knot but its first
throw consist of two throws.

4. Reinforced knot:
Just like the surgeon knot; but it contains four throws

5. Milkers knot:
It contains two encircling wraps to increase friction. Use to ligate the pedicles.

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CHAPTER 7
SUTURE PATTERNS
Suture pattern can be classified as interrupted or continuous by the way they oppose tissue which are
as follow:
Appositional Sutures:
Appositional sutures bring the tissue in close approximation. E.g.; simple interrupted, simple
continuous, subcuticular pattern.
Everting Pattern:
Everting suture turn the tissue edges outward away from the patient and toward the surgeon. For
example, mattress sutures, FFNN, FNNF
Inverting pattern:
Inverting sutures turn the tissue away from the surgeon towards the lumen of a hollow viscous organ.
For example, lembert, Halstead, Pursting, Connell and Cushing sutures
The advantages and uses of various suture patterns will be discussed individually;
Simple Interrupted Suture:
A simple interrupted suture is made by inserting the needle
through tissue on one side of an incision or wound, passing it
to the opposite side, and tying. The knot is offset so that it does
not rest on the incision. The suture should be placed
approximately 2 to 3 mm away from the skin edge.
Advantage:
 Simple interrupted sutures are easy and quick to place.
 Disruption of a single suture does not cause the entire suture
line to fail
Disadvantage:
 More time consuming in tying and cutting additional suture
knot.
 More suturing material is used.
Simple continuous Suture:
A simple continuous suture consists of series of simple interrupted
suture with knot on either end. First simple interrupted suture is
placed and knotted and then needle is directed through the skin
perpendicular to the incision line below the tissue and advances
forward above it. In the end, needle end of suture is tied to last
loop of suture that is exterior to the tissue.
Advantage:
 It provide maximum apposition and relatively airtight and
fluid tight
 It can easily place and removed.
 Minimal use of suture material and minimal amount of knot
are in this technique.
Disadvantage:
 Slippage of either the beginning or end knot is likely to cause failure of entire suture line.
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Vertical Mattress:
The vertical mattress suture is also introduced approximately 8mm from the
incision on one side, passed across the incision line and made to exit at an
equal distance on the opposite side of the incision. The needle is then reversed
to original side by passing 4 mm or less from the incision on each side. The
knot is tied on side of origin. It gives eversion effect.
Advantage:
Vertical mattress suture is also a tension suture. It is stronger in tissues under
tension than the horizontal mattress suture.
Disadvantage:
It requires an increased amount of suture material and is time consuming to
apply.
Horizontal Mattress
It is useful in suturing the skin of dog, horse and cow. The surgeon introduces
the needle 2 to 3 mm to the right of the incision. the needle is passed angularly
through the tissue below the edge of tissue plane, crosses the incision line and
exits in an angular pattern on the opposite side. The suture is advanced
approximately 8 mm and is introduced from the left side, crossing the incision
line to the right side.
Advantage:
It involves small amount of suture material and it can be rapidly applied.
In addition, a tension type suture is obtained.
Disadvantage:
It is difficult to apply in skin without causing excessive eversion.
Cushing and Connell Suture:
Cushing suture passes only to the submucosa. The Cushing suture is
different from Connell in that the suture does not pass into the lumen
but extends only to the submucosal area. Both Connell and Cushing
suture provide inverting effect to the tissue.
Lembert Suture:
The lambert suture is an inverting continuous vertical mattress
suture. It is used primarily to close hollow viscera. That require
inversion and firm mattress pattern. The suture is applied from
outside the lumen with the needle passing through the serosa and
muscularis and returning through muscularis and serosa to the area
outside the viscera on the same side of the incision. The needle is
then passed across the incision to the opposite side and is introduced
on the serosal surface adjacent to the incision. It is passed through
serosa and muscularis and is continued to the distant serosa the
beginning and end are tied.
Advantages: simplest pattern for internal organ rapidly perform
Disadvantages: it produces slight stenosis of bowel

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Halsted suture:
A lambert suture with only two parallel but reversing passages through
the tissue is called a Halsted suture.
Cruciate Suture (Cross mattress):
In this type of suture, the needle is inserted 1 cm from the edge of the
wound on the right side, passes to the left side, drawn 1 cm form the
wound edge, then the needle is reinserted 1 cm below the 1st bite on the
right side and 1 cm from the skin edge, and passes through the wound to
the left side and drawn 1 cm ventral to the 2nd bite on the left side and 1
cm lateral to the wound, and finally the two free ends are knotted.
Pursting Suture:
Pursting suturing pattern can be used to close small holes used to evacuate gas
from the bowel or to keep cannulae in situ, but it is mostly used with anus to
retain rectum during rectal prolapse. The needle is inserted parallel to the anal
opening, 1.5 cm far, and advance subcutaneously for 1.5 cm then drawn, then
reinserted with the direction of watch 360 degree, and then the two ends of the
suture material are tied.
Far Far Near Near:
In this pattern, needle is inserted and is passed from a point
distant from the skin incision to a similar point on the
opposite side, returned across the incision externally and
passed from a point closer to the incision on the original side
to a similar close point on the contra lateral side. The two
ends are tied then.
Far Near Near Far:
FNNF pattern is made by inserting the needle farther from the
incision than usual; the needle is then made to pass through
the skin and subcutaneous tissue, cross the incision line, and
exit through the skin near the incision. The suture is
continued across the incision to the side of entrance, where it
enters the skin at a point that corresponds to the point of exit
just made on other side.
From the entrance point, the suture is passed through the skin
and across the subcutaneous incision to exit at a far distance
equal to the original. The ends are now sutured.
Advantage:
It opposes the edges of skin and provides a degree of tension.
Disadvantage:
The disadvantages include excessive amounts of suture material in the area, with double sutures in
the incision and an overlapping suture pattern on the skin. Similar disadvantages are present with
Far Far Near Near

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CHAPTER 8
FLUID THERAPY
Basics of Body Fluid:
An adult animal contains about 60% fluid of its body weight.
• Intracellular fluid (ICF) consists of about two-thirds of total body fluids. • The extracellular fluid
(ECF) which constitutes about one-third of the total body fluids. It is divided into three sub
compartments: interstitial, intravascular, and transcellular. The interstitial contains three-quarters of all
the fluid in the extracellular space.
• The intravascular contains the fluid, mostly plasma that is within the blood vessels. Total blood
volume is roughly 8% of bodyweight and plasma roughly 5% of body weight
• The fluid in the transcellular compartment is produced by specialized cells responsible for
cerebrospinal fluid, gastrointestinal fluid, bile, glandular secretions, respiratory sections, and synovial
fluids.
• Daily water intake is about 10% of the body weight (can vary from animal to animal with respect of
their age, environment, feed intake etc. Daily water loss equals daily intake and this loss occurs through
the skin, lung, kidney and gastrointestinal tract.
• Body water contains solutes (substances that dissolve in solvent; particles).
• Electrolytes are substances that split into ions when placed in water.
• Primary ions in the body are sodium, potassium, chloride, phosphate, and bicarbonate.
• Cations are positively charged ions.
• Anions are negatively charged ions.
• Body water is the solvent in biological systems
• To establish equilibrium, body water moves along its concentration gradient
Composition of fluid:
• ICF (Ca, Mg, K, PO4, protein.)
• ECF (Na, CI, HCO3.)
Fluid therapy Types:
Replacement therapy: Therapy in which we infuse same type of fluid which is lost from body.
Adjunctive Therapy: One type of fluid is given to remove other type of fluid e.g. mannitol 25% is
given in case of ascites and edema.
Supportive Therapy: Fluid is given to animal just to support him to cure quickly i.e. amino acids,
minerals, multivitamins and carbohydrates etc.
Indications:
• Fluids are administered to patients not only to replace fluid loss but also to correct electrolyte
abnormalities, promote kidney diuresis, and maintain the tissue or organ perfusion.
• During shock.
• Dehydration.
• Diuresis (Toxicities, renal diseases).
• After surgical procedure i.e. to prevent hypotension as hypotension may be due to vasodilation,
decreased cardiovascular function etc.
• Acid base abnormalities.
• Electrolyte abnormalities.
Dehydration:
Dehydration or the loss of fluid from the interstitial space in the form of increased fluid loss
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from vomiting, diarrhea, or polyuria is one of the main cause of water reduction in body.
• Signs include decreased skin tenting, sunken eyes, depressed mentation, and tacky/dry mucous
membranes, CRT 2-3 sec in mild cases and >3 sec in severe cases, Slight depression of eyes into
sockets.
Diagnosing Dehydration:
• Physical exam
• Weight loss
• PCV (HCT) increased
• Albumin or total protein increased
• BUN, creatinine
• Prerenal azotemia
Degree of Dehydration (%)
Clinical examination of Degree of Dehydration
%Degree of Dehydration Clinical signs
<5 Not clinically detectable.
5-6 Subtle-loss of skin elasticity
6-8 % Obvious delay in return of tented skin.
Slightly increase CRT
Eye possible sunken & dry mucous membrane.
10-12 Skin remain tented.
Very prolonged CRT.
Sunken eyes & dry mucous membranes.
Possibly signs of shock (tachycardia, cool extremities, rapid & weak
pulse)
12-15 % Obvious signs of shock.
Death imminent
Types of fluid:
(a) Crystalloids.
• Contain sodium as the main osmotically active particle.
• Useful for volume expansion (mainly interstitial space).
• For maintenance infusion.
• Correction of electrolyte abnormality.
Types of crystalloids
1. Isotonic crystalloids
• Lactated Ringer's, 0.9% NaCI (Normosol)
• Only 25% remain intravascularly
2. Hypertonic saline solutions:
• 3% NaCI
• 0.9% normal saline with 5% dextrose
• 10% dextrose in water
3. Hypotonic solutions
• D5W (dextrose 5 % in water)
• 0.45% NaCI
• 0.25% NaCI
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• Less than 10% remain intravascularly, inadequate for fluid resuscitation.

Lactated Ringer's Solution:
• Composition closely resembles ECF
• Contains physiological concentrations of: sodium, chloride, potassium, and calcium
• Also contains lactate, which is metabolized by the liver alkaline-forming
• Because small animals that are sick or under anesthesia tend towards acidosis
Ringer's Solution:
• Same as LRS except no lactate added.
• Commonly used in Large animals.
• Large animals who are sick tend towards alkalosis instead of acidosis
Normal Saline:
• 0.9% Sodium chloride = ISOTONIC
• Lacking in K+, Ca2+
• Used for hyperkalemia, hypercalcemia
• Used as a carrier for some drugs
• Used if don't want lactate
(b) Colloids
• Contain high molecular weight
•Substances-*do not readily migrate across capillary walls
Preparations
• Albumin: 5%, 25%
• Dextran
• Gelifundol
• Haes-steril 10%.
Natural Colloids
Blood products:
• Whole blood
• Plasma
• Platelet-rich plasma
• Packed RBC's
Synthetic Colloids
Dextrans, Hetastarch
Used when quantity of a crystalloid is too great to be able to infuse quickly.
Stays within the vasculature maintain blood pressure
Duration of effect is determined by molecular size: bigger = longer
Small volumes produce immediate increases in blood pressure
Fluids: How Much to Give?
Correct dehydration:
Weight in kg times percent dehydration equals the amount in liters that the animal is dehydrated
Example: 10 kg animal who is 8% dehydrated
10 kg X 0.08 = 0.8 liters
Patient is lacking 0.8 liters, or 800 ml fluids
So How Is It Delivered?
• Infusion pump (easy)
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• IV drip set: drops per ml written on package

• Regular Drip sets have 10, 15, or 20 drops per ml
• Micro drip sets have 60 drops per ml
Calculate Drops Per Hour
• Calculate ml/hr. •
• Calculate drops/hr by: ml/hr X drops/ml (from the package)
• Gives you drops needed in an hour
• Example: 100 ml X 10 drops per ml = 1000 drops in the first hour
Calculate Drops Per Minute
• Divide drops per hour by 60 min/hr to get drops per minute
• Ex: 1000 drops/ hr divided by 60 minutes per hour = 16.7 drops per minute
• 16.7 drops/min divided by 60 sec per min = 0.28 drops/sec
Principles of Rehydration:
• Correct dehydration, electrolyte, and acid-base abnormalities prior to surgery
• Do not attempt to replace chronic fluid losses all at once
• Severe dilution of plasma proteins, blood cells and electrolytes may result
• Aim for 80% rehydration within 24 hours
• Monitor pulmonary, renal and cardiac function closely
Routes of Fluid administration
Route of Administration Advantages Disadvantages
Oral Safest route Less rapid absorption
Easy Possible aspiration
Cannot use for vomiting animals
Subcutaneous Relatively easy to administer Possible infection
Absorption distributed over time
Must use isotonic fluids
Slower absorption
Intravenous Precise amount given is available Possible fluid overload and vessel
rapidly damage
Various tonicities of fluid used Requires close monitoring
Must be sterile
Intraperitoneal Relatively rapid absorption Possible infection
Can be used when IV access is not Abdominal surgery hindered after
available administration
Cannot use hypertonic solutions
Intraosseous Useful for small animals and birds Lack of confidence in administering
Can be used when vein inaccessible fluid via this route
Rapid absorption Possible infection
Rectally Good absorption Not frequently used
Fluid overload:
• Serous nasal discharge
• Increased respiratory rate (Dyspnea)
• Crackles or muffled lung sounds on pulmonary auscultation
• Late stage consequence = pulmonary edema (or pleural effusion in cats)
•Decreased PCV
• Increased BP

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SHOCK
Clinical signs Hypovolemic and Vasodilatory shock
Cardiogenic Shock
Heart Rate Tachycardia (rapid HR) and Tachycardia
end stage. Severe
bradycardia( slow HR)
Pulse strength Weak becoming absent Bounding (due to dilated
blood vessels)
Mucous Membranes Pale becoming white Bright red (hyperanemic)

Capillary Refill time Prolonged Time Rapid ( as blood pooling

in vessels)

Blood pressure: May initially be normal due Low

to sympathetic response then
decline
Temperature: Cool (vasoconstriction)

Choice of Fluids:
1. Vomiting: Dehydration, K def; met alkalosis: Ringers Sol (KCl as an additive)
2. Diarrhea: Dehydration, K def (if chronic); met acidosis: Lactated Ringers Sol (KCl)
3. Diabetes mellitus: Dehydration, K def; met acidosis: Lactated Ringers Sol (KCl)
4. Adrenocortical insufficiency: Dehydration (vascular collapse), hyponatremia, hyperkalemia, met
acidosis: Lactated Ringers Sol or N.S.
5. Urethral Obstruction: hyperkalemia, met acidosis: Lactated Ringers Sol
6. Acute renal insufficiency: hyperkalemia, met acidosis: Lactated Ringers Sol
7. Chronic renal insufficiency: Dehydration, hyponatremia, slight met acidosis: Lactated Ringers Sol
(NaCl & NaHCO3 in food)
8. Prolonged anorexia: Dehydration, K def; slight met acidosis: Lactated Ringers Sol

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CHAPTER 9
GENERAL AND REGIONAL ANESTHESIA
Premedication:
Sedation or tranquilization of the equine patient is almost always indicated prior to inducing general
anesthesia but is not consistently required for cattle.
Compromised horses, such as a patient with an acute abdominal disorder, may preclude the need for
sedation prior to induction. However, analgesic drugs are still warranted.
Preanesthetic tranquilizers may be omitted from the anesthetic plan for neonatal foals because of
inadequate development of the microsomal enzyme system in the liver and the consequent slow
metabolism of these drugs.
The alpha-2 agonists are commonly used as pre-induction agents in horses and occasionally in
uncontrollable cattle.
Anticholinergic drugs, such as atropine, are not used frequently as preanesthetic agents in horses or
large ruminants as the advantages do not typically outweigh the disadvantages, which include
postoperative ileus, increased myocardial oxygen consumption, tachycardia.

Drug Indications Dosage Comments

Acepromazine Mild 0.05–0.1 mg/kg IM May be used for restraint prior to

sedation induction.
Ketamine/ Sedation 2–5 mg/kg ketamine, Mild sedation with ketamine and
Diazepam 0.1–0.2mg/kg benzodiazepine combinations at these
diazepam IV doses.
Ketamine/midazolam Higher dosages are used for anesthesia.
2–5 mg/kg ketamine, Diazepam is generally given by IV
0.1–0.2 mg/kg whereas midazolam may be given by
midazolam IM either the IV or IM route.
Midazolam may also be used in
combination with opioids such as
butorphanol or morphine to provide
sedation and analgesia.
Xylazine Sedation 0.05–0.1 mg/kg IV Significant negative cardiopulmonary
effects are noted with xylazine in
ruminants. Similar considerations exist
for other alpha-2 agents such as
medetomidine.

General Anesthesia
General anesthesia exempts the restraining and, therefore provides ideal situation for aseptic surgery,
proper handling of tissues, and hemostasis. General anesthesia should never be done casually, however,
and the operator should be experienced in performing general anesthesia before electing to use the
technique.

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Prerequisites of general anesthesia:

A thorough Preanesthetic evaluation should be completed prior to general anesthesia in any patient
which include a history, clinical examination, and a complete blood count (CBC) or at least a packed
cell volume (PCV). Complete serum chemistry profiles are indicated in older and debilitated patients.
All anesthetized patients should be carefully monitored during the procedure and throughout
postoperative recovery.
Feed should be withheld from all patients before general anesthesia unless the urgency of the problem.
This is especially crucial in ruminants, where bloat, regurgitation, and aspiration of ingesta are
concerns. Adult cattle should be kept off feed for 48 hours prior to surgery, especially grain and
concentrates. Water may be removed for 12 hours if environmental temperature permits. Regurgitation
is less of a problem in younger cattle, and feed need only be withheld for 12–24 hours and water
withheld overnight prior to surgery.
Precautions of general anesthesia in ruminants:
Most surgical procedures in cattle can be performed with the animal standing or with physical and
chemical restraint and regional anesthesia in lateral or dorsal recumbency as general anesthesia in
ruminants presents many challenges due to their physiological characteristics.
Prolonged recumbency in cattle may cause the abdominal contents to interfere with normal diaphragm
movement and result in hypoventilation, hypoxia, hypercardia, and respiratory acidosis. Regurgitation
and postoperative bloat are also concerns in ruminants under general anesthesia. Fasting patients prior
to anesthesia and surgery and placement of a cuffed endotracheal tube will minimize the risk of
regurgitation and subsequent aspiration during recumbency. Additionally, an oro-ruminal tube may be
placed to facilitate displacement of gas and liquid contents to reduce bloat. Many procedures in horses
are performed under general anesthesia.
Anesthetic induction regimens in the equine patient
Drug Dosage Comments
Guaifenesin/ketamine 5–10% solution of Excellent for debilitated patients. Provides relatively
guaifenesin smooth induction of anesthesia with little
IV (50–100 mg/kg) cardiopulmonary depression. In healthy patients, a low
followed by bolus to moderate dose of
of ketamine an alpha-2 agent may be administered prior to induction
(1.8–2.2 mg/kg) with guaifenesin and ketamine.

Tiletamine/zolazepam Given following sedation with alpha-2 agonist drugs or

(Telazol®) 0.7–1.0 mg/kg IV guaifenesin. Considered to have superior induction
quality and produce greater muscle relaxation than
some other agents, but is also associated with a
prolonged ataxia during recovery.

Xylazine/ketamine 1.1 mg/kg xylazine This regimen provides anesthesia for a short duration
IV followed (12–15 minutes) and eliminates the need for large-
2–3 minutes later by volume administration through a catheter or needle.
2.2 mg/kg ketamine Induction is smooth when xylazine takes effect before
IV ketamine is administered.

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Anesthetic induction regimens in cattle

Drug Dosage Comments

Guaifenesin/ketamine 50–100 mg/kg IV in cattle Guaifenesin is not approved for use in food
animals. Xylazine (0.1–0.2 mg/kg IM) may
be used in unruly cattle to facilitate sedation
prior to guaifenesin but is not typically
necessary.
Triple drip: Solution prepared as 1 g This combination may be used without
Guaifenesin/ ketamine and 25–50 mg xylazine for non-painful procedures or in
ketamine/xylazine xylazine added to 1 L 5% debilitated patients to minimize
guaifenesin. cardiopulmonary side effects.
Administered IV initially at a
0.5–1.1 ml/kg to effect. May
be maintained at 1.0–2.2
ml/kg/hr.
Ketamine/diazepam Ketamine 2–5 mg/kg IV with In cattle, a tranquilizer or sedative may be
diazepam (0.1–0.2 mg/kg) in necessary prior to administration of this
cattle combination. Butorphanol (0.01–0.05 mg/kg)
may be administered just prior to injection to
improve muscle relaxation. Onset is
approximately 5 minutes and duration is 30–
40 minutes. If anesthesia is maintained with
an inhalant, low arterial blood pressure can
be observed.
Stages of anesthesia:
Depending on the level of anesthetic concentration, the following stages of anesthesia may be induced
within the CNS as the inhalant passes from the airway to the lungs and, eventually, to the brain:
 Stage I
Mild depression (sedation).
Period between the initial administration of the induction agents and loss of consciousness (early
stages of a light plane of anesthesia).
 Stage II
Involuntary excitement (uncontrolled movements including vomiting, pupillary dilation paddling,
vocalization, muscle rigidity, defecation, and salivation). During this stage heart and respiration rate
become irregular
 Stage III
It is called surgical stage of anesthesia.
During this stage skeletal muscles relax, breathing become regular, eye movements slow, then stop
and surgery can begin.
It has been divided into 4 planes:
Plane 1: - eyes initially rolling, then becoming fixed.
Plane 2: - loss of corneal and laryngeal reflex.
Plane 3: -pupils dilate and loss of light reflex.
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Plane 4: -intercostal paralysis, shallow abdominal respiration, dilate pupils.

 If the anesthetic plane is too deep (i.e. the anesthetic concentration is too high) for too long, the
patient may die from low blood pressure, bradycardia, and apnea due to severe depression of the
cardiorespiratory center of the brain and poor tissue perfusion.
 Stage 4: -
It is called stage 4 or overdose. This means that too much anesthesia was given to the patient and he
is suffering because of it. Respiration and cardiovascular health becomes affected. Without
breathing apparatus and heart support the patient can die at this point.
Types of anesthesia
1. General anesthesia
2. Local anesthesia
3. Regional anesthesia i.e. Epidural anesthesia
Xylazine HCL:
 0.1mg/kg is dose rate of xylazine HCL in cattle.
 I mg/kg is dose rate of xylazine HCL in equines.
Chloral hydrate
Chloral hydrate is converted to the active compound trichloroethanol by hepatic alcohol dehydrogenase.
The agent interacts with various neurotransmitter-operated ion channels, thereby enhancing gamma-
aminobutyric acid (GABA)-A receptor mediated chloride currents and inhibiting amino acid receptor-
activated ion currents.
In addition, chloral hydrate enhances the agonistic effects of glycine receptors, inhibits AMPA-
induced calcium influx in cortical neurons, and facilitates 5-HT 3 receptor-mediated currents in
ganglionic neurons. Overall, this results in a depressive effect on the central nervous system.
Clinical use.
Drugs used to induce drowsiness or sleep or to reduce psychological excitement or anxiety
Disadvantage.
Chloral hydrate has been in clinical use for many decades and has not been linked to serum enzyme
elevations during therapy or instances of clinically apparent liver injury.
While prospective studies of the effects of chloral hydrate on liver tests have not been done, the absence
of reported instances of liver injury attributable to chloral hydrate suggests that it has little or no hepatic
toxicity. Chloral hydrate has been linked to hypersensitivity reactions such as rash, fever and
eosinophilia. Chloral hydrate also has major drug-drug interactions with oral anticoagulants,
antidepressants and alcohol. chloral hydrate can trigger or worsen hepatic encephalopathy.
Dosage
 100 mg/kg is the dose rate in cattle and equines.
 10% solution used in equines.
 7% solution used in cattle.
Anesthesia monitoring and management:
Anesthesia monitoring is necessary for patient safety and contributes to a smooth recovery however, it
has no therapeutic value unless intervention action is taken to correct any deficit detected via the
monitoring. Monitoring and proper intervention play a key role in the success of each anesthesia case.
Guidelines for monitoring anesthetized patients.
At a minimum, the following three parameters should be monitored at 3-minute intervals in all
anesthetized patients.
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 Circulation.
 Oxygenation.
 Ventilation.
Other parameters that should be monitored include:
 Signs of pain.
 Blood glucose, blood lactate, electrolyte balance, TPR, and PCV.
 Core body temperature.
 Depth of anesthesia.
Neuromuscular blockage monitoring
Three major vital monitoring areas for ensuring tissues are perfused with well oxygenated blood in the
anesthetized animal:

Monitoring Circulation Oxygenation Ventilation (respiratory

areas/ (cardiovascular (cardiorespiratory function)
techniques function) function)

Basic Palpation of pulse, Assessing mucous Observe chest excursions for

(subjective) Assessing Pulse rate, membrane color respiratory rate, pattern, and
rhythm and quality. depth
Auscultation of heart
sounds, capillary refill
rime

Advanced ECG, blood pressure Pulse oximeter for Capnography for end-Tidal
(objective) monitoring. Doppler hemoglobin saturation CO2.
ultrasound for blood Blood gas analysis for Respiratory blood gas analysis
flow and pressure. PaO2, inspired and expired for PaCO3
Blood lactate end-Tidal oxygen
concentrations concentrations.

Local Anesthesia / Nerve blocking in large Animals

In advance veterinary surgery, every surgeon avoids giving general anesthesia because it is more risky
so a particular area or quarter is selected & blocked by local anesthesia.
In large animal regional nerve blocking is preferred over general anesthesia because it is;
 Relatively simple technique.
 General availability & inexpensiveness.
 Minimal apparatus i.e. needles, syringe, & drugs.
 Little risk of toxic side effects.
Abdominal Region/Perineal Region:
Epidural Anesthesia.
Epidural anesthesia is used frequently to facilitate standing surgical interventions in cattle and horses,
and for postoperative anesthesia.
Cranial Epidural /Lumbosacral anesthesia
 Given in the epidural space between L6 & S1 (in lumbosacral fossa).
 Preferred in small ruminants and sometimes in large animals.
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 Location is easy to approach because here is depression which can be felt easily. In lumbosacral
fossa between Oscoxae & Dorsocranial border of Ilium
 Indications: Flank Laparotomy, Surgery of hind limb & digits, inguinal surgery, Udder & teat
surgery,
 Anesthesia: General & local anesthetic agents are used in combination because 5-10 ml of only
local anesthetic needs longer time.
Caudal Epidural anesthesia.
 Indications: Tail docking, Embryology, Intra vaginal & intra uterine manipulations, dystocia,
rectal prolapse etc.
Bovines: Intervertebral space of S5 & C1.
 C1 & C2 (With older age ossification of S5 & C1 occurs)
Equines: Intervertebral space of S5 & C1 Location is difficult.
 20 G needle of 2cm, 20 ml with green tip.
 4-5 ml of local anesthetic agent.
 5-10 mint duration.
Hanging Drop Method:
It is a method to confirm that the insertion of the needle is either correct or wrong.
Procedure: inject 1-2 drops of distil water after inserting the needle at the required position. If the
water comes back, it means needle is not correctly inserted.

Paravertebral Anesthesia
 Paravertebral block is used to desensitize the flank area for standing procedures in horses and cattle,
sheep, and goats.
 In ruminants, T13, L1, L2 and the dorsolateral branch of L3 supply sensory and motor innervation
to the skin, fascia, muscles and peritoneum of the flank.
Two approaches to performing the paravertebral block have been described for cattle.
Farquharson’s Technique/ Proximal Paravertebral Anesthesia:
The first consists of walking the needle off the transverse process. As the nerve is most distinct at its
intervertebrae. Apply the trocar with needle of 16 G or 18 G. After that insert 21 G spine needle with
slow insertion speed and when we feel rupturing or piercing while crossing the ligamentum flavum

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approximately 10 ml of local anesthetic solution (typically 2% lidocaine or mepivacaine) is

administered below the ligament. An additional 5 ml is placed dorsal to the ligament.
If the drug has been administered correctly, desensitization will be effective within a few minutes.
Indications
Laparotomy, Omentopexy, Rumenotomy,
Caesarian section (Flank incision) L1,2,3
Magda’s technique/ Distal Paravertebral Nerve Blocking:
An alternate technique developed by Magda and modified by Cakala and is sometimes referred to as
“Distal paravertebral or Paralumbar approach”.
The branches of T13, L1, and L2 are blocked close to the ends of the first, second, and fourth transverse
processes respectively. At 1st, 2nd, and 4th lumbar transverse processes an 18-gauge needle is inserted
under each transverse process towards the midline, and 10 ml of solution is infiltrated to block the
ventral branch of the nerve. The needle is then redirected slightly dorsal and caudal to the transverse
process to block the dorsolateral branch of each nerve.
Indications: Laparotomy, Omentopexy, Rumenotomy, Caesarian section (Flank incision) L1,2,3,
Ruptured bladder in calves.

Ophthalmic Region/Cranial Region

 Auriculo-Palpebral Nerve Blocking

 Optic Nerve Blocking
 Cornual Nerve Blocking
Auriculo-Palpebral Nerve Blocking
 It innervates periocular cutaneous muscles, particularly orbicularis oculi muscle, which is
responsible for closure of the lids.
Indication: To facilitate examination of a painful eye.
This nerve can be blocked at one of two sites

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(1) In the depression where a line along the dorsal border of the zygomatic arch intersects with a
vertical line drawn along the posterior border of the ramus of the mandible,
(2) At the palpebral nerve where it crosses the superior margin of the zygomatic arch, halfway
between the eye and the ear.
At the latter site, the nerve can readily be palpated. 3-6 mL of lidocaine hydrochloride 2% (Xylocaine)
is injected at either site.

Retrobulbar /Optic Nerve Blocking:

There are two techniques to block this nerve
1) Four-point retrobulbar block:
It is also called four-point retrobulbar block performed by injecting through the eyelids both dorsally
and ventrally and at medial and lateral canthai. A slight curved 24 guage needle is directed to the apex
of the orbit where the nerves emerge from foramen orbit rotundum.
2) Peterson eye nerve block:
Peterson block technique is achieved by blocking the various nerves emerge from the foramen
orbitorotundum and also by blocking the
auriculopalpabral nerve.
Direct a straight 18 gauge, 4.5 inch long needle
through a notch formed with zygomatic arch and
supraorbital process of frontal bone junction, in a
horizontal direction. Advance the needle slightly
posteriorly and somewhat ventrally until it strikes to
bony plate which is at the depth of 3-4 inch. Deposit
15ml 2% lignocaine to foramen orbitorotundum.
Indications: Enucleation, phacoemulsification,
corneal transplant.
Cornual Nerve Blocking:
 Dehorning or disbudding (Cornual nerve is actually a
branch of Trigeminal nerve)
 Fan shaped to cover more area with single pierce of needle
 Between base of horn & lateral canthus of eye

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Inverted L Block
 This is the simplest technique for laparotomy and laparoscopy in large animal species.
 Local anesthetic agent is administered nonspecifically in the form of an inverted L to block nerves
entering the surgical field.
 by the using an 8- to 10-cm, 16- to 18-gauge needle local anesthetic is infiltered at the dose of 2
mg/kg.
 The vertical portion of the inverted L is caudal to the last rib, and the horizontal portion is just
ventral to the transverse processes of the lumbar vertebrae

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CHAPTER 10
SURGICAL PROCEDURES
(a)TRACHEOSTOMY AND TRACHEOTOMY
Tracheostomy:
A surgical operation performed to make an opening into trachea. Tracheostomy may be permanent or
temporary.
Indication:
Tracheostomy may be performed on emergency and elective basis.
Emergency Tracheostomy:
 Emergency includes obstruction of upper respiratory tract.
 Regional lymph node abscession due to streptococcus infection.
 Nasopharyngeal neoplasia.
 Excessive guttural pouch distention with inspissated pus
 Sever subcutaneous edema of throat in case of hemorrhagic septicemia inruminants.
Elective tracheostomy
 It is performed following the nasal surgery, laryngeal surgery or whenever postoperative
respiratory obstruction is anticipated.
 Retrograde pharyngeoscopy or endotracheal intubation.
 Plugging both nostrils in bilateral epistaxis to cease the hemorrhages.
Anesthesia:
Local anesthesia and General anesthesia are usually used
Surgical Anatomy:
Trachea is a tube comprised of 50-60 hyaline cartilage rings that maintain its structure. The cartilage
rings are incomplete dorsally. A fibro-elastic ligament present between two rings called annular
ligament. Smooth muscle is attached dorsal to the inner surface of cartilaginous plates and combine
with mucosa and adventitia to form dorsal tracheal membrane. Dorsal surface is flattened due to
contact with longus colli muscle. The sternothyroideus and sternohyoideus muscles lie on the
ventral aspect of cervical trachea. The esophagus lies on the dorsal to its origin while in distal neck
it lies to left side. The surgical site is variable, but trachea is most superficial at the junction of
upper and middle third of neck and this area is considered best for tracheostomy or tracheotomy
unless the obstruction is below this area.

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Surgical technique:
1. A 10 cm incision is made through the skin and subcutaneous tissue by tensing the skin with left
hand and making incision with right hand.
2. Following the incision on skin and subcutaneous tissue, bellies of sternothyroideus muscles are
bluntly divided in the midline with scissors.
3. The scalpel is inserted midway between two of tracheal rings with sharp thrust and cut annular
ligament in horizontal direction about 1 cm in either direction from midline.
4. When incision is completed, temporary tracheotomy tube can be inserted. this method is
preferred when tube will be placed for short period of time.
5. Another method is adopted when permanent tracheotomy tube is needed to be placed for long
period of time. In this technique, an elliptical piece of cartilage of two adjacent rings that is a
semicircular piece of cartilage from cranial surface of one ring and caudal surface of next ring is
removed with scalpel.
6. In both method, incision is not closed, and wound should be allowed to heal by secondary
intention when the tracheotomy tube is removed .

Precaution:
 The tracheal ring should not be severed completely because tracheal rings in horses are
incomplete at dorsal aspect
Post-operative management:
 Tracheostomy tube should be cleaned daily with sterile physiological solution.
 The area can be dressed in antibacterial ointments or creams daily.
 Administer anti tetanus serum and antibiotic parenterally.
Comments:
In an emergency situation such as when an animal is in danger of suffocation, a surgeon may need
to forego a complete aseptic preparation. Occasionally, an emphysema may develop where air is
trapped between wound edges and dissect along fascial planes. This condition is self-limiting, and
its chances of occurrences are minimized by handling tissue gently and dissecting around either
side of trachea. Tracheal stenosis is a potential complication of this surgery, and its likelihood
depends upon the length of time tracheostomy tube left in place.
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Tracheostomy in Horse

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(b) OESOPHAGOTOMY
Incision on the esophagus for any purpose is called Oesophagotomy.
Indication:
 To excise the esophageal neoplasm
 To remove any foreign body lodged inside the esophagus (Choking)
 To dissect the oesophagous in case of stenosis as well as stricture and adhesions with jugular
phlebitis.
 To rectify the various conditions of oesophagous like esophageal rupture, Esophageal perforation,
laceration, Esophageal fistula and Esophageal diverticulum.
 To feed the animal in case of tetanus or pharyngeal paralysis
Anesthesia:
Surgical procedure is conducted with the animal under general anesthesia.
Surgical Anatomy:
The wall of esophagus is composed of 3 layers, a fibrous layer (tunica adventitia), muscular layer
(tunica muscularis), a sub mucosal layer (tunica sub mucosa) and a mucosal layer (tunica mucosa). On
surgical incision, the wall separates in two distinct layers. The elastic inner layer, composed of mucosa
and sub mucosa, is freely movable within the relatively inelastic outer muscular layer and adventitia.
Arterial supply to cervical part of the esophagus originates from the carotid arteries. The thoracic and
relatively short abdominal part is supplied by Broncho esophageal and gastric arteries.

Surgical Techniques:
1. The patient is placed in dorsal recumbency and skin of ventral surface of neck is prepared and
draped for aseptic surgery.
2. A 10 cm long incision is made on skin and subcutaneous tissue by scalpel blade.
3. The paired muscle of sterno-thyroid, sternohyoid and omohyoid are separated along midline to
expose the trachea.
4. The left carotid sheath having carotid artery and vagus nerve should be retracted laterally.
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Abdominal retractors aid in exposing esophagus

5. Blunt separation of fascia along the left side of trachea allows the identification of oesophagous
containing stomach tube and gentle sharp dissection of overlying loose adventitia expose the
ventral wall of oesophagous which can be incised in longitudinal Faison sharply through all
layers.
6. After the correction of anomaly esophagus incision is closed in two layers with absorbable
suture material.
 Mucosal and Sub mucosal layer in simple continuous pattern with knots tied inward
 Esophageal musculature can be closed with simple interrupted pattern keeping knots upward
7. Finally, skin incision is closed with non-absorbable suture material in simple interrupted pattern
and a polyethylene drain of ¼ inch diameter is placed beside the esophagus by a stab wound to
remove serum and blood from surgical site.
Approach to the Cranial Thoracic Esophagus via a Lateral Intercostal Thoracotomy
Position the patient in right lateral recumbency over a rolled towel placed perpendicular to the long axis

of the body. Choose the appropriate intercostal space incision based on the radiographic location of the
abnormality. Most abnormalities cranial to the base of the heart can be accessed through an incision in
the left third or fourth intercostal space Identify the esophagus in the mediastinum dorsal to the
brachiocephalic trunk. Identification may be aided by passage of a stomach tube or by palpating the
abnormality. Dissect the mediastinal pleura overlapping the esophagus to just above and below the
proposed surgical site. Preserve the branch of the internal thoracic vein and the costocervical vein,
which cross the cranial esophagus.

Approach to the Esophagus at the Heart Base via a Right Lateral Thoracotomy
The approach is the same as that for the cranial esophagus except that the incision is made
through the right fourth or fifth intercostal space. Identify the esophagus, located just dorsal to
the trachea in the mediastinum. Dissect and retract the azygos vein from the esophagus to
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allow adequate exposure. Ligate the azygos vein if necessary to adequately expose the
esophagus. Closure is the same as for cranial thoracotomy.

Approach to the Caudal Esophagus via a Caudal Lateral Thoracotomy

Position the patient in lateral recumbency as described above for cranial lateral thoracotomy.
Perform a caudal lateral thoracotomy. Although the caudal esophagus can be approached
through an incision in either the left or right eighth or ninth intercostal space, the left ninth
space is preferred. Expose the caudal esophagus by transecting the pulmonary ligament and
packing the caudal lung lobes cranially.
Identify the esophagus, which is just ventral to the aorta. Identify the dorsal and ventral vagal
nerve branches on the lateral aspect of the esophagus and protect them.

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Post-operative care:
 Feed should be withheld for 48 hours.
 Parenteral administration of electrolyte solution, antibiotics and anti-inflammatory drugs.
Most Oesophagotomy incision heals by first intention and intraluminal suture will
slough into lumen within 60 days.

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(c) OPENING OF FRONTAL SINUS

Indication:
 Necrosed turbinate bones
 Injury to walls of sinus
 Neoplasm or cyst in sinus
 Abscess or pus in sinus
 Foreign body or parasitic infection
 Fracture particles of bones
 Sinusitis associated with dehorning.
Surgical Anatomy:
Equine: Frontal sinus consists of frontal and turbinate parts. Frontal part is bounded by frontal bone
while floor is formed by ethmoid masses. Anterior margin extend to anterior border of bony plate and
posterior is through temporal condyle. The lateral extremities projects into supraorbital process.
Turbinate portion of frontal sinus is posterior-dorsal to the turbinate bone and bounded by nasal and
lacrimal bone. Frontal sinus communicates with maxillary sinus through large fronto-maxillary
opening.
Bovine: The frontal sinus is comprised of several compartments. The large caudal frontal sinus is
completely divided by an oblique partition into a rostro-medial and a caudolateral portion. The former
has a narrow naso-frontal opening and a post-orbital diverticulum. The later has the cornual
diverticulum. The borders of the frontal sinus are from the rostral part of the orbit to a transverse line
drawn through the midline of the orbit, laterally to the frontal crest, and caudally to the nuchal crest
(poll). A midline septum separates the two frontal sinuses. The normal small communication of the
frontal sinus with the ethmoid sinus and the nasal cavity is usually occluded due to thickening of the
mucosa and purulent discharge.
Site for trephining:
Equine: Draw two imaginary lines at right angle to each other, one at the level of supra-orbital
foramen and second on midline of head. Where both line cross each other is the site of land mark or
medial corner of frontal sinus.
Bovine: The trephine opening may be located 5 cm dorsal to the line joining the two supra-orbital
processes and about 5 cm from midline. Further landmark: 2–3 cm abaxial at the level of a horizontal
line joining the axial parts of both orbits. Sometimes a soft area of bone presents a suitable site. A
ventral site is preferable if the horn sinus is still patent, permitting flushing from one opening to the
other.
Anesthesia: General anesthesia Local Anesthesia
Surgical technique:
1. Prepare the purposed site of surgery aseptically by clipping and shaving and washing with
antiseptic solution.
2. Remove circular area of skin, subcutaneous tissue and cutaneous muscle 3 cm diameter by
scalpel and forceps.
3. Elevate periosteum with periosteal elevator and remove it with scalpel
4. Trephine bone over sinus using 2.5 cm diameter Galt or Horsley pattern trephine.
5. Place the center piece of trephine in the center of the bone and move the instrument in tro and fro
direction forcefully until the resistance is overcome.
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6. Removed part of bone usually comes with the instrument. Otherwise it can be removed with a
bone forceps and flushing of sinus is performed.
7. As trephine opening closes over, irrigation should be continued with a flexible polypropylene or
PVC catheter attached to the syringe. It is a good idea to suture the catheter in place.

Post-operative management:

 Flush sinus cavity initially with warm water using enema pump, then with hydrogen peroxide
(3%, i.e. 10 vol. diluted with equal volume of water)
 Insert enema pump (Higginson’s syringe) to direct the irrigating mixture into the various
compartments Irrigate finally with dilute chlorhexidine hydrochloride solution (10 ml of 5%
solution made up to 1 liter with water), flushing from top to bottom
 The wound usually heals in three to four weeks. Parenteral medication (five to ten days with
broad spectrum antibiotics) is indicated in animals with systemic signs and in all longstanding
and severe cases.
 Avoid feeding hay/straw from overhead rack

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(d) CORRECTION OF ENTROPION

Entropion is inversion or inward folding of eyelid. It may affect one or both eyelids of one or both eyes.
It may involve only a part or the whole of palpebral border.
Etiology:
Entropion more commonly results from trauma and fibrosis of the lids. Entropion and associated
trichiasis may produce local irritation, lacrimation, epiphoria, conjunctivitis, keratitis, corneal ulcer and
corneal perforation.
Congenital entropion occurs most frequently in sheep and occasionally in foals. Entropion is secondary
to cicatrix formation occur occasionally in horses.
Anesthesia:
General anesthesia (Chloral hydrate 6% solution @ 125 mg /kg of body weight IV) and the eyelids are
desensitized using auriculopalpebral nerve block.
Procedure:
Two important principles are necessary for successful entropion correction.
 Surgery should be restricted to the affected area of eyelid only.
 Surgery in the normal area of eyelid may produce ectropion.
 The incision should be parallel to the eyelid margin at the distance not greater than 4 -5 mm to
provide as near normal eyelid contour as possible.
The Hortze Procedure which relatively simple and quite effective is preferred for surgical correction
entropion
1. Prepare the eyelid aseptically for surgical intervention.
2. Make an incision parallel to the eyelid margins at a distance not greater than 4- 5 mm
3. Excise an elliptical section of skin and orbicularis-oculi muscle
4. Take a fold of skin parallel to and short distance from the palpebral border by means of a special
wide jawed forceps or an ordinary dressing forceps. The depth of the fold being sufficient to
bring the eyelid into its normal position by everything the border.
5. Remove the fold of skin by cutting it with sharp scissor and suture the wound with the fine silk.
Result and Complication:
 The desired effect is always obtaining the eye clearing and resuming its normal appearance
in a short time.
 Over-correction may lead to ectropion.

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(e) CORRECTION OF ECTROPION

Ectropion is the outward turning of eyelids exposing the conjunctiva to irritation. It may be complete or
partial .single or double and unilateral or bilateral and is frequently encountered in large animals.
Congenital or acquired has been observed in horses sheep and cattle. It usually effect the lower eyelid
Etiology:
Edema or chronic thickening of the conjunctiva and cicatrial lesion of the outer aspect of eyelid leads to
ectropion. In the effected eye Cornual conjunctiva is exposed and there is continuous tearing and
laceration
Indications
Ectropion is associated with Cornual and conjunctival disease and when disfigurement and epiphoria
are present Mild ectropion in the absence of occur disease, does not usually require surgery
Anesthesia:
General / local anesthesia
Procedure
The way of correction of ectropion depends upon the lesion .when the abnormality is due to the chronic
thickening of the conjunctiv ,the best procedure is to excise an elliptical to the parallel to the palpebral
border. Other procedures are as fallows
Method I
Make a v shape incision including the scar, with the opening of the “v” next the palpebral border.
Separate the v shape flap from the underlying tissue from its apex to the base border to mobilize it.Push
the separate flap towards the palpebral border and suture the cut edges in a “Y” shape manner
Method II
Excise the facial ectopic areas in a “V” shape fashion. Close the defect by a simple interrupted medium
non absorbable synthetic suture. Excise some of the eyelid margins
Post-operative treatment:
This include the topical antibiotics and the suture are removed in 7-10 days The effect of surgery should
be evaluated after the wound healing has completed

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(f) ENUCLEATION OF THE EYEBALL

Surgical removal of the eyeball is called enucleation.
Indication:
Intra-ocular neoplasia and gross damage to bulb, usually with severe primary or secondary infection.
e.g. infectious bovine keratoconjunctivitis associated with trauma or rupture of globe.
Anesthesia:
Enucleation of eyeball can be performed in General anesthesia with xylazine HCl and Chloral hydrate
and in local anesthesia by nerve blocking technique innervated to the eye.
Retro bulbar Nerve block:
It is also called four-point retrobulbar block performed by injecting through the eyelids both dorsally
and ventrally and at medial and lateral canthi. A slight curved 24-gauge needle is directed to the apex
of the orbit where the nerves emerge from foramen orbito-rotundum. Corneal anesthesia, mydriasis
indicates a satisfactory retro bulbar block.
Peterson eye nerve block:
Peterson eye nerve block technique is achieved by blocking the various nerves emerge from the
foramen orbito-rotundum and also by blocking the auriculopalpebral nerve. Direct a straight 18
gauge,4.5-inch-long needle through a notch formed with zygomatic arch and supraorbital process of
frontal bone junction, in a horizontal direction. Advance the needle slightly posteriorly and somewhat
ventrally until it strikes to bony plate which is at the depth of 3-4 inch. Deposit 15ml 2%lignocaine to
foramen orbito-rotundum. Auriculopalpebral nerve is block 2- 3inch lateral to the zygomatic arch by
deposition of 10ml lignocaine. If the upper lid is involved in surgical procedure infiltrate lignocaine
subcutaneously 1 inch from the margin of the lid.
Surgical Technique:
 Clip and cleanse peri-orbital area.
 Place continuous suture through upper and lower lids and perform lateral canthotomy (2 cm) to
aid exposure.
 Using traction with towel clips or Allis tissue forceps, make circumferential incision 1 cm
from skin – conjunctival junction, or as appropriate depending on the distribution of non-
viable or neoplastic skin.
 Exerting some traction on eye muscles, dissect the extra-ocular muscles bluntly with Mayo
scissors from lateral and medial canthus. Avoid excessive traction on optic nerve.
 Grasp eyeball and use further traction to dissect it free from surrounding retrobulbar tissue
(excluding conjunctival sac) and optic nerve. Leave the maximal amount of healthy retrobulbar
tissue
 Clamp ophthalmic vessels, optic nerve and retractor bulbi muscle with slightly curved, long-
handled artery forceps and ligate vessels with 7 metric chromic catgut
 Check site for complete removal of all neoplastic or infected tissue.
 Meticulous hemostasis during enucleation is time-consuming and, in most cases, not necessary
so pack the orbital space for a few minutes with sterile gauze while subcutaneous layer of simple
interrupted sutures of chromic catgut is inserted and remove packing and all gauze swabs before
subcutaneous tissues are completely closed.
 Appose skin edges of lids by interrupted vertical mattress sutures of monofilament nylon, the
pressure of the suture incision almost always being adequate to stop hemorrhage.

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 Give systemic antibiotics for five to seven days, NSAIDs for three days, and tetanus prophylaxis
as required.
 Remove sutures two to three weeks later

Complications
Complications include failure or inability to remove all neoplastic tissue (SCC), massive intra-orbital
hemorrhage, abscess formation, excessive dead space, and failure to appose the skin margin without
excessive tension on sutures

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(g) Disbudding and Dehorning

Anatomy of Horn
Horns are the pairs of hard, bonelike, permanent growths projecting from the heads of cattle. They grow
from a unique area of skin cells at the base of the horn and termed as corium. At about two months of
age, horns become attached to the frontal bone of the skull. A sinus lies within the skull beneath the
horn bud. As the horn grows and attaches to the skull, this frontal sinus joins into the adjacent portion of
the horn.
Disbudding and Dehorning
Horned cattle have horns because they have not been dehorned or they are not polled. Some breeds are
naturally (genetically) hornless because they do not grow horns. Dehorning of horned cattle is the
process of removal of their horns or the process of preventing their growth. A polled animal is one that
grew no horns or one that was dehorned.
Reasons for Dehorning or disbudding:
f injury and bruising to herd.
the feed bunk and in transit.
farm workers, horses and dogs.
ttle that are easier to handle
ggressiveness at the feed bunk
lities
Types of Disbudding:
Disbudding can be done either by chemical method or mechanical or electrical method.
Chemical Potash Stick, Silver Nitrate, Sodium
Hydroxide etc.
Mechanical Disbudding Forceps, Disbudding
Knife, Disbudding Scoop
Electrical Electric disbudder
Anesthesia and Pain Relief:
Choices in anesthesia and pain relief include:
short-acting, local anaesthetic (e.g., lidocaine) with an effect for about 60-180 minutes.
-2 agonist, e.g., Xylazine) given alone or in conjunction with a local anaesthetic will
provide analgesia for a few hours.
ocal anaesthetic, a sedative (alpha-2 agonist, e.g., Xylazine) and non-steroidal
anti-inflammatory drug (nsaid) provides pain control of longer duration.
Nerve Blocking:
The cornual nerve supplies sensation to the horn. This nerve travels from immediately behind the eye to
the base of the horn. It lies underneath a small overhanging ledge of bone that is a part of the skull. This
ledge is easily detected with slight finger pressure. A vein and an artery are found in association with
the nerve. Administration of the anaesthetic is simple in young calves. Blocking the nerve makes
dehorning easier on the calf to perform procedure. Block one nerve on each side of the head. Local
anaesthetic should be given by a veterinarian, a trained veterinary technician, or a trained operator.
Technique
1. Restrain the calf with a halter in crush.
2. Preferably, sedate the calf with an injection of an appropriate dose of a sedative and a non-steroidal
anti-inflammatory drug as per label directions.
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3. Locate the injection site for the local anaesthetic by putting your thumb on the skin just beside the
outside corner of the eye. You will feel a soft depression at this site. Now, move your thumb
backwards toward the horn. You will feel a small groove that runs in the bone of the skull. The nerve
runs along and under this groove. The injection site is in the upper third (closer to the horn bud)
between the corner of the eye and the base of the horn.
4. Disinfect the site with an alcohol swab.
5. Use a 20- or 18-gauge, 1 to 1.5 inch needle.
6. Use a 6 or 10 cc syringe.
7. Use from 3-10 cc of 2 per cent lidocaine with epinephrine for each horn. The volume depends on size
of calf.
8. While holding the head steady and with the needle on the syringe, push the needle through the skin at
the injection site. The needle should penetrate perpendicular to the skull at the site. Once you are
through the skin, pull back on the plunger to be sure the needle is not in a blood vessel; then inject about
1.5 cc of lidocaine. Push the needle in about 0.25 inches and inject another 1.5 cc. Push it in about
another 0.25 inches and inject the remaining lidocaine. Then withdraw the needle. If you hit the bone
with the tip of the needle, withdraw it slightly and give the last of the lidocaine.
Chemical Dehorning
Caustic chemicals will prevent the growth of horns when properly applied to the horn buds of new-born
(less than one to three weeks of age) calves. The chemical destroys the horn-producing cells around the
horn bud. The chemicals are available as sticks or pastes. To protect yourself, wear gloves when
applying the chemicals. To protect the calf, avoid application near its eyes. Do not use caustics in rainy
weather.
Technique
1. Administer sedation, analgesia and local anaesthetic.
2. Expose the horn bud and apply Vaseline around the bud to make normal cells least effective.
3. Apply the caustic to the horn button. Use a wooden applicator. Apply a thin layer.
4. Re-position the hair over the paste and horn bud - i.e., cover the horn bud.
5. Move in circular fashion till one drop of blood ooze out from that.
6. After that scar will be formed at the area and will result into formation of normal tissue after healing.
Hot Iron Dehorning
Hot iron dehorners are available in versions heated by a furnace or fire, 12-volt battery, 120-volt
electricity, power packs (e.g., Buddex™) or LP gas. The head of the iron is a hollow circle and it fits
over the horn bud. Proper application of the hot iron will destroy the horn-producing skin at the base of
the horn. This technique works well for calves up to 12 weeks old. There are several sizes of dehorning
irons. The proper size is one where the burner makes a complete ring around the base of the horn. For
electric irons, use a short extension cord as voltage drops with a long cord, limiting the amount of heat
generated by the dehorner.
Technique
1. Administer sedation, analgesia and local anaesthetic.
2. Preheat the dehorning iron to a red color. Both electric and gas irons work best when they are "red"
hot.
3. Wear gloves to protect your hands.
4. Hold the calf's ear out of the way to keep it from being burned.

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5. Place the tip of the burner over the horn and apply slight pressure. When the burning hair begins to
smoke, slowly rotate the dehorner by twisting your wrist.
6. Continue the application of heat for 10-15 seconds. Do not leave the dehorner in place for much
longer, especially in young calves. Heat can be transferred through the thin bones of the skull and
damage the calf's brain.
7. Dehorning is complete when there is a copper-coloured ring all the way around the base of the horn.
8. The horn bud or button will slough off in 4 to 6 weeks.
Disbudding Forceps:
Scoop dehorners are used for calves ranging in age from two to four months with horns up to four
inches long. When used properly, it does not go too deep, but the dehorner can open the frontal sinus
when used at the top end of the age and horn-size range. The blades must be kept sharp for best results.
Technique
1. Administer sedation, analgesia and local anaesthetic.
2. Close the handles together.
3. Place the jaws of the dehorner over the horn bud. The objective is to completely remove a ring of
skin
surrounding the horn base. Therefore, adjust the opening as needed.
4. Press the gouger gently against the head. Maintain the pressure and quickly spread the handles apart
to bring the blades together to remove skin and the horn bud.
5. Control bleeding by pulling the artery with forceps or using a hot iron to cauterize the artery.
6. Clean and disinfect the jaws of the gouger between calves.
Dehorning and its types:
Dehorning with Wire for Very Large Horns
ollow pain management practices

orn flush with the scalp.

e present.
Direct amputation of horn:

20-24 hours and off water 8-12 hours at least.

is anesthetized by using general anesthesia and
after that hair is clipped from the horn periphery and after that gives an incision and undermines the
fascia.
then cut
by either dehorning forceps or any other instrument.

-absorbable suture material using silk by simple interrupted suture

patron.
erformed for 5 to 7 days by using BIPP (Bismuth subnitras Idoform paraffin paste)
in the ratio 3:2:1.
er for 5-7 days post-operative.
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(h) LARGE ANIMAL ORCHIECTOMY

Castration techniques and considerations
Terminology: Castration, gelding, orchiectomy, emasculation, cutting.
Equine castration overview.
The Surgical removal of testes and ovaries is called as castration. The main objective of castration is
removing the major of male sex hormones. Orchiectomy is surgical removal of testies is mostly
performed in equines. Ruminants are castrated by burdizo castrator.
Indication
1. To make animal more docile.
2. To prevent the transmission of undesirable mating of animal.
3. Tumor of testies such as sertoli cell tumor, adenocarcinoma etc.
4. Inguinal or scrotal hernia
5. Hydrocele
6. To increase the meat quality of food animals
Surgical Anatomy:
Scrotal pouch consists of skin, subcut, and tunica dortus layers, afterward scrotal fascia is present which
loosely attaches the tunica dortus with testes.
 Testes and epididymis: Oval lie on horizontal axis, covered by tunica albuginea, weigh 150-300
gm..
 Inguinal canal: Oblique passage through abdominal wall, superficial and dee about 15 cm in length.
 Tunic Vaginalis: Also known as common vaginal tunic.
Comprised of parietal and visceral vaginal tunics
Visceral tunic adhered to tunica albuginea/testes.
Parietal tunic continuous with parietal peritoneum of abdomen Abdominal fluid is in vaginal space.
The epididyrnis is attached to the dorsal border of the testes and overlaps the lateral surface.
Spermatic cord.
Composed of tunica vaginalis, testicular artery& vein, pampinform plexuses, lymphatics of testis
epididymis, testicular nerve, ductucs differences.
Cresmetic muscle and genitofemoral nerve lie external to partial tunics
Preoperative considerations.
1. Palpate both testies to ensure they have descended normally into the scrotum prior to surgery.
2. Ensure they have no systemic illness is present
3. Any indication or nasal discharge, diarrhea, fever etc. should be treated. Castration is an elective
4. Tetanus prophylaxis is up-to-date
5. NSAID administration for anti-inflammatory and analgesic effect Phenylbutazone (2.2 mg/kg PO or
IV).
6. Flunixin meglumin (1.1 trig/kg PO or IV).
7. Antibiotics: Penicillin 22,000 iu/kg IM (most often procaine formulation Supplies
8. Instrument pack, sterile gloves, scrub, emasculators, suture, ropes, towels.
9. Recumbent and anesthetized
10. Left lateral recumbency (for right handed surgeon).
11. Dorsal recumbency & Tie the limbs
Age: Castration can be performed at any age however colt generally is operated after 12-18 month.

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Anesthesia: General Anesthesia.

Surgical Technique:
1. Scrotum and parietal tunics are incised.
2. Minimum 10 cm incision on each testis approximately 2-3 cm away from median raphe.
3. First of all, lower testies is grasped between thumb and forefinger and incision is made on skin
and subcutaneous tissue for the length of testis. At the same time pressure is exerted by thumb
and forefinger cause the testis contained in tunica vaginalus to be extruded
4. Then incision is given on the tunica vaginalus over the cranial pole of the testies and hooking
finger with in tunic to maintain tension, continues the incision proximal. inalis over the cranial
pole 0 within tunic to maintain n is given on the
5. Ligament of tail of epididymis (attaching tunic to epididymis is severed or bluntly dissected.
6. The mesorchium is penetrated digitally the vascular and A-vascular part of spermatic cord. The
avascular separate is severed with attention to removing as much of tunic as possible

Emasculators:
 Nut to Nut
1. The severance of mucuionbrous portion (avascular part) may be performed conventionally with
emasculator, and crush need only be applied for a short period of time.
2. Similarly the testis is grasped and spermatic vessels (vascular part) are emasculated. The
emasculator remains in position for 1 to 2 minutes, depending on the size of cord and then
released.
3. The skin incisions are enlarged by pulling them apart with fingers until) 10 cm opening is
obtained.
4. The median raphe and any redundant adipose tissue or fascia may also be removed. Leaves
parietal tunic tissue behind can contribute to infection.

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Precaution:
1. Emasculator must be applied correctly without incorporating the skin between its jaws
2. Prevent any stretch to spermatic cord at the time of emasculation.
3. A long hemostatic forcep may be placed on spermatic cord proximal to the emasculator as a
safeguard.
4. Postoperative recommendations
5. Restricted activity for 24 hours followed by daily exercise
6. Lunging at the trot 10 to 20 minutes/day for 3 weeks to decrease edema formation and promote
drainage.
7. Can consider daily hydrotherapy to aide in controlling of swelling Incision will heal in 2-3
weeks.
Complication:
 Severe Hemorrhage: Emasculator not properly applied not condition. Testicular artery
bleeding Evisceration
 Evisceration:
Uncommon prolapse of the intestinal or omental contents through inguinal canal and out of
scrotal incision
Edema:
Normal response to the local inflammation following castration. Very common and pronounced
response day 3-4 post op. causes significant discomfort in horse.
Septic funiculitis:
Infection of spermatic cord, usually subsequent to improper drainage.
Clostridial infection:
Septic peritonitis
Penile damage
Hydrocele:
1. Fluid filled painless swelling in scrotum from abdominal fluid that collects in the vaginal cavity.
Associated with open castration technique.
2. Excessive swelling of surgical site can arise due to inadequate drainage. • Evisceration may
occur through inguinal hernia. • Hydrocele may form due to collection of fluid in common tunic.
3. Scirrhous cord formation related to poor technique, inadequate exercise and drainage. Post-
operative care:
4. Administer anti-tetanus toxoid, antibiotic and NSAID systemically.
5. Close observation of animal after operation is necessary for several hours
6. Animal should be exercised forcefully twice daily from the day following surgery until healing.
7. Gelding should be kept separate from mares for a week.

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(i) Phallectomy
Surgical removal of a portion of penis is called phallectomy or amputation of penis.
Indication:
1) Neoplastic
2) Granuloma associated with habronemiasis
3) Paralysis or priapism of the penis
4) Squamous cell carcinoma of the glans penis
5) Chronic Para phimosis (unability to retract penis in the prepuce)
6) Distal narrowing of the urethra
Surgical Anatomy:
It may be divided into:
1) Root
2) Body
3) Terminal enlargement, the glans.
Muscles:
The penis consists essentially of two erectile bodies, the corpus cavernosum penis and the corpus
cavernosum urethrae. The corpus cavernosum penis forms the greater part of the penis except at its free
extremity. Tunica albogenia and Paired ischocavrnos muscles are present dorsally while bulbospongios
muscle and paired retractor penis muscle lies distally to urethra..
Blood Vessels:
The penis is supplied with blood by three arteries, viz., the internal pudental, external pudental and
obturator vessels.
Nerve supply:
The nerves are derived chiefly from the pudental nerves and the pelvic plexus of the sympathetic
Anesthesia:
General Anesthesia (6% Chloral hydrate, 100mg/kg body weight)
Local Anesthesia (2% lignocaine HCL)
Surgical technique:
1. The horse is positioned in dorsal recumbency. The penis is prepared for aseptic surgery and
a sterile catheter is passed to identify the urethra (As a guide)
2. A tourniquet of rubber tubing applied proximal to the site of amputation. The penis is also
extended and stabilized using a gauze loop around the neck of the glans.
3. A triangular skin incision is made on ventral aspect of the penis, and the incision is
continued through the fascia and corpus cavernosum urethrae. The apex of triangle is
located on the midline in a caudal direction. The triangle has a 3-cm base with sides
approximately 4 cm in length.
4. These incisions should extend down to the urethral mucosa, and the connective tissue
within the triangle is removed and discarded.
5. With the catheter as a guide, the urethral mucosa is split longitudinally on the midline from
the base to the apex of the triangular and catheter is removed.
6. The edges of urethra are sutured to skin edges along the sides of the triangular defect using
simple interrupted sutures.
7. The urethra and penis are then transected. The incision extends from the base of the

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triangle towards the dorsal surface of the penis in oblique fashion.

8. The principal blood vessels encountered may require ligation.
9. Suturing can be done in two ways.
• Tunica albuginea is closed over the transected corpus cavernosum penis using
simple interrupted sutures in first layer. The transected base of the urethral
mucosa is then sutured to the skin using simple interrupted sutures in second
layer.
• Alternatively, the closure can be made in one layer using simple interrupted
sutures, with four bites taken through urethral mucosa, ventral and dorsal to
tunica albuginea, and skin. At this point, the tourniquet is removed.
Postoperative Management:
1) Tetanus prophylaxis is administered
2) Systemic antibiotic is used for 3 to 5 days.
3) Sutures should be removed in 14 days. A stallion should not be exposed to mare for 4 weeks.
4) Depending upon the condition, fluid therapy could be done.
Complications:
• Dehiscence of suture line,
• Granuloma formation
• Hemorrhages
• Recurrence of neoplasia
• Urethral stenosis
Triangular incision Incision near glans Removal of tissue Suturing

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(j) AMPUTATION OF TAIL (TAIL DOCKING)

Indication
 To ease of mating for pregnancy.
 To keep the rear part of animal cleaner and drier.
 Tumor present on tail.
 To improve the appearance of animal in draught horses and ponies
 Tail gangrene in case of Degnala disease very common in buffaloes
 Dislocation or fracture of coccygeal vertebrae (irreparable injury)
Anesthesia:
The operation may be performed under local anesthesia or Epidural anesthesia.
Surgical Anatomy:
The skeletal frame work of tail is makeup of coccygeal vertebrae. The paired muscles of the tail are
enclosed in the strong coccygeal facia which is loosely attached at the root of the tail. The blood supply
to the tail is through the medical and lateral coccygeal arteries located on the corresponding sides and
nerves supply by coccygeal nerve.
Surgical Technique:
1. A tourniquet placed high around the tail head serves as the best means of controlling hemorrhage
during the surgical process.
2. Tail hairs are clipped 3 to 4 cm cranial to the marked intercoccygeal space and as far caudally as
needed, being certain to leave adequate tail hairs above the surgical site for cosmetic purposes.
3. These hairs are wrapped up and kept out of the surgical field. After aseptic surgical preparation of
the site,
4. A “U” or “V” shape surgical incision is made on the dorsal surface and ventral surface of the tail
to make flaps of skin.
5. Palpate the intercoccygeal joint to be resected by moving the lower portion of tail in upward and
downward direction. It can be confirmed by passing the IV needle in the joint.
6. Identify prominent coccygeal blood vessels present on the lateral and ventral sides and then ligate
them proximal to purposed amputation site with absorbable suture material.
7. The soft tissue underlying the skin flap is bluntly dissected to disarticulate the joint.
8. The skin flaps, created earlier is then folded over the end of the tail and sutured using No. 2 non-
absorbable suture in a simple interrupted pattern.
9. The skin edges generally come together neatly, and the surgical incision heals exceptionally
quickly.

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Post-operative care:
 Before removal of the tourniquet, the surgical site is bandaged with cotton bandage.
 Dressing of the tail should be performed daily to prevent any complication
 Give injection of anti-tetanus toxoid in case of horse.
 Give antibacterial drugs and anti-inflammatory drugs systemically daily.
 The suture can be removed after 7-10 days, when the incision site is healed.
Complication
 Disruption of suture line
 Hemorrhage
 Suppuration.
 Maggot wound production.
 Hematoma may form due to inappropriate ligation of blood vessels

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(k) Post-operative care in Large Animals

 Move the animal to an empty, warm and dry place for recovery from anesthesia. Warmer can used
for maintenance of body temperature. (hot water blankets, hot water bottle or heat lamp)
 Body temperature, specifically, should be monitored until a return to normal or until it levels the
normal temperature.
 Elevations in body temperature may reflect a previous preoperative fever, fever due to the
absorption of necrotic debris around the site of trauma, inflammation, infection, or fever due to
unknown origin.
 Monitor vital signs (Heart Rate, Respiratory Rate, Temperature, Oxygen saturation) every 15
minutes until the animal has fully recovered (able to stand or remain in sternal position)
 Determine the need for further supportive care (e.g. fluid, electrolytes) based on the animal’s
condition and the procedures performed.
 Administer analgesics and antibiotics for surgical pain management and surgical wound infection.
 Examine the animal (whether the animal is bright, alert, and responsive) at least twice daily for the
first 72 hours and daily for next 4 days.
 Examine the incision site for redness, discharge, or swelling.
 Contaminated wound should be properly flushed, debrided, and drained.
 Ensure that the animal is eating, drinking, defecating and urinating, normally.
 Feed should be withheld for 48 hours in case of esophagotomy.
 The animal's diet should be of adequate quantity and well balanced. The addition of supplementary
vitamins and minerals is sometime necessary. If pathologic fractures are present calcium phosphorus
and vitamin D are indicated.
 Remove external skin sutures (if any) after 10-14 days depending upon the conditions
 Animals should be encouraged to continue limited exercise (e.g., leash walks) as soon as possible
 ATT (Anti-tetanus toxoid) should be administered in case of horse.
 Stallion that has undergone phallectomy should not be exposed to mare for 4 weeks.

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 REFRENCES
An Atlas of Veterinary Surgery by John Hickman and Jahn Hilton
Veterinary Surgical Techniques by Amresh Kumar
Equine surgery by Saunders
Atlas of large animal surgery by A. W.Kersjes, F.Nemeth and L. J.E.Rutgers
Techniques in Large Animal Surgery byturner and mcilwraith’s

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