PRINCIPLES OF VETERINARY SURGERY

CHAPTER 3: PREOPERATIVE CONSIDERATION OF THE SURGICAL PATIENT

 Preoperative consideration of the surgical patient is cost effective because it prevents or predicts
costly complications

A. Components of preoperative patient evaluation

1. Operative risk
 “First do no harm”, consider referrals, exercise discretion
 Operative risk involves mortality and postop morbidity
2. Client communication
 Give accurate diagnosis and prognosis , do not exaggerate
3. Surgical plan
 Depends on nature of illness, available facilities and resources
4. Preoperative antibiotics
 Use of antibiotics to minimize chances of infection including other preoperative corrective and
supportive procedures to correct imbalances and stabilize patient
5. Physical examination
 Quick, thorough and methodical. Use of chemical restraints
7. Laboratory Screening
 Amplify less obvious sign of disease
8. Physiological considerations
a. Blood volume
o Blood collection through jugular or cardiac puncture from healthy donors (10-20 ml/kg every 2
weeks).
o Use heparin (15-30 mg/500 ml) for immediate use or acid citrate dextrose if blood is to be
stored. Store blood at 4-6 °C (21 days). Cross match using agglutination technique (Blood
types). Blood can administered IV, IP or into marrow cavity at a rate of 10-15 ml/kg at 5
ml/min.
o BT of whole blood, blood extracts and plasma substitutes for replacement and supportive
therapy.
a) Whole and citrated blood
b) Blood extracts
 Includes packed RBC (correct anemia) , plasma (for shock, electrolyte replacement,
antibody and nutritive value), and albumin (shock therapy, expensive, used
together with crystalloids)
c) Plasma substitutes
 Includes dextrans (for shock, expensive, antigenic, cause moderate diuresis and
bleeding tendencies), hydroxymethyl starch in saline solution (for hemorrhagic shock),
and polyvinylpyrrolidone solutions

b. Fluid and electrolytes

o 60-65% of body wt is water distributed to the ICF (2/3) and ECF (1/3). Electrical neutrality
b/w these 2 compartments is maintained by the semi-permeable membrane and transport
mechanisms of ions. Normal fluid balance is maintained by fluid intake and fluid loss
(ADH and aldosterone function).
o The important electrolytes for therapy are sodium, potassium, chloride and bicarbonates
o Dehydration maybe due to water depletion or sodium depletion.

Clinical signs of dehydration

1. Mild (4% of body wt)
o History of fluid loss and minimal clinical signs
2. Moderate (6% of body wt)
o Dry mucous membrane and skin, reduced and conc. Urine, fatigue,
reduced skin resiliency.
3. Severe (8% of body wt)
o Dry and congested conjunctiva, dry oral mucosa, soft and sunken
eyeballs, scant and concentrated urine, tachycardia, pyrexia, and “tenting”
of skin when pinched
4. Very Severe (10-12% of body wt)
o Pale mucous membrane, weak and rapid pulse, prolonged CRT, oliguria,
skin elasticity severely reduced.
5. Extreme (15-20% of body wt)
o Signs of circulatory shock and eminent death.

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 CHAPTER 3: PREOPERATIVE EVALUATION

Body fluid distribution and water balance (dog)

Intravascular 60
(plasma) 5% Free
Interstitial ECF 20% Water
fluid 15% 50 Urine

Total body
Intracellular Water 60% 40
fluid 40%
Food
30
Insensible
Loss
20 (30 ml/kg/day)

Solids 40%
10 Metabolism
Feces
Body fluid distribution in Intake Output
an average dog

Changes in the volume and osmolal concentration of the

ICF and ECF
a. Water depletion b. Loss of NaCl

ECF ICF ECF ICF

c. Hypotonic solution d. Isotonic solution

ECF ICF ECF ICF

Volume

a. Acid-base balance
o A state of equilibrium b/w acidity and alkalinity of body fluids. It is primarily the
result of hydrogen ion (H+) production and elimination to maintain an
optimum pH (7.35-7.45)
o Acid base balance is controlled by 3 major regulatory systems mainly chemical
(the buffer system), biological (blood and cellular activity) and biological
(kidney and lung function)
o Disturbances in acid-base balance can lead to conditions of acidosis (pH<7.30)
and alkalosis (pH>7.5)
1. Metabolic acidosis
o Occurs in diarrhea, obstructed GIT, diabetes mellitus, septic shock, tissue
hypoxia, renal dysfunction, excessive administration of acidifying or
isotonic saline sol’n, poisoning, dehydration and starvation
2. Metabolic alkalosis
o Vomiting, K depletion, parenteral administration of bicarbonate and its
precursors, use of diuretics.
3. Respiratory acidosis
o Due to respiratory impairment and retention of carbon dioxide.
4. Respiratory alkalosis
o Excessive excretion of CO 2 through the lungs (hyperventilation) in cases
of pain, hypoxia, fever, high environmental T°, poisoning, pulmonary
embolism, CNS diseases

9. Special Considerations
o Age, allergies, previous and existing illness
a) Cardiovascular system
 Monitor the heart rate, CRT, character of the pulse, urine output and signs of shock
(delayed reflexes, tachycardia, weak pulse, prolonged CRT, subnormal T°, cold
extremities).
b) Respiratory system
 Observe for changes in the rate, depth, character and effort during breathing, cyanosis.
c) Urinary system
d) Hepatic system
e) Musculoskeletal system
 Observe for signs of nervous dysfunction (vomiting, convulsion)