Help - diaphragmatic hernia

Re: Help - diaphragmatic hernia

Kerry Spain — Tue, 26 Jun 2012 00:01:58 GMT

I'd just like to point out the advice I gave about inflating the patient's lungs has come from qualified Veterinary Surgeons (and several of them at different practices have followed this method of inflating the lungs at the end of the surgery).

I understand the concern regarding over inflation, however you must understand that I was following the advice of my superior Veterinary Surgeon colleagues. No fatalities have been observed after following their instructions.

Re: Help - diaphragmatic hernia

emvn80 — Wed, 12 Oct 2011 17:04:46 GMT

Don't be tempted to try to over inflate or even fully inflate the lungs at the end of surgery, especially in chronic cases. The lungs are likely to have been collapsed for a while and sudden re-expansion can lead to re-expansion pulmonary oedema which can be fatal. These animals have reduced tidal volumes as they have areas of collapsed lungs.

Instead use careful/gentle IPPV if necessary and take care to to over ventilate, the surgeon can observe the lungs but don't try to fully inflate or re-expand them they will do that of their own accord over time,

PEEP can be useful if you are lucky enough to have the facilities...you can get disposable PEEP valves which you can fit onto the breathing system to deliver a set amount of PEEP.

I agree with other advice about tiliting the table, keeping warm etc

Re: Help - diaphragmatic hernia

Teh Fluffeh — Tue, 11 Oct 2011 20:29:20 GMT

It looks like I have my first one tomorrow, so thanks for putting this up here Nick and Kerry

Re: Help - diaphragmatic hernia

Vicky RVN — Tue, 12 Oct 2010 18:27:39 GMT

Thank you Nick, you're a star If you don't mind i'll print off a copy to put somewhere for everyone to use

Re: Help - diaphragmatic hernia

Nick Shackleton — Tue, 12 Oct 2010 18:19:48 GMT

I did a case report on a diaphragmatic hernia for my diploma. Will try and extract as much info from it and place it into bullet points. That's where I got most of theinfo above from and from my brain......

Re: Help - diaphragmatic hernia

Vicky RVN — Tue, 12 Oct 2010 14:54:10 GMT

Great info here Will def be looking for this thread when i have to do one. In fact, could you put it as an info page in the wiki?

Re: Help - diaphragmatic hernia

Nick Shackleton — Fri, 08 Oct 2010 19:59:09 GMT

Nice one

Re: Help - diaphragmatic hernia

Kerry Spain — Fri, 08 Oct 2010 19:57:59 GMT

Good stuff

Re: Help - diaphragmatic hernia

Viking Dog1 — Thu, 07 Oct 2010 20:29:55 GMT

Hi Guys,

Just wanted to say thanks for your advice, been brill! The surgery went very well and cat recovering better than expected so fingers crossed.

Re: Help - diaphragmatic hernia

Tracy Windler RVN — Thu, 07 Oct 2010 15:13:20 GMT

Hi, I've found those tips interesting too! Will definitely take those on board for the next diaphragmatic hernia we have.

Just a little add- I have found that, depending on the severity of the herniation, I havn't always had to use IPPV. And capnographs are def favourable to pulse-ox if you have one- always used these during cataract surgery when IPPV is required.

Good luck!

Re: Help - diaphragmatic hernia

Kerry Spain — Wed, 06 Oct 2010 22:50:00 GMT

oooh forgot to say just as the vet is about to tighten the last stitch in the diaphragm, inflate the lungs fully to expell as much air from the thoracic cavity, this way it should prevent the risk of a pneumothorax

Re: Help - diaphragmatic hernia

Kerry Spain — Wed, 06 Oct 2010 22:47:51 GMT

Ideally IPPV rate should be close to that of a normal cat (which would normally be observed when the cat is at rest, however this will not be very accurate seen as a degree of dyspnoea/ tachypnoea is observed with most of these patients) so opt for 20-30 breaths per minute.

Use a pulse oximeter to indicate if the IPPV is being sucessful (normal SP02 reading should be seen). Don't be tempted to over ventilate as this can lead to respiratory alkalosis, if you have a capnograph then this should guide you in the right direction.

Also the vet will let you know if the lungs are inflating adequately, hope this helps good luck

Re: Help - diaphragmatic hernia

Viking Dog1 — Wed, 06 Oct 2010 22:01:49 GMT

Thanks muchly nick

Re: Help - diaphragmatic hernia

Nick Shackleton — Wed, 06 Oct 2010 20:47:21 GMT

Tilt the table slightly so that pressure is taken off the diaphragm.

Avoid ACP as this can cause hypotension and spleenic enlargement, which is not good if the spleen happens to be with the thoracic cavity.

Patient should be pre-oxygenated prior to induction (>5mins) with a tight fighting mask. And O2 should be supplied until the patient is suitably anaesthetised to allow for intubation

Heat loss is a worry too with an open abdomen. so heat pads, warm air blankets, fluid warmers, HME etc...

No nitrous oxide as it is contraindicated with patients with respiratory issues. 100% oxygen with inhalation agent.

As soon as the abdomen is open you are likely to have to ventilate the patient, althou the use of a ventilator would be ideal.

Maybe have chest drain stuff out in case you need to place one post of to remove the pneumothorax caused by the hernia.