Plus-Hex CLINICAL
ABSTRACT The surgical management of the equine colic patient can be challenging for veterinary teams to execute safely , accurately and efficiently . Equine veterinary nurses play an important role in the preparation and execution of the surgery . In this article , the authors provide equine nurses with a practical guide to colic surgery .
Keywords equine , horse , veterinary , nursing , colic , surgery
Introduction
Colic is defined as pain in the abdomen . It is generally associated with the gastrointestinal tract , but sometimes with the liver or kidneys [ 1 ] . Many horses experiencing colic will resolve medically , with a high long-term survival rate of close to 90 %. However , it has been shown that approximately 23 % of hospitalised colic cases will require surgical intervention [ 2 ] . When presented with a colic case , attending veterinary surgeons ( VSs ) and veterinary nurses ( VNs ) face both a diagnostic challenge and a potential emergency [ 3 ] . Considering the horse ' s signalment , history and diagnostic findings , the VS will decide whether to pursue medical treatment or to proceed to an exploratory laparotomy , in conjunction with the client ' s wishes [ 3 ] .
It is important that clients are made aware of the high financial costs involved in the surgical procedure and aftercare , and the likelihood of a successful outcome . The expected short-term survival rate of a horse recovering from surgical intervention is estimated to be , on average , 55 – 62 %. However , it is largely dependent on the presenting condition of the horse [ 2 ] . Unfortunately , high financial costs often prevent surgical intervention and the horse may be euthanised [ 4 ] . The surgical team is required to work with safety , accuracy and efficiency , to achieve the best outcome for the horse in what is often an emergency surgical procedure [ 5 ] . The emergency equine VN will cover a wide variety of roles , ranging from laboratory technician to surgical VN , when dealing with emergency colic cases , particularly out of hours . During colic surgery , the VN ' s primary concerns are delivering an efficient service through patient preparation , assisting the VS and maintaining asepsis .
The decision to take a horse to colic surgery is made after considering a variety of factors . Haematology , blood gas analysis and biochemistry are required to evaluate the systemic status of the patient [ 5 ] . Following a physical examination and abdominal ultrasound examination , a trans-rectal abdominal palpation may be carried out to investigate the clinical signs [ 5 ] . An abdominocentesis can also be performed , to evaluate peritoneal fluid as both a diagnostic and a prognostic aid [ 5 ] . Results may be considered as part of the overall clinical examination [ 5 ] . Abdominal radiographs are beneficial to identify sand accumulation or enterolithiasis , which are often seen in dry countries with sandy soils [ 3 ] .
Securing intravenous access by placing an intravenous catheter is advisable early in the patient ' s workup and certainly prior to surgery [ 1 ] . This will allow emergency access , administration of preoperative , antiinflammatory and antimicrobial medications , sedation , anaesthetic drugs and fluid therapy [ 1 ] . Placement of a nasogastric tube is required to decompress the stomach and prevent gastric rupture [ 3 ] . Leaving the tube in place during induction of anaesthesia may be beneficial to allow intraoperative gastric decompression and lavage if necessary [ 3 ] . Horses in severe pain due to gastrointestinal disorders can be unpredictable and dangerous [ 6 ] . Chemical restraint using sedation is often required to avoid injury to the handlers and the horse [ 6 ] . If the horse presents to the hospital in severe pain , it is best to carry out the physical examination in a padded area to reduce the risk of injury to the horse .
Surgical environment and personnel
Colic surgery is one of the most commonly performed and costly surgical procedures carried out in equine hospitals [ 7 ] . The surgery places huge demands on staff and hospital resources , particularly when complications arise [ 7 ] . To maximise time efficiency , the surgical team should consist of a minimum of four people : an anaesthetist , VS , surgeon ' s assistant and circulating theatre VN [ 7 ] . The duty of the circulating VN is to carry out the patient ' s skin preparation , open sterile packs , contain areas of contamination , assist in gowning , respond to the VS ' s requests for equipment or assistance , act as a temporary scrub nurse to hold the contaminated bowel and assist the anaesthetist in anaesthetic emergencies [ 7 ] .
Successful colic surgery is dependent on an environment conducive to efficient and aseptic completion of surgery [ 7 ] . It is important that the theatre is a quiet room to allow orders and requests to be heard and understood clearly [ 7 ] . The theatre room floor should be easy to clean , with an impervious coating and adequate drainage [ 7 ] . The surgical table itself should have the ability to raise or lower the horse , tilt the head or tail of the horse and ideally tilt from side to side as required [ 7 ] .
Surgical hats , masks and surgical scrub suits should be worn as a minimum for all personnel in the operating theatre [ 7 ] . Owing to the copious amounts of fluids used in colic surgery , the VS ' s gown should have a fully impervious body and sleeves [ 7 ] . Powder-free or hydrogelcoated surgical gloves should be worn by the VS [ 8 ] . Sterile rectal-examination sleeves , with the fingers removed , provide an added waterproof layer of protection when the VS places their arm into the horse ' s abdomen [ 7 ] .
Volume 38 ( 3 ) • June 2023
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