End of equine rotation...and now for anesthesia!

Last week I finished my very last week on equine rotation. It was a good end to the 4 week module and we had the final MCQ examination last Friday, which was not too difficult fortunately! After a long 4 weeks on equine, I decided to head down to the city centre last weekend since I had not been down that way in quite some time. It was nice to get out and see something other than my room and the vet school! The rest of the weekend I studied for the NAVLE. I began the anesthesia rotation this week and so far it has been so much fun! Prior to this rotation, I had never seen a surgical procedure done under a general anesthetic. On Monday, we were fortunate enough to have 2 procedures to do. The first case was a horse that fractured its mandible and needed fixation via wires and screws. Unfortunately, the endotracheal tube could not be placed due to the requirement for access to the oral cavity for the procedure. So, they had to place a nasotracheal tube instead and the resident that placed it ended up hitting some of the ethmoid turbinates and caused a massage nasal hemorrhage! Once we had the ET tube in place, we attached the horse to the crane and moved it to the surgery table. About 5 minutes later, the head anesthetist noticed that the ET tube cuff was deflating and we had to place a new nasotracheal tube in. This took about 10 minutes before the anesthetist was able to get it in place, so it was quite stressful and we had to top up the injectable anesthetic so that the horse would not begin to recover. Once the tube was placed, the surgical repair of the mandible was smooth and the horse had a smooth recovery. The second horse had a surgical procedure done in the larynx so we were unable to use an ET tube at all. We had to resort to Total Intravenous Anesthesia (TIVA), which was a mix of Romifidine, Diazepam and Ketamine. TIVA is only meant to be used for about 45 min and after that, there is a ceiling effect which causes the TIVA to become ineffective. The recovery time for TIVA is quite prolonged as well as the tissues become saturated with the drugs. The total time under TIVA in this particular horse ended up being 55min and the recovery time was about 3 hours. We sat in the break room with the TV monitor watching the horse for 2 hours while it was in lateral recumbency and non mobile. The camera has a remote control, so when the horse moves, you can follow it easily. Today, we had a septic tarsal joint case that was coming in for GA to have arthroscopy and joint lavage. All in all, this week has been an extremely good week and I have learned loads on anesthesia so far. I've learned quite a bit about breathing systems and calculating O2 flow rates and interpreting CO2, etc. Has been a very good learning experience. We have some dental cases coming in tomorrow, but they are just coming in for routine rasping so that the students on Soft Tissue rotation can rasp the teeth for practice. We did this 2 weeks ago and now it is our rotation to do the anesthesia for the cases. Should be a good day tomorrow. Anyway, I should head back to study land. Happy Thanksgiving to all and I will see most of you very soon!