Evaluation of Surgical Scrub Methods for Large Animal Surgeons

Objective— The objective of this study was to determine the effectiveness of a 5–minute surgical scrub using either a one-brush or a two-brush technique in clean and dirty surgical procedures, and to compare the efficacy of povidone iodine with chlorhexidine as surgical scrub solutions. Study Design— Prospective clinical trial. Methods— Nine veterinarians scrubbed their hands on eight separate occasions using either povidone iodine or chlorhexidine gluconate. A 5-minute scrub and either a one-brush or two-brush technique used in both clean and dirty operations were evaluated by taking glove juice samples before scrubbing, immediately after scrubbing, and 30, 60, 90, and 120 minutes after scrubbing. Glove juice samples were cultured and the colonies were counted. Percent reductions of bacterial forming units were calculated for all eight scrub procedures. Results— All scrub procedures provided an adequate percent reduction in colony forming units (CFU) during the 2–hour sampling period. The number of CFU immediately after scrubbing were significantly lower than prescrub. At 120 minutes, there were significantly fewer CFUs than presecrub, but there were more than immediately after scrubbing. No significant difference in reduction in CFUs were detected between one-brush and two-brush techniques. Both chlorhexidine and povidone iodine scrub solutions adequately reduced bacterial colony counts for 120 minutes after scrubbing regardless of the amount of contamination before skin preparation. Conclusions— Bacterial counts after a hand scrub procedure using a one-brush technique were not significantly different than after a procedure that used a two-brush technique. Povidone iodine and chlorhexidine are equally effectively in decreasing bacterial numbers on the skin, given a variety of contamination levels present before the scrub procedure. Clinical Relevance— Surgeons may use either chlorhexidine or povidone iodine for antiseptic preparation of their hands before surgery. A two-brush technique is not necessary.     

Outcome of surgical correction of meconium impactions in 8 foals

Meconium impactions are only rarely refractory to medical therapy. The purpose of this paper is to examine the outcome of 8 foals that required an exploratory celiotomy to correct a meconium impaction. Between 1984 and 1992, 24 foals were referred with a primary diagnosis of meconium impaction. All foals were treated medically prior to and following referral. Of the 24 foals, 8 had impactions requiring surgical intervention. Exploratory celiotomies were performed, and the impaction was reduced manually or by enterotomy. Follow up information was available on 7 foals. All survived surgery and were discharged. Four of the 8 foals matured and raced. Two foals were euthanatized due to extensive serosal adhesions and one foal was euthanatized due to an unrelated orthopedic condition. Our results support the decision for an exploratory surgery only after aggressive medical therapy has failed. Several treatment options have been developed in recent years that have reduced the number of foals that may require surgery.     

Recombinant Bone Morphogenetic Proteins: Novel Substances for Enhancing Bone Healing

Bone morphogenetic proteins (BMPs) are differentiative factors whose principal function is to induce transformation of undifferentiated mesenchymal cells into chondroblasts and osteoblasts in a dose-dependent manner. Bone morphogenetic proteins have been isolated postnatally in mammals from bone matrix, periosteal cells, mesenchymal cells of marrow stroma, tooth anlagen, and cells of osteosarcoma and chondrosarcoma. Distribution in additional embryonic tissues implies a broader organogenic function. Bone morphogenetic proteins are the only differentiative factors able to singularly induce de novo bone formation in vitro and in vivo. Recombinant DNA technology allows their production in large and highly purified quantities. The BMPs' osteoinductive ability has been shown with a variety of carriers including collagens and polymers at heterotopic and orthotopic sites in a wide range of species. They are presently being readied for clinical use as alternatives to bone grafts. Other potential applications include use as pulp capping agents, promoters of implant osteointegration and soft tissue reunion with bone, treatments for nonadaptive bone disease, and implants for use with mitotically expanded skeletal stem cell populations. Errors in the genetic coding of BMPs may manifest as clinical disease entities.     

Effects of Carbon Dioxide Insufflation Combined With Changes in Body Position on Blood Gas and Acid-Base Status in Anesthetized Llamas (Llama glama)

Objective— To study the combined effects of intra-abdominal CO₂ insufflation with changes in body position during laparoscopy in xylazine-ketamine-halothane anesthetized llamas. Study Design— Prospective, controlled study. Animals— Nine castrated, male llamas weighing 114 ± 23 kg, 3 to 13 years old. Methods— Three llamas (preliminary study [PS] group) were used to study the effect of right lateral, dorsal, and left lateral recumbency on gas exchange and acid-base status. The other six (experimental study [ES] group) were used to study the combined effects of changes in body position and CO₂ insufflation to an intraabdominal pressure of 10 to 12 mm Hg. Heart rate, respiratory rate, and indirect arterial blood pressures (systolic [SAP], mean [MAP], and diastolic [DAP]) were recorded every 5 minutes during anesthesia. Arterial blood gases (PaO₂ and PaCO₂) and acid-base status (pHa and HCO₃) were measured immediately after induction of anesthesia and before each change of position. Results— In the PS group, significant decreases in SAP, MAP and PaCO₂ and increases in PaO₂ and pHa were observed when the llamas were turned from right lateral to dorsal recumbency. Values for HCO_-3 were lower than the postinduction values, but they remained unaffected by the changes in position. In the ES group, values for MAP were significantly lower when the llamas were placed in dorsal and left lateral recumbency than those observed during right lateral recumbency. Arterial O₂ tension during right lateral recumbency was lower but returned to preinsufflation values when the llamas were placed in the dorsal position. All llamas recovered uneventfully within 30 minutes after termination of anesthesia. Conclusions— Insufflation of CO₂ and changing body position induce minor and transient changes in cardiovascular and respiratory function. Clinical Relevance— Laparoscopy with mild intra-abdominal CO₂ insufflation (10 to 12 mm Hg) can be used safely in spontaneously breathing llamas anesthetized with xylazine, ketamine, and halothane.