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Standing laryngoplasty
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Introduction: Laryngoplasty is the treatment of choice for many horses with arytenoid cartilage collapses. The procedure was first used for routine laryngoplasty in draft horses to minimize the anesthetic risk. Early results revealed that in addition to the avoidance of general anesthesia, the procedure yields greater mobilization of the larynx and permits a more accurate degree of abduction tailored to the horse’s anticipated function. It has since expanded to right side laryngoplasty and revision laryngoplasty.
Objectives: Review of our experiences with the procedure
Methods: The ventriculocordectomy is first performed under the following sedation protocol:
- Detomidine 6mg IV & Butorphanol 4mg IV prior to entering stocks. Bring in once a light sedation is exhibited.
- Top off with 2mg Detomidine IV during procedure if extra sedation is needed.
- After VC send back to the stall to drain for at least 30 minutes.
Bring back to the surgery area and sedate with 200mg Xylazine IV. Proceed to clip the area outside of the stocks after the sedation has taken effect. Dress the horse with the “slinky” which has a cut out for the surgical area on the appropriate site (to prevent hair particles from falling near the incision site). Move the horse into the stocks and position the head stand to the appropriate height. The head stand is needed to maintain the position of the extended head and neck. Maximal neck extension is detrimental to the procedure. A relatively neutral position is needed and facilitates movement of the larynx within the incision. Sedate with 2-3mg of Detomidine IV if needed. The halter is then replaced by a bioplastic head halter without a throat latch. Alternatively use a rope halter and tie the throat latch piece back onto itself so that the throat latch is exposed. For left laryngoplasty, place a full cup left eye blinker and half cup on the right eye of the horse and tuck the sides into the rope halter and secure with white tape. Insert flexible ear plugs into both ears.
With the horse secured in the stocks and fully dressed attached the Detomidine CRI (1mg/100mL). Proceed to scrub the surgical site. Twenty cc of local anesthesia (2% Carbocaine hydrochloride) is used ventral to the linguofacial vein and immediately medial to the sternocephalic tendon junction to the linguofacial nerve to desensitize the second cervical nerve.
During aseptic preparation of the surgical site, we run CRI initially at a medium drip rate (3-4gtts/1sec) until the surgery starts and after the first incision is made. The approach and the procedure are routine. At that point slow the drip rate down to 1-2gtt/sec and then drip to effect. For most of the horses this provides a nice stable plain of sedation. If the horse gets responsive either adjust the fluid rate accordingly or top off with 2mg Detomidine IV.
The main advantages of the procedure are ease of surgery, avoidance of general anesthesia and ability to accurately assess degree of laryngeal abduction.
Results: The procedure was complete in all but one horse whom would not stand quietly. The ease of surgery and complications rate was as reported below.
Conclusions: The procedure is safe and effective for performance of the laryngoplasty procedure and presents a valid alternative to the standard approach.
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