Page 262 - Clinical Manual of Small Animal Endosurgery

250 Clinical Manual of Small Animal Endosurgery

effective in the management of nasal chondromas/chondrosarcomas,
osteosarcomas/osteomas and lymphomas (note: the latter responds
extremely well to the laser but, as lymphoma needs to be managed as a
systemic disease, recurrence if very likely with sole laser therapy). A side
benefit of laser use is that diodes of this wavelength are haemostatic,
neurostatic and lymphostatic, making postoperative complications
minimal. The net result is that postoperative oedema, haemorrhage and
pain are minimised dramatically.

Postoperative care and complications

The two major complications with any sort of rhinoscopic procedure are
haemorrhage and aspiration pneumonia. Life-threatening haemorrhage
is rare unless the underlying pathology lends itself to a bleeding diathesis,
or there has been an unidentified or incompletely managed coagulopathic
tendency. Aspiration pneumonia from irrigant fluid contaminated with
blood and other exudate is a preventable complication if patient posi-
tioning and proper airway management techniques are adhered to.
Care following rhinoscopy is usually quite minimal. It is usually
advised to allow patients to recover from general anaesthesia slowly to
minimise rapid spikes in blood pressure. Intra- or perioperative use of
acepromazine will help keep the patient’s blood pressure on the low
normal side, thus minimising hypertension-induced haemorrhage. It is
expected that there will be some degree of ongoing epistaxis for a few
days following the rhinoscopy. While this is rarely of any clinical concern
it can be quite untidy and alarming to owners. Often I will suggest hos-
pitalising the patients for the first postoperative evening in an effort to
keep the patient quiet and sedated and to minimise any owner anxiety.
Within 3–4 days haemorrhage and discharge as a sole postoperative issue
are resolved.

Rigid tracheoscopy

Although a complete examination of the trachea and bronchial tree is
best accomplished with a flexible bronchoscope, there is significant value
in the use of rigid endoscopes for tracheoscopy. In particular the emer-
gency diagnosis and management of tracheal foreign bodies, as well as
procedures such as guided bronchoalveolar lavages and transtracheal
aspirates/brushings in smaller patients, are well facilitated by rigid
endoscopy.
Patients presenting for rigid tracheoscopy are often in an acute respira-
tory crisis, so respiratory and ventilatory support is of paramount impor-
tance. In most cases the decision to perform rigid tracheoscopy will make
the use of an endotracheal tube impossible. Judicious sedation with flow
by oxygen support is important in the pre-anaesthetic management. An