Development of equine post anaesthetic myelopathy: Thirty cases (1979–2010)

Post anaesthetic myelopathy is a rare but devastating complication of equine anaesthesia and there is a need for better understanding of the condition and to raise veterinary awareness. The aim of this study was to collect data on unreported cases and combine those with reported cases to better identify possible risk factors and early clinical signs and outcomes of horses developing post anaesthetic myelopathy (PAM). A survey was conducted to identify cases of equine PAM. Records were also requested via the American College of Veterinary Anaesthesiologists listserve. Additional cases of PAM were located through review of the literature. Eighteen new cases and 12 published cases were identified. Large‐framed breeds between 6–24 months of age were more commonly affected (23/30). The majority of horses were positioned in dorsal recumbency during anaesthesia. Lack of movement and deep pain of the rear limbs, loss of anal tone and lack of panniculus response from the mid to caudal thorax distally were the most common clinical findings. Reported treatments resulted in no improvement of clinical signs and all horses died or were subjected to euthanasia from a few hours to 8 days post operatively. Poliomyelomalacia of the caudal spinal cord is the most common histopathological finding. Although a rare complication it is a catastrophic risk that can be eliminated by performing a standing operation. Hopefully in the future better understanding of this condition will lead to prevention and treatment strategies.     

Laser Doppler flowmetry: muscular microcirculation in anaesthetized horses

Muscular microcirculation was studied in seven halothane anaesthetised horses in lateral recumbency using a laser Doppler flowmeter. A significant difference between the dependent and the uppermost triceps brachii was recorded. In the dependent muscles, microflow at first decreased and then increased up to the starting value. In the uppermost muscles, a significant rise of the microflow was measured.     

Improvement in arterial oxygen tension with change in posture in anaesthetised horses

Observations were made on horses spontaneously breathing oxygen, with halothane at a constant end tidal concentration. The horses were positioned in dorsal recumbency for the first 45 minutes of each anaesthetic episode during which the arterial oxygen tension (PaO2) was found to peak and then decline. The remaining 60 minutes of each anaesthesia was used to test the effect of various manoeuvres on PaO2. The PaO2 of horses decreased further both when remaining in dorsal recumbency and when repositioned in right or left recumbency. In contrast, placing the horses in sternal recumbency for these remaining 60 minutes caused the PaO2 to rise rapidly providing evidence for redistribution of ventilation. Replacing some inspired oxygen with less absorbable nitrogen did not improve PaO2 in dorsal recumbency. Thus there was no evidence that the low PaO2 of dorsal recumbency was associated with alveoli that had collapsed because of gas absorption.     

Effect of reducing inspired oxygen concentration on oxygenation parameters during general anaesthesia in horses in lateral or dorsal recumbency

Objective

To compare the effects of two concentrations of oxygen delivered to the anaesthetic breathing circuit on oxygenation in mechanically ventilated horses anaesthetised with isoflurane and positioned in dorsal or lateral recumbency.

Methods

Selected respiratory parameters and blood lactate were measured and oxygenation indices calculated, before and during general anaesthesia, in 24 laterally or dorsally recumbent horses. Horses were randomly assigned to receive 100% or 60% oxygen during anaesthesia. All horses were anaesthetised using the same protocol and intermittent positive pressure ventilation (IPPV) was commenced immediately following anaesthetic induction and endotracheal intubation. Arterial blood gas analysis was performed and oxygenation indices calculated before premedication, immediately after induction, at 10 and 45 min after the commencement of mechanical ventilation, and in recovery.

Results

During anaesthesia, the arterial partial pressure of oxygen was adequate in all horses, regardless of position of recumbency or the concentration of oxygen provided. At 10 and 45 min after commencing IPPV, the arterial partial pressure of oxygen was lower in horses in dorsal recumbency compared with those in lateral recumbency, irrespective of the concentration of oxygen supplied. Based on oxygenation indices, pulmonary function during general anaesthesia in horses placed in dorsal recumbency was more compromised than in horses in lateral recumbency, irrespective of the concentration of oxygen provided.

Conclusion

During general anaesthesia, using oxygen at a concentration of 60% instead of 100% maintains adequate arterial oxygenation in horses in dorsal or lateral recumbency. However, it will not reduce pulmonary function abnormalities induced by anaesthesia and recumbency.     

Comparison of recoveries from anesthesia of horses placed on a rapidly inflating-deflating air pillow or the floor of a padded stall

OBJECTIVE: To compare recoveries from anesthesia of horses placed on a conventional padded stall floor or on a specially designed air pillow. DESIGN: Prospective study. ANIMALS: 409 horses (> 1 year old) that were anesthetized for surgical procedures during a 37-month period. PROCEDURES: By random allocation, horses were allowed to recover from anesthesia in either a foammat-padded recovery stall or an identical recovery stall equipped with a rapidly inflating-deflating air pillow. All recoveries were videotaped for subsequent analysis by an independent evaluator. Times to first movement, first attempt to attain sternal recumbency, attainment of sternal recumbency, first attempt to stand, and successful standing were recorded. The numbers of attempts before achieving sternal recumbency and standing were counted, and scores for quality of standing and overall recovery were assigned. Recovery-related variables were compared between groups. RESULTS: Compared with horses allowed to recover in a conventional manner, horses that recovered from anesthesia on the air pillow had a significantly longer rest period before attempting to attain sternal recumbency and rise to standing. Once the pillow was deflated, horses were able to stand after significantly fewer attempts and the quality of their standing was significantly better. Between the 2 groups of horses, there was no significant difference in overall recovery quality scores. The air pillow and padded floor systems were equally safe. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggested that use of a rapidly inflating-deflating air pillow promotes a longer period of recumbency and a better quality of standing after anesthesia in horses.     

The effect of a 50% inspired mixture of nitrous oxide on arterial oxygen tension in spontaneously breathing horses anaesthetised with halothane

The effect of nitrous oxide (N₂O) on arterial partial pressure of oxygen (P_aO₂) was evaluated in 20 adult horses anaesthetised with halothane. A fresh gas flow rate of 20ml/kg/min, comprising a 1:1 N₂O/oxygen (O₂) mixture, was supplied via the rotameter flowmeters of an anaesthetic machine to a large animal breathing system. The horses breathed spontaneously from the circuit immediately after endotracheal intubation. Ten horses were subsequently positioned in lateral recumbency and ten in dorsal recumbency. A further twenty adult horses were anaesthetised with halothane and acted as controls; halothane in 20mls/kg/min of O₂ being supplied to the same breathing system. Fifty percent NO caused significant decreases in P_aO₂ for horses in lateral and dorsal recumbency. However when administered to horses in lateral recumbency it did not promote arterial hypoxaemia. There was a higher risk of intraopera- tive arterial hypoxaemia (P_aO₂ < 8.6kPa) associated with its use in spontaneously breathing horses in dorsal recumbency. Arterial hypoxaemia occurred in all horses during the first fifteen minutes of recovery but when N₂O was discontinued, halothane in oxygen supplied to the breathing circuit for five minutes at a flow rate of 20ml/kg/minute was sufficient to ensure that diffusion hypoxia did not occur. The magnitude of the hypoxaemia was not signficantly different between the groups. The time taken to adopt sternal recumbency was significantly shorter in the horses that had received N₂O.     

Pharmacokinetics and cardiopulmonary effects of guaifenesin in donkeys

Five donkeys and three horses were given guaifenesin, intravenously, by gravity administration, until recumbency was produced. The time and dose required to produce recumbency, recovery time to sternal and standing were recorded. Blood samples were collected for guaifenesin assay at 10, 20, 30, 40, 50, 60 min, and 2, 3, 4 and 6 h after guaifenesin administration. Serum was analysed for guaifenesin using HPLC and pharmacokinetic values were calculated using a computer software package (RSTRIP). In donkeys, heart and respiratory rates and blood pressures were recorded before and at 5-min intervals during recumbency. Arterial blood samples were collected before and at 5 and 15 min intervals during recumbency for analysis of pH, CO₂, and O₂. anova was used to evaluate dynamic data, while t -tests were used for kinetic values.
Respiratory rate was decreased significantly during recumbency, but no other significant changes from baseline occurred. The mean (±SD) recumbency dose of guaifenesin was 131 mg/kg (27) for donkeys and 211 mg/kg (8) for horses. Recovery time to sternal (min) was 15 (SD, 11) for donkeys and 34 (SD, 1.4) for horses. Time to standing was 32 min for donkeys and 36 min for horses. Calculation of AUC (area under the concentration–time curve) (μg.h/mL) (dose-dependent variable) was 231 (SD, 33) for donkeys and 688 (SD, 110) for horses. The clearance ( CL ) (mL/h.kg) was 546 (SD, 73) for donkeys, which was significantly different from 313 (SD, 62) for horses. Mean residence time ( MRT ) (h) was 1.2 (SD, 0.1) for donkeys and 2.6 (SD, 0.5) for horses. Volume of distribution V _d(area) (mL/kg) was 678 (SD, 92) for donkeys and 794 (SD, 25) for horses. At the rate of administration used in this study, donkeys required less guaifenesin than horses to produce recumbency, but cleared it more rapidly.     

Mixed venous oxygen tension as an estimate of cardiac output in anesthetized horses

The relationship between mixed venous O2 tension and cardiac output was studied in six anesthetized horses breathing 100% O2. Cardiac output, O2 consumption, mean arterial pressure, heart rate, and arterial and venous blood gases were measured after administration of xylazine or dobutamine to horses in lateral, sternal, and dorsal recumbencies. After approximately 3 hours, Escherichia coli endotoxin was administered while horses were in dorsal recumbency, and all measurements were repeated. Relationships between cardiac index (CI) and PVO2, heart rate, mean arterial pressure, jugular PVO2, and PVO2 of blood from a superficial limb vein were evaluated by linear regression analysis. Mean arterial pressure was significantly (P less than 0.05) correlated with CI in horses in all positions and after endotoxin administration. However, data points were poorly grouped. Heart rate and CI were significantly correlated in horses in all positions, but not after endotoxin administration. Correlations between jugular PVO2 and PVO2 of blood from a superficial limb vein were not significant in horses in sternal recumbency, and PVO2 of blood from a superficial limb vein was not significantly correlated with CI in horses in lateral recumbency. There was a significant and tight correlation between PVO2 and CI in horses in all positions and after endotoxin administration.     

Salinomycin toxicosis in horses

CASE DESCRIPTION: A 4-month-old American Paint filly was evaluated because of sudden onset of ataxia that progressed to recumbency. Five additional horses from the same and neighboring premises developed signs of poor performance, generalized weakness, ataxia, and recumbency; 2 of those horses were also evaluated. A new batch of a commercial feed supplement had been introduced to the horses' diet on each farm within the preceding 3 days. CLINICAL FINDINGS: Other than recumbency, findings of physical and neurologic examinations of the foal were unremarkable. The other 2 horses had generalized weakness and mild ataxia, and 1 horse also had persistent tachycardia. The foal had mild leukocytosis with neutrophilia, hyperglycemia, and mildly high serum creatine kinase activity. Results of cervical radiography, CSF analysis, and assessments of heavy metals and selenium concentrations in blood and vitamin E concentration in serum were within reference limits. Feed analysis revealed high concentrations of the ionophore antimicrobial salinomycin. TREATMENT AND OUTCOME: The 5 affected horses survived, but the foal was euthanized. At necropsy, a major histopathologic finding was severe vacuolation within neurons of the dorsal root ganglia, which was compatible with ionophore toxicosis. The surviving horses developed muscle atrophy, persistent weakness, and ataxia. CLINICAL RELEVANCE: In horses, ionophore toxicosis should be considered as a differential diagnosis for acute weakness, ataxia, recumbency, or sudden death. Furthermore, ionophore toxicosis should be considered as a cause of poor performance, weakness, muscle wasting, and cardiac arrhythmias in horses. Surviving horses may have impaired athletic performance.     

Predictors of arterial oxygen tension in anesthetized horses: 1,610 cases (1992-1994).

OBJECTIVE: To identify factors associated with various arterial partial pressures of oxygen (Pao2) in anesthetized horses. DESIGN: Retrospective study. ANIMALS: 1,450 horses anesthetized a total of 1,610 times with isoflurane or halothane. PROCEDURE: Anesthesia records, particularly results of blood gas analyses, were reviewed, and horses were grouped on the basis of lowest Pao2. RESULTS: For horses with lowest Pao2 < 120 mm Hg, those with low pulse pressure, that underwent anesthesia on an emergency basis, or that were males were more likely to have Pao2 < 80 mm Hg. For horses with lowest Pao2 < 250 mm Hg, those that were positioned in dorsal recumbency, that underwent anesthesia on an emergency basis, or that had a shorter duration of anesthesia were more likely to have lowest Pao2 < 120 mm Hg. For horses with lowest Pao2 < 400 mm Hg, those that were positioned in dorsal recumbency, that underwent anesthesia on an emergency basis, that had a shorter duration of anesthesia, that were older, that were heavier, or that were being ventilated mechanically were more likely to have lowest Pao2 < 250 mm Hg. CONCLUSIONS AND CLINICAL RELEVANCE: Low pulse pressure, emergency case status, dorsal recumbency, and short duration of anesthesia were significantly related with lower Pao2 in anesthetized horses.     

The influence of bedding on the time horses spend recumbent

To determine if bedding has any influence on the time horses spend recumbent, 8 horses kept on straw and 8 kept on wood shavings were observed from 10:00 to 5:30 for two successive nights. Observations were conducted using time-lapse video recordings. Lying down and rising behavior, as well as frequency and duration of bouts spent in lateral and sternal recumbency, was registered. The results showed that horses on straw were lying in lateral recumbency three times longer than horses on shavings (P < .001), whereas the time horses spent in sternal recumbency did not differ. The longest period of noninterrupted lateral recumbency was longer for horses on straw than for those on shavings. Because horses must lie down, preferably in lateral recumbency, to achieve paradoxical sleep, the reduced time spent in lateral recumbency in horses on wood shavings may affect their welfare and performance. Independent of the bedding, we further observed that, as the horses got up from recumbency, most of them made attempts to roll over before rising. This behavior appeared to be caused by some difficulty in rising, possibly due to the box size, and might have a connection with the fact that horses sometimes get stuck against the box wall.

Introduction

Many riding horses spend the majority of their life in an artificial environment. Horse owners keep their horses under certain conditions because of tradition, because they want to make the horse feel comfortable from a human point of view, or to reduce the amount of work involved in horse husbandry. Often the choice of bedding substrate is made from a subjective point of view without assessing both short-term and long-term effects of the bedding. Part of the reason is that only few studies have analyzed horses' preferences for different bedding substrates and their effect on the time horses spend recumbent. In one study comparing straw and wood shavings, no significant preference was found.[1] In another study comparing plastic, wheat straw, and wood shavings, the time horses spent standing, sleeping, or lying down was not affected significantly by the bedding substrates. [2] Mills et al [3] found that horses, given a choice between straw and wood shavings, spent significantly more time on straw. Whereas the substrates had no significant effect on behaviors such as eating, lying, and standing alert, horses spent more time performing bedding-directed behaviors on straw but more time dozing on shavings. Finally, it has been reported that the use of nonstraw bedding may increase the risk of abnormal behaviors such as weaving. [4]As far as bedding properties are concerned, Airaksinen et al[5] concluded that air quality in the stable and utilization of manure can be improved by selecting a good bedding material. According to Reed and Redhead, [6] both straw and shavings are economical and easy to obtain, and they make a bright, comfortable bed. Straw bales are convenient to store, but may be eaten by the horse, are labor intensive, and may be dusty or contain fungal spores. Wood shavings are not eaten by the horse and are good for respiratory problems but need to be kept very clean because they are porous. In addition, they are not as warm as straw because they do not trap air the way straw does.Electroencephalographic (EEG) studies in cats have demonstrated that sleep can be divided into two stages of differing electrocorticographic (EcoG) patterns, ie, slow-wave-sleep (SWS) and paradoxical sleep (PS).[7] During PS, bursts of rapid eye movements (REM) can be seen at irregular intervals. [8] In humans, dreaming occurs during this stage. [9 and 10] Horses are able to sleep while standing, [11] but in this position they only go into SWS. [14, 15 and 16] During PS there is a complete abolition of muscular tone of antigravity muscles and of neck muscles, as shown in cats. [17] In horses, there is a gradual loss of muscular tone until the middle of the recorded SWS period, whence it decreases to a negligible amount during PS. [15] Consequently, muscular tone disappears entirely at the onset of PS. [18] Horses are unable to complete a sleeping cycle without lying down to enter PS. [8, 19 and 20] They normally fall asleep while standing and, when they feel confident about their environment, lie down in sternocostal recumbency. [8] Thereafter, they proceed to lateral recumbency and enter PS. [14 and 19] Dallaire and Ruckebusch [18] demonstrated that the SWS state was infrequent in the standing animal and most often occurred during sternocostal recumbency with the head resting or not on the ground. PS occurred in both sternocostal and lateral recumbency, although the animal frequently had to readjust its position into sternocostal recumbency due to the disappearance of neck muscular tone.The sleep pattern of horses depends on many circumstances, such as age,[21, 22 and 23] diet, [16] and familiarity with the environment. When horses are put outdoors it may take some days before they lie down. If one horse that is familiar with the environment lies down, the others usually follow. [8 and 13] Dallaire and Ruckebusch [16] subjected three horses to a four-day period of perceptual (visual and auditive) deprivation. After this period total sleep time increased due to an augmentation of both SWS and PS. Finally, there is large individual variation between horses in the time they spend recumbent and sleeping. [15]Horses spend 11% to 20% of the total time in recumbency.[11 and 15] Lateral recumbency represents about 20% of total recumbency time, and uninterrupted periods of lateral recumbency vary from 1 to 13 minutes (mean, 4.6 min). [14 and 16] Steinhart [11] found that the mean length of uninterrupted lateral recumbency periods was 23 minutes, the longest period being one hour. Total sleeping time in the stabled horse averages 3 to 5 hours per day or 15% of the total time. [8, 13 and 16] Keiper and Keenan [24] found similar time budgets in feral horses that were recumbent approximately 26% of the night. PS is about 17% to 25% of total sleeping time, and the mean length of a single PS period is 4 to 4.8 minutes. [13 and 18]In stabled horses sleep is mainly nocturnal and occurs during three to seven periods during the night.[8, 13 and 16] Ruckebusch [13] observed that neither sleep nor recumbency occurred during daytime in three ponies observed for a month and, in another experiment conducted on horses, PS occurred only during nighttime. [15] A group of ponies observed for more than a month between 8:45 and 4:45 spent only 1% of the daytime recumbent.[25] The maximum concentration of sleep occurs from 12:00 to 4:00 .[8, 16, 18 and 24]The purpose of this study was to examine two groups of horses in a familiar environment, one group kept on a bedding consisting of straw, and the other kept on wood shavings, and to determine if there was any difference between the two groups in the time they spend recumbent.

Materials and methods

Housing. The study was conducted in one of the biggest riding clubs in Denmark, housing about 150 horses. The 18 horses used in the study stood in three different parts of the stable. They were all stabled in boxes measuring 3 × 3 m and subjected to the same feeding and management routine. They were unable to see their next-door neighbor because of a tall wooden board, but they were able to see the horses stabled on the opposite side of the corridor through bars. Nine horses were stabled on wheat straw (15 cm long, dry matter content 87-88%) and nine on oven-dried wood shavings (80% spruce and 20% pine, dry matter content 82%).Animals. All horses used in the study were privately owned. They had been kept in the boxes in which they were observed a minimum of three weeks. Three of the horses were mares and 15 were geldings. Most of them were Danish Warmblood used for dressage riding. Their ages ranged from 5 to 18 years (mean, 10.6 y) and their height ranged from 1.60 to 1.76 m (mean, 1.68 m). All horses wore a blanket. Age and sex distribution between the two groups is shown in Table 1.     

Clinical experiences with isoflurane in dogs and horses

The inhalational anaesthetic agent isoflurane was administered to 22 dogs and 21 horses undergoing a variety of surgical procedures. Satisfactory anaesthesia was produced in all the animals. The cardiopulmonary changes were similar to those observed with halothane. Rapid changes in the depth of anaesthesia were achieved and recovery from anaesthesia was rapid in both dogs and horses, which was a reflection of the relative insolubility of isoflurane. Recovery from anaesthesia in the horses was particularly smooth and rapid with the animals spending a greater part of their recumbency in the sternal position, as opposed to lateral recumbency, before standing in a well coordinated manner.     

Evaluation of a novel post operative treatment for sinonasal disease in the horse (1996-2007)

Reasons for performing study: Results of surgical treatment of sinonasal disease in horses have been reported previously; however, this paper describes the outcome of horses in which a specific post operative treatment protocol was used. Objectives: The objectives of the study were to determine: 1) short‐ and long‐term outcome; 2) complications; and 3) recurrence rates of different disease processes, when horses were treated with a specific treatment protocol. Methods: Medical records of horses presented for surgical treatment of sinonasal disease from 1996–2007 were reviewed. Results and duration of surgical exploration were recorded. Post operatively, the sinus flaps were re‐opened with the horses standing and sedated. Number of horses requiring further treatment (debridement and/or lavage), median number of post operative days when the flap was re‐opened, median number of times the flap was opened and median duration of hospitalisation were recorded. Short‐ and long‐term survival and complication rates were determined. Results: Ninety‐one horses were included in the study. The sinus flaps were re‐opened with the horses standing a median of 3 days post operatively. Thirty‐nine horses (43%) required further treatment at this time and 89 horses (97%) survived to discharge. Incision infection was the most common complication encountered (29%). No horse required a blood transfusion. Recurrence rates were 5% for paranasal sinus cysts, 12% for progressive ethmoid haematoma and 50% for neoplasia. Conclusions: Rapid removal of the primary lesion followed by packing the sinuses and re‐evaluating in the standing horse in a more controlled environment offers a safe and effective means to thoroughly assess and treat sinonasal disease. Potential relevance: Surgical time, intraoperative haemorrhage, long‐term complications and recurrence rates of paranasal sinus diseases treated via frontonasal or maxillary sinus flap may be reduced using this technique.     

Evaluation of Propofol as a General Anesthetic for Horses

This study provides baseline information on the potential use of propofol as a general anesthetic for horses. Using a Latin square design, propofol (2, 4, and 8 mg/kg) was administered intravenously on three separate occasions to six mature horses. Information about anesthetic induction, duration, and recovery was recorded along with results of rectal temperature, heart rate, respiratory rate, pHa, Paco₂ and Pao₂. Statistical analysis included a mixed model analysis of variance, a general linear model analysis and least square means test for post hoc comparisons. A P <.05 was considered significant. The quality of induction of anesthesia varied from poor to good. Two horses were not recumbent following the lowest dose of propofol. Brief paddling limb movements occurred occasionally and unpredictably after recumbency induced by all three doses. During recovery, horses were uniformly calm and coordinated in their moves to stand. Duration of recumbency (minutes) was dose related; 15.05 ± 1.58 (±±SD) following 2 mg/kg, 31.06 ± 5.56 following 4 mg/kg, and 47.85 ± 13.63 following 8 mg/kg. During recumbency at all doses, heart rate significantly increased from a predrug value of 40 ± 6 beats per minute. Substantial respiratory depression, characterized by a significant decrease in respiratory rate (from 11.7 ± 2.9 to 3.7 ± 1.6 breaths per minute) and increased Paco₂ (from 44.5 ± 2.5 to 52.7 ± 8.0 mm Hg) was seen only after 8 mg/kg. A significant decrease in Pao₂ was observed throughout the recumbency induced by 8 mg/kg, and also at 3 and 5 minutes following induction of anesthesia with 4 mg/ kg propofol. At 5 minutes after injection, Pao₂ was 87.4 ± 13.8 and 58.1 ± 17.0 mm Hg after 4 and 8 mg/kg, respectively. The results of this study do not favor the routine use of propofol as a sole anesthetic in otherwise unmedicated horses.     

Postanesthetic hind limb adductor myopathy in five horses

Five horses that underwent prolonged anesthesia (greater than 3 hours) in dorsal recumbency for a surgical procedure were unable to stand after recovery and were euthanatized. A provisional diagnosis of postanesthetic myopathy was confirmed at necropsy in all 5 horses. However, distribution of affected muscles in these horses was atypical, because there was bilateral hind limb adductor muscle involvement.     

Subtotal ostectomy of dorsal spinous processes performed in nine standing horses

OBJECTIVE: To describe and evaluate subtotal ostectomy of dorsal spinous processes (DSP) performed in standing horses. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Nine adult horses. METHODS: The diseased portions of the DSP were removed with the horses standing and sedated after infiltrating a local anesthetic agent around the affected DSP. Medical records of affected horses were reviewed to determine history, findings of physical and radiographic examination, surgical technique, postoperative complications, and outcome. RESULTS: Five horses had subtotal ostectomy of DSP because of osteomyelitis, and 4 because of impingement and/or fracture of DSP. Affected portions of DSP were removed safely and effectively, with no apparent discomfort to the horses; hemorrhage was minimal. CONCLUSIONS: Subtotal ostectomy of DSP can be performed safely in standing, conscious horses and the risks associated with general anesthesia are eliminated. Hemorrhage is minimal compared to that which occurs when the procedure is performed with horses anesthetized and in lateral recumbency. CLINICAL RELEVANCE: Access and visibility are better when subtotal ostectomy of the DSP is performed with the horse standing rather than anesthetized and in lateral recumbency. Performing subtotal ostectomy of diseased DSP with the horse standing avoids the expense and risks of general anesthesia.     

Exercise-induced pulmonary haemorrhage in the horses: results of a detailed clinical, post mortem and imaging study. VII. Ventilation/perfusion scintigraphy in horses with EIPH

Detailed post mortem examination of the lungs of horses with exercise-induced pulmonary haemorrhage (EIPH) has demonstrated significant small airway disease and intense bronchial arterial proliferation in the dorsocaudal lungfields. The purpose of this study was to investigate ventilation and perfusion distribution in the lungs of a similar group of horses to compare changes in the live animal with the previously reported post mortem findings. Thoracic radiography and ventilation/perfusion (V/Q) scintigraphy were performed on five racing Thoroughbreds with recent histories of EIPH. Parametric images of V/Q ratios for left and right lungfields were also generated from the scan images. In all horses, ventilation and perfusion deficits were demonstrated in the dorsocaudal areas of the lung corresponding closely to the observed radiographic lesions. In particular, the perfusion images and V/Q ratio displays indicated that, in affected areas of lung, pulmonary arterial perfusion was the more seriously impaired. This finding appears to confirm the post mortem evidence of reduced pulmonary arterial perfusion and bronchial arterial dominance in these areas. Ventilation deficits in the same areas also confirmed the likelihood of partial airway obstruction consistent with the small airway disease noted in previous post mortem observations. These results suggest that the vascular and airway lesions demonstrated in detailed post mortems of horses with EIPH are also functionally important in affected horses, even at rest. As a consequence of the apparent persistent, insidious and progressive nature of the lesions associated with EIPH there are serious long term implications for management of the condition.     

Dobutamine-induced augmentation of cardiac output does not enhance respiratory gas exchange in anesthetized recumbent healthy horses

The influence of pharmacologic enhancement of cardiac output on the alveolar-to-arterial oxygen tension (difference (P[A-a]O2), physiologic right-to-left shunt fraction (Qs/Qt), and physiologic dead space-to-tidal volume ratio (VD/VT) ws studied in halothane-anesthetized horses in left lateral, right lateral, and dorsal recumbencies. Adult horses were anesthetized, using xylazine (2.2 mg/kg, IM), guaifenesin (50 mg/kg, IV), thiamylal (4.4 mg/kg, IV), and halothane (1.5% to 2% inspired) in 100% O2. Mechanical ventilation was controlled to maintain arterial eucapnia (PaCO2) 35 to 45 mm of Hg) for a period lasting at least 1 hour. Dobutamine was administered at dosages of 1, 3, and 5 micrograms/kg/min, IV, on a randomized basis. The P(A-a)O2, Qs/Qt, and VD/VT were calculated during equilibration and after each dobutamine infusion was given. The P(A-a)O2 and Qs/Qt were significantly (P less than 0.05) greater and VD/VT tended to be greater in horses in dorsal recumbency, compared with those values in horses in left lateral or right lateral recumbency. Cardiac output was similar in all horses, regardless of body position (recumbency). The qualitative relationship between horses in the 3 recumbent positions were not altered by dobutamine. Cardiac output was significantly (P less than 0.05) increased by 3 or 5 micrograms of dobutamine/kg/min in all horses, whereas P(A-a)O2, Qs/Qt, and VD/VT were not significantly altered by dobutamine. The results of the present study failed to substantiate our clinical observations of decreased P(A-a)O2 and Qs/Qt in anesthetized compromised horses given dobutamine.     

Complete and partial hoof wall resection for keratoma removal: post operative complications and final outcome in 26 horses (1994-2004)

REASONS FOR PERFORMING STUDY: There are no data on the frequency of post operative complications following keratoma removal, such as recurrence, hoof wall instability and excessive granulation tissue formation, or their relation to the method of surgical removal. OBJECTIVE: To identify important factors in the outcome for horses undergoing surgical removal of a keratoma and compare the post operative complications encountered following keratoma removal by complete hoof wall resection (CR) and partial hoof wall resection (PR). HYPOTHESIS: Horses undergoing PR would have fewer post operative complications and would return to work more quickly than those undergoing CR. METHODS: A retrospective review of medical records from one equine hospital identified 26 horses that underwent removal of a keratoma by CR or PR. Clinical, radiological and surgical findings and outcome were analysed. RESULTS: Common clinical signs included lameness and the presence of a subsolar abscess. Fourteen horses underwent CR and 12 PR. The complication rate following CR (71%) was significantly lower than that following PR (25%) (P<0.01). Complications encountered included excess granulation tissue formation, hoof crack formation and keratoma recurrence at the surgical site. The time taken to return to full work post operatively was significantly shorter in horses undergoing PR compared to CR (P<0.01). All horses, except one, returned to their previous exercise level. CONCLUSIONS: PR resulted in fewer post operative complications and a more rapid return to athletic activity than CR. Potential relevance: Although the overall complication rate for CR was higher than for PR, the overall prognosis for return to soundness and the previous performance level is very good.     

Blood Gas Values During Intermittent Positive Pressure Ventilation and Spontaneous Ventilation in 160 Anesthetized Horses Positioned in Lateral or Dorsal Recumbency

One hundred sixty horses were anesthetized with xylazine, guaifenesin, thiamylal, and halothane for elective soft tissue and orthopedic procedures. Horses were randomly assigned to one of four groups. Group 1 (n = 40): Horses positioned in lateral (LR_G1,; n = 20) or dorsal (DR_G1,; n = 20) recumbency breathed spontaneously throughout anesthesia. Group 2 (n = 40): Intermittent positive pressure ventilation (IPPV) was instituted throughout anesthesia in horses positioned in lateral (LR_G2; n = 20) or dorsal (DR_G2; n = 20) recumbency. Group 3 (n = 40): Horses positioned in lateral (LR_G3; n = 20) or dorsal (DR_G3; n = 20) recumbency breathed spontaneously for the first half of anesthesia and intermittent positive pressure ventilation was instituted for the second half of anesthesia. Group 4 (n = 40): Intermittent positive pressure ventilation was instituted for the first half of anesthesia in horses positioned in lateral (LR_G4; n = 20) or dorsal (DR_G4; n = 20) recumbency. Spontaneous ventilation (SV) occured for the second half of anesthesia. The mean time of anesthesia was not significantly different within or between groups. The mean time of SV and IPPV was not significantly different in groups 3 and 4. Variables analyzed included pH, PaCO₂, PaO₂, and P(A-a)O₂ (calculated). Spontaneous ventilation resulted in significantly higher PaCO₂ and P(A-a)O₂ values and significantly lower PaO₂ values in LR_G1, and DR_G1, horses compared with LR_G2 and DR_G2 horses. Intermittent positive pressure ventilation resulted in normocarbia and significantly lower P(A-a)O₂ values in LR_G2 and DR_G2 horses. In LR_G2 the Pao₂ values significantly increased from 20 minutes after induction to the end of anesthesia. The PaO₂ and P(A-a)O₂ values were not significantly different from the beginning of anesthesia after IPPV in DR_G2 or DR_G3. The PaO₂ values significantly decreased and the P(A-a)O₂ values significantly increased after return to SV in horses in LR_G4, and DR_G4. The PaO₂ values were lowest and the P(A-a)O₂ values were highest in all horses positioned in dorsal recumbency compared with lateral recumbency and in SV horses compared with IPPV horses. The pH changes paralleled the changes in PaCO₂. Blood gas values during right versus left lateral recumbency in all groups were also evaluated. The PaO₂ values were significantly lower and the P(A-a)O₂ values were significantly higher during SV in horses positioned in left lateral (LR_LG1) compared with right lateral (LR_RG1) recumbency. No other significant changes were found comparing left and right lateral recumbency. Arterial hypoxemia (PaO₂ < 60 mm Hg) developed in 35% of DR_G1 horses and 20% of DR_G2 horses at the end of anesthesia. Arterial hypercarbia (PaCO₂= 50–60 mm Hg) developed in DRoi horses. Arterial hypoxemia that developed in 20% of DR_G3 horses was not improved with IPPV. Arterial hypoxemia developed in 55% of DR_G4 horses after return to SV. Some DR_G4 horses with hypoxemia also developed hypercarbia, whereas some had PaCO₂ values within normal limits. Arterial hypoxemia developed in one LR_G1, and two LR_G4, horses. Hypercarbia developed in onlv one LR_G4 horse.