Risk Factors for Equine Postoperative Ileus and Effectiveness of Prophylactic Lidocaine

Background: Postoperative ileus (POI) is a frequent and often fatal complication of colic surgery. Reliably effective treatments are not available.
Objectives: To determine risk factors and protective factors associated with POI, and to assess the effect of lidocaine IV on short-term survival.
Animals: One hundred and twenty-six horses that underwent small intestinal colic surgery and that survived for at least 24 hours postoperatively.
Methods: Retrospective cross-sectional study. The association of 31 pre-, intra-, and postoperative variables with POI and the association of lidocaine treatment with short-term survival were investigated. Associations were evaluated with univariable logistic regression models, followed by multivariable analysis.
Results: Significant associations of high heart rate (odds ratio [OR] = 1.05, 95% confidence interval [CI] 1.03–1.08), the presence of more than 8 L of reflux at admission (OR = 3.02, 95% CI 1.13–8.02) and the performance of a small intestinal resection (OR = 2.46, 95% CI 1.15–5.27) with an increased probability of POI were demonstrated. Prophylactic lidocaine treatment was significantly associated with a reduced incidence of POI (OR = 0.25, 95% CI 0.11–0.56). Lidocaine treatment was also significantly associated with enhanced short-term survival (OR = 0.30, 95% CI 0.09–0.98).
Conclusions and Clinical Importance: The variables associated with an increased risk of POI can be useful in identifying horses at risk of POI and in providing a more accurate prognosis. The results are supportive for lidocaine IV as an effective prokinetic treatment after small intestinal colic surgery.     

A Fresh Look at the Process of Arriving at a Clinical Prognosis Part 2: Colic

Generating an accurate prognosis in a horse with colic involves identifying and determining the severity of homeostatic derangements, particularly aberrations in cardiorespiratory, metabolic, and hemostatic functions. The basic questions to be answered are as follows: How sick is the horse?, How healthy was he to begin with?, and How well has he responded to treatment? Although laboratory data are very helpful in making such determinations, a thorough physical examination can suffice if necessary, particularly when repeated to obtain serial data. By reframing the serious colic case in terms of how the horse’s system is responding—or failing—as a whole in its attempts to restore homeostasis, we are better equipped to act preemptively or promptly enough to avert a fatal result and to ensure minimal short- and long-term complications.     

D-Dimer Improves the Prognostic Value of Combined Clinical and Laboratory Data in Equine Gastrointestinal Colic

The discriminating ability of 15 parameters alone or in combinations, including results from analysis of plasma endotoxin, the Nycomed plasma D-Dimer test and phospholipase A₂, were analyzed to predict morbidity and mortality in equine gastrointestinal colic. Endotoxaemia was a characteristic feature of the colic horses. The problem of adequately predicting non-survivors among colic horses required several parameters to be included in the logistic model: if the “classical parameters”, (heart rate, respiratory rate, PCV, anion gap) were included in the model, addition of plasma D-dimer, phospholipase A₂, and Cl^- significantly improved the predictive value of the logistic model. Increasing heart rate and D-dimer together with decreasing chloride was a risk factor for nonsurvival. The sensitivity of this three-parameter logistic model to predict nonsurvival was 78% and specificity 77%. The Nycomed D-Dimer test is recommended as a horse-site test to predict disseminated intravascular coagulation and nonsurvival in equine colic.     

Colic Surgery in Horses: A Retrospective Study Into Short- and Long-Term Survival Rate,Complications and Rehabilitation toward Sporting Activity

Colic surgery in horses impacts both short-term well-being of horses due to possible surgical and anesthetic complications and also long-term return to a sporting career. In this retrospective study, survival and complication rates, as well as functional outcome and behavioral problems in horses that underwent colic surgery were studied. Data from 283 horses that underwent colic surgery at a veterinary teaching hospital were analyzed. Furthermore, owners were contacted and requested to fill out a questionnaire concerning the first year of rehabilitation. Of 283 horses that underwent colic surgery, 167 (59%) were discharged home. After discharge from hospital, 34 horses (12%) were lost to follow-up. Of the remaining 133 horses, 128 were still alive after 1 year (96.2%), while 5 horses were euthanized due to recurrent colic. Of the horses that did not survive the hospitalization period 73 horses (25.8%) were euthanized intraoperatively and 36 horses (12.7%) during intensive care unit (ICU) stay. Survival of horses entering the ICU up to discharge from hospital was 79.5%. During rehabilitation, 49 horses (59.8%) that returned home experienced one or more recurrences of colic. Fifty-two horses (63.4%) that returned home reached at least preoperative level of performance. Altered behavior and gait-related problems during specific elements of riding (for instance during collecting, lateral bending, etc.) were reported in up to 46.2% of horses. Improving veterinary aftercare in collaboration with other disciplines (e.g., physiotherapy and saddle fitting) during rehabilitation could be a means to further improve athletic performance and welfare after recovery from colic surgery.     

Fecal Sand Clearance Is Enhanced with a Product Combining Probiotics, Prebiotics, and Psyllium in Clinically Normal Horses

Consumption of sand and dirt by horses can cause chronic diarrhea, weight loss, and colic caused by irritation and obstruction of the gastrointestinal tract. Prevention has been primarily focused on changes in management to reduce the intake of sand resulting from feeding on the ground. Studies regarding the use of psyllium for the prevention of sand accumulation in clinically normal horses have not been published. A nutritional supplement combining probiotics, prebiotics, and psyllium was hypothesized to increase fecal sand output in clinically normal horses in a natural environment. A measured volume of feces was collected daily from eight clinically normal horses and screened for sand 1 week before and during 35 days of treatment with a supplement combining probiotics, prebiotics, and psyllium. Sand was isolated from feces using a flotation decanting method and was expressed in milligrams sand per gram of feces. Fecal sand output increased significantly (P < .01) by day 4 of supplementation and remained significantly increased through day 31 of the feeding trial. Daily supplementation with a probiotic, prebiotic, and psyllium supplement demonstrated enhanced fecal sand clearance in clinically normal horses. These results suggest that this product may be an effective prophylactic treatment for sand enteropathy and sand colic in which management alone is not sufficient to prevent intestinal sand accumulation. Further studies are needed to confirm the utility of this product in clearing sand from horses with naturally occurring sand impactions and enteropathy.     

An Intensive Approach in the Treatment of Clinical Equine Protozoal Myeloencephalitis

Equine protozoal myeloencephalitis (EPM) is a serious parasitic disease of horses producing neurologic clinical signs. Sarcocystis neurona is an incriminated pathogen. If approximately 50% of US horses are seropositive but only 0.5 to 1% become clinically affected, there is a suspected immunologic influence whether a horse is S. neurona-exposed or has clinical EPM syndrome. This report presents a treatment of 28 performance horses that were serum immunoblot positive for exposure to S. neurona. This patient population was in full athletic competition, travel, or training with associated stress. We attempted to (1) improve the immunologic status of the horse, (2) protect it against inflammatory reactions, and (3) provide medication to kill the protozoa. The cell-mediated immunity was stimulated by transfer factor in the feed for 37 days. The inflammatory reactions of treatment crises from antiprotozoal activity were prevented by MicroLactin (a neutrophil-activation inhibitor) in feed for 28 days concurrently. The antiprotozoal drug ponazuril was given concurrently for 28 days. Gait abnormalities, stumbling, and behavior change were the most frequent and combined clinical signs before treatment. There were 82% (23/28) treatable horses that were back at work, including five horses that were in physical rehabilitation under saddle. Five severely affected horses were not helped by therapy.     

Clinical Experience Using MicroLactin for the Treatment of Equine Inflammatory Disease

MicroLactin is a patented milk protein concentrate whose mode of action is proposed to inhibit neutrophil activation in inflammation and to bolster the immune response in musculoskeletal diseases. MicroLactin was empirically used in the treatment of a series of equine clinical cases. MicroLactin was given in two trials to 166 horses in which neutrophils were associated with an inflammatory response. The primary clinical groups having the greatest positive responders to the use of MicroLactin were: respiratory (92%), joint lameness/foot trauma (90%), muscle injury/myositis (92%), equine protozoal myeloencephalitis (EPM) (81%), skin trauma/hypersensitivity (89%), and toxic enteritis (89%). Positive clinical results were seen within 10 to 14 days when MicroLactin was used as a daily treatment either alone or in combination with other anti-inflammatory agents or as an adjunct to the primary treatment.     

Clinical and Histologic Evaluation of Polyacrylamide Gel in Normal Equine Metacarpal /Metatarsal-Phalangeal Joints

Polyacrylamide hydrogel (PAHG) is being developed to treat osteoarthritis in horses. Prior to application in osteoarthritic joints, evaluation of PAHG in normal joints is indicated. The objectives of this study are to evaluate the clinical, cytologic, histologic, and metabolic effects of PAHG in normal fetlock joints. This study is an in vivo controlled study utilizing six horses that had each of the four fetlocks assigned to either a 7, 28, 56 days or control group subjected to arthrocentesis only. Synovial fluid was collected prior to administration of 2.5 mL of 4% PAHG and again at the completion of the study for macroscopic, cytological, and cartilage metabolism evaluation. The completion of the study included gross and histologic examination of the cartilage and synovial membrane. There was a small but significant (P = .0242) increase in cell count in the synovial fluid at 7 days. There were significant changes in the synovial membrane histology score (P = .0277) as a result of hypertrophic synoviocytes. Biomarkers indicated a small increase in cartilage turnover 7 days after PAHG administration. The PAHG was visible on the surface of the synovium at 7 days, and PAHG appeared in the interstitial spaces of the synovium and intracellular at days 28 and 56. Data from this study provide information as to the tolerance and disposition on an intraarticular injection of PAHG in a normal fetlock joint during a 56-day study. There were no major or permanent detrimental effects seen with the administration of PAHG in normal joints.     

In Vivo and In Vitro Evidence of the Involvement of CXCL1, a Keratinocyte-Derived Chemokine, in Equine Laminitis

Background: C-X-C motif ligand 1 (CXCL1) is an important chemokine of epithelial origin in rodents and humans.
Objectives: To assess in vivo and in vitro the regulation of CXCL1 in equine laminitis.
Animals: Twenty adult horses.
Methods: Real-time quantitative polymerase chain reaction (PCR) was used to assess expression of CXCL1 in samples of laminae, liver, skin, and lung from the black walnut extract (BWE) model of laminitis, and in cultured equine epithelial cells (EpCs). Tissue was obtained from control animals (CON, n = 5), and at 1.5 hours (early time point [ETP] group, n = 5), at the onset of leukopenia (developmental time point [DTP] group, n = 5), and at the onset of lameness (LAM group, n = 5) after BWE administration. EpCs were exposed to Toll-like/Nod receptor ligands, oxidative stress agents, and reduced atmospheric oxygen (3%). In situ PCR was used to localize the laminar cell types undergoing CXCL1 mRNA expression.
Results: Increases in laminar CXCL1 mRNA concentrations occurred in the ETP (163-fold [ P = .0001]) and DTP groups (21-fold [ P = .005]). Smaller increases in CXCL1 expression occurred in other tissues and organs. In cultured EpCs, increases ( P < .05) in CXCL1 mRNA concentration occurred after exposure to lipopolysaccharide (LPS [28-fold]), xanthine/xanthine oxidase (3.5-fold), and H₂O₂ (2-fold). Hypoxia enhanced the LPS-induced increase in CXCL1 mRNA ( P = .007). CXCL1 gene expression was localized to laminar EpCs, endothelial cells, and emigrating leukocytes.
Conclusion and Clinical Importance: These findings indicate that CXCL1 plays an early and possibly initiating role in neutrophil accumulation in the BWE laminitis model, and that laminar keratinocytes are an important source of this chemokine. New therapies using chemokine receptor antagonists may be indicated.     

Di-tri-octahedral smectite for the prevention of post-operative diarrhea in equids with surgical disease of the large intestine: Results of a randomized clinical trial

The aim of this study was to evaluate the effects of a commercially available di-tri-octahedral (DTO) smectite product on clinical signs and prevalence of post-operative diarrhea in horses with colic associated with disease of the large intestine. Sixty-seven horses with surgical disease of the large intestine were randomly assigned to be treated with DTO smectite (n = 37; 0.5 kg via nasogastric intubation every 24 h for 3 days post-operatively) or a placebo (n = 30). The effect of treatment on fecal scores and clinical and hematological parameters, including heart rate, mucous membrane color, temperature, total white blood cell count, total neutrophil count and total plasma protein values, were determined.Horses treated with DTO smectite had a significant reduction in the prevalence of post-operative diarrhea (10.8%), compared with controls (41.4%). A significant improvement in mucous membrane color was observed 72 h post-operatively in horses receiving treatment, compared with placebo. Administration of DTO smectite to colic patients with disease of the large intestine reduced the occurrence of diarrhea in the early post-operative period.