Clinical use of epidural xylazine in the horse

Xylazine was administered into the epidural space of nine horses to facilitate various perineal manipulations (ie rectovaginal laceration repair, replacement of prolapsed rectum and urethral extension). The resulting caudal analgesia was sufficient for all procedures. The duration of analgesia from a single injection of epidural xylazine (0.17 to 0.22 mg/kg bodyweight) was at least 3.5 h. No horses were ataxic during or after the treatment. This trial demonstrates that xylazine given into the epidural space of horses provides prolonged regional analgesia which is sufficient for clinical use.     

Clinical use of positive-pressure ventilation in the horse

Positive-pressure ventilation is used to provide improved ventilatory support during anesthesia in the horse. Because of the horse's size and the physiologic changes it undergoes during anesthesia, however, the use of positive-pressure ventilation does not always provide the improvement seen in smaller species. Careful attention to respiratory rate, inspiratory pressure, and I:E ratio minimizes the negative aspect of IPPV on the cardiovascular system. The goal of future ventilatory techniques will be to improve oxygenation without cardiovascular compromise and to do so at a reasonable cost to the client.     

Clinical pharmacology and therapeutic uses of non-steroidal anti-inflammatory drugs in the horse

Weak organic acids possessing anti-inflammatory, analgesic and antipyretic properties--commonly known as aspirin-like drugs--have been used in equine medicine for almost 100 years. These non-steroidal anti-inflammatory drugs (NSAIDs) may be classified chemically into two groups; the enolic acids such as phenylbutazone and carboxylic acids like flunixin, meclofenamate and naproxen. All NSAIDs have similar and possibly identical modes of action accounting for both their therapeutic and their toxic effects. They block some part of the cyclo-oxygenase enzyme pathway and thereby suppress the synthesis of several chemical mediators of inflammation, collectively known as eicosanoids. The available evidence indicates that some of the newer NSAIDs have a reasonable safety margin but further studies are required. The toxicity of phenylbutazone in the horse has been investigated very thoroughly in recent years and it has been shown to cause renotoxicity and, most significantly, ulceration of the gastrointestinal tract when relatively high doses are administered. Several factors may predispose towards phenylbutazone toxicity in the horse, including breed and age, but high dosage is considered to be particularly important. The absorption into, and fate within, the body of NSAIDs are considered and particular attention is drawn to the ways in which these pharmacokinetic properties relate to the drugs' toxicity and clinical efficacy. In reviewing current knowledge of the clinical pharmacology of this important group of drugs, it is hoped to provide the clinician with a rational, scientific basis for their safe and effective use in equine practice.     

Chloramphenicol 4. Responsible topical use in ophthalmology

Chloramphenicol has gained widespread use in the topical treatment of ocular infections. The rationale for this use was based on the ability of chloramphenicol to penetrate the cornea and enter the anterior segment, together with its broad spectrum of antimicrobial activity. However, routine use in corneal ulceration or keratitis is not desirable. Hypopyon, when present, is usually sterile. Concerns about human exposure to chloramphenicol and its recent prohibition of use in food-producing animals, raise the need to review its indications and discuss alternatives. The role of chloramphenicol in ocular therapeutics is examined in this article.     

Chloramphenicol 1. Hazards of use and the current regulatory environment

Chloramphenicol is a broad-spectrum antibiotic which has enjoyed extensive use in both medical and veterinary practice. Shortly after its introduction in the late 1940s, the use of chloramphenicol was associated with the induction of an idiosyncratic form of aplastic anaemia in man. This rare and unpredictable adverse effect has since been associated not only with systemic use but with topical applications, as well as occupational exposure. Recognition of the small risk of a potentially fatal adverse reaction, together with the risk of selection of chloramphenicol-resistant pathogens, has led to restrictions on the veterinary uses of chloramphenicol. In Australia at present, the use of chloramphenicol is only permitted in small animals. Its use is specifically prohibited in food-producing animals, including horses.     

Clinical aspects of mycotic keratitis in the horse.

Several manifestations of equine corenal ulcers caused by mycotic agents are discussed. Antifungal therapy is reviewed. Mycotic keratitis should be suspected when routine corneal ulcer therapy is nonproductive.     

The use of phenylbutazone in the horse

This review presents a brief historical prospective of the genesis of regulated medication in the US racing industry of which the nonsteroidal anti-inflammatory drug (NSAID) phenylbutazone (PBZ) is the focus. It presents some historical guideposts in the development of the current rules on the use of PBZ by racing jurisdictions in the US. Based on its prevalent use, PBZ remains a focus of attention. The review examines the information presented in a number of different models used to determine the effects and duration of PBZ in the horse. They include naturally occurring lameness and reversible-induced lameness models that directly examine the effects and duration of the administration of various doses of PBZ. The review also examines indirect plasma and tissue models studying the suppression of the release of arachidonic acid-derived mediators of inflammation. The majority of studies suggest an effect of PBZ at 24 h at 4.4 mg/kg. This reflects and substantiates the opinion of many clinical veterinarians, many of whom will not perform a prepurchase lameness examination unless the horse is free of NSAID. This remains the opinion of many regulatory veterinarians responsible for the prerace examination of race horses that they wish to examine a horse without the possibility of an NSAID interfering with the examination and masking possible musculoskeletal conditions. Based on scientific studies, residual effects of PBZ remain at 24 h. The impact of sustained effect on the health and welfare of the horse and its contribution to injuries during competition remains problematic.     

Clinical pharmacology of nervous system diseases.

The well-developed defense barriers of the CNS and the expense of drug therapy limit the pharmacologic options for the treatment of neurologic diseases in horses. New approaches to controlling inflammation in the CNS are improving the outcomes of bacterial meningitis. The appropriate treatment of EPM remains controversial. More research is needed to evaluate the pharmacokinetics and pharmacodynamics of drugs in the CNS of the horse. Behavioral pharmacology has become fashionable in human and small animal medicine, but it needs to be evaluated for the potential of unethical use in performance horses.     

Cardiovascular drugs. Their pharmacology and use in horses

Knowledge of the dosage, rate and route of administration, and potential side effects of drugs used to treat cardiac disease in horses has been refined. The judicious use of these drugs can increase exercise capacity, improve health, and potentially prolong life. Currently, antiarrhythmics (quinidine, lidocaine), positive inotropies (digoxin), and diuretics (furosemide) are the primary agents used to treat cardiovascular disease in horses. The development of newer drugs (verapamil, milrinone, bumetanide) and their usefulness in therapy for horses with cardiovascular disease require further investigation.     

Residues and considerations for use of pharmaceutics in the performance horse.

Analytic chemistry laboratories responding to the concerns of the industry over drug use and abuse in performance horses should continue to develop more sensitive methods of drug detection. The unwanted result of this increase in sensitivity is the detection of therapeutic medications days to weeks after administration. The adoption of decision or threshold concentrations for residues of nonpermitted medications should allow laboratories to focus their efforts on drugs of abuse in the performance horse industries and permit veterinarians to provide appropriate medical care to these equine athletes.