Predisposing factors for small colon impaction in horses and outcome of medical and surgical treatment: 44 cases (1999-2004)

OBJECTIVE: To identify factors associated with development of small colon impaction in horses and with selection of medical versus surgical treatment and to determine the prognosis for affected horses following medical or surgical management. DESIGN: Retrospective case series. ANIMALS: 44 horses with primary impaction of the small colon. PROCEDURES: Medical records were reviewed for signalment, history, clinical findings, treatment (medical vs surgical), hospitalization time, and outcome. For comparison purposes, the same information was collected for 83 horses with primary impaction of the large colon. RESULTS: Diarrhea was the only factor found to be associated with development of small colon impaction. Horses with small colon impaction were 10.8 times as likely to have diarrhea at the time of initial examination as were horses with large colon impaction. Abdominal distension was the only factor associated with use of surgical versus medical treatment. Horses with small colon impaction that were treated surgically were 5.2 times as likely to have had abdominal distension at the time of admission as were horses with small colon impaction that were treated medically. Overall, 21 of 23 (91%) horses treated medically and 20 of 21 (95%) horses treated surgically survived to discharge. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that diarrhea may be a risk factor for development of small colon impaction and that horses with small colon impaction that have abdominal distension at the time of initial examination are more likely to require surgical than medical treatment.     

Traumatic brain injury in horses: 34 cases (1994-2004)

OBJECTIVE: To investigate the clinical, clinicopathologic, and diagnostic characteristics; treatment; and outcome associated with acute traumatic brain injury (TBI) in horses and assess risk factors for nonsurvival in TBI-affected horses. DESIGN: Retrospective case series. ANIMALS: 34 horses with TBI. Procedures-Medical records of horses that had sustained trauma to the head and developed neurologic signs were reviewed. Data that included signalment, clinicopathologic findings, diagnosis, treatment, and outcome were analyzed. Clinicopathologic variables among horses in survivor and nonsurvivor groups were compared, and risk factors for nonsurvival were determined. RESULTS: Median age of affected horses was 12 months. Findings of conventional survey radiography of the head alone failed to identify all horses with fractures of the calvarium. Horses with basilar bone fractures were 7.5 times as likely not to survive as horses without this type of fracture. Depending on clinical signs, horses received supportive care, osmotic or diuretic treatments, antimicrobials, anti-inflammatory drugs, analgesics, or anticonvulsants. Twenty-one (62%) horses survived to discharge from the hospital. In the nonsurvivor group, mean PCV was significantly higher, compared with the value in the survivor group (40% vs 33%). Risk factors associated with nonsurvival included recumbency of more than 4 hours' duration after initial evaluation (odds ratio, 18) and fracture of the basilar bone (odds ratio, 7.5). CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that prognosis for survival in horses with acute TBI may be more favorable than previously reported. Among horses with TBI, persistent recumbency and fractures involving the basilar bones were associated with a poor prognosis.     

Comparison of medical and surgical treatment for impaction of the small colon in horses: 84 cases (1986-1996)

OBJECTIVE: To characterize clinical findings and compare effects of treatment and outcome for horses treated medically or surgically for impaction of the small colon. DESIGN: Retrospective study. ANIMALS: 84 horses with impaction of the small colon. PROCEDURE: Medical records were reviewed for history, physical examination findings, laboratory values, treatment, response to treatment, complications, out-come, and necropsy findings. RESULTS: 47 horses were treated medically and 37 horses were treated surgically. Significant differences between groups were not identified for duration of clinical signs, physical examination findings, or laboratory values. Horses treated surgically were hospitalized longer than horses treated medically. Complications recorded during hospitalization included diarrhea, jugular thrombophlebitis, recurrent colic, fever, and laminitis. Salmonella organisms were isolated from 20 horses. Horses treated surgically were more likely to have signs of moderate abdominal pain, gross abdominal distention, and positive results for culture of Salmonella spp than horses treated medically. Follow-up information was available for 27 horses treated medically and 23 horses treated surgically. Twenty-four (72%) and 21 (75%) of the horses, respectively, survived and were being used for their intended purpose at least 1 year after treatment. CLINICAL IMPLICATIONS: Colitis may be a predisposing factor for impaction of the small colon in horses. Prognosis for horses treated surgically or medically is fair.     

Medical and surgical management of small-colon impaction in horses: 28 cases (1984-1989).

Medical records of 28 horses with impaction of the small colon were reviewed; 20 horses were admitted during the winter months. Diagnosis of small-colon impaction was made in 21 horses by rectal examination, and in 7 horses at exploratory celiotomy. Ten horses were treated medically, and 18 were treated surgically. Horses that were treated surgically were more likely to have abdominal distention than were those that responded to medical treatment (P less than 0.025). Signs of greater degree of abdominal pain and higher heart rate were seen in horses treated surgically, but these values were not significantly different from values in medically treated horses. Duration of hospitalization was less in horses treated medically (P less than 0.025). Long-term survival was higher for horses treated medically (P less than 0.025). All horses treated medically and 7 of the horses treated surgically were alive at follow-up evaluation, at least 1 year after discharge. Fever and diarrhea were common complications after surgery. Four horses were fecal culture-positive for Salmonella sp after surgery. Early and aggressive medical management of horses with impaction of the small colon is recommended.     

Hemoperitoneum in horses: 67 cases (1989-2004)

OBJECTIVE: To evaluate clinical findings, underlying causes, and short-term outcome associated with hemoperitoneum in horses. DESIGN: Retrospective case series. ANIMALS: 67 horses with hemoperitoneum. PROCEDURES: Medical records of horses with hemo-peritoneum (excluding postoperative abdominal hemorrhage) from 1989 through 2004 were analyzed. Information obtained included history, signalment, physical examination findings, diagnostic test results, and short-term outcome. RESULTS: Breed distribution was 28 Thoroughbreds, 13 Arabians, 10 Quarter Horses, 5 Warmbloods, 3 Appaloosas, and 1 each of 8 other breeds. There were 40 mares, 23 geldings, and 4 stallions. Median age was 12 years (range, 1 month to 40 years). Signs of abdominal discomfort were the primary complaint in 79% of horses. Clinical findings included shock (60%) and pale mucous membranes (60%). Median heart rate was 76 beats/min (range, 30 to 216 beats/min), median respiratory rate was 30 breaths/min (range, 8 to 92 breaths/min), median Hct was 31% (range, 10.5% to 73.0%), and total protein concentration was 5.8 g/dL (range, 3.3 to 8.7 g/dL). Cause of hemoperitoneum was attributed to trauma (25.4%), neoplasia (17.9%), uterine artery rupture (13.4%), mesenteric injury (11.9%), disseminated intravascular coagulopathy (6.0%), other causes (3.0%), and idiopathic causes (22.4%). Fifty-one percent of horses survived to hospital discharge, 37% were euthanized, and 12% died. Poor short-term outcome was significantly associated with high respiratory rate and certain underlying causes. CONCLUSIONS AND CLINICAL RELEVANCE: Hemoperitoneum is an infrequent but important cause of abdominal discomfort in horses. Predominant underlying causes were trauma, neoplasia, and idiopathic causes. Identification of underlying cause is important because of its association with outcome.     

Peritonitis in horses: 55 cases (2004-2007)

Factors associated with the outcome of peritonitis in horses are seldom described. The objectives of this study were to determine the common clinical signs and clinicopathologic findings and to reveal prognostic factors associated with the outcome of peritonitis in equine patients. Data were examined in a retrospective manner in 55 horses diagnosed with and treated for peritonitis. The most common clinical and clinicopathologic findings were tachycardia (94%), increased amount of peritoneal fluid on ultrasound (84%), altered mucous membranes (82%), bacteria noted on the direct smear (67%), hyperfibrinogenaemia (58%) and left shift (40%). The most commonly isolated organism was E. coli (37%). Survival rates were as follow: 78% in the whole study, 81% in the abdominal lavage group, 93% in the medically and 46% in the surgically managed groups. Complications were more common in the non-survivor group (P < 0.001). Initial haematocrit and surgical interventions were strongly associated with non-survival in the multivariate logistic regression model (P = 0.049, OR: 1.07 and P = 0.01, OR: 9.87, respectively). Prognosis of peritonitis without gastrointestinal rupture depends on the initial hydration status, surgical interventions and development of secondary complications, while other clinical and clinicopathologic findings do not appear to correlate with survival. Prospective evaluation of hydration and perfusion parameters and abdominal lavage warrants further investigation.     

Excision as treatment of dermal melanomatosis in horses: 11 cases (1994-2000)

OBJECTIVE: To determine whether excision was an acceptable treatment for dermal melanomatosis in horses. DESIGN: Retrospective study. ANIMALS: 11 horses with dermal melanomatosis involving the perineal, perianal, or perirectal region or ventral surface of the tail in which treatment consisted of tumor excision. PROCEDURE: Medical records were reviewed. Follow-up information was obtained from owners through telephone interviews. RESULTS: 9 of the 11 horses were alive at the time of follow-up interviews. None of the horses had regrowth at the surgery site where the primary tumor was removed. There were no confirmed clinical signs of internal metastasis. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that excision of dermal melanomatosis in horses may be a reasonable treatment option.     

Factors associated with development of ileal impaction in horses with surgical colic: 78 cases (1986-2000)

Deal impaction is prevalent in the south-eastern USA, where feeding of Coastal Bermuda hay has been implicated as a risk factor. Alternatively, infection with the tapeworm Anoplocephala perfoliata has been identified as a risk factor for ileal impaction in the UK. We hypothesised that feeding Coastal Bermuda hay and failure to administer routinely an anthelmintic with efficacy against tapeworms would place horses at risk of developing ileal impaction in the USA. Seventy-eight horses, with surgically confirmed ileal impaction and 100 horses admitted for colic that did not have an ileal impaction, were selected retrospectively for logistic regression analysis. Using odds ratios (OR) as an index of risk, feeding Coastal Bermuda hay (OR = 2.9) and failure to administer a pyrantel salt within 3 months of admission (OR = 3.1) placed horses at risk of development of ileal impaction. This study confirms the belief that feeding Coastal Bermuda hay places horses at risk of ileal impaction, although the quality of the hay may also play a role. Periodic administration of anthelmintics with efficacy against tapeworms should be considered to reduce risk of ileal impaction.     

Immune-mediated keratitis in horses: 19 cases (1998-2004)

OBJECTIVE: The purpose of this study is to describe clinical and histologic findings, treatment, and outcome of horses with suspected immune-mediated keratitis (IMMK). DESIGN: Retrospective study. ANIMALS: Nineteen horses that presented to NCSU-VTH from 1998 to 2004 with IMMK. Procedures Information retrieved from the medical records included signalment, duration of clinical signs, therapy prior to initial examination, ophthalmic abnormalities, diagnostics performed, therapy instituted, and long-term vision. RESULTS: Nineteen horses (22 eyes) were diagnosed with IMMK. Three distinct clinical groups were identified based on the depth of the lesion in the cornea: superficial stromal (n = 11 eyes), midstromal (n = 6 eyes), or endothelial (n = 5 eyes). Horses ranged from 5 to 19 years of age, with a mean age +/- SD of 11.9 +/- 3.6 years. Eleven horses had 12 months or greater duration of clinical signs of corneal disease prior to referral. Overall there was a mean duration of 11.8 +/- SD 8.3 months. Superficial stromal keratitis appeared as a superficial stromal cellular infiltrate with diffuse vascularization. Midstromal keratitis appeared as midstromal cellular infiltrate with mild, surrounding corneal edema and vascularization. Endothelial disease appeared as endothelial cellular infiltrate with diffuse corneal edema. In all types of IMMK, signs of uveitis or severe discomfort were not observed. CONCLUSIONS AND CLINICAL RELEVANCE: Horses with superficial IMMK responded to topical medical therapy, but responded best to surgical removal of the lesion. Horses with midstromal keratitis responded to topical cyclosporine therapy. Endothelial disease was the least amenable to therapy.     

Heel bulb lacerations in horses: 101 cases (1988-1994)

OBJECTIVE: To determine clinical history, structures involved, treatment, and outcome of lacerations of the heel bulb and proximal phalangeal region (pastern) in horses. DESIGN: Retrospective study. ANIMALS: 101 horses. PROCEDURES: Medical records of horses with lacerations of the heel bulb and pastern were reviewed, and follow-up information was obtained. RESULTS: 75 horses were Quarter Horses. Most horses were not treated with antimicrobial drugs prior to referral. Mean +/- SD time from injury to referral was 24 +/- 45 hours (range, 1 to 168 hours). Lacerations were most frequently caused by contact with wire or metal objects. In 17 horses, lacerations involved synovial structures; the distal interphalangeal joint was most commonly affected. One horse was euthanatized after initial examination. Wound treatment consisted of cleansing, lavage, debridement, lavage of affected synovial structures, suturing of fresh wounds, and application of a foot bandage or cast. Fifty-six horses were treated with systemically administered antimicrobial drugs. Follow-up information was collected for 61 horses. Fifty-one horses returned to their intended use and had no further complications; 10 horses had complications associated with the wound, and of those horses, 5 were euthanatized and 1 horse died from an unrelated cause. Horses with lacerations that involved synovial structures had worse outcomes than horses with lacerations that did not involve synovial structures. CONCLUSIONS AND CLINICAL RELEVANCE: Horses that sustain heel bulb lacerations can successfully return to their intended use. Involvement of the distal interphalangeal joint is associated with poor prognosis.     

Outcome of medical treatment for horses with foot pain: 56 cases

Reasons for performing study: Currently, there are limited data regarding the long‐term outcome of horses with foot pain treated with corrective shoeing, rest and rehabilitation, and intrasynovial anti‐inflammatory medication to target lesions detected with MRI. Objective: To report the long‐term (≥12 months) outcome of horses with foot lesions following medical therapy. Hypotheses: 1) There is no association between clinical parameters considered and a poor response to therapy. 2) Horses with a deep digital flexor tendinopathy are less likely to respond to medical therapy than horses without a deep digital flexor tendinopathy. Methods: The medical records of horses with foot pain subjected to MRI examination and medical therapy (2005–2007) were evaluated retrospectively. Data collected included history, signalment, occupation, duration and severity of lameness at the time of MRI, radiological and MRI abnormalities. Number of treatments, complications and long‐term response to treatment were obtained by detailed telephone questionnaires. Association between clinical and MRI findings and long‐term lameness were investigated. Results: Frequent abnormal structures included the navicular bone, the deep digital flexor tendon, the navicular bursa and the distal interphalangeal joint. Thirty‐four of 56 horses (60.7%) failed to return to previous level of exercise due to persistent or recurrent lameness or owners' decision to decrease the horse's athletic level; however, 11 horses (32.3%) were being used for light riding. Prognosis for horses with concurrent deep digital flexor tendon, navicular bone and navicular bursa lesions was worse than horses with individual lesions. Deep digital flexor tendinopathy was strongly associated with persistent or recurrent lameness. Conclusions: Horses with multiple foot lesions managed with conservative therapy have a guarded prognosis for long‐term soundness. Deep digital flexor tendinopathies negatively influence prognosis.     

Evaluation of transfixation casting for treatment of third metacarpal, third metatarsal, and phalangeal fractures in horses: 37 cases (1994-2004)

OBJECTIVE: To evaluate clinical findings, complications, and outcome of horses and foals with third metacarpal, third metatarsal, or phalangeal fractures that were treated with transfixation casting. DESIGN: Retrospective case series. Animals-29 adult horses and 8 foals with fractures of the third metacarpal or metatarsal bone or the proximal or middle phalanx. PROCEDURES: Medical records were reviewed, and follow-up information was obtained. Data were analyzed by use of logistic regression models for survival, fracture healing, return to intended use, pin loosening, pin hole lysis, and complications associated with pins. RESULTS: In 27 of 35 (77%) horses, the fracture healed and the horse survived, including 10 of 15 third metacarpal or metatarsal bone fractures, 11 of 12 proximal phalanx fractures, and 6 of 8 middle phalanx fractures. Four adult horses sustained a fracture through a pin hole. One horse sustained a pathologic unicortical fracture secondary to a pin hole infec-tion. Increasing body weight, fracture involving 2 joints, nondiaphyseal fracture location, and increasing duration until radiographic union were associated with horses not returning to their intended use. After adjusting for body weight, pin loosening was associated with di-aphyseal pin location, pin hole lysis was associated with number of days with a transfixation cast, and pin complications were associated with hand insertion of pins. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that transfixation casting can be successful in managing fractures distal to the carpus or tarsus in horses. This technique is most suitable for comminuted fractures of the proximal phalanx but can be used for third metacarpal, third metatarsal, or middle phalanx fractures, with or without internal fixation.     

Outcome and complications associated with treatment of pemphigus foliaceus in dogs: 43 cases (1994-2000)

OBJECTIVE: To identify factors affecting prognosis, outcome, and complications associated with pemphigus foliaceus in dogs. DESIGN: Retrospective study. ANIMALS: 43 dogs with pemphigus foliaceus. PROCEDURE: Medical records were reviewed for signalment, age at diagnosis, duration to diagnosis, body area affected, initial immunosuppressive regimens and concurrent use of antimicrobials and sucralfate or histamine receptor 2 blocking agent, adverse effects of treatment, duration of treatment, number of visits for follow-up care, cause of death, and credentials of the veterinarians responsible for continued care. RESULTS: The case fatality rate was 60.5%. Factors significantly correlated with survival time included concurrent use of antimicrobials during initiation of immunosuppressive treatment and a lower number of adverse effects to treatment. Treatment times lasting more than 10 months from diagnosis correlated significantly with survival. CONCLUSIONS AND CLINICAL RELEVANCE: Treatment with or prophylactic use of antimicrobials may be warranted during initial immunosuppressive treatment. The inverse correlation between survival time and number of adverse treatment effects was not unexpected because it was reflective of the owners' decision to euthanatize their dogs and of corticosteroid-related secondary diseases. Survival beyond the tenth month of treatment predicted long-term survival, which suggests that dogs require careful management during the early months of treatment.     

Comparison of surgical versus medical treatment of nephrosplenic entrapment of the large colon in horses: 19 cases (1992-2002)

OBJECTIVE: To compare the outcome of horses with nephrosplenic entrapment of the large colon (NSELC) treated surgically or medically by rolling, administration of phenylephrine hydrochloride (or both), and exercise. DESIGN: Retrospective study. ANIMALS: 11 medically treated horses and 8 surgically treated horses with NSELC. PROCEDURE: Medical records of horses with nephrosplenic entrapment between 1992 and 2002 were reviewed. Medically treated horses were included if diagnosis and outcome of treatment of nephrosplenic entrapment were confirmed via transrectal examination and ultrasonographic examination. Surgically treated horses were included if the diagnosis was confirmed by exploratory laparotomy. Horses in which the large colon was entrapped between the spleen and body wall were not included. RESULTS: Significant differences in mean age, heart rate, and duration of colic prior to treatment were not detected between horses treated surgically or medically. Ten medically treated horses recovered without complications, and 1 died. In the surgically treated group, 6 of 8 horses recovered without complications and 2 died. Mortality rate did not differ between treatments. Duration of hospitalization for medically treated horses was significantly shorter and the cost significantly less than for surgically treated horses. CONCLUSIONS AND CLINICAL RELEVANCE: Results indicated that medical treatment of horses with NSELC via administration of phenylephrine hydro-chloride, rolling during general anesthesia, or both appears to be as effective as and less expensive than surgical treatment.     

Palmar carpal osteochondral fragments in racehorses: 31 cases (1994-2004)

OBJECTIVE: To evaluate records of racehorses with palmar carpal osteochondral fragments and determine whether the fragments were indicators of the severity of pathologic joint changes or prognosis. DESIGN: Retrospective case series. ANIMALS: 31 racehorses. PROCEDURES: Medical records, radiographs, and videos of arthroscopic procedures were reviewed. Information gathered included signalment; location, number, and size of the primary lesion; number and size of palmar carpal fragments; and details pertaining to surgical procedures. Outcome variables were obtained from race records. RESULTS: 31 horses met the selection criteria. Multiple palmar fragments were diagnosed in 58% of horses; small fragments (< 3 mm in diameter) were most common (52% of horses). Fifty-two percent of the horses returned to racing, 48% returned to racing and earned money, and 32% had at least 5 more starts. Horses with multiple fragments had significantly less earnings per start and lower performance index values after surgery than those with 1 fragment. Horses with palmar fragments < 3 mm in diameter were significantly less likely to return to racing and have 5 starts or to win money after surgery than horses with larger fragments. CONCLUSIONS AND CLINICAL RELEVANCE: Palmar carpal osteochondral fragments can be used as an indicator of clinically important joint pathology and as a prognostic indicator in racehorses. Horses with multiple small fragments were less likely to successfully return to racing than horses with only dorsally located carpal fragments or horses with 1 or 2 large palmar fragments. When possible, removal of palmar carpal osteochondral fragments should be considered.     

Cardiac lymphoma and pericardial effusion in dogs: 12 cases (1994-2004)

OBJECTIVE: To determine clinical characteristics and clinicopathologic findings, including results of pericardial fluid analysis, and determine the outcome associated with pericardial effusion caused by cardiac lymphoma in dogs. DESIGN: Retrospective case series. ANIMALS: 12 dogs. PROCEDURE: Medical records of affected dogs were reviewed for echocardiographic findings, radiographic findings, results of pericardial fluid analysis, clinicopathologic findings, treatment protocols, and outcomes. RESULTS: Pericardial effusion was detected by echocardiography in all 12 dogs, and lymphoma was detected by cytologic examination of the effusion (11/12 dogs) or histologic examination of pericardium (3/12). Large-breed dogs were overrepresented; median weight was 40.5 kg (89.1 lb). Most hematologic and biochemical changes were mild and non-specific. Survival time for dogs treated with combination chemotherapeutic agents was 157 days and for dogs that did not receive chemotherapy survival time was 22 days. This difference was not significant, but several dogs had long-term survival. CONCLUSIONS AND CLINICAL RELEVANCE: Cardiac lymphoma is an uncommon cause of pericardial effusion, and results suggest that cardiac lymphoma does not always warrant the poor prognosis of other stage V, substage b lymphomas.     

Comparison of two surgical techniques for management of intramural ureteral ectopia in dogs: 36 cases (1994-2004)

OBJECTIVE: To determine outcome associated with intramural ureteral ectopia treated with 1 of 2 surgical techniques (neoureterostomy with ligation of the distal ureteral segment vs neoureterostomy with resection of the distal ureteral segment) and compare results of these 2 techniques in dogs. DESIGN: Multicenter retrospective case series. ANIMALS: 36 dogs (15 treated with the ligation technique and 21 treated with the resection technique). PROCEDURES: Information was obtained from medical records. Long-term follow-up information was obtained by owner questionnaire. RESULTS: 15 of 21 (71%) dogs in the resection group and 7 of 14 (50%) dogs in the ligation group still had urinary incontinence after surgery. Three of 20 (15%) dogs in the resection group and 4 of 14 (29%) dogs in the ligation group reportedly had multiple episodes of urinary tract infection following surgery. The outcome of surgery was judged to be excellent by the owners of 10 of 18 (56%) dogs in the resection group and 9 of 14 (64%) dogs in the ligation group. No significant differences were found between surgery treatment groups. CONCLUSIONS AND CLINICAL RELEVANCE: Results of the present study suggest that although most owners of dogs that undergo surgery for treatment of intramural ureteral ectopia consider the outcome of surgery to be excellent, substantial proportions of dogs will continue to have urinary incontinence and recurrent urinary tract infections after surgery. Findings do not provide any support to the hypothesis that the resection technique is superior to the ligation technique for management of dogs with intramural ureteral ectopia.     

Outcome of desmoplasty and fasciotomy for desmitis involving the origin of the suspensory ligament in horses: 27 cases (1995-2004)

OBJECTIVE: To determine outcome of percutaneous ultrasound-guided desmoplasty with simultaneous fasciotomy for proximal suspensory desmitis (ie, desmitis of the origin of the suspensory ligament) in horses that have not responded to stall rest. DESIGN: Retrospective case series. ANIMALS: 27 horses. PROCEDURES: Medical records of horses with proximal suspensory desmitis treated by means of desmoplasty with fasciotomy were reviewed. Follow-up information was obtained through telephone conversations with owners and trainers of the horses or by examination of horses at the hospital. RESULTS: 23 of the 27 (85%) horses, including 3 of 4 horses with forelimb lesions and 20 of 23 horses with hind limb lesions, were able to return to full work after surgery and rehabilitation. All horses had ultrasonographic evidence of healing of suspensory ligament lesions. CONCLUSIONS AND CLINICAL RELEVANCE: Results suggest that desmoplasty with fasciotomy is a viable treatment option in horses with proximal suspensory desmitis that have not responded to stall rest.     

Tilt table recovery of horses after orthopedic surgery: fifty-four cases (1994-2005)

OBJECTIVE: To describe an assisted anesthetic recovery technique using a tilt table for horses after high-risk orthopedic-related procedures and to evaluate outcome. STUDY DESIGN: Retrospective study. SAMPLE POPULATION: Anesthetic recoveries (n=54) for 36 horses. METHODS: Medical records (April 1994-October 2005) for horses that had high-risk orthopedic surgery and recovery from general anesthesia on a tilt table were reviewed. Information about the surgical procedure, anesthetic and recovery period was analyzed. RESULTS: Of 54 anesthetic recoveries, 1 horse (1.9%) had complete failure of internal fixation during recovery and was euthanatized. Six (11% recoveries) horses failed to adapt to the tilt table system, which necessitated transfer to a conventional recovery room. Complications without important consequences for clinical outcome (skin abrasions, myositis, cast breakage, partial implant failure) occurred during 8 (15%) recoveries. CONCLUSIONS: A tilt table recovery system was associated with minimal incidence of serious complications. Potential disadvantages of the system are the number of personnel required, longer recovery time, and the need for a specialized table. CLINICAL RELEVANCE: A tilt table is a useful system for recovering horses believed to be at increased risk of injury during anesthetic recovery after high-risk orthopedic-related procedures.