Peri-anaesthetic and anaesthetic-related mortality risks in great apes (Hominidae) in zoological collections in the UK and Ireland

OBJECTIVE: To estimate the risk of death and identify the major risk factors for peri-anaesthetic mortality in great apes (Hominidae) that underwent anaesthesia in zoological collections in the UK and Ireland between 1 January 1990 and 30 June 2005. STUDY DESIGN: confidential, retrospective cohort study. ANIMAL POPULATION: The study population comprised all great apes from 16 zoological collections in the UK and Ireland that were anaesthetised during that period. METHODS: All available anaesthetic records were collected. Outcome at 7 days post-anaesthesia was recorded as alive, dead or euthanased. The risk of peri-anaesthetic mortality was calculated. Multivariable analysis of potential risk factors was performed. RESULTS: A total of 1182 anaesthetic records were collected and analysed. Sixteen peri-anaesthetic deaths occurred, resulting in a peri-anaesthetic mortality risk of 1.35%. Twenty percent of deaths (3/15) occurred during maintenance and 80% (12/15) occurred post-anaesthetic but within 7 days. A subjective assessment suggests at least five anaesthetic-related deaths occurred; in other words an anaesthetic-related mortality risk of 0.42% (5/1182) or above. In the multivariable analysis, health status and age were significantly associated with peri-anaesthetic mortality. Animals assessed as 'sick' pre-anaesthetic were associated with a 26-fold (95% CI 5.55-122.32) increased risk of death compared with animals with a good health status. Animals aged over 30 years were associated with a 30-fold (95% CI 3.44-261.85) increased risk of death, compared with adults aged between 10 and 30 years. CONCLUSIONS AND CLINICAL RELEVANCE: This study has shown that great ape anaesthesia appears to carry a high risk of mortality. Sick and aged patients are at an increased risk of death and particular care should be exercised during their anaesthesia. Standardisation and completeness of anaesthetic records across zoological collections would assist greatly in further studies.     

Risk of anaesthetic mortality in dogs and cats: an observational cohort study of 3546 cases

Objective To evaluate the anaesthetic death risk for dogs and cats in a French private practice. Study design Observational cohort study. Animal population All small animals anesthetized at the Centre Hospitalier Vétérinaire des Cordeliers between April 15th, 2008 and April 15th, 2010. Methods General anaesthesia was defined as a drug‐induced unconsciousness characterised by a controlled and reversible depression of the central nervous system and analgesia, sufficient to allow endotracheal intubation. Patient outcome (alive or dead) was assessed at the end of anaesthesia defined as the meeting point of the return of consciousness, rectal temperature >36 °C and ability to maintain sternal recumbency. Death occurring during anaesthesia was recorded. Relationship between anaesthetic death and ASA status, species, age, nature of the procedure, anaesthetic protocol and occurrence of epidural administration of a combination of morphine and bupivacaine were analysed. Results During the study period 3546 animals underwent general anaesthesia. The overall death rate in the present study was 1.35% (48 in 3546, 95% CI 0.96–1.75). The death rate of healthy animals (ASA 1 and 2) was 0.12% (3 in 2602 95% CI 0.02–0.34). For sick animals (ASA status 3 and over), the overall death rate was 4.77% (45 in 944 95% CI 3.36–6.18). The death rates in the ASA 3, 4 and 5 categories were 2.90%, 7.58% and 17.33%, respectively. The main factor associated with increased odds of anaesthetic death in ASA categories 3 and over was poor health status (ASA physical status classification). The nature of the procedure the patient underwent and epidural administration of a combination of morphine and bupivacaine were not correlated with the occurrence of death during anaesthesia. Neither species nor age effects were detected. Conclusion and clinical relevance Specific factors were associated with increased odds of anaesthetic death, especially poor health status. Efforts must be directed towards thorough preoperative patient evaluation and improvement of clinical conditions if possible. Identification of risk factors before anaesthesia should lead to increased surveillance by trained staff. This could result in better outcomes.     

Equine perioperative fatalities associated with general anaesthesia at a private practice--a retrospective case series

OBJECTIVE: To determine the fatality rate of horses undergoing general anaesthesia at a private equine referral practice using a limited number of anaesthetic protocols. METHODS: A retrospective analysis of records (n = 17 961) from all horses undergoing general anaesthesia for surgical procedures from 1997 to 2001 at Rood and Riddle Equine Hospital, Lexington, Kentucky, USA. Results were reported as percentage of the population, and as crude mortality rates for each procedure (deaths per 1000). RESULTS: The prevalence of equine fatalities directly related to anaesthesia was 0.12% (n = 21) and this rose to 0.24% (n = 42) with the inclusion of horses killed or dying within 7 days post general anaesthesia. Causes of death directly related to anaesthesia were cardiac arrest (n = 10), fracture in recovery stall (n = 8), neuropathy and myopathy necessitating euthanasia (n = 3). Crude mortality rates per procedure were < or =7 deaths per 1000 cases, except arthrodesis/osteotomy cases were 66.7 deaths per 1000 cases. CONCLUSIONS: The anaesthetic fatality rate at this practice is lower than has been reported previously. CLINICAL RELEVANCE: Familiarity with an anaesthetic protocol in combination with reduced anaesthetic time, emergencies of shorter duration between diagnosis and surgery, and adequate preoperative examination appear to minimize the risks associated with general anaesthesia in horses.     

Is isoflurane safer than halothane in equine anaesthesia? Results from a prospective multicentre randomised controlled trial

REASONS FOR PERFORMING STUDY: Approximately 1 in 100 horses suffer unexpectedly from anaesthetic-related death. Identification and use of the safest anaesthetic drugs should support this aim. Experimental evidence has suggested that isoflurane should be a safer maintenance agent in equine anaesthesia than halothane. HYPOTHESIS: The death rate would be reduced in horses being maintained with isoflurane compared to halothane. METHODS: A multicentre randomised controlled trial was undertaken to compare the effects of isoflurane and halothane for maintenance of equine anaesthesia for all types of operation. Data were analysed from 8242 horses in which anaesthesia was maintained with either halothane or isoflurane using mixed effects logistic regression models. RESULTS: No overall benefit of either drug was detected. However, although not part of the primary hypothesis, data showed that the overall death rate was significantly reduced in horses age 2-5 years with isoflurane and that death from cardiac arrest was also reduced with isoflurane, particularly in high risk cases. CONCLUSIONS AND POTENTIAL RELEVANCE: Halothane remains an acceptable anaesthetic for maintenance of anaesthesia in horses, but isoflurane may be safer in the young horse and in high risk cases.     

Post anaesthetic myopathy/neuropathy in horses undergoing magnetic resonance imaging compared to horses undergoing surgery

REASONS FOR PERFORMING STUDY: Patient positioning and long anaesthetic duration required for magnetic resonance imaging (MRI) may result in a higher frequency of post anaesthetic myopathy/neuropathy syndrome (PAMNS) as compared to horses undergoing anaesthesia for surgery. HYPOTHESIS: Equine anaesthesia for MRI is associated with a higher frequency of PAMNS than anaesthesia for nonemergency, nonabdominal surgery. METHODS: Anaesthetic and medical records of horses (n = 633) undergoing MRI or surgery between January 2001 and January 2005 (inclusive), were reviewed. Information obtained included patient details (breed, sex, age, bodyweight), area of body scanned or involved in surgery, body position, anaesthetic and inotropic agents administered, anaesthetic duration, adverse events during anaesthesia and outcome at 7 days. Data were examined by cross tabulation and Chi-square or Fisher's exact test of association. The influence of individual variables was examined by univariant and multivariant analysis models. RESULTS: There were no statistically significant differences between the 2 groups in parameters examined, except that horses in the MRI group were heavier (P<0.0001) and anaesthetic duration longer in the surgery group (P<0.004). Eight horses (2.3%, 95% Confidence interval [CI]: 1.1-4.2) in the MRI group had clinical signs of PAMNS in the post anaesthetic period, whereas only 2 horses (0.98%, 95% CI: 0.2-2.8) in the surgery group were affected. This was not statistically significantly different (odds ratio = 2.7, 95% CI: 0.8-13, P = 0.3). Two horses undergoing MRI were subjected to euthanasia due to the severity of PAMNS. CONCLUSIONS: There was no difference in the occurrence of PAMNS between the 2 groups. POTENTIAL RELEVANCE: The risk of performing general anaesthesia for diagnostic procedures such as MRI may not be greater than that for a surgical procedure. However, the benefits should be carefully weighed against the risks involved.     

Risk factors for colic in horses after general anaesthesia for MRI or nonabdominal surgery: absence of evidence of effect from perianaesthetic morphine

REASON FOR PERFORMING STUDY: Post anaesthetic colic is a recognised risk of general anaesthesia (GA), but causes are poorly understood. OBJECTIVES: To identify risk factors for development of colic following GA for magnetic resonance imaging (MRI) or nonabdominal surgery and to test whether the use of perianaesthetic morphine was associated with an increased risk of post anaesthetic colic. METHODS: A total of 553 anaesthetic and clinical records of 500 horses anaesthetised at the Animal Health Trust were analysed, 342 (62%) involved MRI and 211 (38%) nonabdominal, predominantly orthopaedic surgery. Multivariable logistic regression analysis was used to examine the association between post anaesthetic colic and explanatory variables, including use of perianaesthetic morphine. RESULTS: Twenty horses (3.6%) developed colic within 7 days of GA. A significantly larger (P = 0.001) proportion of the surgical cases developed post anaesthetic colic (7.1%) compared with MRI cases (1.5%). Having controlled for the effect of MRI/surgeon, there was evidence for a significantly increased risk of colic associated with maintenance of anaesthesia with isoflurane and administration of benzyl penicillin and/or ceftiofur. A reduction in risk of colic was associated with premedication with romifidine, longer duration of anaesthesia and sedation within 2 days of GA. Perianaesthetic morphine administration was not associated with increased risk. CONCLUSIONS: This study identified apparently novel risk factors for colic in horses following GA. Use of morphine was not found, after controlling for other MRI and surgery related risk factors, to be associated with an increased risk. The low prevalence of colic after GA and resulting low study power mean that further larger, multicentre collaborative studies are warranted to corroborate findings in this study. POTENTIAL RELEVANCE: Better knowledge of risk factors should lead to achievable measures to reduce frequency of occurrence.     

Canine anaesthetic death in Spain: a multicentre prospective cohort study of 2012 cases

ObjectiveTo study current perianaesthetic mortality in dogs in Spain and to identify the main risk factors predisposing to perianaesthetic mortality in our country.Study designA multicentre prospective cohort study.Animal populationDogs anaesthetised for different surgical and diagnostic procedures at 39 Spanish veterinary clinics between February 2007 and March 2008.MethodsData of patients, procedures and anaesthetic management were recorded. Anaesthetic death was defined as perioperative death within 24 hours of the procedure end. A multivariate study evaluated perinanaesthetic death using logistic binary regression models with the Wald technique.Results2012 animals were included in the analyses. Twenty‐six dogs died. The global mortality rate was 1.29% (95% Confidence interval (95% CI): 0.88–1.89%). ASA I‐II was 0.33% (95 CI: 0.14–0.78%); ASA III‐V was 4.06% (95% CI: 2.67–6.13%). Most deaths occurred during the post‐operative period (20 dogs, 77%). The multivariate analysis revealed that high ASA grade was associated with an increased risk of mortality. The use of opioids plus NSAIDs during anaesthesia was related with a decrease of the risk.ConclusionsPerianaesthetic mortality in dogs in Spain was 1.29% (95% CI: 0.88–1.89%). ASA grade was the main prognostic factor of likelihood of death. The use of some analgesics (opioids and NSAIDs) in the perioperative period was associated with reduced odds of death and may be protective.Clinical relevanceEvaluation and stabilisation of patients before interventions may help lower risk of death during the anaesthesia. In addition to their use for welfare purposes, analgesics may be beneficial in reducing anaesthetic‐related deaths.     

The risk of death: the confidential enquiry into perioperative small animal fatalities

Objective To estimate the risks of anaesthetic and sedation‐related mortality in companion animals in the UK. (The Confidential Enquiry into Perioperative Small Animal Fatalities, CEPSAF). Study design A prospective cohort study with nested case–control study. Animal population All small animals anaesthetized and sedated at participating centres between June 2002 and June 2004. Methods Patient outcomes at 48 hours (alive, dead and killed) were recorded. Anaesthetic and sedation‐related death was defined as death where surgical or pre‐existing medical causes did not solely cause death. Species‐specific risks of anaesthetic‐related death and 95% confidence intervals (95% CI) were calculated. Risks were also estimated in the sub‐sets of dogs, cats and rabbits that were either healthy or sick (ASA 1–2 and 3–5, respectively). Results One hundred and seventeen veterinary practices participated in the study and 98 036 dogs, 79 178 cats and 8209 rabbits were anaesthetized and sedated. Overall risks of anaesthetic and sedation‐related death in dogs were 0.17% (1 in 601, 95% CI 0.14–0.19%), in cats 0.24% (1 in 419, 95% CI 0.20–0.27%) and in rabbits 1.39% (1 in 72, 95% CI 1.14–1.64%) within 48 hours of the procedure. In healthy dogs, cats and rabbits, the risks were estimated to be 0.05% (1 in 1849, 95% CI 0.04–0.07%), 0.11%, (1 in 895, 95% CI 0.09–0.14%) and 0.73% (1 in 137, 95% CI 0.54–0.93%), respectively. In sick dogs, cats and rabbits, the risks were 1.33%, (1 in 75, 95% CI 1.07–1.60%), 1.40% (1 in 71, 95% CI 1.12–1.68%) and 7.37% (1 in 14, 95% CI 5.20–9.54%), respectively. Postoperative deaths accounted for 47% of deaths in dogs, 61% in cats and 64% in rabbits. Most other small animal species had higher mortality risks. Conclusions and clinical relevance Small animal anaesthesia appears to be increasingly safe. Greater patient care in the postoperative period could reduce fatalities.     

Anaesthesia in horses using halothane and intravenous ketamine–guaiphenesin: a clinical study

Objective The aim of this study was to define and evaluate a combined inhalation?intravenous anaesthetic protocol for use in equine anaesthesia. Study design Prospective, randomized clinical trial. Animals Twenty‐eight horses (body mass 522 ± 82; 330–700 kg [mean ± SD; range]) with a mean age of 6 ± 4 years (range: 2–18 years) presented to the university hospital for various surgical procedures requiring general anaesthesia. Materials and methods Animals were randomly allocated to one of two treatment groups. Anaesthesia was maintained in 14 horses with halothane alone (H group). The mean end‐tidal halothane concentration was 1.24%. In the second group (n = 14) anaesthesia was maintained with both halothane (end‐tidal concentration 0.61%) and a continuous infusion of a ketamine–guaiphenesin mixture (HKG group). The two techniques were compared in terms of qualitative differences and cardiopulmonary effects. Results The stability of anaesthesia was significantly greater in group HKG and the need for dobutamine to maintain blood pressure was significantly less. Recovery times and quality were acceptable in all cases. There were no significant differences between the groups. Conclusions The infusion of ketamine and guaiphenesin in horses receiving low inspired concentrations of halothane provides suitable surgical anaesthesia and lowers the risk of hypotension. Clinical relevance The anaesthetic technique described in this study is a useful and practical alternative to inhalation anaesthesia using halothane alone.     

Contemporary use of acepromazine in the anaesthetic management of male horses and ponies: a retrospective study and opinion poll

Reason for performing study: Current use of acepromazine in the anaesthetic management of male horses and ponies and associated risks are largely unknown. Objectives: To explore anaesthetic acepromazine use and related adverse effects in the male horse. Methods: Of 8533 anaesthetised horses and ponies medical records of male animals treated perianaesthetically with acepromazine were reviewed. Demographic data, time and dose of acepromazine administration, co‐administered drugs, quality of induction and recovery from anaesthesia, arterial blood pressures, and occurrence of penile dysfunction were recorded. Practising ACVA and ECVAA diplomates were polled on the use of acepromazine and its effects on blood pressure and penile dysfunction in the equine. Results: Of all animals, 12% females and 11% males (n = 575 including 42% stallions) received perianaesthetic acepromazine, predominantly for premedication. Anaesthetic induction was smooth in 566 animals. Lowest mean arterial pressures averaged 65 ± 9 mmHg. Recovery was good or very good in 70% of all animals and 74% stood after 1–2 attempts. In 14 horses (2.4%; 7 stallions, 7 geldings), penile prolapse occurred for 0.5–4 h and in one stallion (0.2%) for >12 but <18 h post recovery. Most surveyed anaesthesiologists use acepromazine in stallions (occasionally 63%; frequently 17%) but more frequently in geldings (occasionally 34%; frequently 59%) and mares (occasionally 38%; frequently 59%), primarily for premedication with other sedatives and analgesics. Persistent intraoperative hypotension was not frequently reported. Only 5% of surveyed anaesthesiologists recall penile prolapse post acepromazine administration lasting for >12 h and only one recalls 3 cases of irreversible penile prolapse in 20 years of anaesthesia practice. Conclusions and potential relevance: The extremely low risk of permanent penile dysfunction (≤1 in 10,000 cases) does not justify more restricted use of acepromazine in the intact male vs. geldings and mares.     

Avian anaesthesia related mortality and the associated risk factors in a UK zoological collection

ObjectiveTo analyse avian anaesthesia-related mortality in a UK zoological collection over a 5-year period and identify risk factors for mortality.Study designRetrospective cohort study.AnimalsA total of 135 individual birds across 37 species, anaesthetized during 206 events in a UK zoological collection between 1 January 2014 and 30 June 2019 (inclusive).MethodsAnaesthesia records were reviewed and variables such as age, body condition, weight, sex, duration of anaesthesia and health status were collated. Anaesthesia-related mortality was defined as those deaths occurring during anaesthesia and up to 7 days postanaesthesia. Outcome was analysed using multivariable conditional logistic regression. Overall mortality was defined and included birds euthanised during anaesthesia for non-anaesthesia related reasons. Data were summarised as median (range). A value of p < 0.05 was considered significant. Relative risks and 95% confidence intervals (95% CI) were calculated for the association between risk factors and anaesthetic death where a statistically significant difference was found.ResultsThe overall mortality rate was 10.19% (95% CI = 6.06–14.3%), while anaesthesia-related mortality was 3.88% (95% CI = 1.69–7.51%). Birds with an abnormal health status had a 15.53-fold (95% CI = 1.95–123.63) increased risk of death compared with those with a normal health status. The duration of anaesthesia was also a statistically significant risk factor (p = 0.021) in the univariable analysis, but not when combined with health status. No other variables were associated with anaesthesia-related mortality.Conclusions and clinical relevanceAbnormal health status and longer anaesthetic procedures were associated with a significantly increased risk of anaesthesia-related death in this population of birds. It is recommended that anaesthetic duration is minimized, and pre-existing diseases are diagnosed where possible prior to general anaesthesia of birds. Anaesthetizing healthy birds was associated with a low risk of mortality.     

A retrospective evaluation of the effect of perianesthetic hydromorphone administration on the incidence of postanesthetic signs of colic in horses

ObjectiveTo describe the incidence of postanesthetic signs of colic (PASC) in horses and determine if perianesthetic administration of hydromorphone was associated with an increased risk of PASC.Study designRetrospective, cohort study.AnimalsA total of 409 horses.MethodsAnesthesia and clinical records of horses admitted for various procedures from July 2018 to September 2019 were reviewed. Signs of colic and interventions were recorded up to 48 hours after anesthesia. A binomial logistic regression model was used to evaluate the association between the type of surgery, administration of hydromorphone, the duration of anesthesia and the incidence of PASC.ResultsOverall, 25 (6.1%) horses developed PASC within 48 hours of general anesthesia. Of 60 horses that underwent colic surgery, 16 (26.7%) developed PASC. Of 349 horses that underwent noncolic procedures, nine (2.6%) developed PASC. Thus, the incidence of PASC was higher in horses that underwent colic surgery than in horses that underwent noncolic procedures [odds ratio (OR) = 13.74 (5.73–32.95)]. No effect of hydromorphone on the incidence of PASC was identified [OR = 1.61 (0.71–3.62)]. Longer procedures (>2 hours) were identified as an independent risk factor for PASC [OR = 4.13 (1.52–11.22)].ConclusionsNo association between hydromorphone and an increase in the incidence of PASC was identified. Anesthesia for colic surgery and duration of anesthesia were associated with an increased risk of PASC.Clinical relevanceHydromorphone did not increase the incidence of PASC in this population.     

Plasma endotoxin in horses presented to an equine referral hospital: correlation to selected clinical parameters and outcomes

Reasons for performing study: Endotoxaemia is frequently presumed on the basis of clinical signs in horses with colic. Objective: Measurements of plasma endotoxin (LPS) are rarely made in clinical cases and there is little information on the correlations between this variable, clinical variables and outcomes. Objectives: To measure LPS levels in plasma of horses presented to the Philip Leverhulme Equine Hospital on admission and daily for up to 4 days and to relate LPS levels to selected clinical parameters, such as heart rate and packed cell volume, and outcomes. Methods: Blood samples were collected and stored at ‐20°C prior to assay of the plasma using a validated kinetic chromogenic Limulus amoebocyte lysate (LAL) assay. Clinical parameters and outcome variables were collected from hospital records. Associations were determined by Chi‐squared test and logistic regression analysis. Results: Daily blood samples were collected from 234 horses. LPS was detected in 26.5% of the study population and in 29% of those horses presented for colic. Horses providing samples with detectable LPS were more likely to die whilst in the hospital than those that did not (P = 0.045). Horses presenting with colic were more likely to have detectable LPS in their plasma than noncolic cases (P = 0.037), although LPS was detected in the plasma of 8 out of 42 noncolic horses. A horse that did not meet the study definition of clinical endotoxaemia was 10 times less likely to provide a positive LPS sample (OR 0.10, 95% CI: 0.05–0.22). Conclusions: The proportion of horses providing samples with detectable LPS was similar to other studies. Potential relevance: LPS was detected in the minority of horses presented with colic. Increased levels of LPS positively correlated with packed cell volume and with risk of mortality in colic cases.     

An evidence‐based medicine approach to small animal anaesthetic mortality in a referral practice: the influence of initiating three recommendations on subsequent anaesthetic deaths

ObjectiveTo evaluate anaesthetic death after implementation of recommendations and its risk factors in a small animal practice.Study designObservational cohort study.AnimalsAll cats and dogs anaesthetized at the Centre Hospitalier Vétérinaire des Cordeliers during two periods, from April 15th, 2008 to April 15th, 2010 (period 1) and from June 15th, 2010 to August 24th, 2011 (period 2).MethodsDeath occurring during or before full recovery from anaesthesia was recorded. At the end of period 1, a logistic regression model was generated to describe anaesthetic death and identify risk factors. Potential risk factors in our practice setting were identified, and three recommendations, relating to improving physical status and anaesthetic/analgesic regimen implemented for period 2. The relationship between anaesthetic death and recorded variables were analyzed, and where relevant, compared between periods.ResultsSix thousand two hundred and thirty-one animals underwent general anaesthesia. The overall death rate during period 1 was 1.35% (48 in 3546, 95% CI [1.0–1.7%]) and during period 2 was 0.8% (21 in 2685, 95% CI [0.6–1.2%]). For sick animals (ASA status 3 and over), the overall death rate was 4.8% (45 of 944 95% [CI 3.5–6.4%]) during period 1 and 2.2% (18 of 834 95% CI [1.3–3.5%]) during period 2; this represented a significant decrease in death rate in period 2 (p = 0.002). In period 2, the main factors associated with an increased odds ratio of anaesthetic death were poor health status (ASA physical status classification) and old age. Species, gender, anaesthetic regimen, the nature and urgency of the procedure were not associated with risk.Conclusion and clinical relevanceFollowing evidence based recommendations, the death rate related to anaesthesia was significantly decreased during period 2 compared to period 1. Application of evidence-based medicine may contribute to an effective approach to decrease death rates. Other factors, not monitored in this study, may also have had an impact.     

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.     

Complete caecal bypass without ileal transection for caecal impaction in horses: seven clinical cases (1997-2007)

Objectives To report the clinical outcome in seven horses following use of a newly described surgical technique for treating caecal impaction. Methods The medical records of seven horses with caecal impaction treated surgically using a stapling technique to create a complete caecal bypass without ileal transection were reviewed. Data were obtained from the records and through telephone interviews with case-associated personnel. Results The mean age was 10 years (range 2–22 years) and duration of colic ranged from 24 h to 2 weeks. Five horses had type II motility dysfunction and the remaining two had type I. Mean surgical time was 185 min (range 146–245 min) and the horses were hospitalised for a mean of 12.4 days (range 9–22 days); 71% (5/7) were discharged from hospital and all five were alive 60 days from the surgery date. One horse was lost to follow-up. The four (66.7%) available remaining horses were alive ≥ 1 year (long-term survivors). Conclusions Complete caecal bypass without ileal transection for clinical cases of caecal impaction had comparable outcomes to complete bypass with ileal transection. The technique is easy to perform, has the potential to reduce surgical time, compared with traditional bypass techniques, and may reduce the risk of intraoperative abdominal contamination. It is recommended for use in clinical cases in which caecal bypass is desirable.     

Retrospective Study: Incidence of transfusion reactions to commercial equine plasma

Objective – To report on the incidence of transfusion reactions to commercial equine plasma in a hospital‐based population of horses, to characterize these reactions and report on outcome. Design – Retrospective study. Setting – University teaching hospital. Animals – Client‐owned horses referred to the University of Wisconsin. Interventions – Intravenous administration of 2 commercial equine plasma products when clinically indicated. Measurements and Main Results – Medical records of 107 horses that received plasma transfusions between 2003 and 2008 were evaluated. Transfusion reactions were recorded in 6 of 107 transfusions. All individuals were administered plasma from 1 commercial source. Foals <30 days of age received a hypergammaglobulinemic product and all adults received a lower IgG concentration product. No reactions were recorded in adults. In foals (<30 d) reactions were recorded in 6 of 69 cases (8.7%), all of which occurred in neonates <7 days of age (6/62; [9.7%]). The most frequent reactions were fever (4/6), tachycardia (2/6), tachypnea (2/6), and colic (2/6). All affected foals survived the reaction. There were no statistically significant differences (P<0.05) in any of the variables examined between those foals that did and those that did not experience transfusion reactions. Conclusion – The incidence of transfusion reactions was 8.7% in foals and 0% in adult horses in our referral population. Five of 6 foals responded to medical therapy and eventually received the clinically indicated transfusion. No transfusion related mortality occurred.     

Complications associated with anaesthesia for ocular surgery: a retrospective study 1989-1996

This retrospective study was initiated to identify complications of anaesthesia occurring during ocular surgery. Records of 74 horses anaesthetised for eye enucleation, 65 horses anaesthetised for surgery of the eye and adnexa, and 51 horses anaesthetised for splint bone excision were reviewed. Fifty-three percent of the horses anaesthetised for eye enucleation moved during surgery which was significantly more frequent than in the other groups (P = 0.001). The incidence of moving was significantly reduced by use of an anaesthetic gas analyser for monitoring (P = 0.001). Transient hypertension was measured in 6 horses during removal of the eye. One horse experienced a momentary decrease in heart rate from 36 to 26 beats/min at the start of surgery involving a mass on the third eyelid. The incidence of unsatisfactory recovery from anaesthesia involving multiple attempts to stand was significantly greater after ocular surgery than after splint bone excision (P = 0.036). Our conclusions were 1) the oculocardiac reflex was not active in these horses undergoing ocular surgery, 2) increased attention must be paid to provision of analgesia and adequate depth of anaesthesia, which may be facilitated by use of an anaesthetic gas analyser and 3) horses were at greater risk for unsatisfactory recoveries from anaesthesia after ocular surgery.     

Bispectral index and the clinically evaluated anaesthetic depth in dogs

Objective This study investigated whether the bispectral index (BIS monitor) corresponded with the clinical assessment of anaesthetic depth in dogs. Study design Prospective clinical study. Animals Sixty‐five dogs undergoing anaesthesia for surgery. Methods Dogs were assigned to one of three different anaesthetic techniques. A three point scale was devised to determine the clinical depth of anaesthesia (CDA); CDA 1 represented light, CDA 2 surgical and CDA 3 excessive depth of anaesthesia. BIS values were recorded and CDA assessed at specific times and points throughout surgery. Data were statistically analysed using mixed model regression. Results Clinical depth of anaesthesia was assessed as CDA 1 on 68, 2 on 748 and 3 on four occasions. The BIS recorded for CDA 1 differed significantly from that for CDA 2 (p < 0.001). However, individual BIS values measured at light and surgical levels of anaesthesia overlapped considerably. The sensitivities and specificities calculated for BIS to diagnose CDA 1 compared to CDA 2 in the three anaesthetic protocols were 28–86% and 55–85%. The accompanying positive predictive value was 0.08–0.29 and the negative predictive value was 0.95–0.97. End‐tidal isoflurane concentrations (anaesthetic techniques 1 and 3) and propofol infusion (technique 2) at CDA 1 was significantly lower than those at CDA 2 (p = 0.001). Conclusions Although BIS values overall distinguished between CDA scores, the calculated specificities, sensitivities and predictive values were low, and there were anomalous results in individual cases. Clinical relevance The use of the BIS as the sole method to determine anaesthetic depth in dogs is imprudent.     

A comparison of recovery times and characteristics with sevoflurane and isoflurane anaesthesia in horses undergoing magnetic resonance imaging

Objective To compare recovery times and quality following maintenance of anaesthesia with sevoflurane or isoflurane after a standard intravenous induction technique in horses undergoing magnetic resonance imaging (MRI). Study design Prospective, randomised, blinded clinical study. Animals One hundred ASA I/II horses undergoing MRI. Materials and methods Pre‐anaesthetic medication with intravenous acepromazine and romifidine was followed by induction of anaesthesia with diazepam and ketamine. The animals were randomised into two groups to receive either sevoflurane or isoflurane in oxygen. Horses were subjectively scored (0–5) for temperament before sedation, for quality of sedation, induction and maintenance and anaesthetic depth on entering the recovery area. Recoveries were videotaped and scored by an observer, unaware of the treatment, using two scoring systems. Times to the first movement, head lift, sternal recumbency and standing were recorded along with the number of attempts to achieve sternal and standing positions. Variables were compared using a Student t‐test or Mann–Whitney U‐test (p < 0.05), while the correlation between subjective recovery score and other relevant variables was tested calculating the Spearman Rank correlation coefficient and linear regression modelling performed when significant. Results Seventy‐seven horses entered the final analysis, 38 received isoflurane and 39 sevoflurane. Body mass, age and duration of anaesthesia were similar for both groups. There were no differences in recovery times, scoring or number of attempts to achieve sternal recumbency and standing between groups. Weak, but significant, correlations were found between the subjective recovery score for the pooled data from both groups and both temperament and time in sternal recumbency. Conclusions No differences in recovery times or quality were detected following isoflurane or sevoflurane anaesthesia after intravenous induction. Clinical relevance Sevoflurane affords no obvious advantage in recovery over isoflurane following a standard intravenous induction technique in horses not undergoing surgery.