Hyperthermia and Delayed-Onset Myopathy after Recovery from Anesthesia in a Horse

A 13-year old Thoroughbred cross gelding (528 kg) underwent lameness investigation. Because of his temperament, general anesthesia was required to facilitate ultrasound of the left fore fetlock and intra-articular medication of three joints. Anesthesia was induced with ketamine/diazepam after acepromazine/detomidine premedication. Anesthesia was maintained for 40 minutes with a guaifenesin/detomidine/ketamine intravenous infusion. Recovery from anesthesia was initially uneventful, although of a moderate duration (70 minutes). Once standing, the horse proceeded to box walk in an agitated state and became recumbent on two occasions. The horse was manually restrained, at which time its rectal temperature was 41.8°C. Cooling measures were employed (fans, ice-water enemas, wet rugs, intravenous fluid therapy (IVFT), and topical application of surgical spirit) until rectal temperature reached 38.7°C. IVFT was continued for a further 16 hours. Four days after recovery from anesthesia, bilateral triceps, deltoideus, trapezius, and rhomboideus muscle swelling was observed. Blood creatinine kinase was elevated (24,898 IU/L). Treatment for postanesthetic myopathy was initiated (hot packing of the muscle groups, topical dimethylsulfoxide [DMSO] cream application, and oral phenylbutazone). Myoglobinuria was not observed at any time. Muscle swelling decreased over the following 3 days. The horse was discharged on day 11 and has since returned to work.     

The Effects of Anesthesia on Laryngeal Function and Laryngeal/Pharyngeal Trauma in the Horse

Laryngeal paralysis in horses has been reported after inhalational anesthesia and can result in significant morbidity/mortality. The cause of the condition is unclear. The objective of this study was to examine the effects of a standardized anesthetic protocol on laryngeal function and laryngeal/pharyngeal trauma in the peri-anesthetic period in a prospective study. A 30- to 60-second digitalized video clip of laryngeal movement from a standardized endoscopic view was recorded at five time points: before sedation, post-sedation, post-induction, immediately after recovery to standing, and at 24 hours after recovery. A standardized anesthetic regimen was used in all cases. Video clips were randomized and evaluated by two blinded assessors. Each assessor scored each clip for laryngeal function and trauma using previously validated scoring systems. Agreement between assessors was calculated using the mean of the five time-specific weighted kappa statistics. Post-anesthesia laryngeal function and trauma scores were compared with initial scores using the Wilcoxon signed rank test with Bonferroni adjustment. Spearman's rank coefficient was used to assess correlation between trauma and function scores and between anesthetic duration and laryngeal function and trauma scores.There was no significant effect of anesthesia on laryngeal function. Trauma scores were not significantly higher after tracheal intubation. The trauma scoring system requires further validation. There was no correlation between higher trauma scores and laryngeal function or duration and laryngeal function or trauma.Further work is required to evaluate other variables that may affect laryngeal function after anesthesia, using a larger number of horses with varying degrees of laryngeal dysfunction.