Special Issue "Anesthesia and Analgesia in Equids"

A special issue of Animals (ISSN 2076-2615). This special issue belongs to the section "Equids".

Deadline for manuscript submissions: 31 March 2022.

Special Issue Editors

Prof. Dr. Regula Bettschart-Wolfensberger
E-Mail Website
Guest Editor
Department of Diagnostics and Clinical Services, Vetsuisse Faculty, University of Zurich,Winterthurer Str. 258c, 8057 Zürich, Switzerland
Interests: veterinary anaesthesia and analgesia; horse anesthesiology
Dr. Thijs van Loon
E-Mail Website
Guest Editor
Department of Clinical Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584CM Utrecht, The Netherlands
Interests: donkey medicine; pain assessment, local anaesthetic techniques, anaesthesiology, intensive care
Special Issues and Collections in MDPI journals
Dr. Miguel Gozalo-Marcilla
E-Mail Website
Guest Editor
The Royal (Dick) School of Veterinary Studies and The Roslin Institute, Easther Bush Campus, The University of Edinburgh, Edinburgh, UK
Interests: anaesthesia of domestic animals

Special Issue Information

Dear Colleagues, 

It is well known that the fatality rate related to general anaesthesia is higher in equids than in other companion animals. As a result, there is currently a tendency to perform surgery on standing horses, where possible, under sedation, with or without local anaesthetic techniques.

Recently, a multicentre equine anaesthesia study investigating equine anaesthesia fatalities was launched (https://cepef4.wordpress.com), which will not only investigate the risk of anaesthesia and its related factors, but also standing sedation and its risk and possible benefits compared with general anaesthesia. After more than 20 years without robust multicentre data on anaesthesia- or sedation-related risk, this study will reveal where we are at the moment. There is no doubt that there is still immense room for improvement. In addition, there is increasing interest in pain recognition in horses, with the aim of providing adequate pain management to our patients.

Therefore, this Special Edition was designed to publish any study that could help to improve anaesthesia or sedation safety in equids, as well as providing adequate analgesia. 

Prof. Dr. PhD Regula Bettschart-Wolfensberger
Dr. Thijs van Loon
Dr. Miguel Gozalo-Marcilla
Guest Editors

Manuscript Submission Information

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Keywords

  • Equine
  • Anaesthesia
  • Sedation
  • Mortality
  • Monitoring
  • Recovery
  • Artificial ventilation

Published Papers (8 papers)

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Research

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Article
Methadone or Butorphanol as Pre-Anaesthetic Agents Combined with Romifidine in Horses Undergoing Elective Surgery: Qualitative Assessment of Sedation and Induction
Animals 2021, 11(9), 2572; https://doi.org/10.3390/ani11092572 - 31 Aug 2021
Abstract
While butorphanol is the most commonly used opioid in horses, methadone is not licensed in most countries. Our aim was to compare the effects of both drugs, combined with romifidine, regarding the quality of sedation and induction in horses undergoing elective surgery. Results [...] Read more.
While butorphanol is the most commonly used opioid in horses, methadone is not licensed in most countries. Our aim was to compare the effects of both drugs, combined with romifidine, regarding the quality of sedation and induction in horses undergoing elective surgery. Results indicate the suitability of both methadone and butorphanol in this patient population. Animals were scored 10 min after intravenous injection of sedatives. Despite lower overall sedation (OS) score in horses receiving methadone (p = 0.002), the quality and time of induction and intubation remained unchanged. None of the horses had the lowest OS score (no sedation), nor the highest score for ataxia (horse falling). Methadone induced a tendency for minor noise reaction yet minor head lowering scores, the latter being probably the most influencing parameter when scoring OS. Measured physiological parameters decreased in both groups, with greater bradycardia recorded after methadone (p = 0.017), including a higher incidence of atrioventricular blocks that resolved during general anaesthesia. The quality of induction was good–excellent in most of the animals. While comparisons between the degree of antinociception were beyond the scope of this study, analgesic potency might influence the choice when considering opioids as pre-anaesthetic drugs in combination with romifidine before surgery in equines. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
Article
Data Collection for the Fourth Multicentre Confidential Enquiry of Perioperative Fatalities (CEPEF4) Study: New Technology and Preliminary Results
Animals 2021, 11(9), 2549; https://doi.org/10.3390/ani11092549 - 30 Aug 2021
Viewed by 145
Abstract
It is almost 20 years since the largest observational, multicentre study evaluating the risks of mortality associated with general anaesthesia in horses. We proposed an internet-based method to collect data (cleaned and analysed with R) in a multicentre, cohort, observational, analytical, longitudinal and [...] Read more.
It is almost 20 years since the largest observational, multicentre study evaluating the risks of mortality associated with general anaesthesia in horses. We proposed an internet-based method to collect data (cleaned and analysed with R) in a multicentre, cohort, observational, analytical, longitudinal and prospective study to evaluate peri-operative equine mortality. The objective was to report the usefulness of the method, illustrated with the preliminary data, including outcomes for horses seven days after undergoing general anaesthesia and certain procedures using standing sedation. Within six months, data from 6701 procedures under general anaesthesia and 1955 standing sedations from 69 centres were collected. The results showed (i) the utility of the method; also, that (ii) the overall mortality rate for general anaesthesia within the seven-day outcome period was 1.0%. In horses undergoing procedures other than exploratory laparotomy for colic (“noncolics”), the rate was lower, 0.6%, and in “colics” it was higher, at 3.4%. For standing sedations, the overall mortality rate was 0.2%. Finally, (iii) we present some descriptive data that demonstrate new developments since the previous CEPEF2. In conclusion, horses clearly still die unexpectedly when undergoing procedures under general anaesthesia or standing sedation. Our method is suitable for case collection for future studies. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Article
Comparison of Recovery Quality Following Medetomidine versus Xylazine Balanced Isoflurane Anaesthesia in Horses: A Retrospective Analysis
Animals 2021, 11(8), 2440; https://doi.org/10.3390/ani11082440 - 19 Aug 2021
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Abstract
Medetomidine partial intravenous anaesthesia (PIVA) has not been compared to xylazine PIVA regarding quality of recovery. This clinical retrospective study compared recoveries following isoflurane anaesthesia balanced with medetomidine or xylazine. The following standard protocol was used: sedation with 7 µg·kg−1 medetomidine or [...] Read more.
Medetomidine partial intravenous anaesthesia (PIVA) has not been compared to xylazine PIVA regarding quality of recovery. This clinical retrospective study compared recoveries following isoflurane anaesthesia balanced with medetomidine or xylazine. The following standard protocol was used: sedation with 7 µg·kg−1 medetomidine or 1.1 mg·kg−1 xylazine, anaesthesia induction with ketamine/diazepam, maintenance with isoflurane and 3.5 µg·kg−1·h−1 medetomidine or 0.7 mg·kg−1·h−1 xylazine, and sedation after anaesthesia with 2 µg·kg−1 medetomidine or 0.3 mg·kg−1 xylazine. Recovery was timed and, using video recordings, numerically scored by two blinded observers. Influence of demographics, procedure, peri-anaesthetic drugs, and intraoperative complications (hypotension, hypoxemia, and tachycardia) on recovery were analysed using regression analysis (p < 0.05). A total of 470 recoveries (medetomidine 279, xylazine 191) were finally included. Following medetomidine, recoveries were significantly longer (median (interquartile range): 57 (43–71) min) than xylazine (43 (32–59) min) (p < 0.001). However, the number of attempts to stand was similar (medetomidine and xylazine: 2 (1–3)). Poorer scores were seen with increased pre-anaesthetic dose of xylazine, intraoperative tetrastarch, or salbutamol. However, use of medetomidine or xylazine did not influence recovery score, concluding that, following medetomidine–isoflurane PIVA, recovery is longer, but of similar quality compared to xylazine. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Article
Analgesic and Sedative Effects of Epidural Lidocaine-Xylazine in Elective Bilateral Laparoscopic Ovariectomy in Standing Mule Mares
Animals 2021, 11(8), 2419; https://doi.org/10.3390/ani11082419 - 17 Aug 2021
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Abstract
The purpose of this study was to determine the analgesic efficacy and safety of epidural lidocaine-xylazine administration in standing mules undergoing elective bilateral laparoscopic ovariectomy in order to suppress unwanted behaviour. Eight mule mares were sedated with intramuscular 0.05 mg/kg acepromazine followed by [...] Read more.
The purpose of this study was to determine the analgesic efficacy and safety of epidural lidocaine-xylazine administration in standing mules undergoing elective bilateral laparoscopic ovariectomy in order to suppress unwanted behaviour. Eight mule mares were sedated with intramuscular 0.05 mg/kg acepromazine followed by 1.3 mg/kg of xylazine and 0.02 mg/kg of butorphanol intravenously. Sedation was maintained by a constant rate infusion of 0.6 mg/kg/h of xylazine. The paralumbar fossae were infiltrated with 30 mL of 2% lidocaine. Epidural anaesthesia was performed at the first intercoccygeal space with 0.2 mg/kg of lidocaine and 0.17 mg/kg of xylazine. After 15 min, bilateral laparoscopic ovariectomy was performed. Heart rate, respiratory rate, rectal temperature, invasive arterial blood pressure, degree of analgesia, sedation and ataxia were evaluated during surgery. The laparoscopic ovariectomy was successfully completed in all animals. Sedation and analgesia were considered satisfactory in six out of the eight mules. In conclusion, caudal epidural block allowed surgery to be easily completed in six out of eight. The animals did not show any signs of discomfort associated with nociception and were mostly calm during the procedures, however additional studies are needed to establish epidural doses of xylazine and lidocaine that result in reliable abdominal pain control in mules for standing ovariectomy. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Article
Analgesic Effect of Butorphanol during Castration in Donkeys under Total Intravenous Anaesthesia
Animals 2021, 11(8), 2346; https://doi.org/10.3390/ani11082346 - 09 Aug 2021
Viewed by 523
Abstract
Pain management is necessary for all surgical procedures. Little scientific evidence about drug efficacy in donkeys is available. The aim of this study was to evaluate the analgesic effect of butorphanol in donkeys undergoing orchiectomy under total intravenous anaesthesia with guaifenesin-ketamine-detomidine. A randomized [...] Read more.
Pain management is necessary for all surgical procedures. Little scientific evidence about drug efficacy in donkeys is available. The aim of this study was to evaluate the analgesic effect of butorphanol in donkeys undergoing orchiectomy under total intravenous anaesthesia with guaifenesin-ketamine-detomidine. A randomized blinded prospective clinical trial (Protocol n. 2021/0000338), was carried out on 18 clinically healthy donkeys undergoing bilateral orchiectomy. Patients were assigned to Group D (n = 8) or Group DB (n = 10) if receiving intravenous detomidine or detomidine-butorphanol respectively, before induction of general anaesthesia with ketamine-diazepam. Intraoperative muscle relaxation, nystagmus, palpebral reflex, heart and respiratory rate, and non-invasive blood pressure were evaluated every 2 min; time to prepare the patient, duration of surgery and anaesthesia and recovery score were recorded. Group D had significantly longer surgical time, higher heart rate, higher systolic and mean blood pressure (p < 0.05; repeated measure ANOVA), increased muscle rigidity and expression of palpebral reflex (p < 0.05; Mann–Whitney U test) than group DB. Top-ups with thiopental were statistically higher in Group D. Butorphanol and detomidine together produced a more stable anaesthetic plan. The low dosage of opioid and alpha-2-agonists and reduced rescue anaesthesia are responsible for a safer and more superficial anaesthesia, which is mandatory under field conditions. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Article
Spontaneous Behaviors of Post-Orchiectomy Pain in Horses Regardless of the Effects of Time of Day, Anesthesia, and Analgesia
Animals 2021, 11(6), 1629; https://doi.org/10.3390/ani11061629 - 31 May 2021
Cited by 1 | Viewed by 1294
Abstract
This prospective and longitudinal study aimed to identify spontaneous post-orchiectomy pain behaviors in horses regardless of the effects of anesthesia, analgesia, and recording time of day. Twenty-four horses divided into four groups were submitted to: inhalation anesthesia only (GA), or combined with previous [...] Read more.
This prospective and longitudinal study aimed to identify spontaneous post-orchiectomy pain behaviors in horses regardless of the effects of anesthesia, analgesia, and recording time of day. Twenty-four horses divided into four groups were submitted to: inhalation anesthesia only (GA), or combined with previous analgesia (GAA), or orchiectomy under pre (GCA), or postoperative (GC) analgesia. The data obtained from the subtraction of frequency and/or duration of 34 behaviors recorded during seven 60-min time-points in the 24 h after the anesthesia from those recorded in the mirrored time-points in the 24 h before the anesthesia (delta) were compared over time and among groups by Friedman and Kruskal–Wallis tests, respectively (p < 0.05). Time of day influenced the behaviors of walk, look out the window, rest the pelvic limb, and rest standing still. The only pain-related behaviors were decreased mirrored proportional differences in time spent drinking, and eating, and increased mirrored proportional differences in the frequency or duration of look at the wound, retract the pelvic limb, expose the penis, and look at the back of the stall. In conclusion, confounding factors rather than pain may influence several suggestive pain-related behaviors documented in the literature. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Review

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Review
Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature
Animals 2021, 11(6), 1777; https://doi.org/10.3390/ani11061777 - 14 Jun 2021
Cited by 1 | Viewed by 1490
Abstract
Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in [...] Read more.
Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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Other

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Systematic Review
Evaluation of the Effect of the Inspired Oxygen Fraction on Blood Oxygenation during Inhalant Anaesthesia in Horses: A Systematic Review with Meta-Analysis
Animals 2021, 11(8), 2245; https://doi.org/10.3390/ani11082245 - 30 Jul 2021
Viewed by 764
Abstract
In anaesthetized horses, pronounced ventilation/perfusion mismatching often occurs. Several authors have investigated the effect of lower inspired oxygen fractions (FiO2) to reduce formation of absorption atelectasis. This systematic review compared the effects of low (<0.6) and high (>0.8) F [...] Read more.
In anaesthetized horses, pronounced ventilation/perfusion mismatching often occurs. Several authors have investigated the effect of lower inspired oxygen fractions (FiO2) to reduce formation of absorption atelectasis. This systematic review compared the effects of low (<0.6) and high (>0.8) FiO2 on the arterial oxygen tension (PaO2), the alveolar-to-arterial oxygen tension difference (P(A-a)O2), and the PaO2/FiO2 ratio in horses during inhalation anaesthesia. Using the Systematic Review Protocol for Animal Intervention Studies, four experimental and one clinical investigations were deemed suitable for inclusion. A meta-analysis was performed on the four experimental studies. The PaO2 was significantly lower (p = 0.0007, mean difference −23.54 kPa, 95% CI −37.18, −9.90) with a lower FiO2. However, the P(A-a)O2 was also significantly lower (p < 0.00001, mean difference −20.80 kPa, 95% CI −26.28, −15.32) when using a low FiO2. For the PaO2/FiO2 ratio, only one study fitted the inclusion criteria, so no meta-analysis was performed. It is concluded that, while only a limited number of studies are available, the use of a higher FiO2 in horses during inhalation anaesthesia will result in higher levels of PaO2, but also a larger P(A-a)O2 difference. Further studies are needed to increase the level of evidence on this subject. Full article
(This article belongs to the Special Issue Anesthesia and Analgesia in Equids)
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