ANAESTHESIA - Standing Sedation and Equine Anaesthesia Flashcards
=What can be done as an alternative to general anaesthesia in horses for particular procedures?
Standing sedation
Where should you carry out a standing sedation in a horse?
Carry out the sedation in a quiet room and avoid stimulations such as light, noise and other horses. It can also be useful to put a blinder on the horse and swabs in their ears once they are sedated to reduce stimulation
Why are equine standing sedations commonly converted to general anaesthesia?
Equine standing sedations often result in the sedation not working or there being oversedation and recumbency, both of which require conversion to general anaesthesia
How should you prepare for the possibility of converting a standing sedation to general anaesthesia?
- Have induction drugs at hand and doses already calculated
- Move the horse to an appropriate area for recovery
Which phenothiazine is licensed as a sedative in horses?
Acepromazine
What is the clinical use of acepromazine in equids?
Acepromazine provides light sedation with no analgesia and thus tends not to be a sufficient sedative in horses when used on it’s own. However, it can be very useful to reduce the excitatory and locomotor effects of opioids as well as reduce α2 agonist doses required
Which α2 agonists are licensed as sedatives in horses?
Xylazine
Detomidine
Romifidine
What are the two routes of administration of xylazine in horses?
Intravenous (IV) (has to be done under the cascade)
Intramuscular (IM)
What are the three routes of administration for detomidine in horses?
Intravenous (IV)
Intramuscular (IM)
Oral transmucosal gel (Dormosedan)
What are the routes of administration for romifidine in horses?
Intravenous (IV)
Intramuscular (IM)
Why is romifidine the best α2 agonist for procedures on the horse’s head?
Romifidine has the least muscle relaxing properties resulting in reduced ataxia which is ideal for head procedures
However not all practices have romifidine so detomidine is also a good choice
Which α2 adrenoreceptor agonist provides the most reliable sedation in horses?
Detomidine
Which opioid is commonly used in combination with α2 agonists in horses?
Butorphanol
Why is butorphanol commonly used in combination with α2 agonists in horses?
Butorphanol has a potent synergistic effect on α2 agonists
When would you not want to use butorphanol in horses?
Butorphanol can cause head shaking and twitching so is not ideal for head procedures
Why should you be cautious when administering opioids to healthy horses?
Opioids cause increased excitability and locomotion in healthy horses
Why are general anaesthetics particularly challenging in horses?
General anaesthetics can be challenging due to a horse’s fight or flight response. They tend to react before they think which can result in dangerous situations for both the handlers and the horse itself, especially when they are recovering from anaesthesia
What information should you gather when taking a history prior to equine anaesthesia?
Signalement
Passport
Medical history
Information about previous anaesthetics and how the patient responded
Time of last meal
Any allergies/intolerances
What is the maximum amount of time in which you should carry out field anaesthesia in horses?
You should carry out field anaesthesia for no more than 90 minutes
What should you do if you anticipate equine field anaesthesia to take longer than 60 - 90 minutes?
Consider moving the horse to an equine hospital for anaesthesia
Why is it not always necessary to fast a horse prior to anaesthesia?
Horses do not vomit so the risk of aspiration is not considered a primary risk when undergoing anaesthesia. Allowing the horse to eat prior to undergoing anaesthesia maintains normal gut motility which can decrease the risk of post-operative colic
When should you never fast a horse prior to anaesthesia?
You should never fast a suckling foal prior to anaesthesia
What should you carry out to prepare for equine field anaesthesia?
Get a patient weight
Establish intravascular access
Wash out the mouth with water
Which three methods can you use to obtain a horse’s weight?
Weighing scales
Measuring band
Calculate using a formula
What is the formula that can be used to calculate a horse’s weight?
Body weight (kg) = (Girth (cm2) x Length (cm)) / 11,877
Why should you wash out a horse’s mouth prior to anaesthesia?
This is done to prevent the endotracheal tube carrying food material into the trachea and lungs
What is the standard premedication combination for horses?
α2 agonist and Butorphanol
Which two analgesia techniques are good to use in combination in horses?
Systemic analgesia
Locoregional analgesia
Which drug classification do you use for locoregional anaesthesia?
Local anaesthetics
Which three local anaesthetics are lisenced in horses?
Lidocaine
Bupivacaine
Mepivacaine
What is the standard anaethesia induction protocol for horses?
Ketamine and Benzodiazepine
Which benzodiazepine is licensed in horses?
Midazolam
Which induction protocol would you use for short procedures (less than 20 minutes)?
Standard protocol
Which induction protocols are recommended for intermediate procedures (20 to 40 minutes)?
Standard protocol
Triple drip induction
What induction protocol is recommended for longer procedures (30 to 90 minutes)?
Triple drip induction
Which three drugs are used for triple drip induction?
α2 agonist (usually the same one that you used for the premedication)
Ketamine
Guaifenesin (GGE)
What is the purpose of guaifenesin (GGE) in the triple drip?
Guaifenesin is a muscle relaxant which counteracts the hypertonicity caused by ketamine
Why should guaifenesin (GGE) only be administered IV?
Guaifenesin (GGE) should only be administered IV as it is a perivascular irritant and can cause tissue necrosis
Why should Guaifenesin (GGE) only be infused at a concentration of less than 10% in horses?
Guaifenesin can cause thrombophlebitis in horses
What are the main advantages of a triple drip?
Easy
Increases cardiovascular and respiratory function
What are the two main disadvantages of a triple drip?
Can only be used for up to 90 minutes
Horse will appear light due to dissociative anaesthetic affect of ketamine
Why can you only use a triple drip for up to 90 minutes?
Due to the risk of drug accumulation and a prolonged and more ataxic recovery
How is anaesthesia maintained in equine field anaesthesia?
Total Intravenous Anaesthesia (TIVA)
What are the two advantages of intubating horses for field anaesthesia?
- Allows for airway maintenance and protection
- Intermittent positive pressure ventilation (IPPV) is possible if you have a large animal ventilator available
What are the two disadvantages of intubating horses for field anaesthesia?
- Large animal endotracheal tubes are expensive
- May not have a large animal ventilator available for intermittent positive pressure ventilation (IPPV)
According to veterinary evidence, identify nine risk factors that can increase anaesthetic risk in horses
Patient ASA grade
Procedural urgency
Major procedures
Duration of procedure
Patient signalement (age, breed, body weight/conditon)
Concurrent disease
Patient temperament
Inadequate pain management
Level of monitoring and degree of intervention by anaesthetist
Which two horse breeds are susceptible to more difficult anaesthetic recoveries?
Thoroughbreds
Arabian
How does inadequate pain management increase anaesthetic risk in horses?
Horses are flight animals and pain will result in an increased stress and flight response during the recovery period which increases their risk of post-operative injury
What are the three classifications of complications associated with equine inhalant anaesthesia?
Intra-operative complications
Post-operative (recovery) complications
Post-recovery complications
What are the three main organs systems affected by inhalant anaesthetic agents in equids?
Cardiovascular system
Respiratory system
Neuromusculoskeletal system
How should you assess a horse for cardiac arrhythmias prior to an anaesthetic?
Carry out a thorough auscultation on both sides of the heart. If you hear anything abnormal, use an ECG for further investigation
How can you tell the difference between physiological and pathological murmurs in horses?
Physiological murmurs tend to be low grade and localised over the base of the heart, whereas pathological murmurs and usually louder towards the apex of the heart
How do you determine if the second degree atrioventricular (AV) heart block is physiological or pathological in a horse?
The arrhythmia should stop during exercise, if the arrhythmia continues, this suggests that it is a pathological rather than physiological arrhythmia and an ECG should be carried out
When would a racehorse be classified as tachycardic at rest?
A racehorse would be classified as tachycardic with a heartbeat above 40bpm
When would a small pony be classified as tachycardic at rest?
A small pony would be classified as tachycardic with a heartbeat above 60bpm
How does tachycardia affect cardiac output?
Tachycardiac decreases cardiac output as the increased heart rate doesn’t allow for sufficient ventricular filling, resulting in decreased stroke volume and cardiac output
When would a racehorse be classified as bradycardic?
A racehorse would be classified as bradycardic with a heartbeat below 28bpm
When would a small pony be classified as bradycardic?
A small pony would be classified as bradycardic with a heartbeat below 30-35bpm
Why is bradycardia particularly concerning in horses under anaesthesia?
Bradycardia is a precursor to asystole in horses