Recovery from Anaesthesia: Equine

Question 1

What do you need in recovery box?

Answer 1

Dry Floor
Towels
Nasal tubes
Oxygen
Sedatives
(de)cuffing syringe

Question 2

When is inhalation agent switched off

Answer 2

Prior to moving horse to recovery box

Question 3

How to position horse in recovery box if in dorsal during surgery

Answer 3

Lateral, side to give best access to IV

Question 4

How to position horse in recovery if in lateral during surgery

Answer 4

Lateral, same side as surgery
Don’t want to deflate the upper lung which would be the more inflated

Question 5

Order of return of equine reflexes in recovery

Answer 5

Nystagmus-> blinking-> swallowing
(remove ETT when horse is swallowing)

Question 6

Signs of upper airway obstruction in horse recovery (5)

Answer 6

Stridor and stertor following extubation
Nostril flaring on inspiration
Abdominal respiratory effort
Exaggerated thoracic excursion
Absence of airflow at nostril

Question 7

Where is airway obstruction normally in horse

Answer 7

within nasal passages or at level of larynx

Question 8

What to do in case of upper airway obstruction in horse

Answer 8

Reintubate
Emergency tracheostomy can be completed under GA

Question 9

nasal Oedema in recovery

Answer 9

Common
Usually resolves as horse stands
Use nasopharyngeal tubes or phenylephrine if severe
Can recover horse to standing with ET tube in place

Question 10

Epistaxis

Answer 10

Nose bleed
Common in recovery of horses
Not a major issue

Question 11

Pulmonary Oedema in horse recovery

Answer 11

Frothy, pinkish fluid at the nostrils after horse has been reintubated and airway patency returned
Exaggerated respiratory efforts & cyanosis
The pathogenesis of this condition is thought to be related to changes in venous return and an influx of fluid into the alveoli as a result of excessive negative pressures within the thorax
Remove obstruction, provide oxygen, frusemide and dexamethasone

Question 12

Key to reducing adverse events

Answer 12

preparation

Question 13

Main reasons horses die as a result of anaesthetic (5)

Answer 13

intra operative cardiac arrest
Post anaesthetic myopathy
Fractures in recovery
Neuropathies and spinal chord malasia
Respiratory obstruction

Question 14

Risk factors for horses under anaesthetic

Answer 14

ASA- risk categories
Age- due to likeliness to have a comorbidity
Surgery type and position
Duration
Time of day, OOH provision
Agents used- inhalation v IV anaesthetics
Recovery quality

Question 15

Problems in maintenance that manifest as problems in recovery (4)

Answer 15

Hypotension
Hypoxaemia
Hypercapnia
Poor positioning

Question 16

Post operative myopthy in horses

Answer 16

Caused by intraoperative malposition and hypotension (+ reduced perfusion pressure to muscle)
Occurs when horse wakes up
Hot, swollen, firm on palpation muscle

Question 17

How to reduce risk of pot-op myopathy

Answer 17

mechanisms to improve blood pressure (inhalation agents, reduce inhalation agents, move towards TIVA or PIVA) and perfusion

Question 18

Post operative Neuropathy

Answer 18

Caused by pressure on verve and hypotension
Lack of sensation/use rather than pain
Will eventually recover with supportive care (can take days)

Question 19

Cause of post-op facial paralysis

Answer 19

(Muzzle deviates away from site of injury)
Dental procedures
Head collar not removed for surgery

Question 20

Spinal Chord Malasia

Answer 20

Cause unknown
Lost function of hindlimbs- fatal

Question 21

How to avoid eye problems after equine surgery

Answer 21

Protect lowermost eye with padding
Lubrication for eye