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How To Become A Equine Vet Nurse – Early studies of perioperative mortality in horses suggested that horses remain at high risk of mortality from general anesthesia, with an overall operative rate of 1 percent (Gozalo-Marcilla).
., 2021). This is still high compared to death rates for cats and dogs; however, preliminary research data suggests that the mortality rate in horses today is lower than it was 20 years ago. Veterinary Nurses (VN) involved in equine anesthesia need specialist knowledge of horses to reduce risk to patients.
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It is important to take the time to properly prepare your sick horse before the GA. A complete history of the owner should be taken and a complete physical examination should be performed. You should also consider:
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Premedication is the administration of an appropriate drug before anesthesia to facilitate induction, maintenance and recovery (Murrell and Ford-Fennah, 2012). Premedication and induction often involve the use of multiple types of medication simultaneously to achieve a balanced overall effect. This is known as multimodal anesthesia (see Table 1 for drugs used).
Preoperative analgesia is a key element of the anesthetic regimen and can help improve postoperative pain management.
Preoperative analgesia is a key element of the anesthetic regimen and can help improve postoperative pain management (Murrell and Ford-Fennah, 2012). Analgesic strategies are usually multimodal and the VN should be familiar with the different classes of analgesics used. They should also work with the veterinarian responsible for anesthesia (VS) to ensure that adequate analgesia is administered prior to induction. The VS in charge of anesthesia and the surgeon should discuss and agree on the antibiotics to be given before surgery. Antibiotic protocols should be in place, based on the British Equine Veterinary Association (BEVA) ‘Protect ME’ campaign, to promote the responsible use of antimicrobials in practice.
Peripheral action to inhibit tissue prostaglandin production by inhibiting the cyclooxygenase enzyme that mediates prostaglandin production.
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Hypnotic effects are largely mediated by blockade of NMDA and HCN1 receptors, but the cholinergic, aminoergic, and opioid systems appear to play both positive and negative modulatory roles in sedation and analgesia (Sleigh
FIGURE (1) Example of an induction box for an equine patient undergoing surgery under general anesthesia. It is a padded room that reduces the risk of injuring the horse when entering
All GA medications used by the patient must be prescribed by the VS, who may then delegate the administration of these medications to the VN. Generally, a sedative such as acepromazine is given first, intravenously or intramuscularly (IM). This helps to calm the patient. When this works, the patient is directed to the induction box – a padded room where the horse is used to reduce the risk of injury during the induction process (Figure 1). An alpha-2 agonist is then administered to sedate the patient before the injectable medication is given.
When the anesthesiologist deems the patient ready, ketamine and diazepam are administered intravenously to induce GA. There are several methods of trying to control induction in horses, including free fall, handler assistance, swinging gates, and slinging. Each induction method has advantages and disadvantages, and the VN should discuss with the anesthesiologist which method is most appropriate.
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Maintenance of GA in horses can be achieved by administering intravenous or inhalation anesthetics. Total intravenous anesthesia (TIVA) orotracheal is used only for short procedures where intubation has been problematic. Inhalational anesthesia is the most common way to maintain GA. This technique involves the administration of anesthetic inhalations, but for this the patient must be intubated.
Total intravenous anesthesia (TIVA) orotracheal is used only for short procedures where intubation has been problematic.
After the horse is intubated, a circular anesthetic circuit is connected to the endotracheal tube and inhalation anesthetic (usually isoflurane) is administered along with oxygen to maintain GA. The patient is then strapped to the sling and transported to the operating room to be placed on the operating table.
Careful positioning of the horse under the GA is critical to reduce the risk of post-anesthetic complications such as myopathy and neuropathy. The VN must ensure that the patient is properly positioned for the procedure.
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Monitoring an anesthetized horse is to ensure that the physiological functions and depth of anesthesia are adequate (Taylor and Clarke, 2007). Table 2 provides information on the most commonly used monitoring techniques. Never underestimate the human senses and the power of interpretation and data integration when it comes to anesthesia control (Dugdale
., 2020). Modern equipment can help and often provide warning signs to prevent a serious incident from occurring; however, machines should never be completely trusted (Dugdale
The VN can assist the anesthesiologist in all monitoring techniques, whether it is device setup and configuration, arterial line insertion, or manual clinical parameter acquisition.
The VN can assist the anesthetist in all monitoring techniques, whether it is device preparation and setup, insertion of arterial lines, or manual acquisition of clinical parameters. Although the final decision on any treatment will rest with the anaesthetist, good communication between VS and VN is required. In this way, the detection and response to any irregularity will be guaranteed quickly and efficiently. A written record should be kept of each anesthetic used in horses, detailing the anesthetics administered and the intraoperative monitoring. After the operation is completed, the horse must be winched to the rescue box.
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The palpebral reflex finger is gently passed along the free edge of the upper eyelid. This reflex is usually preserved during surgical anesthesia
The pulse should be palpated periodically (at least every 5 minutes) during the duration of anesthesia. The heart can also be auscultated periodically with a stethoscope
Mucosal color and capillary refill time provide some clues as to the adequacy of oxygenation and perfusion. Capillary refill times greater than two seconds are cause for concern (Taylor and Clarke, 2007). The mucous membrane should be pale pink
ABP provides a wealth of information about the cardiovascular system and is the most important aid in monitoring an anesthetized horse (Taylor and Clarke, 2007). ABP can be measured by direct or indirect methods, although direct monitoring is more accurate
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Mean blood pressure should be maintained at or above 70 mmHg throughout anesthesia to reduce the patient’s risk of post-anesthetic myopathy (PAM).
IV fluids should be given to horses as a standard part of GA to help maintain adequate perfusion and prevent dehydration.
The ECG provides information about the electrical activity of the heart and can be useful in the diagnosis of arrhythmias. However, the EKG will not provide information about cardiac output. Therefore, blood pressure monitoring should be performed in conjunction with regular palpation of the pulse to obtain an overall picture of the patient’s progress.
Respiratory frequency and rhythm: the movement of the chest wall and breathing bag should be monitored regularly (at least every five minutes). If intermittent positive pressure ventilation (IPPV) is used, it should be carefully monitored
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Arterial blood gases provide information on respiratory and metabolic functions. Arterial carbon dioxide, oxygen concentration, and pH are the most useful indicators of respiratory function
Pulse oximetry measures pulse rate and provides information on the adequacy of arterial blood oxygenation and peripheral perfusion. During anesthesia, a hemoglobin saturation above 94 to 95 percent is desirable
Capnography measures the concentration of carbon dioxide in a gas sample taken from the end of the endotracheal tube. This indirectly reflects the concentration of carbon dioxide in the blood arteries. Capnography is useful for measuring trends, especially in ventilated horses (Murrell & Ford-Fennah, 2012).
Horses should be placed in a recovery box so that they have adequate space to lie down and stand safely. Horses that have been placed on their side during the GA must be placed in the same position in the recovery stall. The lower forelimb should also be moved forward to relieve pressure and reduce the risk of developing myopathy or neuropathy. Horses that have been recumbent in GA should be placed on the side that facilitates access to the IV catheter, or with the operated limb elevated (Dugdale
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Some horses try to get up too early after GA. Such attempts are often uncoordinated and can increase the risk of injury (Murrell & Ford-Fennah, 2012). Sedation with an alpha-2 agonist will delay recovery from anesthesia and allow the patient time to regain coordination before attempting to stand. The VN should discuss with the anesthesiologist in advance the type and dosage of sedative needed before preparing and labeling the drug to ensure prompt administration. Extubation should not be delayed until the horse has swallowed (Murrell & Ford-Fennah, 2012). VN should also ensure that
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