How To Become An Equine Vet Nurse – Preliminary results of equine perioperative mortality studies suggest that horses still carry the highest mortality rate due to general anesthesia (GA), with the highest mortality rate from perioperative complications at 1 percent known (Gozalo-Marcilla.
., 2021). This is high compared to the reported mortality rates for cats and dogs; however, preliminary data from the study suggests that the mortality rate for horses is lower than 20 years ago. Veterinary nurses (VN) involved in equine anesthesia need equine knowledge to minimize risks to their patients.
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It is important to take the time to properly prepare equine patients before GA. A complete history should be taken from the homeowner and a complete physical examination should be performed. The following should be considered:
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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 are often used in the use of different drugs to provide a balanced effect. This is known as multimodal anesthesia (see Table 1 for drugs used).
Preoperative analgesia is an important part of any anesthesia care and can help improve pain management in the postoperative period.
Preoperative analgesia is an important part of any anesthesia and can help improve pain management in the postoperative period (Murrell and Ford-Fennah, 2012). Common analgesic strategies are multimodal, and the VN should be familiar with the different classes of analgesic drugs used. They should also work with the pharmacologist (Pharmacologist) responsible for anesthesia to ensure that the appropriate analgesic drug is administered before induction. The VS should manage the anesthetized patient and the surgeon should discuss and approve the required preoperative antibiotics, if any, and these should be given first. Antibiotic protocols should be documented and based on the British Equine Veterinary Association (BEVA) “Protect ME” campaign, which aims to promote the responsible use of antimicrobials in practice.
Peripheral action inhibits the production of tissue prostaglandins by inhibiting the enzyme cyclooxygenase, which mediates the production of prostaglandins.
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Hypnotic effects are mediated mainly by blockade of NMDA and HCN1 receptors, but cholinergic, aminergic and opioid systems are known to play a positive and negative modulatory role in sedation and analgesia (Sleigh
FIGURE (1) An example of an induction kit for an equine patient operating under general anesthesia. This is a padded compartment to reduce the risk of injury to the horse during insertion
All GA drugs used for the patient must be prescribed by a VS, then he can give the administration of these drugs to a VN. Usually, a sedative such as acepromazine is given first, either IV or intramuscularly (IM). This helps relieve the pain. Once this is done, the patient goes to the insertion box – a padded compartment used to reduce the risk of injury to the horse during the insertion process (Figure 1). An alpha-2 agonist is given to calm the patient before the induction agent is given.
When the patient is judged ready by the therapist, ketamine and diazepam are given IV to induce GA. There are a number of different methods to try to prevent the induction of equine disease, including free fall, support from hand tools, ax door and the introduction of slings. Each insertion method has advantages and disadvantages and the VN should discuss the most appropriate method to be used with the anesthetist.
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Treatment of GA in horses can be accomplished by administering IV or inhalation anesthetics. Total intravenous anesthesia (TIVA) is usually used for short procedures or situations where orotracheal intubation is difficult. Inhalation anesthesia is the most common method of treating GA. This technique involves the use of inhaled anesthetics, but the patient must be hospitalized for this.
Total intravenous anesthesia (TIVA) is usually used for short procedures or situations where orotracheal intubation is difficult.
Once the horse is intubated, a circular anesthetic circuit is connected to the endotracheal tube and an inhaler (usually isoflurane) with oxygen is given to maintain GA. The patient is secured to a sling and taken to theater to be placed on the operating table.
Correct positioning of the horse during GA is important to reduce the risk of post-anesthetic complications such as myopathy and neuropathy. VN must ensure that the patient is properly prepared for the procedure in question.
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Monitoring of the trained horse is carried out to ensure the effectiveness of the physiological function and depth of anesthesia (Taylor and Clarke, 2007). Table 2 contains information on commonly used monitoring techniques. Human factors and the power of data interpretation and integration should not be underestimated when it comes to anesthesia monitoring (Dugdale
., 2020). New equipment can help and often provide early warning signals to prevent a serious incident from occurring; however, machines should not be fully trusted (Dugdale
The VN can assist the patient with all observation techniques, whether it is preparing and setting up machines, inserting an arterial line, or hand-carrying medical devices.
The VN can assist the patient with all observation techniques, whether it is preparing and setting up machines, inserting an arterial line, or hand-carrying medical devices. Although the final decision on any treatment remains with the anesthetist, there should be good communication between the VS and VN. This will ensure that adverse events are identified and responded to quickly and effectively. A written record of each equine anesthetic must be maintained showing the anesthetics administered and intraoperative monitoring maintained. When the work is done, the horse must be taken with winches into a recovery box.
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The palpebral reflex is elicited by gently running the finger along the free edge of the upper eyelid. This reflex is usually suppressed during surgical anesthesia
The pulse must be checked frequently (at least every five minutes) during anesthesia. The heart can be seen periodically with a stethoscope
Mucosal color and capillary refill time provide a guide to oxygenation and adequate perfusion. A capillary refill time of more than two seconds is cause for concern (Taylor and Clarke, 2007). Red should be bright red
ABP provides important information about the cardiovascular system and is an important aid in monitoring the anesthetized horse (Taylor and Clarke, 2007). ABP can be measured using direct or indirect methods, although direct observation is more accurate.
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ABP should be maintained at or above 70 mmHg during anesthesia to reduce the patient’s risk of developing post-anesthetic myopathy (PAM)
IV fluids should be given to horses during GA regularly to help maintain adequate perfusion and help prevent dehydration.
The EKG provides information about the electrical activity of the heart and can be used to diagnose arrhythmias. However, the ECG does not provide any information about cardiac output. Therefore, blood pressure monitoring should be done with regular palpation of the pulse to create a complete picture of the progress of the disease.
Respiratory rate and volume: Chest wall movement and respiratory rate should be monitored regularly (at least every five minutes). If intermittent positive pressure ventilation (IPPV) is used, this should be closely monitored
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Blood gas analysis provides information about the respiratory system and metabolic activity. 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 oxygenation and peripheral perfusion. A hemoglobin saturation of more than 94 to 95 percent is desirable during anesthesia
Capnography measures the concentration of carbon dioxide in a gas sample taken from the end of an endotracheal tube. This accurately reflects the carbon footprint. Capnography is useful for measuring behaviour, particularly in shedding horses (Murrell and Ford-Fennah, 2012).
Horses should be placed in a backbox that has enough room for them to move into the sternum and stand securely. Horses placed in lateral recovery under GA must be placed in the same position in the recovery box. The lower extremities should be pulled forward to relieve pressure and reduce the risk of developing myopathy or neuropathy. Horses restrained laterally during GA should be placed in lateral recumbency to facilitate access to the IV catheter, or the limb being operated on should be positioned superiorly (Dugdale).
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Some horses try to get up early in the morning after GA. Such trials are often not combined and may increase the risk of injury (Murrell and Ford-Fennah, 2012). Treatment with an alpha-2 agonist delays anesthesia and allows the patient time to regain coordination before attempting to stand up. The VN should discuss the type and amount of sedative required with the patient before the drug is drawn and preregistered to ensure that it can be administered without waiting. Extubation should not be delayed until the horse is eating (Murrell and Ford-Fennah, 2012). VN must confirm
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