Background: Opioid epidural analgesia has been shown to provide effective analgesia in horses. There is a lack of evidence regarding the effect of opioid epidural analgesia on quality of recovery in horses. Objectives: Identify whether opioid epidural analgesia influences quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Study design: Single-centre retrospective cross-sectional study. Methods: Data were obtained from the clinical records of horses which had undergone arthroscopic or tenoscopic surgery for management of hindlimb synovial sepsis over a 9-year period in a referral hospital population. Multivariable logistic regression analysis was used to identify the perioperative factors that impact on quality of recovery. Results: Records from 149 horses, undergoing 170 general anaesthetics were included. Multivariable logistic regression analysis showed that opioid epidural analgesia (OR 3.0, 95% CI 1.2 to 7.2, P = .02) was associated with good quality of recovery, whereas Cob breeds (OR 0.16, 95% CI 0.06 to 0.46, P = .001), age (in years) (OR 0.90, 95% CI 0.83 to 0.97, P = .004) increasing intraoperative dosages (in mg/kg) of thiopental (OR 0.64, 95% CI 0.46 to 0.90, P = .01) or ketamine (OR 0.42, 95% CI 0.18 to 0.98, P = .04) were associated with poor quality of recovery. Main limitations: Certain variables that may influence quality of recovery, such as patient temperament and hindlimb orthopaedic co-morbidities were not recorded. The clinical prediction model obtained is only applicable to the specific facilities, population and perianaesthetic management practiced at our institution. Conclusions: Opioid epidural analgesia is significantly associated with good quality of recovery in horses undergoing general anaesthesia required for management of hindlimb synovial sepsis. Other risk factors, such as increasing age, cob breed, use of higher intraoperative dosages (in mg/kg) of ketamine and/or thiopental, were associated with poor quality of recovery. This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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The objective of this case series is to describe the clinical course, treatment and outcome in six dogs following acute hyperkalaemia during general anaesthesia. A total of six dogs were presented for routine surgical and/or imaging procedures requiring general anaesthesia. All patients developed hyperkalaemia (ranging from 7.0 to 8.7 mmol/L, reference interval: 3.4–4.9 mmol/L), and electrocardiographic changes were seen in all but one case. The prognosis for treatment of hyperkalaemia during general anaesthesia appears to be excellent as all dogs fully recovered following treatment. To the authors’ knowledge, this is the first reported case series of hyperkalaemia during general anaesthesia in dogs. Our objective is to provide further information regarding possible causes for the development of hyperkalaemia in dogs under general anaesthesia.

Background In equine anaesthesia, the recovery period is a time of considerable risk and has been the focus of prolific research. Risk factors, including age, type and duration of procedure or temperament may influence recovery quality. Unfortunately, the anaesthetist is unable to control for these factors, therefore various pharmacological interventions and recovery methods have been developed with the objective of improving recovery quality. However, no consensus among anaesthetists has been reached for many of these interventions and their implications for recovery‐related mortality and morbidity. Objectives To conduct a systematic review of the published evidence relating to risk factors and interventions in the recovery period which may influence recovery quality from equine general anaesthesia (GA). Study design A systematic evaluation of the equine veterinary literature using the GRADE framework. Methods A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub‐topic was assessed using the GRADE framework. Results Thirty‐nine studies were identified which directly assessed the impact of risk factors and recovery interventions on recovery quality after equine GA. There was evidence to support that peri‐anaesthetic risk factors such as anaesthesia duration, American Society of Anesthesiologists (ASA) physical status and surgical procedure influenced recovery quality. We also identified sufficient evidence that administration of α‐2 adrenoreceptor agonists immediately prior to recovery, improves recovery quality. Main limitations The validity of the results of some studies may have been compromised by missing data and small sample sizes. Conclusions Recovery quality is influenced by factors including: anaesthesia duration, ASA physical status and surgical procedure. Recovery quality can be improved by the administration of an α‐2 adrenoreceptor agonist immediately prior to recovery.

Background The recovery phase after equine general anaesthesia (GA) is a time of considerable risk and therefore has been the subject of extensive research over the last 20 years. Various pharmacological interventions have been developed and studied with the objective of improving recovery quality and reducing anaesthetic‐related mortality and morbidity. Nevertheless, some controversy remains regarding the influence of anaesthetic protocol choice on recovery quality from GA and its implications for recovery‐related mortality and morbidity. A systematic review of the literature investigating the influence of anaesthetic protocol choice on recovery quality is currently lacking. Objectives To perform a detailed evaluation of the equine veterinary literature investigating the effect of anaesthetic protocol choice on equine recovery quality utilising the GRADE framework. Study design A systematic evaluation of the equine veterinary literature was performed using the GRADE framework. Methods A literature search was performed and studies were assessed for eligibility by both authors utilising PRISMA guidelines. Studies meeting inclusion criteria were evaluated by both authors, categorically summarised and the quality of evidence for each sub‐topic was assessed using the GRADE framework. Results A total of 124 studies were identified which directly assessed the impact of anaesthetic protocol choice on recovery quality after GA in horses. Evaluation of the available evidence indicated that certain partial intravenous anaesthesia (PIVA) agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality. Main limitations The validity of the results of some studies may have been compromised by missing data and small sample sizes. Conclusions There is evidence to indicate that certain PIVA agents, cessation of intravenous lidocaine 30 minutes prior to recovery and provision of adequate analgesia improves recovery quality.

Background: In equine anaesthesia, the recovery period is critical, accounting for most anaesthesia-related fatalities reported. Horses may recover unassisted or may be assisted, for example, using a head and tail rope recovery method.Objectives: To compare the impact of head and tail rope and unassisted recovery method on quality of recovery in horses undergoing colic surgery under general anaesthesia (GA).Study design: Single centre retrospective cross-sectional study, with prospective model performance analysis.Methods: Clinical data were obtained from horses undergoing emergency exploratory laparotomy over a 6-year period. Multivariable logistic regression analysis was used to identify the perioperative factors that affect quality of recovery. The final prediction model was assessed prospectively.Results: Records from 502 general anaesthetics (490 horses) were included.Multivariable logistic regression analysis showed that head and tail rope recovery (OR 2.2, 95% CI 1.4-3.3, P < .001) and sevoflurane administration (OR 1.6, 95% CI 1.2-2.3, P = .02) were associated with better quality of recovery when compared with unassisted recovery and isoflurane administration respectively. Increasing GA duration (OR 1.0, 95% CI 0.99-1.0, P = .03), increasing intraoperative dosages (in mg/ kg) of thiopental (OR 0.85, 95% CI 0.75-0.98, P = .02) or ketamine (OR 0.67, 95% CI 0.46-0.99, P = .04) were linked to poor quality of recovery. No statistically significant difference was found between recovery groups in terms of mortality. Main limitations:The clinical prediction model obtained is only applicable to the specific facilities, recovery methodology, referral population and anaesthetic protocols practiced at our institution.Conclusions: Head and tail rope recovery is significantly associated with better quality of recovery, compared with unassisted recovery, in horses undergoing emergency exploratory laparotomy. Sevoflurane administration, in detriment of isoflurane, was associated with better quality of recovery. Other risk factors, such as increasing GA duration, the use of higher intra-operative dosages of ketamine and/or thiopental, were associated with poor quality of recovery.

Identify whether pre-anaesthetic clinical examination influences anaesthetic and analgesic agents and techniques protocol in dogs presented for general anaesthesia and sedation at a large referral hospital. Materials and MethOds:In this prospective clinical audit, 554 dogs, undergoing general anaesthesia or sedation for surgical, diagnostic or imaging procedures were included. Multiple attending anaesthetists completed a questionnaire divided into four sections (American Society of Anesthesiologists physical status classification, anaesthetic and analgesic agents and techniques protocol, pre-anaesthetic clinical examination findings and changes made to the anaesthetic protocol). The attending anaesthetist was able to review the patient's history before planning the anaesthetic and analgesic agents and techniques protocol. The patients were examined and changes in American Society of Anesthesiologists physical status classification or anaesthetic protocol were recorded. results:The initial anaesthetic and analgesic agents and techniques protocol was altered in 23.3% (n=129/554) of cases following a pre-anaesthetic clinical examination, but American Society of Anesthesiologists physical status reclassification occurred in only 8.0% (n=37/464) of cases. Multivariable logistic regression analysis showed that pre-anaesthetic clinical examination performed by European College of Veterinary Anaesthesia and Analgesia diplomates (odds ratio 5.8, 95% confidence interval 2.0 to 17.2), compared to anaesthesia interns, and the presence of an audible heart murmur (odds ratio 2.4, 95% confidence interval 1.4 to 4.4) were factors linked to changes in anaesthetic and analgesic agents and techniques protocol, whereas for each one kilogram increase in patient's weight, the odds of a change in anaesthetic and analgesic agents and techniques protocol to occur decreased by 1.7% (odds ratio 0.98, 95% confidence interval 0.97 to 1.0). clinical significance: Pre-anaesthetic clinical examination has impact on American Society of Anesthesiologists physical status classification, therefore estimation of patient's anaesthetic risk, and influences anaesthetic and analgesic agents and techniques protocol choice.

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