Clinical features and management of equine post operative ileus (POI):Survey ofDiplomates of theAmericanColleges ofVeterinaryInternalMedicine (ACVIM),VeterinarySurgeons (ACVS) andVeterinaryEmergency andCriticalCare (ACVECC)

Abstract

Summary Reasons for performing study A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. Objectives To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. Study design Cross‐sectional survey. Methods Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). Results The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0–20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti‐inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. Conclusions There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

An update on equine post‐operative ileus: Definitions, pathophysiology and management

“…The presence of nasogastric reflux on intubation represents a universally applied diagnostic criteria, which along with ultrasonographic and palpable (via per rectum examination) evidence of distended SI, are the most commonly applied diagnostic indications [8,9]. The presence of nasogastric reflux on intubation represents a universally applied diagnostic criteria, which along with ultrasonographic and palpable (via per rectum examination) evidence of distended SI, are the most commonly applied diagnostic indications [8,9].…”

“…The presence of nasogastric reflux on intubation represents a universally applied diagnostic criteria, which along with ultrasonographic and palpable (via per rectum examination) evidence of distended SI, are the most commonly applied diagnostic indications [8,9]. Recent surveys of European and American equine clinical specialists confirmed the presence of nasogastric reflux as the most important criterion for defining POI, but there was no consensus with respect to the rate and volume of reflux adopted as diagnostic markers [8,9]. There is a wide disparity in the volume of reflux considered to reflect the presence of POI, either on a single intubation and/or over multiple intubations within a 24-h period (Supplementary Item 1).…”

“…The ultrasonographic and/or palpable (via per rectum examination) detection of distended SI, tachycardia, abdominal discomfort, reduced faecal output and reduced/absent borborygmi are also valuable means of POI diagnosis [8,9]. The ultrasonographic and/or palpable (via per rectum examination) detection of distended SI, tachycardia, abdominal discomfort, reduced faecal output and reduced/absent borborygmi are also valuable means of POI diagnosis [8,9].…”

“…Current recommendations in humans are to restrict the use of nasogastric tubes to patients that have delayed gastric emptying following surgery [121]. In contrast to the inclination of European equine clinicians to pass a nasogastric tube when required, there is a preference among North American equine clinicians to retain an indwelling tube [8,9]; however, there is no evidence to suggest that this practice reduces the incidence of POI. In contrast to the inclination of European equine clinicians to pass a nasogastric tube when required, there is a preference among North American equine clinicians to retain an indwelling tube [8,9]; however, there is no evidence to suggest that this practice reduces the incidence of POI.…”

Extrapyramidal side effects following subcutaneous metoclopramide injection for the treatment of post operative ileus

“…) and American Colleges (ACVS, ACVIM and ACVECC) (Lefebvre et al . ) as the second most commonly used prokinetic agent after lignocaine (lidocaine).…”