Data Collection for the Fourth Multicentre Confidential Enquiry into Perioperative Equine Fatalities (CEPEF4) Study: New Technology and Preliminary Results

Abstract

It is almost 20 years since the largest observational, multicentre study evaluating the risks of mortality associated with general anaesthesia in horses. We proposed an internet-based method to collect data (cleaned and analysed with R) in a multicentre, cohort, observational, analytical, longitudinal and prospective study to evaluate peri-operative equine mortality. The objective was to report the usefulness of the method, illustrated with the preliminary data, including outcomes for horses seven days after undergoing general anaesthesia and certain procedures using standing sedation. Within six months, data from 6701 procedures under general anaesthesia and 1955 standing sedations from 69 centres were collected. The results showed (i) the utility of the method; also, that (ii) the overall mortality rate for general anaesthesia within the seven-day outcome period was 1.0%. In horses undergoing procedures other than exploratory laparotomy for colic (“noncolics”), the rate was lower, 0.6%, and in “colics” it was higher, at 3.4%. For standing sedations, the overall mortality rate was 0.2%. Finally, (iii) we present some descriptive data that demonstrate new developments since the previous CEPEF2. In conclusion, horses clearly still die unexpectedly when undergoing procedures under general anaesthesia or standing sedation. Our method is suitable for case collection for future studies.

Suspected severe post‐anaesthetic myopathy or myelopathy in a Clydesdale horse resulting in euthanasia

“…Preliminary results from an ongoing investigation report a peri-operative mortality rate of 0.6% for anaesthetised horses not undergoing colic surgery. 1 A historical iteration of this study reported an equivalent mortality rate of 0.9%. 2 Myopathy is a notable complication of general anaesthesia in horses, accounting for 7% of all deaths in a non-emergent population.…”

Erector spinae plane block as part of a multimodal analgesic approach in an anaesthetised horse undergoing dorsal spinous process ostectomy and desmotomy

“…25 An interspinous ligament desmotomy has been described as a complimentary technique to reduce the impingement between dorsal SP. 15,24,28,29 In our institution, surgical management of KSS is typically performed under deep sedation, with the patient remaining in standing position. Although sedation has widely been associated with a lower rate of complications when compared with general anaesthesia (less cardiovascular depression, gas exchange and muscle perfusion impairment associated to the lateral recumbency), 27,28 from the authors' point of view, aggressive and difficult horses often receive higher doses of sedatives.…”

“…A less invasive method consisting of an endoscopic resection of the dorsal SP has also been described as safe and effective alternative 25 . An interspinous ligament desmotomy has been described as a complimentary technique to reduce the impingement between dorsal SP 15,24,28,29 . In our institution, surgical management of KSS is typically performed under deep sedation, with the patient remaining in standing position.…”

“…15,24,28,29 In our institution, surgical management of KSS is typically performed under deep sedation, with the patient remaining in standing position. Although sedation has widely been associated with a lower rate of complications when compared with general anaesthesia (less cardiovascular depression, gas exchange and muscle perfusion impairment associated to the lateral recumbency), 27,28 from the authors' point of view, aggressive and difficult horses often receive higher doses of sedatives. High doses of sedatives can result in an increased degree of ataxia and risk of the horse collapsing in the box, putting both the horse and the operators at risk of injury.…”

Anaesthesia management of transvenous implantation of a single‐chamber, rate‐adaptive pacemaker in a donkey with high‐grade second and third degree atrioventricular block

“…Indeed, if asystole occurs, cardiopulmonary resuscitation (CPR) is difficult to perform: in literature, it is reported that peri-anaesthetic cardiac arrest carries a poor outcome in horses, mainly because of the difficulties performing CPR manoeuvres in this species. [9][10][11][12] Another consideration in the anaesthesia management is the transport and positioning during anaesthesia for fluoroscopy guidance where lead dislodgement of the temporary pacemaker could occur. Furthermore, the risk of lead displacement of the permanent pacemaker during recovery and the early postoperative period needs to be considered.…”