Risk Factors for Equine Postoperative Ileus and Effectiveness of Prophylactic Lidocaine

Torfs, Sara; Delesalle, Cathérine; Dewulf, Jeroen; Devisscher, Lindsey; Deprez, Piet

doi:10.1111/j.1939-1676.2009.0311.x

Cited by 97 publications

(121 citation statements)

References 30 publications

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“…Both only to the presence of SI distension. This likely reflects an awareness of the increasing body of published evidence supporting a pivotal role for inflammation in equine POI pathogenesis 3,13,14,15,16 . Similarly, it is likely that the reported anti-inflammatory effects of lidocaine 17,18,19 , in addition to its perceived prokinetic effects 2 , also contributed to the high frequency with which this drug was used, both intra-and postoperatively.…”

Section: Discussionmentioning

confidence: 99%

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

Lefebvre

Hudson

Elce

et al. 2015

Equine Veterinary Journal

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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.

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Section: Discussionmentioning

confidence: 99%

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

Lefebvre

Hudson

Elce

et al. 2015

Equine Veterinary Journal

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“…Also, lidocaine CRI significantly reduced the hourly volume of reflux and decreased duration of hospitalization (Malone et al 2006). In horses that had small intestinal surgery only in a single hospital, lidocaine CRI reduced the prevalence of POI and improved short-term survival (Torfs et al 2009). …”

Section: Lidocainementioning

confidence: 99%

Ischemia in equine intestine – mechanisms of injury and methods of treatment

Freeman¹,

Grosche²

2012

PHK

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SummaryThe importance of reperfusion injury in equine intestine is controversial and unclear. Large colon volvulus and small intestinal strangulation are the most devastating causes of intestinal ischemia in horses and result in severe mucosal damage, barrier dysfunction, endotoxic shock and death. Although essential for tissue recovery, reperfusion after these types of ischemia could exacerbate intestinal injury. Responses to ischemia and reperfusion (I/R) involve a series of synchronized biochemical, cellular and structural changes characterized by generation of reactive oxygen metabolites, activation of immune cells, and epithelial cell degeneration and death. The intensity of neutrophil activation and influx is central to the process of reperfusion injury and the associated inflammatory events. The classic paradigm of reperfusion injury is best displayed after the segmental hypoperfusion or low-flow ischemia model, in which arterial inflow is adjusted to 20% of normal baseline flow, and then allowed to return to normal or greater values during reperfusion. In such cases, injury during the ischemic phase is mild, compared with the reperfusion injury that follows. Although there is some evidence of reperfusion injury in equine colon and jejunum after low-flow ischemia, attempts to ameliorate this by pharmacologic means have met with only moderate success. A multimodal approach, using solutions designed to improve survival in transplanted organs, seems to hold the greatest promise, although these have not been embraced in the clinical setting. Expense and difficulties in delivery are the two most serious limitations. Recent studies to assess the effect of colonic I/R on equine pelvic flexure involved a complete ischemia model that was similar to the clinical lesion, and for periods of 1 to 2 hours of ischemia followed by 30 minutes, 4 hours, or 18 hours of reperfusion. Ischemia caused degeneration and detachment of epithelial cells, early apoptosis, and opening of tight junctions (TJs), all of which decreased transepithelial resistance (TER) and increased mannitol flux when the tissues were studied in vitro. Autophagy was a prominent feature in epithelial cells after 1 hour of ischemia. Reperfusion was characterized by apoptosis, epithelial regeneration, and closure of TJs with improved TER and reduced mannitol leakage. Neutrophils infiltrated colonic mucosa during reperfusion, and macrophages, mast cells and eosinophils were activated during I/R. Equine colonic mucosa subjected to ischemia can repair rapidly and regain barrier integrity during reperfusion, despite intense mucosal inflammation. Recently, attention has focused on inflammation induced by intestinal handling and on remote organ responses to intestinal injury, both of which could be highly relevent to postoperative management of horses that undergo colic surgery. The use of lidocaine in a continuous rate infusion is a popular approach to ameliorate the intestinal inflammatory response after colic surgery, although there is no evidence that it has a...

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“…Aus diesem Grund muss der inkarzerierte Darmteil vor der Reposition entleert und auch ausmassiert werden, um den Durchmesser des inkarzerierten Darmteils reduzieren zu können. (Peiro et al 2010, Torfs et al 2009 Haemorrhage and haematoma formation after small intestinal resection and anastomosis. Adhesions between the haematoma and small intestines resulted in recurring colic.…”

Section: Lebensbedrohende Blutungunclassified

Potential complications in equine colic surgery

Fürst¹,

Kummer²,

Kümmerle³

et al. 2012

PHK

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Potential complications in equine colic surgeryThere are many potential complications of intestinal surgery in the horse. Inability to reposition displaced intestines and rupture or life-threatening to fatal haemorrhage after manipulation of the intestines can impede surgical success. Postoperative complications include peritonitis, endotoxaemia, colitis, haemoabdomen and recurring colic because of paralytic ileus. Laminitis, cardiac arrhythmia, postoperative myopathy and hyperammonaemia are other potential postoperative problems. Suture failure, abscessation or constriction of the intestinal lumen may occur after enterotomy or anastomosis. Intestines that appear vital during surgery may later become necrotic. Intraabdominal adhesions are common sequelae of colic surgery. Important complications involving the laparotomy incision include suture line infection, suture dehiscence and incisional herniation. Differentiation of the various causes of postoperative colic is difficult and requires serial examination of the patient. Horses undergoing colic surgery present a particular challenge to the anaesthesia team because of circulatory compromise and the need for dorsal recumbency of the patient. Placement of a jugular catheter under aseptic conditions and regular catheter maintenance are critical for the prevention of thrombophlebitis. Postoperative analgesia is critical to the outcome, even after surgery without apparent complications. Because of advances in veterinary medicine, survival rates of approximately 80% are now seen in horses after colic surgery. There is a strong correlation between the experience of the surgeon and a favourable outcome.

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Risk Factors for Equine Postoperative Ileus and Effectiveness of Prophylactic Lidocaine

Cited by 97 publications

References 30 publications

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

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

Ischemia in equine intestine – mechanisms of injury and methods of treatment

Potential complications in equine colic surgery

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