Equine Sedation
and
An&th(ia
VTEC 2107
Large Animal Clinics
Fall 2020
Sedation and an#th%ia
• Standing sedation
• Short minor procedures
• Field anesthesia
• Horse is recumbent
• Short elective procedures
• Emergency procedures
• General anesthesia
• Longer procedures
• Painful procedures
• High risk patients
Standing sedation
• Physical restraint
• Chemical restraint (IV,
CRI)
• alpha2-agonists (xylazine,
detomidine, romifidine)
• opioids (butorphanol,
morphine, buprenorphine)
• acepromazine
• Local nerve blocks
(specific and regional)
• Epidural (caudal)
Alpha-2 agonists
• Widespread use
• Consistent and reliable dose-
dependent sedation
• Analgesia
• Muscle relaxation
• Reversible: yohimbine,
tolazoline, atipamezole
• Can be used IV or IM
• Adverse effects: ↑ SVR,
bradycardia, upper airway
relaxation, ↓ GI motility
Alpha-2 agonists
Xylazine
⍺1 short
Detomidine
Romifidine
Medetomidine
⍺2 long
Dexmedetomidine
Alpha-2 agonists
Detomidine
Xylazine • Possible aggression
• Rapid arousal and kicking, aggression • Extreme head-down
• Extreme head-down posture posture
• 160:1 alpha-2:alpha-1 • 260:1 alpha-2:alpha-1
• 20-30 min duration • 45-60 min duration
Medetomidine
Romifidine • Good analgesia
• Milder ataxia • 1620:1 alpha-2:alpha-1
• +/- analgesia • 30-45 min duration
• 340:1 alpha-2:alpha-1
• 45-60 min duration
Opioids
• E.g. butorphanol, morphine,
meperidine
• Cause minimal sedation alone
• Used for adjunct sedation and
analgesia when combined with
other sedatives
• Cardiovascular safety
• Reversible: naloxone
• Adverse effects: ileus,
paradoxical excitement, urticaria
Acepromazine
• Can be added for anxious,
excitable, aggressive horses
• No analgesia
• Can be given prior to other
agents (oral formulations
available)
• Adverse effects: hypotension,
dose-dependent priapism
Field an#th%ia
• Risks of recumbency in
uncontrolled setting
• Injury
• Effect on CV, respiratory,
muscular systems
• < 45 minutes duration
• Preparation:
• Limit food for 8-12 hours *
• Choose a suitable location
• IV catheter
• Head, feet, tail
Checklist
Field an#th%ia
• Ketamine
• Dose-dependent sedation, recumbency
• Apnea, muscle tremors
• Monitoring
• Respiratory rate
• Pulse quality,
auscult heart
• Reflexes,
anesthetic depth
• Blood pressure
• Oxygen saturation
Constant topups?
• Ketamine 2.2 mg/kg IV
for induction
• Top-ups:
• 1/4 to 1/3 induction
dose q~10 min
• Plus, 1/4 to 1/3 dose of
⍺-2 agonist
• Do not exceed original
dose!
Constant rate inf8ion!
Gen:al an#th%ia
• Mortality rate for GA & surgery
• Horses 1:100 (healthy); 1:50 (sick)
• Humans 1:10000
• Dogs 1:1483
• Cats 1:2065
• Cardiovascular (e.g. arrhythmia): 20-50%
• Respiratory (poor ventilation/perfusion): 4-25%
• Fractures/injuries: 13-28%
• Myopathy: 7-44%
• Abdominal (colitis, peritonitis, colic): 13%
Senior JM. 2013. Morbidity, mortality, and risk of general anesthesia in horses. Veterinary Clinics of North America: Equine 29.
Pre-op evaluation
• History
• Physical exam à ECG,
thoracic rads
• CBC/chem/fibrinogen
Pre-op c@e
• Groom the horse first
à brush, curry, bath,
clip?
• Remove shoes, do not
discard (HB p 291)
• Pick and clean the
feet, apply leg wraps
• IV catheter in jugular
• Withhold food 12
hours *
• Rinse out mouth
Premedication and induction
• Premedication:
⍺2 + opioid
+/- acepromazine
• Induction
ketamine + diazepam
+/- guaifenesin
+/- xylazine
Induction sta or tilt table
Intubation
• Lateral or sternal recumbency
• PVC pipe gag
• Circle circuit • Blind intubation
• Adults: 26 mm
• Giants: 30 mm
• Foals: 10-11 mm
Positioning
Monitoring
• TPR (> 36.6 // 30-50 bpm // 8-12 bpm)
• ECG
• Blood pressure (100-120 S, 70-80 D, > 70 M)
• Capnography
• Pulse oximetry (>90%)
• Depth of anesthesia
• Eye position (central à rostral
à central)
• Palpebral reflex (slow is good)
• Corneal reflex (strong)
Recov:y
• Recover in lateral
• Quiet, dim, calm
environment
• More xylazine?
• Supplemental
oxygen until
extubation
• Extubate when
swallowing and exit
the stall
• Continue to monitor
Safety
• Caution working around sedated horses
• Rules for working around horses still apply!
• No sitting
• Careful crossing behind
• Loud noises, sudden movements may result in
breaking through sedation
