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Dr. Stuart Clark-Price on Equine Anesthetic Recovery
413 Plays9 months ago
In this episode, we are going to shine the spotlight on a species that doesn’t always get the limelight on this podcast: the horse! Horses pose a unique challenge for anesthetists, especially when we turn off the vaporizer at the end of anesthesia and ask these rather large animals to stand up while under the influence of medications designed to cause sedation and muscle relaxation. In equine anesthesia, the recovery period is a time of considerable risk and has been the focus of prolific research, with many studies attempting to pinpoint risk factors that increase the risk of adverse events occurring in the recovery period and identify pharmaceutical protocols and recovery techniques that will mitigate these risks.
Lucky for us, we have an exceptional guest joining the podcast to delve into this particularly challenging aspect of veterinary anesthesia. Dr. Stuart Clark-Price is a renowned expert in the field, boasting board certifications in both Large Animal Medicine and Anesthesia, and recently ascended to the role of full Professor of Anesthesia at Auburn University College of Veterinary Medicine. Together, with host Dr. Bonnie Gatson, we'll explore why recovery from general anesthesia poses such a significant challenge for the horse, shed light on the various risk factors that can increase the likelihood of undesirable recoveries, and share evidence-based recommendations for interventions that can enhance the quality of recovery for equine patients.
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Thank you to our sponsor, Dechra - learn more about the pharmaceutical products Dechra has to offer veterinary professionals, such as Zenalpha.
If you have questions about this episode or want to suggest topics for future episodes, reach out to the producers at education@mynavas.org.
All opinions stated by the host and their guests are theirs alone and do not represent the thoughts or opinions of any corporation, university, or other business or governmental entity.
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Transcript
Introduction to the Podcast and Topic
00:00:06
Speaker
Hello to all those gas pastors out there. Welcome back to another episode of the North American Veterinary Anesthesia Society podcast. I am your host and fellow gas pastor, Dr. Bonnie Gatson. As always, our goal with this podcast is to help veterinary professionals and caregivers like you advance and improve the safe administration of anesthesia and analgesia to all animals. And for today's episode, I'm super excited because we are going to spend the entire time focusing on a species that admittedly doesn't get a lot of love on this podcast. Welcome to an entire discussion focusing on equine anesthetic recovery.
Challenges of Equine Anesthetic Recovery
00:00:49
Speaker
If you only work with dogs and cats, I honestly wish I had a better hook to keep you tuning in because the utter and complete challenge of recovering horses from general anesthesia is strictly unique to the condition of the equine practitioner. And there's nothing quite like it for our small animal friends. I mean, you are asking a thousand pound animal that is scared of being eaten and basically runs for a living. And then you're giving some medications to scramble up its brains. And now you're asking that animal to stand up in a coordinated and calm fashion without injuring itself or others around it.
00:01:33
Speaker
You are potentially asking for trouble for you or your patient if you don't have a good plan for how to handle this sort of exceptional challenge.
Sponsor Acknowledgment and Upcoming Events
00:01:43
Speaker
But before we get into it, I want to give a huge shout out to our sponsor, Decra, without whom this podcast would not be possible. We are very grateful to them as they allow us here at the NAVAS podcast to pick and choose what kinds of discussions we get to have on this podcast, while also aligning with the overall mission of NAVAS regarding education and veterinary anesthesia.
00:02:09
Speaker
If you have not done so already, I strongly recommend that you check out their line of anesthesia related products at www.decra-us dot.com. Second, the American College of Veterinary Anesthesia and Analgesia will be hosting its first ever solo annual meeting in Denver from September 25th to the 27th later on this year. NABES members get a small discount on registration and I am going to be there and I really hope to see some of you there too. Learn more and register for the upcoming annual ACVAA meeting at VetVacationCE.com.
Introduction to Dr. Stuart Clark Price
00:02:49
Speaker
Back to our episode for today about what makes recovery from general anesthesia a challenge for equine practitioners and veterinary NASA tests.
00:02:58
Speaker
I couldn't think of a better person to chat with than Dr. Stuart Clark Price. He is a veterinarian boarded in both large removal medicine as well as anesthesia. He is a recent full professor of anesthesia at Auburn University, and he's published dozens of research papers and books on multiple topics in veterinary anesthesia, including equine anesthetic recovery. Together, we are going to talk about what risk factors may alter the likelihood of an adverse event happening in the recovery period, and we'll provide some evidence-based recommendations for appropriate interventions that will hopefully help improve the quality of equine recovery. So let's shine some light on the anesthetic management of our often neglected friend, the horse, right here on the NavAss Podcast.
00:04:00
Speaker
Thank you so much for coming on to the NavVis podcast today. Why don't you start by introducing yourself and briefly describe your past training and what you're currently doing. Great. Well, thank you for having me. My name is Stuart Clark Price. I'm a soon to be professor of anesthesia at Auburn University. Congratulations on that, by the way. Thank you. It feels really nice. I won't lie. I like to ask all of my guests this, but what interests you about anesthesia? Why did you start studying anesthesia in the first place?
00:04:33
Speaker
Yeah, so as I was making my journey through the through academics, I thought I wanted to make foals and be a stereogenologist and then realize I like playing with foals more than anything, and and the sick ones. So I did the medicine residency, and then I thought, well, maybe I'll also sit the critical care boards and sort of do that. But back then, they didn't have large animal critical care residencies. and so You just did another residency and then sat the boards. I thought if I did anesthesia, that would really help me prepare for that. and so Then I started doing anesthesia and thought, wow, I i really like this. so yeah I had such a great time during my residency. It was a lot of fun. I had great resident mates, amazing mentors. and
00:05:14
Speaker
i just I wanted to do both, and that's when I went to private practice, but then realized I really, really enjoyed the anesthesia part. and I still get to dabble in the medicine part, but the anesthesia part to me is a very short-term burst of intensive critical care. and Then I get to sort of throw my hands up like the end of a eight seconds in a rodeo and when they recover and be like, all right, I'm
Risk Factors in Equine Recovery
00:05:35
Speaker
done, I'm out. you know So I had you on today because I feel like you're a wonderful person to talk to about the topic we're going to jump into today. And of course, as you know, one of the greatest challenges of an s sizing a horse is going to be the recovery phase. And my mentors always told me that we ask horses to do something that we don't ask a lot of other species to do when we recover them, which is that we ask them to stand up. Absolutely.
00:06:04
Speaker
And so in equine anesthesia, the recovery period is usually a time of considerable risk. And it's been the focus of some research, especially about equine morbidity and mortality, trying to identify risk factors as far as what makes equine recovery challenging and what kind of risk factors make it so that horses might be more likely to suffer from an injury or death related to a recovery phase. So in your opinion, what is it about e-crime recovery beyond asking them to stand up? Or maybe that is the key of it, but what is it about recovering horses that makes it especially challenging?
00:06:46
Speaker
That's a very loaded question, obviously, and the reason we're here. you know You've got this very unique animal that is basically this ginormous set of lungs of very poorly designed GI tract running around on toothpicks. and Because of their athletic ability and and what they do, in nature and what we asked them to do, they're just not designed to be in a recumbent position for very long. Those folkss that work with horses know that horses that are down for a prolonged period of time are are really problematic. So you've got that aspect where we need to get these horses basically standing up on what I think are force stilts, essentially.
00:07:22
Speaker
right They're not this broad-based foot. They're not designed for lateral movement. They're designed for running straight ahead. And so if you take an animal that's built like that and you basically scramble their brain a little bit where they're not very coordinated, it makes for a very dangerous potential problem. and And I think for us, one of the biggest things, and I think a lot of the research is focused on how do we make these animals more coordinated when they move to a standing position? Or how do we assist them when they're moving to that position so that that lack of coordination, that lack of proprioception, if you want to say it, makes it easier for them to get up so that they don't have this large mass driving them into the ground if they fall or move back into a recumbent position. So I think that's where our biggest challenge is with them
00:08:10
Speaker
Yeah. I like the idea. I've never thought about it that way, but they're really designed for like lateral movement and not necessarily like vertical movement. Yeah. Well, and their their lateral movement is is fairly poor as well. You know, if you, you know, you watch a very sedated horse and they move forward very well, even when they're sedated, but when they go lateral, their legs go all over, right? They're just, yeah they they don't do it well. What do we know about the incidence of complications and mortality for equine patients in the recovery period?
Studies and Improvements in Recovery Practices
00:08:40
Speaker
And I guess another question about that is I know there were studies that were done quite a few years ago, which I had to study from my board's exam about equine morbidity and mortality. And I know there's been some more recent research looking at this, and I'm i'm just curious
00:08:55
Speaker
How has the incidence of morbidity and mortality, specifically in the recovery phase, how has that changed over time? Is it the same? Are we getting better? Generally speaking, what do we know about that? For you and I and those and anesthesia residencies and studying for boards and things like that, the CPAP for the confidential inquiry into perianesthetic equine fatalities, those are the big studies that that we have to know. And the older ones from the early 2000s and stuff, you know the the the mortality rate generally hovers around 1%. That's the the one that we all use, but we have to remember that these are studies that cover the world, right? There's so many people that have
00:09:33
Speaker
put data into these that we get these, what I think is a high number, right? So it's one in 100 horses die during anesthesia or have an a fatality for various reasons. And i'm I'm always concerned with those because everyone I talk to who works as particularly anesthesiologists or anybody who equines surgeons, internists, whatever that work with with horses in a specialty type practice. Everyone I talked to is like, my mortality is nowhere near that. right So I think people that have experience doing it that do it a lot and maybe have advanced training in it, whether that's, I mean, I have like some of the most amazing technicians that only do horse anesthesia. There's
00:10:14
Speaker
they're extraordinarily good at it. Their mortality rate is nowhere near that. you know So I think that has a lot to do with it is is training facility, all that kind of stuff. Now, when they're working on the newer CPEF, you know some of the stuff has been presented and and unfortunately, the mortality rate doesn't look like it's changing very much. But when you break down and look at some of the other resources come out and some of the subsets, we're getting better at certain things. And and one of those is equine anesthetic associated myopathy. Depending on the breed and the condition, the incidence of that and or the prevalence of that has come way down. So recovery in that aspect has gotten better. In the years that I've been doing this, I've seen the way we recover horses change dramatically. And I think a lot of that is
00:11:01
Speaker
intuitive. and I don't want to say it's sort of evidence-based, but it's not peer-reviewed evidence-based. It's evidence-based in the fact that people have been doing it for so long. they're like They make little changes over time and and see improvement. and i can tell you I think, and again, this is my opinion, but I think the horses that I work with recover vastly better than the horses I worked with 20 years ago. And i I think it's a lot of things that we're doing. I think it's the use of propofol in anesthesia and horses. I think it's how we sedate them. I think it's the footing. I think it's the stalls we recover. You know, I think there's a lot of things that we're doing that are improving that. And that may not be reaching all corners of the world to bring down that overall number in the seapath, but I think
00:11:45
Speaker
You would talk to anybody in a big center that's doing a lot of horses, and I would bet you they would say that their mortality rate is nowhere near what what the report puts out there. One of the things that I get a little concerned about with the data about equine perianesthetic mortality and things like that is that I feel like the data sometimes is inconsistent just because we're using different like mortality periods. So sometimes people are like, oh, perianesthetic mortality is within like three days of recovery or within like
00:12:20
Speaker
a certain timeframe within recovery. And so I feel like some of the data is skewed because of that. The other thing I think also is at least if you're looking at studies across the board, they're are comparing, you know, maybe drug protocols that are associated with better quality recoveries and horses is that sometimes those studies are hard to compare across the board because they're using various like recovery grading systems. Yes, that is a ah huge issue, right? And so the first thing, there's all these scales and all this stuff out there on grading, quote, quality of recovery. We can't even agree what a quality recovery is. So how can we build a scale that says this is a quality recovery? You can talk to one practitioner or or one veterinarian. And and I've got a faculty member who's when he was a resident, his mentor said, I want the horse standing as
Defining Quality in Equine Recovery
00:13:12
Speaker
quick as possible. I don't care how bumpy it is. As long as they stand and walk out, it's a successful recovery.
00:13:17
Speaker
Then you've got another person who's like, no, I want them to stand up in one attempt. I want it to be very smooth. I don't want them to ricochet off the walls. And I don't want to see any kind of bumps or scratches. To me, that's a quality recovery. So the paradigm shift between those two people, that I mean, that is such a gulf of difference. How can you say you know that this is a quality recovery when we can't even agree on that? so there There are a lot of of scales out there. There's nothing that's validated because we don't know what a quality recovery is to validate against that. and so You're going to see a lot of very different opinions. Do you have a personal consensus? like one where like Let's say in ideal worlds, what would your highest quality in innocent recovery look like?
00:14:03
Speaker
For me, what I would consider an ideal recovery is the horse lays there quietly for a while. Their first movement is a movement to a, maybe they move their head and look around a little bit, but their first major movement is to a sternal position. and They sit in sternal for a little while and gather themselves, get their head clear, and then they stand up using their front legs first. They're able to extend their thoracic limbs. They stand up like they would be if they were sleeping out in a pasture. in one movement, they don't bounce against a wall. If you watch a horse recover that's been laying down in a pasture, they make this smooth recovery to a standing position, they need their head to swing themselves up, and then they stand, they shake off the dust, and then they put their nose down and eat or look around, right? They're not ataxic, they're not knuckling, anything like that.
00:14:49
Speaker
So to me, a horse getting up in the pasture is what an ideal recovery would look like. And if you're in private practice andre or wherever you're at and you've got a large caseload and you're trying to turn over horses, you need a horse to do that quickly to get out of that stall to turn it around. I think that's one of our issues is trying to rush these horses up. you know There's sort of this unwritten rule that a horse should be standing within an hour. And I don't know where that comes from. i'm like i don't care how long they take up, how long they take to stand up, as long as they stand up well. If they want to take an hour and a half, I'm okay with that. you know I don't expect a colic to get up for two hours. So it just it it really just depends. And again, I think a lot of it is opinion-based because we don't have a lot of great evidence or a consensus to build evidence around.
00:15:38
Speaker
So we're going to jump now into risk factors as far as what we know to be associated with poor quality anesthetic recovery in horses. So I'm going to run through a few factors that I can think of and feel free to give me your opinion. So do we know if there's a particular signalment or breed of horse that's associated with having more likely have a poor recovery? There's one paper that came out of Davis years ago that pointed to Arabs, which I don't think anyone was surprised about that. I think there's some breeds that may be a little more flighty. I i think it's also a little bit individualized. We looked at something here a while back.
00:16:17
Speaker
that we use the teaching horses who get handled and used a lot for these kinds of things, and they all have these like amazingly great recoveries regardless of what their breed is. and so I think it's they're used to being in that situation. um I also think that the breed can be a problem based on your facilities, right? So we see a fair number of draft horses here and our recovery stalls just aren't built to hold draft horses. They're just not big enough. And I think that's a factor in in that breed having more difficult recoveries here because our stalls just aren't appropriate. I think for when we built the place, they just, they just weren't seeing as many and now we see more. And I don't think our recovery stalls are the greatest for those. And so actually on occasion, I'll take those outside and recover them in ah in a big grass area because it's just,
00:17:06
Speaker
larger for them. As far as I'm concerned, all minis recover really well, right? Because we can hold them down until we need to and, you know, it's like like doing a goat or something, you know, it's it's not nearly as difficult. What about ASA status? And of course, as an aside too, I know there's controversy about whether or not there's even interreuter agreements about ASA statuses, particularly even in equine patients. I think you can look at what's the most common thing that we do after hours with horses, and it's probably colic surgery. I think the older colics, you know you get that old horse and they're late teens. It's a small intestinal strangulating lesion. They're really endotoxic. They come in looking poor. You know those aren't going to be very strong when they recover and are going to need a lot of help.
00:17:51
Speaker
as opposed to the two-year-old quarter horse that has a simple displacement, right? So while they may sort of have the same ASA status, I think their recovery is going to be very different, again, because that's going to go back to the signalment a lot. So I think the signalment and somewhat their state of debilitation and how sick they are is going to affect it a lot. And I guess you could plug that into ASA status a little bit, you know, depending on, you know, whether you want to call them a three or a four or a five, but depending on how systemically ill they are. So, in small animals, we know that pretty consistently across a variety of studies looking at morbidity and mortality, that the duration of anesthesia, it's directly correlated with the chance of ah morbidity or mortality events, at least for dogs and cats. So, is that true of horses? Do we know if the duration of anesthesia will affect if they're more likely to have a poor
Factors Affecting Equine Recovery
00:18:41
Speaker
recovery?
00:18:41
Speaker
I think there's enough clinical evidence and I think there's a ah little bit of the CPAP and some of the others. There's a little bit of published research out there. To me, that golden hour, that golden time period is three hours. And I think most people agree when you you start getting over three hours of anesthesia and horses. I think they exponentially have more complications in recovery as we go on that. When you take something like a long bone fracture that takes six hours to repair or longer, you know that horse is going to be horrible in the recovery box and and it's going to take a lot of manpower and a lot of sedation and a lot of help to get that horse into the right position.
00:19:18
Speaker
I haven't done one in a long time, but things like bagby baskets for wobblers, those take forever and you know that's going to be a recovery that is going to take a while, going to need a lot of help and huge, huge risk. But then we start getting into things like muscle perfusion and all that kind of stuff when we we talk about duration, how long that recumbent Does the surgical procedure or like the reason the horse is being anesthetized in the first place, so either a diagnostic or a surgical procedure, do we know if there are certain types of procedures that will influence the quality of recovery? Yeah, I think there's some of that out there. Certainly, MRIs have a greater risk of myopathy or neuropathy, and I think a lot of that is positioning in the MRI or duration. Long bone fractures, clearly, you know we know that they have a much higher mortality rate. And then, you know if you go back to the CPEF, regardless of the procedure, if it's out of hours, you know they're at much higher risk. And that's probably because it's colic or long bone fracture or something like that.
00:20:23
Speaker
What about the incidence of perioperative complications like hypotension or hypoxemia or even hypercapnia under general anesthesia? Do we know if exposure to those types of complications will affect the recovery? Certainly hypotension. I think we've pretty well unlocked the association of hypotension with equine anesthetic-associated myopathy. When you look at some of the human stuff with like crush injury and things like that, the duration of
00:20:59
Speaker
cellular acidemia or acidosis and hypoxemia certainly causes inflammation, reperfusion, injury, things like that. And so I think that link is is very well known, especially the early studies with these horses when we first started using halothane and then the introduction of dobutamine into those changed the incidence of myopathy dramatically. So I think there's not much of an argument there. Hypoxemia, I've had some wonderful conversations with some of the anesthesiologists in Europe about this, and one in particular, she fully believes that hypoxemia in horses is not a problem. She's like, I don't care what the oxygen is, it doesn't matter. And I think I somewhat agree with her in that I think our definition of hypoxemia in horses is probably not the same as it should be as it is for other species. Horses are
00:21:52
Speaker
incredibly efficient at unloading oxygen from their hemoglobin at the cellular level. and I remember talking about this with my mentor. I'm like, okay, I've had all these colleagues and I can't get their oxygen above 60. They stand up and they look fine afterwards. and My mentor at times was i think trained into the same group of people. He's like, yeah, because it doesn't matter. right you know so There's very, very little evidence on hypoxemia and mortality and we really want to make that link and and it's discussed a lot. But what's in the papers is very, very tenuous. A few years back, there was a case report that talked about hypoxemia and recovery and how it affected this horse. But then when you start to read it, you're like, yeah, but this horse had so many other problems. I have a really hard time linking the hypoxemia to that in a single horse.
00:22:42
Speaker
But a lot of these other things, we just haven't been able to find it. We have yet to publish it. but Working on it, I did a project with a graduate student where we looked at hyponormo and hyperoxia in horses, and we looked at urine isoprostanes as a marker for oxidative stress in the horses. And regardless of how hypoxemic you made them, they never showed oxidative stress. I don't know what the definition of hypoxemia in horses, but I I certainly don't think below 80 is hypoxic anymore in horses, even though I've done studies with albuterol trying to increase arterial oxygen tension. I don't know that it it's as problematic as as in other species. Yeah, I appreciate everything you just said about hypoxemia in horses because I always felt the same way. I mean, we went outside as horses for colic surgery.
00:23:35
Speaker
And I mean, we would have the AO2 in the 40s, 50s for our listeners. Again, anything under 80 millimeters of mercury is considered hypoxemic, ah generally speaking, across mammalian species. And they would all stand up beautifully. It's like, what is going on? Well, you're like, their tissues are so acidemic and hypoperfused or whatever that whatever red cells are getting there with oxygen, they're unloading everything. Yeah. So they're really efficient. And I mean, if you look at the studies on these racing horses,
00:24:08
Speaker
you know They complete races and they have oxygens in the 20s to 40s. It's unbelievable how low or or how depleted their red cells and their arterial blood gets of oxygen, but it doesn't necessarily mean their tissues are hypoxic. So yes, they may be quote hypoxemic, but it may not be as problematic. And remember again, you know You only have to get that one oxygen molecule to the end of the electron transport chain to be that last acceptor. right That's the only thing that you need. You need one molecule to get there. and so I think horses are are really good at doing that. Do you have any other thoughts about any risk factors that we know are associated with poor anesthetic recovery?
00:24:48
Speaker
I think the the facility that you recover them in, I think is a risk factor or the room or how you recover them is potentially a risk factor. I think having appropriate footing and appropriate size stall, I think that's important. And we're going to talk about that in a minute too, because we're going to talk about things that we can influence as anesthesiologists or anesthetists to help maximize the success of equine recovery. other risk factors. I think the systemic health of the horse while you're anesthetizing him, a lot of those things have been picked out in the CPAP papers pretty well that are well-known risk factors. I think the experience of the people doing it is really important. and I think the number of personnel that you have is really important as well. It takes a lot of people to move a horse around safely. And yes, we've automated a lot of these things or use assisted lifting devices and things like that. But i I still think you need a lot of people to to do that. and i think
00:25:49
Speaker
planning is really important as well, particularly in some things that are more risky or longer types of procedures, orderly checklists, things like that for process improvement and reducing medical error. is That's not exclusive to horses, right? That's any species that that we do anything on, but I think that's a big potential for error and risk in horses as well. I love that you brought up checklists because I've had many episodes on this podcast about how do we improve anesthetic safety. We've talked a lot about checklists, so I appreciate you mentioning that. I think something you mentioned already is about something that I think is really important with equine anesthesia in particular.
00:26:31
Speaker
is like doing things efficiently and being speedy. yeah And so having processes already in place and ready to go so that you can do things as quickly as possible is like so important. It's important for really any type of anesthesia, but I find that in equine anesthesia, a smooth process where everybody knows their roles and everybody knows what they're going to do and everything's in the same place and everyone knows where those things are, it's really important. Yeah, I think it becomes even more so in a teaching environment where you're trying to let students and interns and residents learn and do things. you know i I think in in academia and a lot of these large referral equine practices, there is a ton of teaching going on and we need to be cognizant that that is that can impact our outcomes as well, which I think most of us are.
00:27:19
Speaker
Yeah. So as I alluded to just a few moments ago, we're going to move into what are some things that we can do as anesthetists to help maximize the success of equine recovery. And the first thing we're going to talk about is anesthetic drugs. And I always joke all the time that people always blame the drugs when something goes wrong. But I think a lot of research has gone into drug protocols, probably more so than maybe some other things. I don't know if you agree with that. I do. there's There's a lot of literature that I think potentially confuses things and maybe not as helpful as we hope it would be where there's like, well, I did this plus this plus this drug versus this plus this plus this drug versus this plus this plus, you know, there's all these combination of things on, you know, did they breathe better because nobody's measuring the same things. I think it's really muddied the water a little bit on that. So
00:28:13
Speaker
When I have people call me general practitioners, technicians, whoever, even surgeons or whatever, you know, they're like, well, I've got these and I was thinking about changing to this. And I'm like, why are you going to change if what's working for you is working? Don't change your drug protocol because that's where you're going to get in trouble. You're familiar with what that animal looks like with that drug protocol. So stick with it because I love the term the enemy of good is better, right? you know right If you're doing a good job, don't try and be better if your outcomes are good. So while I think we can make some changes on drug protocols, I think just making change for the sake of change may not be in the best interest of our patients.
00:28:54
Speaker
so Now with that said, have I made changes in how I do things? Absolutely. But it's been gradual over time to get to where I am with what, I don't want to say standard, but what my usual protocol is for a lot of my adult horses. Yeah. And I think that plays into what we were just discussing about having a process that works. And part of that process, you know, it's not time in your like emergency colic patient to be like, Oh, let's try this new thing. We've been thinking. No, or we're not doing that. Yeah. Like, sticking with things that are familiar are really helpful, I think, for making sure that things go as smoothly as possible, at least from a protocol standpoint. But in any case, let's talk about sedative agents for horses, because I have some personal questions myself, but obviously we use alpha-2 agonists with very regularity and in equine anesthesia. Is there any evidence beyond using alpha-2s, either
00:29:51
Speaker
as a pre-medication or in the post-anesthetic period, things like asepromazine or midazolam, do we know if those other types of sedative agents can affect the quality of recovery? I think there's some evidence out there. If we started pre-med process all the way through, there's you know if you were worried about hypoxemia, there's quite a bit there's quite a few studies showing intramuscular asepromazine prior to these horses are going to have better oxygens on the table and that's probably helping balance your VQ mismatch, your ventilation and perfusion matching in your lung. and I think that's one way. ah But to me, it's it's really interesting because I talked to a lot of colleagues in Europe. They do things very differently than a lot of us do in the U.S. I think one of that is drug availability, cost of drugs, and also training. and
00:30:40
Speaker
and so that pre-medicating IM, ace-promazine an hour before. So it's really interesting to me because I never think of that, but yet that's fairly common in some places in the UK and in some of the European countries. And to me, I'm like, God, I wish I'd thought of that, but I never remember to do it. you know It was never a consistent thing in my training. so But I do use a lot of ace-promazine in in the recovery box. But again, that's a personal development over time that I've found to be helpful. I'm using, obviously, you know my sedation protocols are alpha-2-based. I'm using less and less and less xylazine and more and more ditomidine. I like the longer action of it. I like the the greater specificity of it. And quite honestly, with all the trouble surrounding xylazine, while it's not become scheduled drug yet where I'm at, we're still sort of treating it like a scheduled drug, whereas we're not with the other alpha-2s. And so I just don't want the hassle of it. So I i use more and more ditomidine.
00:31:37
Speaker
And I continue that through anesthesia and into the recovery box. ah Most of my horses now I'm doing ditomidine CRIs and then giving them additional ditomidine in the recovery stall. And we can talk about why I'm doing that. As far as pre-meds and the benzodiazepines, I think most of us know you're not going to give a standing awake adult horse a dose of a benzodiazepine because they're they're kind of like cats, right? they It can make them quite unhandleable and change their personality to such that you wouldn't want to be around them, right? so you know if we're using benzodiazepines, that's usually in combination with our dissociative for our induction agent. So it's not given until that. And I'm usually waiting until my horses are on the table before I give them opioids as well. Even though i I'm sedating them heavily with the Alpha 2, I'm just trying to avoid the risk of the potential excitement that you can see with opioids. Now, with that said, I'm i'm a fairly heavy opioid user in horses as well. So none of the pure muse. And then several years ago, we had the shortage of the
00:32:36
Speaker
benzodiazepines, they were hard to get. And then the Lisa Posner paper came out on using propofol with ketamine for induction, and we started hearing about that at conferences and things like that. I started doing that, and and that's fairly routine now for here, that instead of ah benzodiazepine, we're combining our ketamine with propofol for our induction agent. And I've really, really come to like that combination. I think the horses are are a little bit deeper of a plane of anesthesia initially. And I think they, in my opinion, and I don't know that the research is out there really to support it, but I feel they're better at recovery. They're less
00:33:18
Speaker
rubbery, for lack of a better term. I mean, i i've i mean if you've ever given a horse a triple drip and you've given them too much quite venecin and they're really rubbery in the recovery stall, I think we've all seen that. When you're well past 45 minutes of triple drip, you know it's going to be ah an interesting recovery. and I think I see less of that by removing the the benzodiazepine from the end anesthesia process in horses. so I tend to do propofolcadamine for my inductions. Do you use like a bottle of each? Like a standard size horse? Like a... Yes. Yeah. So the ketamine is still 2.2 makes per kg or one mil per hundred pounds. And then every horse, they get the full vial, the 20 mils of propofol. So they're sedated once their face is almost to the ground. You know, we know they're a peak sedation. We push the ketamine and propofol, it doesn't matter which order, it's just rapid.
00:34:08
Speaker
Is there any effect on the quality of recovery depending on the inhalant use? I mean, we talked a little bit about triple drip, but I'll move to inhalants as far as maintaining anesthesia is concerned. Do we know if there's an effect on like the type of inhalant you use? I don't know that the the research is that, if I mean, if you want to pick out ISO versus SIVO versus Desflorane, while there's evidence showing quicker recovery or quicker return to consciousness or whatever, I don't know that we're seeing much difference in quality of recovery from those. And again, I think where you do see it, it's very site specific because they know how to use that combination there.
00:34:49
Speaker
So if you're using CRIs during general anesthesia, whether it be xylosine, ditomidine, dexametomidine, lidocaine, whatever you might be using, I've always been curious about this. So do you keep your CRI going all the way up into like your discontinuing your inhalant? Do you discontinue those might be a certain, like maybe 30 minutes before recovery? Like what are you kind of doing in your practice? Yeah, that's that's a good question. you know and Everyone refers back to there's the the paper on lidocaine that says you need to stop at 30 minutes before. and and I'm not sure I 100% agree with the conclusions to that paper, but I typically run my CRIs right up to the point where we're about to roll out of the operating room. because you know When the surgeons are done, i I have to pull my art line and hold that off, and I have to get them the horse. you know I mechanically ventilate.
00:35:41
Speaker
probably 99% of my horses. So I need to get them on a c assist mode and get them ventilating on their own again. And then the trip from the OR to a recovery stall and hoist them and place them. I mean, that's going to take its time as well.
Clinical Practices in Recovery
00:35:54
Speaker
you know Again, that's in my facility at the speed of of glaciers that we move on a lot of things. I don't, I i keep them on it up until the point that we're ready to roll them out of the OR. Do we know if there is an effect on the type of alpha-2 adrenergic agonists that you're using in the recovery phase? For personal experience, during my residency, we were using a lot of rheumifidine just due to the alpha-2 specificity and the length of time that
00:36:23
Speaker
it works. And there was some evidence as well that romifidine in horses was associated with less ataxia. ye Recovery periods we were using a lot of romifidine. I really actually liked romifidine a lot. And then for some reason, we no longer had access to that drug. So we had switched over to xylazine instead. I don't know why we weren't using mergetomidine, but you know, I was actually surprised. I think in my mind, I was like, Oh, our recoveries are going to get worse now that we're using xylosine, but they were not, they were fine, at least on a clinical basis. So, yeah so I'm just curious, is there research out there looking at alpha twos beyond like what I just mentioned about remifitine and like the timing of when you should give those alpha twos to sedate the patient in the recovery stall? Like what do we know about kind of all that stuff?
00:37:14
Speaker
Yeah, there's a little bit of stuff here and there. I don't think any of it is when you put it all together. I think the answer is there's not enough information to to make those recommendations. I think there's one of the remit of seeing papers that picked out the Arabs as being you know worse at recovery. you know and i I played with romifodine as well for a while because I thought it was going to be this great thing. Certainly, if you're in private practice and you were doing equine dentistry, romifodine was nice because the horses, they planted their feet like sort do they do with ditomidine, but they didn't drop their head as much. and so I thought that was a really cool drug, but it never seemed to really catch on. To me, the most important thing is, and again, if you look at the the human studies, right when you look at human Mac studies, when you start getting at 0.3, 0.4 Mac, humans start regaining consciousness. And it's probably, you know, because Mac is so well-conserved across species, it's probably fairly similar to our horses. I think when you're getting 0.3 to 0.4 Mac and your horse starts waking up, while their brain and their eyes might be connected, their brain is not connected to their legs yet.
00:38:16
Speaker
Yeah, by no means. And so I think that's the key thing is how do we keep them sedated enough to let them get from Mac awake or Mac consciousness to Mac zero when they can stand up, right? That's ideally you can get them to Mac zero before they make their first attempt to stand up when they're going to hopefully be as coordinated as possible. And so that that that starts becoming time being more important or being the most important factor rather than any of the drugs that you're using. And that's where I've really started to lean towards ditomidine instead of having to do multiple top-ups of say a drug like xylazine because of the shorter action. I can give ditomidine and and they'll they'll stay down longer, but they'll stay sedate longer.
00:39:02
Speaker
But the other thing that I find is they're way less ataxic with ditomidine than they are with xylazine. Xylazine is a really dirty drug, right? it's It has such poor specificity. I think it it affects a lot of things. As we get better at using them and we get more specific and get away from the the more dirty types of alpha-2s, I think we get better clinical outcomes that that we're looking for. so yeah If I've got a horse on a ditomidine CRI, they're going to go into the box. They may get a little more of a bump of ditomidine once they're extubated, they get some aspromazine, and then they may lay there for an hour. But when they move to that sternal position, they're very quiet. They sit for a while. ah Most of my horses I feel take one attempt to stand and and stand up really well. But again, it may be of a duration that is unacceptable to certain situations.
00:39:56
Speaker
So let's talk now about physical interventions in the recovery period. I'm curious about your opinion and also if there's any evidence to support any of the following physical interventions that we can do as anesthetist during the recovery period and their effect on recovery quality. So the first one is something that was a little bit of a hot topic when I was resident, lights on versus lights off. Do we have any studies about how bright the recovery stall is and whether or not that affects horses' recovery? We do, as a matter of fact. We have one of those, right? so yeah Obviously, that was my my residency project, was looking at the recovery of an illuminated versus darkened recovery stall. and that That was a funny story because the way we were recovering horses when I was a resident at Cornell, the the lights were dimmed and all the recovery stalls.
00:40:47
Speaker
I can specifically remember remember during my first year, we've put one in there, we've turned out the lights, and I look up at my mentor and I'm like, do you think that makes a difference? And he looked at me and said, well, let's find out. And that was the genesis of that research project. And we found it it made no difference. And you know we did everything we could to make sure the two groups that we were looking at, you know we we used a little camera that had an infrared light so that it could see them to record them for the recovery. And we made sure that you know We spoke to experts that horses didn't see in that visual spectrum and you know did a lot of stuff to to make sure that how we were measuring it was correct. and Again, we did use a subjective scoring system, but some of the non-subjective things like first movement, time to recovery, some of those things that aren't subjective, right there're there' we just we didn't find any differences anywhere. and you know
00:41:36
Speaker
Again, it it wasn't a ton of horses, but in that situation. So the the evidence doesn't support turning off the lights or covering the eye or anything like that. Now, if I'm recovering horses outside, I often do cover their eye if I'm in a sunny situation because I worry about the potential UV damage on a retina or something like that. So I want to keep the eye protected, but until their the horses are blinking and keeping their eyes closed. But otherwise, I don't feel it makes a difference, you know, and you see in in textbooks where they talk about modern designs of recovery stalls. They always talk about, well, you need a dimmer switch on your lights and things like that. And I'm like, why would show me the, you know, show me the evidence of it. When I recovered horses, I always covered their eye with a towel. We had a dimmer, but I never used it, but I always covered their eye. And again, this is not based on anything, but I always felt bad that horses get pretty bad in a Stagmus when they're waking up from anesthesia. So I always felt like
00:42:34
Speaker
bad that they're like looking at the world and it's spinning. That's what I imagine is happening. And if I was that person who had vertigo, I would prefer to like have my eyes closed. I think it would center me more. So that's the only reason I did it, but I don't think it was based on any science at all. Right. But that's the key to to keeping them to date long enough to blow off enough inhaler anesthetics that by the first time they moved to sitting up, they don't have any nice diagnosis. Yeah. You're hoping anyway. yeah Right. Yeah. If they can't pull their tongue into their mouth and swallow and they still got nice segments, they have no business trying to stand up. A hundred percent agree. Yeah. Yeah. So what about placing the horse on a mat in the recovery stall versus just placing them directly on the floor?
00:43:18
Speaker
I think the the flooring and that you put them on could potentially make a difference. and one if we're looking for but If we're worried about muscle, then obviously you know it's just physics. right you want a You want to distribute the points of contact as much as you possibly can. ah so So instead of a removable mat, what I have here, and i it's taken me 20 years or whatever to find what I consider the one of the best floor options out there. and And I may be completely full of it, but this is what I seem to work with.
00:43:52
Speaker
We have a product that is basically like a closed foam cell. It's almost like a very tough memory foam. It it fills the entire floor of the recovery cell, and then there is a like a rubber conveyor belt type material that's strapped over it, and it's all bolted to the floor. So it's watertight, but it also has some give. So the heavier the horse is, the more the floor gives. So when they're placed in lateral recumbency, they sink into the floor a little bit to help distribute their weight. And I think that's important. I really don't like horses on a very, very hard floor. You don't see horses laying on a hard floor out in nature. They're pin bones and whatever else. There's a lot of places that are have the potential for damage and also for muscle injury.
00:44:32
Speaker
but I like this floor because then when they move to stand up, the floor sinks a little bit and gives them ah some traction, almost kind of like a grass field. right To me, a grass field is the perfect environment for a horse to recover on because it gives cushion, it gives great footing. and so That's what I try and mimic as much as I can. and so I really like this product that that we have on the floors here. Now with that said, I have other stalls that sometimes I have to recover horses in that is a hard floor and I do put a pad under under them for that. The part that's a bummer is that when they start to stand up and there's this pad shifting around that they're trying to stand up on, it's super squishy, it's getting and in the way of their feet, you know it can cause them to stumble. That's where i am I'm more concerned about that. So I like padding, but I like padding that's not gonna interfere with their ability to ambulate once they're up or trying to get up.
00:45:23
Speaker
Have you used one of those like giant inflatable mattresses that cover the entire wall? Yeah, we have that here too. So we can put that on top of this floor. But again, they're not standing up on that, right? They're still standing on a hard floor because you pull that tight to the floor and deflate it once they start to move. So that's just giving them a cushion to lay on, but they're not recovering on it, so to speak. They're not trying to stand up on it. I believe it's at the University of Georgia when I was there. I saw they have one skull that they have like a lot, like the floor is like this inflatable mattress. They're just like not able to get up on this like big inflatable mattress. It helps to like physically restrain them down. And then when, you know, no more nystagmus seems like they've got a good hound and shoulders, just like this big zipper, you just like unzip it and all the air comes out and then the horse can stand up. So the first one was at Kansas state. And when I was there, I used to watch them use that all the time and it said this big blower. And then when the horse was ready to stand up, they'd pull one string that pulled the zipper and then they pulled four cords at the corners that strapped it down tight to the floor deflated so that there was, you know, it was like a a firm surface for the horse to stand up on. and And that's similar to what, what we can set up here. I just, I don't use it very much because they're already on this sort of padded floor that we have.
00:46:41
Speaker
Yeah. where i When I anestized a lot of horses, we just had our flooring. I actually really liked our flooring. It had a lot of traction, but it was very hard. And so we would recover all of our patients on like a large pad, but the big bummer about using the pad is like once horse starts getting up, you got to run into the stall yeah and like kind of figure out how to get this like ginormous, but like huge yeah out of the stall without getting hurt. Yeah. So I never liked that about it, but I do understand the importance of making sure that the horse's weight is distributed evenly. So your design is really fascinating to me. What about the size of the recovery stall? Is there an ideal size? like Is there is such thing as a stall that's too big or a stall that's too small? Is smaller better? Is bigger or better? What's your opinion about that?
00:47:29
Speaker
So I have a strong opinion on that, but it depends on what horse population that you're seeing, right? Like if you're ah just doing a mini practice, you don't need much of a very big stall. I don't like stalls that are too large where the horses can can take two to three steps. They can generate a lot of speed and collide into a wall potentially. So I don't like it so big that they can get up to speed moving across it. But again, ah it's got to be big enough that They can have enough room to get to sternal, be able to stretch their legs out and stand up. and Again, as I was saying before, like with draft horses, I have a problem with them here because my stalls are probably too big for some of these really big Belgians that we see. I think it's really nice for the quarter horse and the standard bread. because They can't take more than about one and a half steps to get from one side to the other of the stall.
00:48:19
Speaker
and so i think They just don't generate the velocity to to be able to, if they do collide into the wall, they're not going as fast, right? I don't want them being able to go fast into the wall. Here's another one that I think, even when I was anesthetizing a lot of horses, this was a big controversial issue, which was how do you keep patency of the airway of a horse? So for our listeners, if you don't know, horses are obligate nasal breathers, at least that is what I was always taught. So they're at risk potentially of an airway obstruction during the recovery phase. And so there would be controversy, at least amongst all the different surgeons and faculty about how to maintain appropriate airway patency during the recovery period.
00:49:04
Speaker
So we had some that wanted to keep the horse intubated all the way up through recovery until standing, and then we would excavate the horse after they were standing. We had some people who were in favor of extubating before the horse stood up, and then we had some that were all into placing a nasotrichial tube. So I'm just curious, what is your opinion about you know keeping them intubated, not keeping them intubated, putting in a nasotracheal tube? you know Do we know if there's like the right way to be doing this? ah Again, I think it it depends.
00:49:39
Speaker
i I think it depends on the horse and the procedure that that they've had. I don't recover most of my horses with any tubes in, and i so I tend to pull the tube once they are breathing spontaneously, even before they're swallowing on their own, because I want them against the date long enough that you know they can eliminate the inhalant anesthetic. So as soon as I'm comfortable that they are ventilating well on their own, I'm pulling the endotracheal tube. Now, i have I've had to do it twice now on horses that had an endotracheal tube in place where during recovery, they either bit it or whatever and it severed and I had to get a scope to go down and go down their trachea to retrieve the piece of endotracheal tubes still in them. So to me, that that's ah again, it's only
00:50:25
Speaker
twice in, I don't know how many horses in years that I've done, but I vividly remember those thinking, oh, oh expletive, you know what what do we do now? And having to sedate the horse and then go in there with the scope to fish this piece out. In the private practice that I was at, the surgeons were absolutely adamant that all the horses had this long, thin nasotracheal tube place that basically looked like a stomach tube. but And then they would tape it to the muzzle of the horse. And I never understood the reason for that. If it's a horse that like had airway surgery that you're worried about laryngeal spasm, then yeah, I think that's potentially something that you can do. Quite honestly with those, I like to just recover them with a temporary tracheostomy. They heal up so well that you just avoid those problems, right?
00:51:13
Speaker
But I think most of the airway obstruction is rostral to the larynx. right it's It's mostly nasal. Now, with that said, we use a lot of nasal spray in our horses, but I also have nasal tubes available in every stall in case the horse tries to obstruct. We can insert these. They don't go into the trachea. They just go from the external nares into the pharynx to open up that passage. And so, that's again, that's just what i do I'm doing. Again, I don't know that there's a whole lot of research that says one is better than the other. I always found it interesting, the nasotracheal tubes or the oral tracheal tubes. Naturally, when any patient contracts its abdomen to move into a standing position, you write it we close our glottis, right, to be able to put that force in the thorax and the abdomen to stand up against. And while like I can do it with my glottis open, because I've tried this, you know, like, as you stand up,
00:52:07
Speaker
You can do it. It's just weird and you don't feel like you have as much control. So I'm like, does the horse need to be able to close his galatus to stand up? Well, now the horses with the temporary tricks, they all stand up too. So maybe they don't, but I think maybe that makes it a little easier or it's more natural feeling to stand up doing that. Yeah, I always felt that, well, for me personally, when I was doing this, I recovered horses, all three of those different ways. And I didn't think as far as recovery quality was concerned, there was a big difference, but I always felt like the horses that had the endotracheal tube and the nasotracheal tube, they just seem like more irritated. and Yes, they're so agitated. they They hate it. They hate it. Yeah.
00:52:49
Speaker
I can imagine. like I would not want to wake up with the tube in my trachea either. I'm sure it feels very terrible to do that. Absolutely. and so to To me, you know I want that recovery period quiet and comfortable and anything that's going to agitate the horse I'm trying to avoid. and To me, that seems really irritating. Going back to the basal constructors that we place inside the nose for horses to help them open up their nasal passages and reduce nasal edema, do we know like how much we've got to put in there to make an effect? Or maybe if there's like a timing, like how much time do we think it takes for it to really reduce nasal edema?
00:53:28
Speaker
Yeah, I think time-wise, it's fairly quick. I think you know you're probably getting effect within five to ten minutes. and If you've ever used Neosynephrine yourself, you know it it works pretty quickly. so it's It's a very potent vasoconstrictor. I've done it both where you use a store-brought commercial product, or we get the pharmacist to just use Phenylephrine and dilute it out. if you use the store bought product and it's in the squeeze bottle, you can stick that in there and just squeeze it. I just don't know how well it distributes. There's a, it's a human product. It's ah a laryngeal spray device that you put on the end of a syringe. It's like a flexible long tube. I don't know. It's about six, eight inches long and it makes the solution into a fine mist. And so I really like to use that. And I, I'll usually fill a 10 or 12 CC syringe with dissolution and put half in each nostril. And as I do it, I go back and forth multiple times the length of that little sprayer to try and coat as much of the nasal mucosa as I can. Do you think it causes any systemic hypertension?
00:54:28
Speaker
That's a really good question. I don't know, but I can tell you, certainly in ophthalmology cases when they do topical phenylephrine, boy, the pressures go up. And I've had, you know, colleagues that are left dorsal displacements where they want us to give some phenylephrine on the table to shrink this plane. And obviously the pressure, that's the whole point, but their blood pressures get really high. So I think it depends on how dilute and how much you give, but there's probably enough systemic ah absorption that you probably are getting some effect. I just don't know what because I've never measured it.
00:54:59
Speaker
The last thing I'm going to ask you is about assisted recoveries and specifically rope recoveries, and whether or not there's any data to suggest that rope recovering horses improves the quality of recovery in
Environmental and Methodological Considerations in Recovery
00:55:12
Speaker
horses, as opposed to just like giving them chemical sedatives, closing the door, and just you know saying, like good luck to you, horse. like what Do we know what's what's better? so So I wanted to step one thing back. I want to mention, when you asked me about the appropriate recovery box size, I think the recovery shape is also important. I hate corners, right? Horses get their nose stuck in the corner. So if you're building a new facility, I think an octagonal where you don't have a 90 degree angle in any wall where the horses can move and out of it. you know a lot of I've had so many horses press their nose in a corner where you're worried about them obstructing if you've got padding on the walls.
00:55:51
Speaker
So I think ah an octagonal or rounder type of shape, you know, less acute angles is very helpful. As far as as assisted versus free recovery, I think this is one of the muddiest areas in equine anesthesia research. There are the same number of papers or there there are enough papers supporting rope recovery and saying it's better versus free recovery as the other way around, right? There's so much conflicting papers out there. And as a matter of fact, there's two papers that came out of the same institution where one says free recovery is better. And then the next one said rope recovery is better. And this came out of the same place. So it's really, really confusing. And I think again,
00:56:35
Speaker
This I think is really where we start getting to site specific research, right? That this is what works in their institution with their people, with their equipment, the way they're trained. And I think it's very difficult to say I do it this way, it's going to work well for everyone. I don't know that we can do that. And I think it's also preference, right? If someone can show me a multi-centered long-term outcome study that says one is better than the other, I would love to see it, but it's not it's just not there. I mean, there's there's so many different ingenious and unique things going on. There's that there's the one big giant blow-up pad that basically surrounds the horse
00:57:17
Speaker
as they stand up so that you know they're so padded, there's nothing to move into except this giant inflatable that goes around them. to Cornell just published their preliminary stuff on their their new recovery system that that they're designing that is basically like kind of like a seat belt. It has a thing on the ceiling and a harness that goes to the horns and a single cable that If the horse stands and then falls, it slows their deceleration or it decelerates them as they fall. I'm sure that that it it looks really cool, but there's no way and everybody's going to be able to afford to put that into their clinics. right and so You have to figure out what works for you. Personally, I'm not a huge assisted recovery person except for a small, maybe 2% of my horses. really debilitated horses, orthopedic, long bone injuries, C-sections, ah because I worry about as much relaxant that's in. i've I've had two horses in my past that opened up their hawks trying to stand up that I thought had so much relaxant in their systems that theyre their ligaments and tendons were friable. so It really depends. The other thing is, I think, is the way that we use rope recoveries and what is their purpose. I don't know that we can even agree on that. I have people like, well, you know, we use it to help lift the horse when it stands. Well, I don't think you're really lifting the horse. I think the horse needs to be able to stand on its own and you tighten those ropes as they stand, right?
00:58:41
Speaker
And I think the benefit of the head and tail rope is to minimize or limit lateral movement in the horse. They have to be able to stand up on their own and then you don't want them swinging left or right, right? So you you pull them tight to keep that happening. Now with the same thing, if I sedate my horse well enough that they stand up on one attempt really clear headed, why would I need head and tail ropes? And again, that's my preference. Again, a private practice I worked in, the surgeons demanded and wanted head and tail recoveries on all these horses. Well, they're in there. They're doing this. They're pulling on these ropes. They're agitating these horses. They're trying to get them standing way before they're ready to stand. They've got these horses stretched between these ropes that are standing. They've got nystagmus. They're unable to pull their tongue into their mouth and swallow. These are horses that are not ready to stand up. and so i think
00:59:32
Speaker
in some places, maybe we're we're not seeing good rope recoveries because the rope stimulates the horse to try and stand before they're ready. Other places do it really well. They still sedate the horse and keep them down a long time and then use a head and tail rope. There are places where you know they have a couple of people that go in and lay on the horse until the last minute and then help the horse stand up manually. I'm not a big person. I don't think I can hold down any full-size horse. I think any horse could toss me across the stall if it wanted to. So, you know, that's not an option for me. And, you know, at my age, I don't want to do that anyway. Yeah. I don't know that that we have an answer. I always felt very strongly that, you know, I always want my patients to recover well, but I always think about the safety of my personnel as number one. And then number two is the safety of the patient, which
01:00:21
Speaker
Maybe that's the wrong priority. I don't know. I felt pretty good about it. I could sleep at night. I am 100% on board with that. And even on the small animal side, right? You have an aggressive animal come in and the students like, well, I don't want to use an Alpha 2 or ketamine because it has condition X. And I'm like, yes, but anything else is going to let that horse kick you or that dog bite you. Sorry, we're using the Alpha 2 and we're going to sedate the hell out of it because our safety is always going to come first. So yeah, I am on board 100% with that.
Conclusion and Encouragement for Continued Learning
01:00:50
Speaker
Well, on that note, I just want to thank you so much for your time talking to me today all about equine recovery. It was an excellent conversation. Thank you. I appreciate you being here. Thank you so much. It was a lot of fun and I had a great time and I i hope there are some useless pearls of wisdom in there that someone can find helpful.
01:01:17
Speaker
If you like what you heard today, I encourage you to check out the North American Veterinary Anesthesia Society and consider becoming a member. As a member of NAVAS, you get tons of benefits, including access to CE events, focusing on anesthesia and pain management, blog posts, fireside chats with board and anesthesiologists, as well as specialty technicians, and just so much more. VIN rounds are another benefit for NAVAS members. VIN rounds are hour-long presentations on a specific topic in veterinary anesthesia that provides tips and tricks that you can use on your very next day at work. In fact, the next VIN rounds, discussing the anesthetic management of courses for colic procedures, is happening very soon. If any of this sounds interesting to you, visit www.mynavas.org
01:02:08
Speaker
to advance your anesthesia journey today. If you have been enjoying the content of this podcast, I would sincerely appreciate it if you could give us a like or subscribe to our podcast, write a review, or simply spread the word about this podcast to your friends and coworkers. We appreciate any and all listeners' support. If you have any questions about this week's episode or the NavAss podcast in general, or if you want to suggest topics you would like for us to discuss in future episodes, please reach out to us at education at mynavass.org. We would love to hear from all of you.
01:02:46
Speaker
Also, a huge thank you to our sponsor, Decra, without whom this podcast would not be possible. Visit their website, www.decra-us s dot.com to learn more about their line of veterinary anesthesia products. I want to thank our guest, Dr. Stuart Clark Price, for this insightful discussion on equine anesthetic recovery. This podcast was produced by Maria Bridges, edited by Chris Webster of Chris Webster Productions, and technical support was provided by Sal Jimenez. And lastly, a huge thank you to all the gas pastors out there who choose to spend their time with me today on the North American Veterinary Anesthesia Society podcast. Becoming a skilled anesthetist is a lifelong journey of learning and self-discovery, so I hope you consider listening in the future.
01:03:36
Speaker
I'm your host, so Dr. Bonnie Gatson, and thank you for listening. See you next month with another episode of the Navas Podcast.