The internet will be a boon for the next major international horse anesthesia study

The high risk of mortality associated with general anesthesia in horses remains one of the greatest concerns of equine practitioners.

The rise of the internet has opened new avenues for the next major international study to assess the risks of death associated with general anesthesia in horses, the researchers say.

Miguel Gozalo-Marcilla and his fellow researchers noted that almost 20 years have passed since the largest multicenter observational study assessing the risks of death from general anesthesia in horses, known as the Confidential Investigation of perioperative death (CEPEF).

The high risk of mortality associated with general anesthesia in horses remains one of the greatest concerns of equine practitioners and veterinary anesthetists, the researchers said.

Many studies have reported risks of death from anesthesia, most of which were retrospective, they said.

To date, the second confidential investigation into perioperative deaths in equines (CEPEF2), published in 2002, remains the largest multicenter observational study on the subject to date, with 41,824 cases collected from 62 clinics over six years. This study found that the overall death rate up to seven days after anesthesia was 1.9% = 0.9% in non-colic cases and 7.8% in colic cases.

“Although a lot has changed since then, we are still a long way from reducing these numbers, and the need for an update of CEPEF data was proclaimed eight years ago,” the study team said. .

“Avoiding general anesthesia by undertaking certain procedures in standing horses may reduce mortality, but there is no data yet to support this hypothesis,” they noted.

The authors proposed that an online method could be used to collect data for a major new study on the subject. The Internet, they said, would allow online data collection from a large number of participants with few geographic limitations.

“Online data collection is fast, inexpensive and increases the accuracy and efficiency of data entry. The data could be analyzed interactively with the possibility of following up with participants.

The researchers set out in their study to assess the usefulness of an internet-based method for a multicenter study that used an electronic questionnaire and statistical software to show data and report the results of horses undergoing general anesthesia and certain procedures. using standing sedation.

In six months, 8,656 cases from 69 centers (covering 20 countries and four continents) were collected, comprising 6,701 procedures under general anesthesia and 1955 under permanent sedation. Of these, only 39 cases were field procedures – 31 intravenous anesthetics in total and eight standing sedations.

Typically, 48 cases per day were reported during the study period.

Sixty-six of the 6,701 horses that underwent general anesthesia died, representing a mortality rate of 1%. Of these, 35 (out of 5,784) were classified as non-colic deaths (0.6%); and 31 (out of 917) as death from colic (3.4%).

Deaths reported within the seven-day window after surgery increased as horses were euthanized due to postoperative complications. This was especially important for colic-related surgeries. While 31 deaths occurred among the 917 horses directly related to the general anesthesia, 253, or 27.6%, were subsequently euthanized within the next seven days due to problems.

Of the 5,784 surgeries classified as non-colic, 76 were euthanized.

A total of 329 of the 6,701 horses that underwent general anesthesia were euthanized.

Four of the 1955 horses that underwent standing sedation died (0.2%). All were non-colic surgeries.

The study team said the results showed the usefulness of an internet-based data collection method. He also showed that some horses died unexpectedly while undergoing not only general anesthesia but also standing sedation.

The researchers concluded that the internet-based method they used proved to be suitable for this type of study, proving to be a reliable, easy, fast and inexpensive way to collect data, with geographic limitations. minimum.

They said their end goal is to use the same method to collect around 45,000 cases of general anesthesia for the next CEPEF survey to increase statistical power and compare the results with those of the past. 20 years old.

The impact of the latest CEPEF study, cited by 448 other publications, reflects the importance of undertaking an update, they said.

Based on the cumulative cases collected per week to date, the proposed numbers of cases sought should be reached in approximately two years.

As reported in the latest CEPEF study, the overall rate of equine anesthetic mortality is still higher than in other veterinary species such as dogs and cats, they said. However, preliminary data from a small population suggests the current rate is lower than 20 years ago.

As researchers AHA Dugdale and PM Taylor stated in a 2016 article: “We always lose horses after anesthesia to a series of disasters that would not happen if the horse was not anesthetized. “

“Our preliminary results support this claim,” said Gozalo-Marcilla and his fellow researchers.

They noted that many of the procedures previously performed only in anesthetized horses are now performed using standing sedation. In fact, 23% of the cases in this study were standing sedations.

New techniques could reduce the death rate, they said. However, the results presented in the present study should be interpreted with caution, as they are only preliminary, with figures lower than those of the last CEPEF.

Details of the case were collected between November 1, 2020 and April 30 of this year.

The study team consisted of Gozalo-Marcilla, the Royal (Dick) School of Veterinary Studies and the Roslin Institute in Edinburgh; Regula Bettschart-Wolfensberger, with the University of Zurich in Switzerland; Mark Johnston, at Vetstream Ltd in Cambridge, England; Polly Taylor, with Taylor Monroe, also in Cambridge; and Jose Redondo, with CEU Cardinal Herrera University in Spain.

Gozalo-Marcilla, M.; Bettschart-Wolfensberger, R .; Johnston, M .; Taylor, PM; Redondo, JI Data Collection for the Fourth Confidential Multicenter Perioperative Death Survey (CEPEF4): New Technology and Preliminary Results. Animals 2021, 11, 2549.

The study, published under a Creative Commons License, can be read here.

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