Effect of reducing inspired oxygen concentration on oxygenation parameters during general anaesthesia in horses in lateral or dorsal recumbency

Evaluation of the Effect of the Inspired Oxygen Fraction on Blood Oxygenation during Inhalant Anaesthesia in Horses: A Systematic Review with Meta-Analysis

In anaesthetized horses, pronounced ventilation/perfusion mismatching often occurs. Several authors have investigated the effect of lower inspired oxygen fractions (FiO₂) to reduce formation of absorption atelectasis. This systematic review compared the effects of low (<0.6) and high (>0.8) FiO₂ on the arterial oxygen tension (PaO₂), the alveolar-to-arterial oxygen tension difference (P(A-a)O₂), and the PaO₂/FiO₂ ratio in horses during inhalation anaesthesia. Using the Systematic Review Protocol for Animal Intervention Studies, four experimental and one clinical investigations were deemed suitable for inclusion. A meta-analysis was performed on the four experimental studies. The PaO₂ was significantly lower (p = 0.0007, mean difference -23.54 kPa, 95% CI -37.18, -9.90) with a lower FiO₂. However, the P(A-a)O₂ was also significantly lower (p < 0.00001, mean difference -20.80 kPa, 95% CI -26.28, -15.32) when using a low FiO₂. For the PaO₂/FiO₂ ratio, only one study fitted the inclusion criteria, so no meta-analysis was performed. It is concluded that, while only a limited number of studies are available, the use of a higher FiO₂ in horses during inhalation anaesthesia will result in higher levels of PaO₂, but also a larger P(A-a)O₂ difference. Further studies are needed to increase the level of evidence on this subject.

Recovery after General Anaesthesia in Adult Horses: A Structured Summary of the Literature

Simple Summary

Recovery is the most dangerous phase of general anaesthesia in horses. Numerous publications have reported about this phase, but structured reviews that try to reduce the risk of bias of narrative reviews/expert opinions, focussing on the topic are missing. Therefore, the aim of the present article was to publish the first structured review as a summary of the literature focussing on the recovery phase after general anaesthesia in horses. The objective was to summarise the available literature, taking into account the scientific evidence of the individual studies. A structured approach was followed with two experts in the field independently deciding on article inclusion and its level of scientific evidence. A total number of 444 articles, sorted by topics and classified based on their levels of evidence, were finally included into the present summary. The most important findings were summarised and discussed. The present structured review can be used as a compilation of the publications that, to date, focus on the recovery phase after general anaesthesia in adult horses. This type of review tries to minimise the risk of bias inherent to narrative reviews/expert opinions.

Abstract

Recovery remains the most dangerous phase of general anaesthesia in horses. The objective of this publication was to perform a structured literature review including levels of evidence (LoE) of each study with the keywords “recovery anaesthesia horse”, entered at once, in the search browsers PubMed and Web of Science. The two authors independently evaluated each candidate article. A final list with 444 articles was obtained on 5 April 2021, classified as: 41 “narrative reviews/expert opinions”, 16 “retrospective outcome studies”, 5 “surveys”, 59 “premedication/sedation and induction drugs”, 27 “maintenance with inhalant agents”, 55 “maintenance with total intravenous anaesthesia (TIVA)”, 3 “TIVA versus inhalants”, 56 “maintenance with partial intravenous anaesthesia (PIVA)”, 27 “other drugs used during maintenance”, 18 “drugs before/during recovery”, 18 “recovery systems”, 21 “respiratory system in recovery”, 41 “other factors”, 51 “case series/reports” and 6 “systems to score recoveries”. Of them, 167 were LoE 1, 36 LoE 2, 33 LoE 3, 110 LoE 4, 90 LoE 5 and 8 could not be classified based on the available abstract. This review can be used as an up-to-date compilation of the literature about recovery after general anaesthesia in adult horses that tried to minimise the bias inherent to narrative reviews.