Horses are susceptible to developing large areas of pulmonary atelectasis during recumbency and anesthesia. The subsequent pulmonary shunt is responsible for significant impairment of oxygenation. Since ventilation perfusion mismatch persists into the post-operative period, hypoxemia remains an important concern in the recovery stall. This case report describes the diagnosis and supportive therapy of persistent hypoxemia in a 914 kg draft horse after isoflurane anesthesia. It highlights how challenging it can be to deal with hypoxemia after disconnection from the anesthesia machine and how life-threatening it can become if refractory to treatment. Furthermore, it stresses the point on the interactions between hypoxemia and other factors, such as residual drug effects and hypothermia, that should also be considered in the case of delayed recovery from general anesthesia.

A 13-month-old Sphynx cat was referred for patent ductus arteriosus (PDA) ligation. A left thoracotomy was performed and the PDA was efficiently ligated. Immediately after chest tube placement, it presented extensive intrathoracic bleeding from the caudal intercostal artery. In view of the absolute necessity of a blood transfusion and given that compatible feline blood was not available, xenotransfusion of canine blood was administered to the cat and resulted in a positive outcome.

Equine anesthesia is related to high morbidity and mortality rates and recent studies suggested that the period of recovery remains the phase associated with the greatest risk of mortality in horses. Intraoperative hypotension, hypoxemia, and hypercapnia are recognized as potential determinants of recovery quality. This study, conducted at the Equine University Hospital of Liege, aimed to explore how these factors influence recovery outcomes and compare complications between non-emergency and emergency procedures. We analyzed data from 1057 horses, with a mean weight of 498 kg (ranging from 150 to 850 kg) and a mean age of 10.7 (ranging from 0.5 to 37 years), undergoing standardized general anesthesia for non-emergency and emergency procedures to assess which factors influence recovery quality. Recoveries were graded as ‘good’ or ‘bad’ and age, sex, breed, American Society of Anesthesiologists (ASA) physical status classification, weight, anesthesia duration, presence of hypotension, hypoxemia, and hypercapnia were compared with a logistic regression analysis. Our findings highlight the multifactorial nature of anesthetic recovery in horses, with breed, age, anesthesia and recovery duration, and emergency status emerging as significant influencing factors. Additionally, monitoring and managing hypoxemia and hypotension remain critical due to their recognized impact on recovery quality. However, despite their clinical relevance, the specific effects of these variables on anesthetic recovery in horses remain insufficiently studied, emphasizing the need for further research to refine perioperative management strategies and improve outcomes.

Controversy continues to surround the use of opioids in equine anaesthesia, with variable effects reported. This blinded clinical study aimed to investigate the influence of a low-dose fentanyl continuous rate infusion (CRI) on isoflurane requirements, parasympathetic tone activity (PTA), and anaesthetic parameters in horses during general anaesthesia. All of the twenty-two horses included in the research underwent a standard anaesthetic protocol. Eleven horses in the fentanyl group (Group F) received a loading dose of fentanyl at 6 µg/kg, followed by a CRI of 0.1 µg/kg/min during anaesthesia. A further 11 horses in the control group (Group C) received equivalent volumes of normal saline. Anaesthetic parameters and PTA index were recorded during anaesthesia. The achieved mean fentanyl plasma concentration was 6.2 ± 0.83 ng/mL. No statistically significant differences between groups were found in isoflurane requirements, MAP values, and mean dobutamine requirements. However, horses in Group F required a significantly lower dose of additional ketamine to maintain a sufficient depth of anaesthesia. Significantly higher PTA values were found in the fentanyl group. Further research is warranted to determine the limitations of PTA monitoring, and the influence of various anaesthetics on its values.