Why standing operations can be better for horses *H&H Plus*
In some cases, keeping a horse on his feet for surgery is safer and more effective than general anaesthesia. Patrick Pollock FRCVS outlines what’s involved
While general anaesthesia is a wonderful technique, allowing types of surgical intervention that veterinary surgeons of the past could only dream about, it is not without its risks. A ground-breaking study performed in 62 clinics across the globe, including 41,824 horses, over six years, determined that the risk of death in horses undergoing general anaesthesia for elective surgery was 0.9%. Put simply – and this is what I say to every owner whose horse requires a general anaesthetic – around 1 in 100 normal horses subjected to a general anaesthetic do not survive. Once you add in sick horses, including those with pre-existing risks such as the severe compromise that goes alone with colic, or the risks of pregnancy, the risk of mortality increases further. By contrast, the anaesthetic mortality rates in dogs is around 0.02% – and in humans the rate is closer to 1 in 100,000.
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"}