The number of equine deaths associated with general anaesthesia has declined in the last 20 years, data has shown.

Researchers – who formed the Confidential Enquiry into Perioperative Equine Fatalities Community Interest Company (CEPEF CIC) – have published their latest phase of the enquiry, CEPEF4, into general anaesthetic-related horse deaths since the 1990s. The work, published in 2025, involved analysis of data from 47,000 procedures across 93 veterinary practices and hospitals, in 23 countries and four continents.

The aim was to build on the work of the original studies published in 2002 and consider the seven-day outcome for horses following general anaesthesia. Key findings include the fact that the death rate in otherwise healthy horses – those who underwent anaesthesia for an elective procedure rather than for emergency abdominal surgery such as colic or caesarean section – has decreased from 0.9% to 0.6% since CEPEF2 in 2002. Whereas 33% of deaths in these cases previously related to cardiac arrest, this figure has dropped to around 12% in the last 20 years. This decline has been attributed to a change in some of the drugs used, new techniques and improved monitoring in equine general anaesthesia. The new data found that, in those non-colic cases, the main causes of death were fractures occurring during the recovery period (35%) followed by post-anaesthetic colic during the seven-day period (20%).

As expected, mortality in compromised patients was higher but decreased from 7.8% to 4.2% in the last two decades. The main reasons for this are the improvements in perioperative management of colic by both referring vets and the specialised treatment provided in referral hospitals.

Lead researcher Miguel Gozalo-Marcilla of the University of Edinburgh told H&H that even with this reduction in death rate, risks of anaesthetising a horse are still much greater than a dog. For example, horses are more prone to complications owing to their size and the fact of being prey animals, especially in the immediate recovery period after general anaesthesia. When they recover from a general anaesthetic, horses are more at risk of panicking and try to stand, which can lead to fractures. Good management of anaesthesia during the operation, maintaining a healthy blood circulation and respiration will reduce the likelihood of disaster such as post-anaesthetic myopathy which may lead to catastrophic recovery.

“The reduction in deaths is mainly because the drugs and techniques we are now using are safer, vets are better trained in monitoring and stabilising the more compromised patients pre-operatively in an adequate manner, apart from providing better pain management,” said Dr Gozalo-Marcilla.

“We also know more about certain risk factors – a compromised patient with colic, a pregnant mare, a very fat or skinny horse or if the anaesthetic is longer than two hours, all increase the risk of the horse not surviving the seven-day period. We were also able to identify some protective factors too, like giving a little sedation before the recovery phase to reduce the risk of the horse panicking.”

“The results are promising but there are still some unanswered questions; particularly around post-operation recovery, the critical phase. We can let a horse recover on its own, or ropes can be used to support them, but there’s still no evidence as to which is better – and whether we should be ventilating patients. We want to know how we can reduce this 0.6% death rate further.”

Dr Gozalo-Marcilla said the message to owners is that general anaesthesia in horses is very high risk – more so if a horse is unwell going into it – but that “things have improved massively in 20 years”.

“Things have changed for good, we know there have been improvements and when owners send their horses to a referral setting, they are in good hands,” he said.

Horse Trust director of research and policy Jan Rogers told H&H: “The Horse Trust was pleased to be able to fund this study, which drew data from nearly 48,000 cases across the world.

“The results are reassuring, that there are fewer horses lost under general anaesthetic than was shown in a similar study 20 years ago and that good information is available about the causes of the losses that did occur. This means we can continually improve by monitoring and supporting patients better and by careful use of pre-medication and sedation during recovery – all of which can help to lower risk factors and inform clinical decisions and patient safety.”

The CEPEF CIC are: Dr Miguel Gozalo-Marcilla (University of Edinburgh), Dr Polly Taylor (Taylor Monroe, UK), Dr Mark Johnston (Vetstream Ltd, UK), Prof Regula Bettschartt-Wolfensberger (University of Zürich, Switzerland), Prof José Ignacio Redondo García (Universidad Cardenal Herrera – CEU, Spain).

The authors would like to thank as sources of funding the Association Veterinary Anaesthetists (AVA), Kate Borer-Weir Memorial Fund and the AVA Trust, and the Horse Trust.

“Also, the open-mindedness, hard work, honesty and diligence of the personnel, ambassadors and every single user of each collaborating centre who submitted the cases for the standing sedation study,” said the authors.

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A horse who underwent “pioneering” surgery to remove a life-threatening tumour from his stomach is back in work and “feeling amazing”.

The owner of 15-year-old warmblood Valtano had asked Rainbow Equine Hospital to investigate suspected gastric ulcers last autumn and was shocked to hear he had a 12cm growth in his stomach. The team at Rainbow used a keyhole technique to remove the mass, and a scan six months later showed it had not regrown.

Katie Boddy, who has owned the 17.1hh gelding for seven years, said: “I’m so grateful to Rainbow for all they’ve done for Valtano. It’s so exciting that Valtano has a future ahead of him and it’s all thanks to the team at Rainbow.”

Vet Lizzie Cullen, a European specialist in equine internal medicine, discovered the mass. A follow-up a few weeks later showed it had grown “significantly” to the point it was life-threatening.

“It was blocking food material from passing through the digestive system and causing it to build up in the horse’s oesophagus and stomach,” a Rainbow spokesperson said, adding that Valtano’s stomach was at risk of rupturing.

Gastric surgery is uncommon in horses but the Rainbow vets used the advanced keyhole technique; they made an abdominal incision and were able to pass instruments through smaller incisions in his stomach wall. Two surgeons, guided by a camera fed down Valtano’s throat, were able to cut the mass away.

“The Rainbow team has specialists in multiple disciplines, so Lizzie was able to discuss the case with her colleagues to find a solution that would save Valtano,” the spokesperson said. “Her husband and colleague Matthew Cullen is a European specialist in equine surgery and he suggested keyhole surgery.”

Mr Cullen, who performed the operation with fellow surgical specialist Jonathan Anderson, said the procedure combined techniques that have been used before, but not together.

“Gastric surgery is not common in horses as the stomach is deep inside the abdomen, making it difficult to access,” he said. “The keyhole approach allowed us to get bigger instruments into the stomach and also improved our access to the base of the mass so we could remove more of it.

“Valtano was anaesthetised and placed on his back for the surgery, then his abdomen was opened using a J-shaped incision to make it easier to access the stomach. Small keyhole incisions were then made in the stomach so laparoscopic instruments measuring 1cm in diameter could be inserted to operate on the mass. At the same time, Lizzie passed a gastroscope into Valtano’s stomach so we could see the mass and the surgical instruments.”

Mr Cullen said the team was very pleased with the surgery; they were able to remove most of the mass, cutting it close to the wall of the stomach.

“As well as successfully helping Valtano, this surgical method could be beneficial in the future by giving us another option to operate on the inside of other hollow organs inside the body that are difficult to access, such as the bladder, uterus and other parts of the gastrointestinal tract,” he said.

Valtano was kept under observation at Rainbow Equine Hospital for two weeks after his surgery in October and a six-month follow-up gastroscopy in April showed no regrowth of the mass.

Mrs Cullen said: “Valtano made really good progress after his surgery and everyone was delighted to see him recover – he became very popular with all of the team.

“We had been concerned that the mass was cancerous because it looked quite nasty, but a sample was sent away for analysis and we were delighted to find out it was benign. The lab report said it was benign hyperplasia, an overgrowth of normal tissue. This is not something commonly found in horses.”

Valtano underwent a rehab programme at Katie’s Sprixton Grange Equestrian Centre.

“It was a huge shock when Lizzie told me about the mass inside his stomach, as I’d been expecting a diagnosis of ulcers based on the signs he’d been showing and because he’d suffered from them before,” Katie said.

“At first, the mass appeared quite small but I took Valtano back to Rainbow a few weeks later because he’d started to eat intermittently and pass droppings infrequently, and that’s when we found out it had grown quite rapidly and was now causing serious issues. I needed to make a big decision quickly; have him put to sleep or have the surgery.

“Rainbow talked me through all the options and what I needed to consider, and while at that point we didn’t know if the lump was cancerous or not, I wanted to do what I could to save Valtano. He’s such a lovely horse with a big personality and I knew that he was in safe hands and Rainbow would do the best for him. After the surgery he was bright and alert straight away and it was such a relief when we heard that the mass wasn’t cancerous.”

Valtano had 12 weeks’ box rest, then progressed to a pen and a small paddock.

“He’s done really well, I’ve brought him back into work slowly and he’s now being ridden and rebuilding his fitness,” Katie said. “He feels amazing to ride and I’m hoping to go out competing in dressage soon.”

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A tiny foal who was found unable to nurse as she had somehow smashed her lower jaw on both sides was saved by expert vets – who bolted external plates on to her face.

Breeder Amanda Johnson was confronted by a “frightening scene” in her yard, in California, US, late February; she found her five-day-old filly Quincy with a bloody face and her lower jaw hanging, broken on both sides.

Amanda called her vet, who recommended Amanda take the foal to the University of California, Davis (UC Davis) veterinary hospital.

When Quincy arrived, vets found that other than the obvious injury, she was “alert, responsive, and in good health”.

“X-rays showed complete displaced fractures of both of her mandibles,” a UC Davis spokesperson said. “The injury left the foal unable to nurse, so a nasogastric tube was placed for feeding. Faculty surgeon Sandra Valdez manually reduced the fractures and bandaged the wound for short-term stabilisation until surgery.”

A CT scan helped classify the fractures and allowed the surgeons to plan their approach.

“After discussion with Amanda Johnson, it was determined that the fractures would be stabilised with external fixators,” the spokesperson said. “Faculty surgeon Scott Katzman and surgery residents Bridget Ratliff and David Orozco-Lopez reduced the fractures and placed locking compression plates on the exterior of her face.

“Quincy recovered well from anesthesia and was able to nurse just one day after surgery. She was hospitalised for the following week before being discharged to continue her recovery at home. X-rays at her two re-check appointments showed appropriate healing, and the fixators were removed five weeks after surgery.”

Amanda said she was pleased with the foal’s recovery and “looks forward to her foal’s bright future”.

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The surgeon who led the extremely rare procedure to replace a dislocated equine shoulder hopes to get the message out that this is possible, adding: “It’s so good when you can make such a difference.”

Cheryl Bell’s 15.3hh Irish sport horse/Connemara mare Willow could hardly bear weight on her left foreleg, after, it is thought, she landed badly having jumped out of her field. But after her operation, she towed Andy Fiske-Jackson, associate professor of equine surgery and deputy head of Royal Veterinary College (RVC) equine, back to her stable with barely a limp.

“It’s nice to be able to make such a difference to a horse in such a short space of time,” Mr Fiske-Jackson told H&H.

Mr Fiske-Jackson said miniatures and Shetlands are more likely to suffer such an injury than full-size horses, for whom it is “incredibly uncommon”, and “even less commonly attempted to fix”. He said there have been a few cases, in the US, or one of an Icelandic horse whose shoulder popped out immediately after surgery, so was anaesthetised straight away to put it back in.

“But this was two days down the road, and a big horse,” he said. “Beforehand, I told the owner it was very unlikely to work and there was no precedent, no evidence to draw on.”

Mr Fiske-Jackson consulted colleagues internationally, none of whom had carried out the procedure.

“It was either ‘Try it but it probably won’t work’ or ‘You should probably euthanise as it won’t work’,” he said. “Apart from the difficulty in replacing it, there’s often collateral damage to the joint itself – something has to be injured for the shoulder to pop out – which renders the prognosis much poorer.”

But X-rays revealed no bony abnormalities so Willow was anaesthetised, and a sling readied should she need its support.

“There was an audible pop and a jolt as it went back in,” Mr Fiske-Jackson said. “When she got up, it was in a very sensible way, and she was incredibly more comfortable. It was the middle of the night and she was practically dragging me back to her stable; from her not being able to walk, I could hardly hold her. It was surreal; amazing, but worrying!”

The main fear was that the ease with which the joint went back in meant it could pop back out, but Mr Fiske-Jackson paid tribute to Willow’s calmness after anaesthesia, which undoubtedly helped. After a day or two she went home, for box rest and physio exercises. Mr Fiske-Jackson said there was muscle damage in the area and there may be cartilage injury, but this should heal.

“It’s a really good result,” he said. “I wasn’t even supposed to be on call that night but I’m glad I was there. One of those once-in-a-lifetime cases, and it’s important as if it happens to another horse, there will now be realisation that it’s worth trying.”

Cheryl told H&H she found Willow on three legs; although she had never jumped out of her field before, Cheryl thinks she must have gone over a double fence and landed awkwardly.

“She was dragging her leg like it was broken,” she said. “When the vet X-rayed and told me it was dislocated, they said it wasn’t something they’d ever done before.

“No one knew whether it would stay in; I thought I would have to have her put to sleep; the vets said it wouldn’t be the wrong thing to do, but they said they’d give it a go. I cried when I got the call afterwards.”

Cheryl said she knows it is a long road, and even if Willow cannot go back to the jumping and pleasure rides they have done together, she is happy just to have her still.

“It means everything,” she said.

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Towels don’t fit through donkey bowels, as vets treating a miniature filly found out.

Specialists at the Virginia-Maryland College of Veterinary Medicine at Virginia Tech, US, had to operate on three-month-old Harper, as it turned out she had eaten a whole towel.

A spokesperson for the hospital said Lexi Tarpy, manager of Stone Ridge Stables, brought Harper in after she developed a fever and showed signs of colic.

“We brought her in here because our vet said it was an emergency situation,” Lexi said. “Come to find out when they went in for surgery, she ate a towel — an entire towel.”

Vets performed an exploratory celiotomy, a surgical procedure to enter the abdomen, and removed two pieces of towel that were blocking Harper’s colon.

“Removing foreign bodies from the digestive tract of an equine like a horse or donkey is uncommon,” said Elaine Claffey, assistant clinical professor of large-animal surgery.

“They’re usually pretty good at sticking to the things that they should normally eat; we don’t do as many foreign body removals as a small animal veterinarian would because dogs, as we know, are indiscriminate eaters and eat all sorts of things that they shouldn’t.”

Harper’s condition improved quickly after the surgery but her dam Daisy then went downhill.

“Daisy arrived the day after surgery to allow Harper to nurse and put them back together,” Dr Claffey said. “But she developed a couple of fevers and had some medical issues, developed a little bit of enteritis, which is inflammation in the intestines.

“When we recognised she had these additional illnesses, our internal medicine team took over and took primary care for her case, which was great, because we really needed their expertise for her.”

Daisy was treated with IV fluids, antibiotics and anti-inflammatory medication and both she and Harper made a full recovery.

“It’s been hard because we couldn’t come up and see Harper and Daisy so often but they were in great hands, and we’re ready for them to come home,” Lexi said.

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The owner of a “miracle” pony who suffered three cardiac arrests after surgery and was brought round on the third attempt said she could not believe such a thing could happen.

Vets nicknamed Christine Moore’s five-year-old Welsh section A Luna “Phoenix” after her incredible recovery. Eight weeks on, Christine told H&H, the little mare is as healthy and happy as ever.

Christine said she had fallen in love with and bought Luna as a weanling, as a companion and for her grandchildren. She was treated for sarcoids, but then the vet found a lump in her chest.

“They thought it was an internal sarcoid, and that it would be best to put her under general anaesthetic, a 20-minute job and all done,” she said. “I took her over and she stayed overnight for surgery the next morning.”

But in the morning, the vet rang.

“I knew by the tone of her voice,” Christine said. “She said they were having some problems; the operation had been fine but in recovery, she had three cardiac arrests. I went into shock.”

Christine said at the time of the call, Luna was unresponsive.

“They wanted me to call it,” she said. “I ran off screaming and in tears. My husband took the phone and said could they call back as he needed to get to me. Then, after 10 minutes of me hyperventilating and convinced I’d never see her again, the phone rang and they said ‘She’s come round’. I said ‘I’m coming over’.”

Christine said the vets told her they were not aware of such a thing ever happening before.

“They said bringing one back after two attempts is rare enough, three is unheard of,” she said. “Bless them, they worked on her for an hour and a half as they didn’t want to give up, and the vet nurses were all crying when she came round.

“They renamed her Phoenix as she’s such a miracle. Then when I got there, she had her head in a bucket, eating, and she didn’t give a damn!”

The vet who operated on Luna told H&H cardiac arrests after anaesthesia are very rare; she had only seen one in 11 years of surgery.

“The operation had been uneventful and she was coming round, then she stopped breathing in recovery, and then her heart stopped,” she said. “We had to give her CPR, and medication to induce contraction of the heart – and we did that three times. I thought we’d lost her but she just kept going. Thankfully, complications like this are incredibly rare.”

The vet said that within a couple of hours, Luna looked as though nothing had happened, and Christine said she still does.

“She’s completely fine; no brain damage, back to being normal Luna again,” she said. “She’s my baby; I’ve got four horses and you shouldn’t have favourites! But she’s my little best friend.

“I can’t believe something like that could happen; she came back from the dead three times. I’d gone through all the emotions you ever could, in 10 minutes, then it was ‘She’s fine’ and I got there and she was eating. I thought, really? It’s aged me 10 years!

“She’s a fabulous little pony and I love her to bits. Miracles do happen.”

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Phil Cramp — a partner at Hambleton Equine Clinic, Yorkshire — recalls one of his most memorable cases of equine surgery, with an eventer that had run into a fence

“A case that will always stick in my mind is that of an eventer who had run through a fence and staked himself with the fence post,” says vet Phil Cramp. “It had gone in through the side of his neck and created a large, deep wound. He had the post removed and the wound cleaned, flushed out and stitched.

“At first, all seemed fine, but the area started to periodically swell up, develop an abscess and he would be in a lot of pain with a stiff neck. There had to be a fragment of the fence left in there somewhere, but despite multiple scans and X-rays, no one could get to the bottom of it.

“Having had the wound reopened a number of times, he came to me on his very last chance — he was to be put down if I couldn’t solve the mystery.

“I could clearly find and follow the pocket but I could find no remnants of the fence post or any other foreign body in the wound. So, while he was under general anaesthetic — his third — I decided to use a coat hanger to create a sterilised long probe to extend all the way in. I realised the tract extended a lot further than I thought — about 40cm beneath the shoulder blade — so I enlarged the hole with my fingertips in order to put my whole arm in.

“I was faced with a choice — keep pushing my hand further into the horse to try to find the foreign body and get it out, or don’t wake him up. It would be dangerous — it was very risky making such a large incision so close to the shoulder joint, and I was very concerned about the nerves and vessels in the area and the damage I could do getting the foreign body out. But I had nothing to lose by trying.

“So I slowly worked on the tract with my fingertips, enlarging it and extending it with my arm inside the wound up to above my elbow. I had to keep stopping because it was cutting off the blood supply to my arm, but I also had to work as fast as I could. I was having to push and pull so much that I was physically moving the horse around on the table.

“Finally, I felt something at the tip of my finger and as I wrapped my fingers around it, I could feel it move. I tried to ensure I had it all in my hand because not only was I worried that I might not get it all out, but that he might come round and not be able to move his left leg.

“All of a sudden, the object started to come out easily — and there it was, a 4x2in splinter of fence post. Having checked there was nothing left behind, I thoroughly lavaged the wound and stitched it with a large drain in place.

“Thankfully, the horse came through the recovery safely from the general anaesthetic, and the wound healed up surprisingly well.”

• Please note, the picture above is not of this particular veterinary case

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A Suffolk foal who broke his leg in multiple places at two weeks old is back in his field with a bright future ahead thanks to his surgeon’s expertise.

Rancher is cantering about on a leg containing two metal plates and 20 screws, and vets hope he will enjoy a normal life.

Owners Eugenie and Randy Hiscock, of Donhead Hall Stud in Dorset, have no idea what caused the injury, which occurred in March while Rancher and his dam Montana were waiting to come in from the field.

“We caught and led in the other horses first, and only left Rancher and Montana for a few minutes, but as soon as we got back to the paddock, I could tell something was terribly wrong,” Mrs Hiscock said.

“The lower half of Rancher’s leg was swinging, and it was absolutely horrific. I can only imagine that he twisted round suddenly causing the leg to snap.

“We were straight on the phone to our vet and I stood with Rancher while we waited for them to arrive. I felt so sick.”

A vet from Damory Equine Clinic in Blandford Forum applied a plaster cast but X-rays showed the fractures were not healing, so the Hiscocks made the trip to Liphook Equine Hospital in Hampshire.

Liphook vet Russell Parker, a Royal College of Veterinary Surgeons and European specialist in equine surgery, operated on Rancher. He believed that despite the severity of the injury, the colt had a “fighting chance”, owing to his size and age.

Mr Parker said: “Rancher’s fracture wasn’t straightforward because the leg was broken in more than two places and the bones were displaced, but foals are relatively light and their bones heal more quickly than adult horses, making fracture repair an option. It also helped that there was no wound associated with the injury.

“The operation took 2.5 hours and involved using metal plates and screws to realign and fix the broken bones. The modern implants we use today help us create a more stable repair because the screws lock into the plates as well as the bone.”

Russell added that there is always a risk of complications following this type of surgery.

He said: “Our first challenge was to make sure that Rancher got safely to his feet as he came round from the anaesthetic, and we gave him a helping hand to avoid him accidentally damaging the repair.

“Also, there is a risk of the incision getting infected or the implants breaking, but Rancher made excellent progress over the next few days. In fact, he felt so well in himself, he became very boisterous in the stable, but luckily his mum did a great job of keeping him calm.”

After three weeks at Liphook, Rancher was able to go home, where he spent six weeks on box rest in a barn.

In early June, he was allowed back out in the field, and Mrs Hiscock said it has been “wonderful” to watch him enjoying the sun.

“We can’t thank Russell and the team at Liphook enough for saving Rancher and giving him the best care possible,” she said. “As well as the Suffolk being an extremely rare breed that needs its numbers boosting, Rancher was the first foal we had bred in four years, so he is very special to us. He is such a lovely, bonny foal and it would have been devastating to lose him.”

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The couple own 12 adult Suffolks, and four other 2021 foals. Some of the horses work on the farm, and take part in shows and displays, and they have a team of mares who pull the Badger Brewery dray.

Mrs Hiscock said: “We may keep Rancher entire so he can breed his own foals in the future, or he could be used as a driving horse. On the day his accident happened I really thought we were going to lose him, so it is lovely to think that he has an exciting future ahead of him.”

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The teenage rider of a 22-year-old pony who is still enjoying his work having lost an eye wants others to know there is still hope of fulfilling, happy lives for one-eyed horses.

Jessica Venter’s loan pony Peter had surgery to remove his left eye, and although she was concerned, especially at his age, she said he is doing well.

“He was sceptical at first; he’d try to put his head to that side, and I don’t think he understood why he couldn’t see,” she said. “But he trusts me, because I can see for him.”

Jessica first saw Peter, a 14.2hh chestnut, about five years ago, when his owner was looking for someone to loan him. Initially, his owner thought Peter would not be as suitable as Jessica’s other pony, as he was spookier and more excitable, but the pair clicked.

They competed in dressage, cross-country and showjumping, their favourite being jumping, including qualifying for the Sunshine Tour championship at Hickstead.

Then Jessica’s parents bought her a horse, Star, and Peter was loaned to a new home in Wales.

“It wasn’t nice but I understood the owner’s decision,” she said. “Then we had the news he’d had an infection, and had to have his eye removed.

“The owner, and the rider in Wales, decided it would be best for him to come back here; it was nice he was back.”

Jessica researched one-eyed horses and took Peter’s return to work very slowly, but he has coped very well, she said, and still very much enjoys his work.

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“I’ve competed him in showjumping, and in dressage, where he surprisingly did better than he did before his eye was removed,” she said, adding that Peter is still jumping at the same height as before.

Jessica added that she wants other riders to know losing an eye is not the end.

“Although there is the disability, and it depends on the horse, it doesn’t mean their ridden career is over for ever,” she said. “I’d like this to give other people hope.”

Horse & Hound magazine, out every Thursday, is packed with all the latest news and reports, as well as interviews, specials, nostalgia, vet and training advice. Find how you can enjoy the magazine delivered to your door every week, plus options to upgrade to access our H&H Plus online service which brings you breaking news as it happens as well as other benefits.

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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.

There are many reasons for death or injury during induction, maintenance and recovery from anaesthesia. These include an abnormal reaction to the medications used to induce and maintain anaesthesia, an unforeseen event leading to severe depression of the heart or lungs, or a significant musculoskeletal injury such as a fracture or dislocation during recovery.

In addition to these complications, horses are not really designed for recumbency. Once anaesthetised, lots of body systems become compromised. The heavy abdominal organs compress the thoracic cavity and lungs, reducing the amount of oxygen getting into the blood, and the lungs gradually collapse so that as the anaesthetic progresses it is possible for the horse to become hypoxic (starved of oxygen).

At the same time, the great blood vessels (the aorta and vena cava) are compressed, reducing the amount of blood returning to the heart and increasing the work required by the heart to pump the blood around the body. This combination of reduced perfusion (blood flow) and reduced oxygenation (ventilation) is a perfect storm and referred to as a ‘ventilation/perfusion mismatch’. Alongside hypoxia, this can lead to poor blood flow to the muscles, causing further problems such as myopathy (muscle damage) and occasionally even the development of abnormal heart rhythms (arrythmias) which can have fatal complications.

Although the science of anaesthesia and the skill of anaesthetists has never been more advanced, anaesthesia will never be a procedure which can be performed totally without risk.

Some surgical procedures can be performed only during general anaesthesia, so work goes on to reduce the risks. However, in recent years, an increasing number of procedures have been attempted with the horse standing and sedated. Some of this is due to the development of sedative and local anaesthetic protocols that allow the horse to be restrained in a welfare-friendly manner that is safe for both the patient and the vets. But, as vets transitioned to undertaking more and more surgery with the horse standing, it became clear that many procedures were easier, quicker, more successful and safer for the horse when performed with the horse standing, sedated and with appropriate pain control.

Pioneers of standing surgery

As a surgical resident, I was lucky enough to work with two of the pioneers of standing surgery, Professor Jim Schumacher and Dr Tom Russell. Jim realised that a number of surgical procedures could be accomplished more safely and at less cost with horses standing and undertook the first standing surgery procedure in the 1990s. This was followed by reproductive, airway, ocular and even some colic surgery performed on the standing horse. However, it was probably the area of orthopaedics and specifically fracture repair that was the most transformative. Tom was concerned that following the repair of medial condylar fractures (a type of cannon bone fracture which is inherently very unstable), up to 25% of horses suffered a catastrophic and fatal breakdown of the leg while returning to their feet after surgery. Jim and Tom were pioneers – it was amazing to be in the room when the first screws were placed into the limb of a standing horse, or a large bone flap was created and opened on the front of the horse’s head to gain access to the sinuses.

Multiple different procedures are now routinely performed with the horse standing and sedated. These include enucleation (removal of the eye) and other ocular surgery, removal of the thyroid, laryngoplasty (“tie-back”), dental surgery, sinus surgery, wound reconstruction, skin grafting, foot surgery, reproductive surgery, laparoscopic (keyhole) thoracic and abdominal surgery – and that’s only the tip of the iceberg.

These procedures are possible because we have some fantastic sedative and pain relief protocols, including the development of continuous rate infusion (CRI). During this technique, an intravenous catheter is placed into the jugular vein in the horse’s neck and the anaesthetist drips in the medication mixture throughout the procedure. A combination of medications used that not only reduces movement, but also eliminates anxiety in the horse. It is fair to say that we can never really know what a horse thinks or feels, but careful observation and communication between anaesthetists and surgeons has led to protocols that keep the horse quiet and non-reactive. Movement, heart rate, facial expression and other reactions are monitored throughout the procedure and the quality of the sedation is scored to allow us to continually refine these protocols.

As more and more procedures were performed with the horse standing, vets began to notice that post-operatively these horses had lower pain scores and returned to normal behaviours, such as eating and interacting with other horses in the hospital, more quickly. They generally made a faster recovery. But sedation is only part of the story; it is the local anaesthetic protocol that really makes these procedures possible. Anyone who has ever had a lameness examination performed on their horse will know that nerve blocks are a big part of equine veterinary practice. This technique involves injecting a small volume of local anaesthetic over a nerve, eliminating sensation to a specific area. Equine vets pioneered these techniques, ahead of our small animal and even human medical colleagues, so it was therefore easy to adapt these diagnostic procedures into nerve blocks to allow specific surgery to be performed.

In addition, the horse’s ears are plugged prior to surgery to reduce the stimulation that may be caused by sound. One eye may also be covered.

The surgical procedure

As a surgeon, I will always discuss details of the surgical procedure with the horse’s owner. This includes the risks, success rates and aftercare involved, but now it may also include the fact that this procedure could be performed standing. Many horse owners understand the risks of general anaesthesia, but it is not unusual to be asked “Could my horse come around from the sedation during surgery?” or “Will he feel anything?” These are understandable concerns, but the answer to both questions is no. Recovery from sedation and local anaesthesia is gradual, and, because the horse is carefully monitored throughout the procedure, any changes noticed by the anaesthetist that might suggest that the effects are reducing can be quickly corrected. The appearance of most horses during these procedures suggests that they are almost totally unaware of their surroundings, and most will not react to stimulus. Humans undergoing these types of procedures often have difficulty recalling what happened and there is no reason to suspect this is not also the case in horses.

There are of course some risks with any type of sedation and surgery. The medication combinations used have effects on many different body systems; one of these is the motility (movement) of the intestines. What that means is that horses sedated for prolonged periods are at a slightly increased risk of developing an impaction and showing colic signs. To mitigate against this, we generally place a stomach tube at the end of a standing surgical procedure and administer a mixture of water and electrolytes to encourage normal intestinal movement and soften the ingesta (gut contents).

Lots of things must be taken into account before undertaking any surgery, such as how to clean and prepare the horse so that the surgical site is sterile and doesn’t become contaminated during the procedure. For some of our surgery, the horse will wear a compression suit with zips that allow access to specific areas. This reduces the chance of hair and dust falling into the surgical incision. Because we cannot use clamps to attach the surgical drapes, as would be common during general anaesthesia, we use adhesive drapes and often sterilise bandages to keep areas clean.

Accomplished by feel

Recently, we began to undertake more complex procedures in the standing sedated horse, one of these being prosthetic laryngoplasty or “tie-back”. During this complex and technically tricky surgery, which is a treatment for laryngeal paralysis, one side of the larynx (voice box) is permanently pulled out of the airway to allow the horse to breathe more easily. With the horse anaesthetised and lying on his side, the surgery was performed through a small incision with much of the procedure accomplished by feel. It sometimes felt like operating down a cave. In contrast, the same procedure in the standing sedated horse is almost easy by comparison – the horse’s body is in natural, upright alignment and his neck is stretched out and at the surgeon’s eye level, so surgical access is more straightforward. Because the horse is “awake”, an endoscope placed in his airway allows the surgeon to work out perfectly exactly how much to “tie-back” the paralysed side of the larynx.

Perhaps the pinnacle of standing surgery has been the move to undertake re-innervation of the paralysed larynx. During this procedure, the larynx is literally re-plumbed and given a new nerve supply by implanting two nerves into the paralysed muscle. We began doing this in the standing horse last year – it is easier and the success rates are higher than when performed during general anaesthesia.

Ref Horse & Hound; 20 August 2020

• This article has been edited and approved by Karen Coumbe MRCVS, H&H’s veterinary advisor since 1991.

The decision to put a horse under a general anaesthetic should not be taken lightly as one in every 100 healthy horses will not survive the procedure or the seven days that follow surgery

General anaesthesia in horses: Risks | Preparation | Five stages of anaesthesia | Pain control | Post-anaesthesia care

When a horse has to undergo anything beyond minor standing surgery, which can be achieved under heavy sedation, a general anaesthetic is required so that the animal is safely immobilised, unconscious and provided with suitable pain relief throughout the procedure.

While the challenges associated with placing a horse under general anaesthesia should not be under-estimated as the risks associated with it are significant, there has been a notable increase in the knowledge, equipment and medications available to anaesthetise horses safely in recent years. This allows veterinary teams to successfully perform much more complicated procedures, such as colic surgery and repair certain fractures, than was previously possible.

What are the risks?

Research reviewing more than 41,000 cases across six years¹ found that one in 100 (0.9%) horses die during or within seven days of anaesthesia, with the figure higher still (1.6%) for emergency cases. This compares to one in 1,000 for small animals and one in 29,000 for humans. This unsatisfactory figure in horses has not changed appreciably over the past 20 years.

In part this is because as anaesthesia technology has improved, more sophisticated longer surgical procedures are being performed. Equally surprising perhaps is that the figure applies to healthy horses undergoing surgery for routine procedures; the risk is inevitably greater in emergency cases involving sick horses. For these reasons it is important that anaesthesia and surgery are only ever performed when they are genuinely justifiable.

So why are horses at a much higher risk than humans and small animals?

Firstly you have the challenge of getting around half a tonne of horse from standing awake on all four legs to recumbent and anaesthetised, then moved on and off an operating table prior to recovering smoothly to standing up again. Even when using a padded ‘knock down’ room for this purpose, such as the ones that are available at many equine hospitals, there are risks as the horse goes down and also when they regain their feet after surgery. Unfortunately horses may sustain a fatal fracture either during induction at the start of anaesthesia or more likely as they regain their feet during the recovery phase.

The horse’s bulk also complicates anaesthesia. Horses are extremely heavy, and it is possible for muscle damage to occur on their underside when they are lying still under anaesthetic for any length of time – put simply this can be similar to severe muscle cramps, which then impede their recovery.

If a horse needs to be positioned on their back during a surgical procedure, which is often the case, for instance with colic surgery, the bulky guts tend to squash the lungs and reduce their ability to inflate and, or oxygenate blood. While such changes can occur in humans and smaller animals, the large size of the horse, along with anatomic adaptations for athletic performance, makes the problem considerably worse. The use of mechanical lung ventilators help, but do not fully resolve problems with breathing and blood oxygenation.

Cardiac arrest was once thought to be the most common cause of anaesthetic death in horses. However, progressive improvement in monitoring and medicines to support the cardiovascular system has occurred over recent years, so that anaesthesia alone is less likely to be fatal.

Unfortunately – and to some extent unavoidably – horses still succumb during recovery from anaesthesia to catastrophes that would not have occurred had the horse not been anaesthetised, hence the safety of “standing surgery”. Probably the most distressing of these – to both horses and those attending them – are unexpected fractures that occur in recovery when horses stand clumsily, or normally, but when bone is weakened by surgery, undetected injuries or disease.

Preparing a horse for an anaesthetic

If your horse is insured, then you should speak to your insurance company before your horse is booked in for any routine operation to ensure the procedure is included in your cover.

In the case of an emergency, you should notify your insurance company as quickly as possible. If surgery goes ahead without your insurer’s knowledge then it is possible you may find yourself with a very large vet bill to pay. Some companies may request an extra premium to cover the higher risk of a general anaesthetic.

Most equine hospitals will ask for the horse’s shoes to be removed, to reduce the risk of injury, but this is not always the case so check with your vet. You should also ask whether the horse should be starved ahead of the procedure and if so, for how long. Current thinking is that starving a horse prior to surgery is not necessarily beneficial and can be linked to complications such as gastric ulcers or post-operative colic. This may also be linked to the medications administered, so careful monitoring before, during and after surgery is really important.

While minor, brief, simple procedures can be done safely in the field, challenging operations need to be conducted where optimum facilities are present, which really means an equine hospital with full theatre facilities and vets with specialist skills in both anaesthesia and surgery. This reduces the risks involved with anaesthetic and, if problems do occur, more equipment and expertise is readily available.

However, optimum facilities also require dedicated and skilled personnel. Despite the introduction of new drugs, equipment and knowledge, the most important safety factor after the horse itself is the hospital team, comprising anaesthetists, grooms, nurses and surgeons.

The five stages of anaesthesia

The risks of anaesthesia-related tragedies can be reduced by proper planning, training and paying meticulous attention to detail. Most anaesthetics are uncomplicated and uneventful, but in others critical events can occur for (occasionally) no obvious reasons. These demand prompt action to avoid serious consequences. Regrettably, not all cases result in a successful outcome.

• The vital planning phase

Any horse that is due to be anaesthetised will be given a thorough check-up to detect risks of any potential complications. The anaesthetic regime can then be modified to suit that horse. It’s possible that a routine operation will need to be postponed until the horse is fit enough to be anaesthetised. In addition the horse’s temperament can be assessed. Usually, the neck is clipped and a catheter inserted into the jugular vein to provide a pain-free route for giving the anaesthetic and intravenous fluid therapy. The area for surgery may also be clipped to save time later.

• Pre-anaesthetic

This often includes giving the horse a “pre-med” injection as a tranquilliser, which reduces anxiety and provides protection for the horse’s heart once anaesthetised. The horse is then groomed, the feet and mouth washed and the tail bandaged.

• Induction or start

Unlike people, horses do not lie down quietly counting to 10 as anaesthetic is injected and so measures are required to ensure they do not harm themselves (nor those around them) as they collapse at the start of anaesthesia (induction). Modern anaesthetic techniques help, but purpose-built padded induction and recovery boxes fitted with various means to support the horse are becoming increasingly popular, so that the horse lies down on a soft surface. Initially, the horse is heavily sedated and then several minutes later an anaesthetic injection is given to render it unconscious.

• Maintenance of anaesthesia

Once the horse is lying down, an “endotracheal tube” — a long, hollow tube — is passed through the mouth via the larynx and down into the windpipe. A cuff is blown up around the tube so that the horse breathes only the gases supplied via the anaesthetic machine. This is a mixture of oxygen and the anaesthetic gas that keeps the horse unconscious. Frequently, cocktails of intravenous anaesthetic drips are used instead of or as well as breathing in gases.

An overhead hoist may be used to move the horse from the padded box into the theatre — some patients may weigh up to 1,000kg. The horse is then carefully positioned on the operating table on its side or back, depending on the surgery to be performed.

Positioning is very important, especially for operations lasting several hours, to avoid a complication known as post-anaesthetic myopathy, where horses’ muscles become swollen and painful as a result of poor blood supply while being “squashed” during the operation.

During any operation, the horse is constantly monitored so that the depth of the anaesthetic is known. The eye reflexes are noted and the rate and character of breathing are recorded. Sometimes it is necessary to control the breathing via a ventilator. Sophisticated monitoring equipment records the horse’s heart rate and rhythm and other vital signs. A catheter may be placed in an artery to monitor blood pressure and if it drops, specific treatment is given. Low blood pressure during surgery can result in major complications.

• Recovery

After the operation the horse is hoisted back into a padded recovery room. Usually it is left alone to come round in a darkened, quiet environment while being watched from a safe distance. It can be necessary to give further sedatives to make the recovery smoother.

Recovery from anaesthesia in horses is frequently unpredictable and it is not until the horse is safely back on its feet that an operation can be considered successfully completed. Many different techniques have been used to ensure a horse stands up successfully after surgery, from a quiet independent “natural” recovery to interventional systems using ropes² or slings. In some US and Swiss centers, horses are recovered on modified rafts in purpose-designed swimming pools.

Understandably, not all horses are temperamentally suited to these (or other “interventions”) and there is no one fail-safe technique. This is why so many different options are being tried. However, a recent survey showed that 40% of equine anaesthetists provide some form of assistance during recovery, although techniques that suit one horses may not be tolerated by others. The reality is that a limb dislocation or fracture only requires the horse to make one unsteady step in its attempt to stand.

Pain control

Pain has a major effect on the quality of a horse’s recovery from anaesthesia, with animals experiencing the highest levels of pain having the worst recoveries. Fortunately, there is now a considerable amount that can be done to make horses more comfortable at this time. Options range from giving “bute” in minor cases to potent analgesics like morphine, and newer morphine-like drugs, where required.

Different painkillers can also be given in several ways, ranging from sophisticated mixtures given by intravenous “drip”, to epidural catheters: thin tubes passed into the spine via the tail-head. The latter are particularly good for controlling chronic debilitating hind limb lameness.

Previously, concerns with drug side effects or fears that painkillers would “mask” clinical signs were used as a reason not to give them to horses. Fortunately (for horses) these fears are being increasingly recognised as groundless.

Furthermore, it is being increasingly appreciated that pain itself produces major problems, e.g., it delays healing. Consequently, analgesics are being used more aggressively, and in different ways. For example, giving analgesics before surgery (and pain) begins – in an approach known as pre-emptive analgesia – improves the quality of pain relief produced, so is becoming standard practice.

The potential side-effects of potent drugs are also being minimized by multi-modal treatment, which involves giving a combination of different pain-killers, together, at reduced doses, to produce a comfortable animal with lower risk of adverse drug effects.

Post-anaesthetic after care

The horse’s care after coming around from an anaesthetic will depend on the length of surgery and the procedure that was performed. Most horses will need to spend days in the equine hospital before being discharged to return home to reduce the risk of post-surgery complications. The aftercare required at home will also vary, but your vet will be able to advise on your horse’s needs. All aftercare instructions should be closely adhered to in order to avoid the likelihood of complications.

References

• The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of Phases 1 and 2 September 2002
• A retrospective report (2003–2013) of the complications associated with the use of a one-man (head and tail) rope recovery system in horses following general anaesthesia February 2018

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A pony who was impaled by a 70cm fence post in her chest as she jumped a fence “in panic” is expected to make a full recovery following major surgery.

Jasmine Price was taking part in a cross-country lesson at Poplar Park Equestrian Centre with her pony Penny before Christmas when a jump flag caught by wind caused the pony to spook and unseat Jasmine.

Juliet Price, Jasmine’s mother, said: “Penny was clearly in a panic and she was heading towards her own field. In order to get there, she jumped a post and rail fence.”

*NB: Please wait for the video to load. Warning: video contains graphic footage*

A spokesman for Newmarket Equine Hospital said when Juliet caught Penny she saw blood “trickling down her back legs” which didn’t appear to be serious but then found a large wound on her chest.

“It was huge and at that stage I didn’t know what had caused it. I assumed she had caught it on something when she jumped the fence,” said Juliet.

Staff from Poplar Park came to help and it was noticed Penny had a swelling on her right side.

“A call had been made to the local veterinary practice, Ryder Davies, and by the time the vet arrived the swelling was quite pronounced,” said the Newmarket spokesman.

“The shape was unusual, almost square, and led them to wonder whether a piece of the fence post had caused the chest wound and was now protruding beside the rib cage.”

Penny was transferred to Newmarket Equine Hospital and admitted immediately for emergency surgery by a team led by consultant surgeon Matt Smith.

“It was obvious that the protrusion in her side was indeed a section of post which presumably had broken off as she jumped the fence,” said the spokesman. “Matt knew that his first task was to locate the exact position of the piece of wood and remove it, while doing as little internal damage as possible.

“What he had not anticipated however was that although it was not visible at the wound site, the section was 70cm in length.”

Mr Smith said while he had seen a “wide range of traumatic injuries” and removed “a multitude of foreign bodies”, this was a first.

“When I started to extract it via the chest wound it just kept coming. It is quite remarkable it didn’t damage any vital structures and avoided penetrating the thoracic cavity,” said Mr Smith.

Penny survived the surgery but required round-the-clock care in the hospital’s intensive care unit.

“One of the main concerns following an injury of this nature is development of a pneumothorax – when air gets into the chest cavity causing collapse of the lungs. Penny was monitored closely for any indication of this. Thankfully she started to show early signs of recovery and proved to be a model patient,” said the spokesman.

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Three weeks after the incident Penny was allowed to go home.

“I just can’t thank Matt and his team enough,” said Juliet. “From the time we arrived with Penny to the time we picked her up they have been incredibly kind and supportive.

“We were so worried about Penny but we knew she was in the best possible hands and I was confident that if anybody could have save her it would be Newmarket Equine Hospital.”

Penny “still has a long way to go” but Mr Smith is “optimistic” she will make a full recovery.

For all the latest news analysis, competition reports, interviews, features and much more, don’t miss Horse & Hound magazine, on sale every Thursday.

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An H&H reader is appealing for walkers to take more care when using footpaths in paddocks after her horse was injured on a gate.

Mary Emeny, from Scaynes Hill in West Sussex, was shocked to find her three-year-old filly with a huge wound in her side on 5 June.

The three-year-old home bred, called Midwych Skylla, escaped from her field after walkers left a gate unlatched.

Her side was caught on the gate latch, causing a serious wound, 40cm long and 20cm high.

“Walkers untied and left a footpath gate open into our neighbours’ field, even though there is a stile next to the gate,” Ms Emeny told H&H.

“The filly went through the gate but caught her ribcage on the gate hook. She ripped a horizontal gash down to the bone.”

The horse had 500 stitches put in by Cinder Hill Equine Vets.

Vet Hazel Steven, who treated Skylla, told H&H she’d seen similar things in the past, but more commonly leg injuries related to fences.

“She had a serious wound on her flank,” said Ms Steven.

“I imagine a few horses tried to squeeze through and she was caught. It’s the biggest and most traumatic injury of that type I’ve seen — it took seven hours of surgery.

“She’s very lucky the latch didn’t go into her chest or abdomen. It had gone through three layers of muscle and the bone was exposed.

“She’s also fortunate she avoided any complications and has made a good recovery.”

Skylla was then on box rest and treated daily with antibiotics.

“Luckily she is recovering well and we turned her out for the first time on 29 July,” added Ms Emeny.

Skylla is bred to showjump and is being aimed at the four-year-old championship at Hickstead next year.

Ms Emeny is now urging walkers to think about the implications of leaving a gate open.

“The general rule of the countryside is if you find a gate shut then shut it and if open leave it open,” added Ms Emeny. “Be aware of any livestock in the field and respect other people’s land.”

Ms Steven added: “There are so many public footpaths in the area. People need to understand the idea of sharing land as there are so many different groups of people in the area using the paths.”

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Blackthorns are the bane of many hunters, because of the vicious thorns that act almost like poisoned arrows.

These nasty thorns can penetrate the soft tissues taking all sorts of bacteria in with them to cause potentially catastrophic infections. Location is key for blackthorn punctures — even though they are tiny, it is where they end up that causes problems.

There are multiple joints, tendon sheaths and bursae in every horse’s limb, which are relatively superficial, beneath the skin, so they are alarmingly vulnerable.

All these vital structures are closed pouches of synovial fluid, which are designed to lubricate the horse’s joints every time his limbs move. This normally works well until an injury allows a blackthorn or any other foreign body to penetrate a synovial cavity.

Any such puncture wound allows bacteria to invade and produce a potentially very serious infection. This produces obvious pain and lameness because of the inflammatory reaction, which causes swelling within the synovial cavity. This can cause career-ending damage to surrounding tissues, such as joint cartilage or surrounding tendons.

Effective management of these injuries requires prompt recognition of the condition and appropriate treatment right away. If a horse has a blackthorn inside a joint, then the best treatment is keyhole surgery (arthroscopy) to look inside the damaged area, then flush and remove debris and infection from the joint.

Best chance of success

The University of Liverpool vet school has recently published a review of more than 200 horses treated in this way, to identify the factors that may be associated with survival.

To confirm that a joint or similar is affected, a vet will collect a fluid sample, commonly called a joint tap. The research showed that when this had higher levels of total protein — meaning it was more inflamed — this was a bad sign. Similarly, the presence of moderate to severe inflammation at surgery was also not good, especially as such cases are likely to require multiple surgeries.

An interesting finding was the increased likelihood of survival where an obvious wound was present. This may be related to the injury being noticed sooner, but also because an open joint wound may allow drainage of inflammatory fluid, thus reducing detrimental joint swelling and build-up of damaging inflammatory mediators.

Surprisingly there was no significant link between time from initial injury to treatment, the level of white blood cells (pus) measured or the presence of bacteria cultured in the sample.

It was found that when anaesthesia was induced out of normal working hours, it was not advantageous to horse outcome. Instead it seems that there are benefits to stabilising the patient prior to anaesthesia and not going for immediate emergency surgery.

The good news is that overall survival rates were good.

Ref: Horse & Hound; 22 January 2015

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Whether it’s elective (planned) surgery or emergency equine operations, the news that a horse must be admitted to hospital can trigger an avalanche of worry.

An understanding of what’s involved in an equine operation can allay certain fears and, in some cases, enhance the chances of a positive outcome. Lynn Irving of the Rossdales Equine Hospital nursing team outlines common hospital practice.

How do I prepare my horse?

“While it can’t be helped if a horse comes in covered in mud in an emergency, for elective surgery it is helpful if he’s clean. Some owners give their horse a bath, but brushing him over and picking his hooves is sufficient.

“Some hospitals will request that a horse’s shoes are removed before surgery. We don’t, as we cover and tape them before anaesthesia, but check with your vet before admission.

“With a planned procedure it’s usual to receive paperwork beforehand, detailing anything you need to arrange. You might like to bring your horse with his own equipment, such as a headcollar and rugs, if a hospital allows, but at Rossdales we have everything that’s needed.”

He’s a fussy eater – should I bring his own food?

“Most hospitals supply standard food, although you may choose to bring supplements or a particular type of forage. You’ll be able to discuss your horse’s dietary needs or any food allergies with the head nurse when you arrive.

“Keeping a horse in his usual routine can help reduce complications, stress and intestinal problems, so the nursing team will be keen to make him feel at home. Tell the hospital about his likes and dislikes. A donkey once turned up with his own supply of gingerbread men!”

Will the staff tolerate my horse’s bad habits?

“Horses are out of their comfort zone in hospital and often need injections or other procedures. The aim is to make the experience as stress-free as possible.

“Be honest about your horse’s habits. It doesn’t matter if he kicks or bites — we’re not here to judge — but we can deal with him safely if we are aware. And if he resumes his usual habit of pulling faces or banging the door at feed time, we’ll know he’s starting to feel better too.”

Should he be starved before an operation?

“Ideally he shouldn’t eat for six to seven hours before an elective procedure, so that his gastro-intestinal system is not full of food. It’s important that his system starts working again afterwards, so he’ll be offered a bran mash or a warm feed as soon as he is able to eat.”

Hospitals vary on their policy on starving horses as it is not always necessary —nor practical, for instance in emergencies.

Is my horse at risk of infection?

“Strict hygiene protocols should be in place to prevent admission or spread of infection and to protect healthy patients. You’ll be expected to produce your horse’s passport and paperwork before he can be unloaded. Infectious cases are often dealt with in an isolation unit, away from the main yard area.”

Will he settle?

“Hospitals work to a routine and most horses settle into this surprisingly quickly. Nursing staff will appreciate how difficult it can be to leave a horse, giving you ample time to say goodbye and ask any questions about his treatment and care.”

How long must he stay?

“The post-op stay is kept as short as possible. Most referring vets have great practice set-ups for rehab, and there’s no better place for a horse to recover than in his familiar home environment. Expect a two- to three-day stay for simpler elective procedures, or around seven to 10 days for something more complicated, such as colic surgery.”

Will I be able to visit him?

“Very occasionally a horse will get stressed when his owner comes but in most cases a visit really peps up a horse and changes his demeanour for the better. Most hospitals try to facilitate this if it is safe to do so, once the post-op grogginess has passed, usually after 24 hours. Even horses in isolation can be visited if owners wear protective clothing.

“There are exceptions, such as if the horse has had a bone scan or treatment with radioactive iridium wires.”

What if the worst happens?

“Sadly, there are some horses that do not recover or must be put to sleep. At Rossdales, euthanasia takes place in the padded recovery room. Owners can stay but it’s not something we encourage. If they do, it’s important that they’re aware of what they’ll see.

“People are welcome to spend the time they need with their horse and take mementos home, such as his shoes, mane or tail hair.

“Don’t be afraid to ask the questions that may be on your mind.”

How do I care for my horse after surgery?

“It can be worrying to take a horse home, especially after major surgery, but it’s an important step in the recovery process. The vet team should issue discharge instructions explaining any medication or management he will need and outlining feeding, turnout and exercise.

“Be vigilant for the usual signs of infection or illness, such as smell or discharge from a wound, or colic. Call the hospital sooner rather than later if you are unsure.

“With luck, recovery will be trouble-free. Just don’t forget to send in a photo of your horse once he’s back in action or competing again — it’s what makes the job so worthwhile.”

General anaesthesia: what are the risks?

The decision to place a horse under general anaesthesia is not taken lightly. An estimated one in 100 (0.9%) horses die during or within seven days of anaesthesia, with the figure higher still (1.6%) for emergency cases. To put this in perspective, figures stand at one in 1,000 for small animals and one in 29,000 for humans.

“The biggest risk for horses is heart failure,” says Amanda Piggot MRCVS of Rossdales. “Certain muscle conditions (myopathies) and nerve complications (neuropathies) can occur during surgery and recovery. There is danger of a leg fracture during recovery (e.g. leg or neck) and always a risk of colic post-surgery.”

However, in recent years procedures have improved.

“Many of the “knock-down” drugs used haven’t changed for decades but the inhalation agents — the “gas” — are much safer,” she explains. “Whereas previously we might not have been aware of complications until after the operation, we can now monitor blood pressure and oxygen levels more closely during surgery.

“Some horses don’t cope as well under general anaesthesia. Age and breed don’t appear to affect outcome, although a heavier horse is more likely to suffer a myopathy or neuropathy due to muscle weight.

“It takes between 20 minutes and two hours for the horse to stand after surgery. We place the horse in a padded room and assist with head and tail ropes to guide him to his feet.”

While results of current research into mortality rates may well reveal slightly lower figures, it is likely that risks will remain.

“Certain surgeries, such as colic surgery and arthroscopies, have to take place under general anaesthesia because of the high risk and expensive equipment used,” says Amanda. “But more procedures can be carried out ‘standing’ with local anaesthetic and sedation. These include ovariectomies, dental work and some kissing spine operations.”

Don’t forget insurance for equine operations

Notify your insurance company before an operation unless the procedure is an out-of-hours emergency.

“This could include colic surgery, fracture repair or an emergency procedure on a mare struggling to foal,” says Fiona Gordon-Clarke of Carriagehouse Insurance.

“If something happens during the night or at a weekend and a snap decision must be made, it should be OK to ring them on the Monday to explain.”

This article was first published in Horse & Hound magazine (6 November 2014)

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Find out more about the latest advances in keyhole surgery from H&H's vet news expert, Peter Green MRCVS

Keyhole surgery, or arthroscopy, is now the method of choice for removing bone chips from joints, sorting out osteochondrosis problems with joint cartilage and looking inside tendon sheaths.

Although there have been a few brave attempts to perform keyhole joint surgery in standing horses under sedation, the vast majority is undertaken with the horse on the operating table under general anaesthesia.

Compared with old-fashioned joint surgery, in which the surgeon made an incision big enough to open up the joint and look inside with the naked eye, our contemporary keyhole techniques are a revolution. The current standard keyhole instruments are about 2-4mm in diameter, the thickness of a medium-sized knitting needle.

But even these are beginning to look dated as cameras and imaging equipment become smaller and smaller. Scientists have developed cameras small enough to stick on to tiny insects as they go about their daily life. Now, they have developed arthroscopy equipment no thicker than a hypodermic needle.

Vets in Colorado, USA, have reported on the use of 18-gauge keyhole surgery equipment for operating on the stifles of standing horses. This needle gauge is only just over 1mm in thickness, just like the needles we routinely use to perform joint blocks as part of the lameness work-ups.

The images obtained from this miniaturised equipment were just as good as those the standard 4mm camera could produce and the surgeons were able to operate on the stifles without sending the horses to the operating table.

Pioneering new surgery to help heal broken ribs is allowing riders to return to the saddle sooner.

Until now, treatment options for this common injury have been limited – time, heavy strapping and plenty of painkillers have traditionally been doctors’ orders. Ribs can take months to heal.

The Synthes Rib Matrix procedure uses advanced technology to stabilise the fracture and pull the ribs back into place. It is said to reduce healing time and ease pain considerably.

Consultant thoracic surgeon Tom Routledge, who has performed the procedure on several riders at London Bridge Hospital, said: “A small incision is made above the affected area and we insert a tailor-made titanium plate, which holds the bones in place.

“Within 24 to 48 hours after the operation, patients are more comfortable, are in better shape and are usually only in hospital for two or three days.”

Although the procedure is available on the NHS for patients with orthopaedic fractures, such as those in the knee, foot and ankle, it is currently only available privately for rib fractures. It costs in the region of £15,000.

Cleone Pengelley, 60, believes she would no longer be riding had she not had the operation.

“I fell off a broncing four-year-old 18 months ago, landed flat on my back and broke five ribs,” she told H&H.

“I went to my local hospital several times, but was told to let nature take its course. I heard about the new surgery from another doctor and had the operation last July. I was hunting again by Christmas.”

Mrs Pengelley recommended the surgery to Angie Whittington, mother of event riders Francis and Bryony, who was kicked in the back a year ago.

“I was still in agony two months after the accident and was having trouble breathing,” said Mrs Whittington.

“My ribs were smashed to pieces and were not knitting back together as they should. Without the surgery I have no doubt I would still be struggling. I was back teaching again after four weeks.”

Visit: www.londonbridgehospital.com.

This news story was first published in the current issue of H&H (30 August 2012)

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History was made in Chinese veterinary surgery last month when the first stifle arthroscopy (keyhole procedure) was carried out.

A team led by specialist equine surgeon Cedric Chan, who runs his own practice NW Equine Referrals Ltd, travelled to Shanghai on 27 October to perform surgery on one of China’s top showjumpers, Heraldo.

London based Mr Chan was assisted by anaethetist Claire Booth and Michelle Barber as head nurse, both from the Towcester Veterniary Centre Equine Clinic, Northamptonshire.

“[The surgery] was a complete success for the Chinese and Western veterinary teams,” Mr Chan told H&H.

The procedure took place in a modified stable with the addition of hay bales, a gymnastics mat, ropes from the ceiling and local manpower to move, position and recover the anaesthetised horse safely.

Nonetheless, the actual surgical equipment used was state of the art.

Ms Booth said: “It was very exciting to be involved in the first steps of development of equine surgery in China.”

There are now plans for a hospital similar to the Towcester Equine Clinic to be built at the Shanghai Equestrian Centre, where some of China’s best competition horses are in training.

Equestrianism in China is rapidly expanding alongside the overall wealth of the country.

However Mr Chan added: “The level of equine veterinary care overall in China is similar to Western standards around 20 years ago.”

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Read more on surgery

Find an equine vet

Such swellings include bursitis, an inflammation of the fluid-filled sac that lies between a tendon and skin, or between a tendon and bone.

Examples include a capped hock or elbow, hygroma of the knee, a thoroughpin, an articular windgall or some bog spavins.

While these swellings may be unsightly, they rarely compromise performance. They will only occasionally become so pronounced that they limit joint mobility and cause physical unsoundness.

Needle drainage (with or without a corticosteroid injection) and pressure bandaging frequently has disappointing results – the distension usually returns rapidly once the pressure is removed.

Surgical removal is difficult and traumatic, with post-operative swelling and scarring often compounding the pre-existing fibrous deformity.

Vets will rule out the presence of any underlying pathology by X-raying, ultrasound scans or other investigations, before agreeing to attempt to reduce a swelling.

For the full veterinary article ‘Under the knife’, see the current issue of Horse & Hound (27 October 2011)

Looking for more articles on surgery?

Find an equine vet

A shire foal has become the first horse in the UK to undergo a radical new procedure to restore her sight.

Vets advised owners Donald and Jane McIntrye from Bristol to put Mary Anne down when she was discovered to be blind shortly after birth. But after carrying out research the couple opted for pioneering cataract surgery, carried out by vet Tim Knott.

“The operation cost about £6,000 — I guess we are big softies,” said Mr McIntrye. “But it was worth it. After the operation she was literally dancing around and jumping for joy. There was no stopping her.

“It was also the first time that she could see her mother and that made her very happy. Mary Anne has settled down really well and we have no regrets about it.”

The surgery, which involved removing Mary Anne’s cataracts and inserting lenses into her eyes, is a recent development in equine care.

Mr Knott explained: “Cataract surgery on animals has been around for a while, but has always been unsuccessful on horses. There are now three vets in the UK doing it, alhtough Mary Anne was one of the first, if not the first, to have it done.”

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Italian event rider Susanna Bordone is to undergo emergency facial reconstructive surgery after a freak accident at Luhmühlen Horse Trials in Germany last weekend (14-19 June).

Susanna was putting an extra rug on her CIC*** ride Amacuzzi during late-night stables on the Saturday evening when he snapped at her, badly biting her face. She was due to have her first operation at the end of this week.

Susanna, 29, is Italian national champion and was a team bronze medallist at the 2007 European Championships. She also rides at the top level in pure dressage, competing in both disciplines at last year’s World Equestrian Games.

This news story was first published in Horse & Hound (23 June, 2011)

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Construction work has started on a state-of-the-art surgical facility for treating horses and farm animals at Bristol University’s School of Veterinary Sciences at Langford.

The £3million centre, which will be completed in October, will be known as the Alborada Building, after its main benefactors the Alborada Trust.

Besides surgical treatment, investigation and diagnosis for large farm animals, the centre will be used for training undergraduate and post-graduate students in advanced clinical techniques.

Professor Jo Price, head of the school of veterinary sciences, said: “It will house surgical and treatment facilities that will be unique to the region and confirm the university’s veterinary school as a centre of excellence for the treatment and care of horses and farm animals, the training of veterinary surgeons and the development of welfare research.”

She added that research undertaken at this new centre will be of “immense value to vet students and clinical academics” here and abroad.

The information will be made available to horse owners, farmers and vets in research papers and conferences.

The ceremony to cut the “first turf” was opened by the chairman of the Langford Trust, Sir David Wills yesterday (14 February). Miles Littlewort lifted the first turf on behalf of the Alborada Trust.

“This exciting event is a great milestone for both the Langford Trust and the university’s veterinary school,” said Sir David.

“We are extremely grateful to the trustees of the Alborada Trust for making it possible.”

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Colic surgery has been successfully performed on Dante, a two-year old zebra, at the Washington National Zoological Park in the US.

Dante had been visibly uncomfortable and lying down for uncharacteristically long periods of time, demonstration that there was a serious colic problem.

“When one of these animals is sick, it is pretty challenging because, as prey animals, they tend to hide pain,” said Carlos Sanchez, associate vet at the zoo.

It was a routine operation for vet Jennifer Brown, who is the clinical assistant professor in emergency care and equine surgery at the Marion duPont Scott Equine Centre, but unlike domestic horses, zebras are unapproachable without anaesthetic and dangerous to handle. They are also harder to anaesthetise. Once on the operating table the process is similar to that used on a horse.

“Once his stripes were covered up, I couldn’t tell the difference between him and a horse — they have almost the same gastrointestinal tract, although colic is fairly uncommon among zebras,” she said.

Dante was returned to the zoo 10 days after surgery to continue his successful recuperation.

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The most frequent uses for laser surgery in horses at present are for the treatment of upper airway disorders and skin problems such as sarcoids. Lasers have also been used to perform neurectomies (surgical cutting of a nerve), and less commonly, surgery of the eye, uterus (removal of uterine cysts) and inside the joints of horses, combined with arthroscopes.

Internal use of laser surgery

Upper airway conditions that may be treated using laser surgery include:

• In horses with epiglottic entrapment, the fold of tissue entrapping the epiglottis can be transected with the laser fibre, freeing the epiglottis and allowing it to function normally.
• Axial deviation of the aryepiglottic folds — a condition in the soft tissue of the larynx that can cause noise at exercise and reduced performance — can also be treated by removing a portion of the fold .
• Treatment for roarers. Similarly, laser surgery can be used to remove the vocal cord or to obliterate the laryngeal ventricle (laser Hobday procedure) in horses with recurrent laryngeal neuropathy (laryngeal paralysis). Laser surgery has not replaced conventional surgery but the procedures can be combined.
• Soft palate surgery. The laser can be applied to the soft palate at numerous points in horses with dorsal displacement of their soft palate. This is the technical term for those that choke up or gurgle, making them slow down when they race. The principle of this treatment is to create more fibrous tissue in the soft palate making it stiffer in nature and hence less likely to displace. This is similar to treatment undertaken in humans to stop snoring.
• Laser can also be used to remove masses (such as cysts and tumours) or scar tissue that has formed in the upper airway and to remove the remains of ethmoid haematomas after formalin treatment.
• Guttural pouch tympany. A new opening can be created between the pharynx and guttural pouch allowing air to move out more easily.

Following laser surgery of the upper airway, horses are usually given anti-inflammatory treatment and, in some cases, antibiotics as well. Depending on the surgery performed, horses are normally kept rested for two weeks and provided that upper airway inflammation has reduced, they can resume normal exercise.

External use of laser surgery

Skin masses such as sarcoids, melanomas and other skin tumours may be removed by laser depending on their location and suitability for removal.

Lasers can also be used to assist management of wounds, e.g. preparation of granulation tissue for placement of grafts.

Sealing of vessels and nerves by laser may result in less swelling and pain after surgery and can make recurrence of masses less likely compared to traditional removal by a scalpel.

This veterinary feature was first published in Horse & Hound (17 May, ’07)

A horse’s chances of surviving colic surgery have improved greatly during the past 35 years. Significant improvements have been made. Earlier referral of cases for surgery, specialist training of surgeons and anaesthetists, developments in anaesthetics and advances in post-operative care have bettered the outcome for horses with colic. The end result is that surgery is performed more commonly and the patient’s chances of survival have improved significantly.

What does colic surgery for horses involve?

Fortunately, of all the horses with colic, less than 10% require surgery to save their lives. However, when colic surgery is required, it is a major job involving a team of skilled surgeons, anaesthetists and nursing staff. Severe colic can occur at any time of day or night, so a trained team needs to be available 24hr a day, 365 days a year, which is why this type of surgery is performed in a relatively small number of equine hospitals.

Colic cases needing surgery present a challenge, as they usually need to be operated on quickly and kept under anaesthesia for as short a time as possible. The risks associated with anaesthesia in horses are greater than in humans or dogs, and these risks are even greater with colic, due to the harmful effects of toxins released from the intestine.

In many cases, it is impossible to know what the exact problem is until surgery is under way and the abdomen can be examined properly. In some instances, such as when intestine has ruptured or when severely injured intestine cannot be removed, the chances of recovery may be so small that the surgeon may advise that the patient be euthanased while under anaesthesia.

Post-operative care after colic surgery

Following colic surgery, some horses make an uneventful recovery and can return home within five to seven days. For others, it may be a roller-coaster ride of ups and downs, requiring several days of intravenous fluids and intensive medical care — or, in the worst cases, repeat surgery.

The most common problems encountered in the first few days after surgery are:

• the effects of endotoxaemia (toxins released by damaged gut)
• ileus (where the intestine becomes “paralysed”)
• continued abdominal pain.

In common with humans, adhesions (scar tissue) can be a major problem following abdominal surgery in the horse and these may go undiagnosed. These adhesions have the potential to cause signs of colic in the weeks or months after surgery.

Once discharged from the hospital, colic patients require several weeks of box-rest to allow the abdominal incision to heal, followed by periods of controlled turnout and gradually increased exercise. Most patients can return to gradually increasing work within four to six months.

Success rates of colic surgery in horses

Currently, around 80% of horses undergoing colic surgery at specialist clinics will return home and research has shown that the prognosis may be just as good for an older pony as a fit, young Thoroughbred.

The prognosis for individual patients will vary depending on the type and severity of the problem, and mortality rates are highest in the first few days after surgery.

Several studies have shown that horses suffering from severe endotoxic shock beforehand stand less chance of survival following surgery. Typically, they have severely damaged intestine that requires removal and colic will have been going on for many hours. In addition, reduced survival has been associated with resection of intestine, post-operative ileus and repeat abdominal surgery (laparotomy).

Once horses have recovered from the effects of surgery and the incision has healed fully, there is no reason why they cannot return to their previous jobs. There are many examples of horses who have recovered from colic surgery and have gone on to compete internationally in all disciplines.

Research has shown that the most common problem encountered after discharge from the clinic is colic, so one or more episodes in the year after surgery may not be unexpected. Many of these episodes are minor and cause no further problems, but some may be more severe, requiring further surgery or euthanasia.

These episodes are usually thought to be associated with adhesion formation, particularly after small intestinal surgery, or recurrence of the problem (more common in certain large colon disorders).

So is colic surgery in horses worth it?

The prognosis is good for most horses and ponies undergoing colic surgery, provided it is undertaken early. A delay of several hours in a horse with intestinal strangulation — where the blood supply to the intestine is lost — can change the prognosis from good to extremely poor.

The costs involved are anything from £2,000 upwards, depending on various factors. This is due to the number of skilled personnel required and the expense of medical therapy; for example, anaesthetics and intravenous fluids are more expensive for a horse than a much smaller animal. Invariably, the horses that are extremely sick when they arrive at the clinic tend to require more intensive — and expensive — care following surgery, but, even in horses that appear to stand a good chance of survival, unexpected complications may occur.

Unfortunately, there is no guarantee of success and an owner may be left with a large bill and no horse. Good communication between owners and carers of horses undergoing colic surgery, the hospital team and the referring vet is vital to discuss the patient’s chance of survival, likely complications, costs and aftercare following discharge from the clinic.

Continued research will further improve survival rates following colic surgery and, in common with humans, some focus will be on minimising the harmful effects of endotoxins and preventing adhesions forming. However, the single most important factor in giving a horse or pony the best chance of survival following colic surgery remains early referral.

• This veterinary feature was first published in Horse & Hound

If the corneal surface of the eye is damaged, the most likely result is an ulcer, which can be very painful. Such corneal injuries are prone to secondary infection by bacteria and fungi, which can, in some unlucky horses, result in the development of deep, non-healing ulcers or abscesses.

Corneal ulcers are so common that they will be the first thing a vet will suspect when presented with a horse with suddenly red, sore, half-closed and weeping eye.

Diagnosis is made following a thorough examination of the eye. Some corneal injuries are readily observed, but very tiny ulcers or abrasions show up more clearly following the application of various coloured dyes that stain them green or pink. The appearance of the lesion can be suggestive of the cause.

Swabs, scrapings or biopsies are sometimes necessary to confirm diagnosis with deep or non-healing ulcers. The material can be examined under the microscope to detect the presence and type of bacteria or fungi. Antibiotic sensitivity testing may also be performed.

Thankfully, treatment of most corneal ulcers is straightforward. Providing the equine patient is amenable to having medication administered to the eye, a short course of antibiotic drops or ointment will rapidly return the eye to normal.

Difficulties arise when the horse objects to anything being put into the sore eye, and if bribes, sedation or a twitch will not improve matters, the vet may insert an indwelling catheter. This allows remote administration of the treatment via soft rubber tubing implanted under the eyelid and then plaited into the mane enabling treatment at a safe distance. There are even sophisticated tiny battery-driven pumps available that permit — at a price — a constant drip of treatment to be pumped into the eye.

Typically, not everything with horses goes according to plan, so although the majority of ulcers will resolve within a few days, a small percentage do not heal within the expected time frame. It can be a really frustrating condition for all concerned, when despite all efforts the eye does not seem to improve. There can be a variety of reasons for this:

• Something continually rubbing on the eye, such as a tiny bit of dirt embedded under the eyelid or, more rarely, an eyelash growing the wrong way or in the wrong place, so it constantly irritates.
• A persistent infection may prevent healing. Bacteria are usually to blame, but in hot, humid areas, especially America, fungal eye infections can be catastrophic. Recently, such cases have been reported in the UK, which could be considered a nasty side effect of global warming.

The most difficult to deal with is the so-called indolent ulcer, where the damaged eye surface becomes unhealthy and unable to heal. These cases may need surgical intervention as well as medical treatment.

Surgery

If eye drops or ointments do not produce a cure, the vet may treat the non-healing ulcer by gently scraping away the area of unhealthy tissue. Sometimes this is achievable with the horse standing, but other cases will require general anaesthesia.

A variety of different procedures can be performed, from a simple scrape to a more elaborate removal of diseased tissue known as a keratotomy. A study of 23 cases suggested that a single debridement, or surgical scrape, early on was beneficial in reducing healing time.

Some cases also benefit from cautery with chemicals, and others are treated by application of a soft contact bandage lens, which helps to protect the eye as it heals.

Some cases end up having more radical surgery under general anaesthesia, where a graft of tissue from the conjunctiva (membranes around the eye) is carefully sutured on to the eye as a natural bandage to encourage healing.

In small animals, such eye problems are sometimes treated by either sewing the third eyelid over the eye or by sewing the eyelids together. However, it is not ideal for the majority of horses, as it conceals what is going on underneath and makes treatment difficult to apply to the eye.

In recent years, treatment techniques have improved and the correct medical therapy and prompt surgical intervention have improved the chance of a successful outcome in many horses who previously would have gone blind.

• This article formed part of a veterinary feature first published in Horse & Hound

The University of Liverpool has successfully operated on a horse with severe cataracts in a rare surgical procedure, which may ultimately pave the way for other horses with the condition to have their sight restored.

The equine patient, James, was completely blind in his right eye and had only limited vision in his left eye due to cataracts before the operation. His prognosis was poor until Dr Derek Knottenbelt and his team at Liverpool University’s large animal hospital at Leahurst on the Wirral decided to operate.

Dr Knottenbelt explains: “This lovely horse was going to become completely blind unless we operated, but the procedure is a rare and difficult one with major risks. We only went ahead as there was really no other option.

“The procedure took around 40 minutes and involved the removal of the lens in the right eye using ultrasound to disrupt the lens material. James’ cataract was so solid that conventional methods for human lens removal were not possible and so the eye itself was opened and the solid portion removed directly.

“We are grateful to Dr David Wong from the University’s Ophthalmology Research Unit for his help with the surgery.”

Although eye surgery is commonly undertaken in humans and small animals, the horse’s eye is particularly difficult to operate on because it is extremely sensitive and can easily collapse when the internal structure is interfered with.

Dr Knottenbelt continues: “Any work on the horse’s eye makes it susceptible to uveitis, or moon blindness as it is also know, which causes the horse a lot of pain, in addition to a lack of sight. At present James is showing no signs of uveitis and is responding to light and dark, which is fantastic news, although his prognosis remains guarded.”

Dr Knottenbelt hopes to operate on James’s left eye once he has fully recovered from the surgery but is keen to emphasise that his team’s success is only a tiny step forwards in understanding and improving equine eye surgery, an area which is fraught with dangers.

“We are trying to develop ways of increasing the chances of a successful outcome and the restoration of sight. We are determined to improve the outlook for horses that would otherwise be condemned,” he says.

The horse’s owner, Tony Sumpton, was pleased with the outcome of the initial operation.

“I am extremely grateful to Dr Knottenbelt,” says Tony. “James is showing good signs of recovery and we hope the operation on his left eye will be an equal success.”

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