EQUINE | Equine Disease Update
the two agents overall. However, there was a significant
reduction in risk for horses aged 2–5 years, and a 60%
reduction in risk of cardiac arrest, with the use of isoflu-
rane [10]. It is now recognised that inhalant anaesthet-
ics do not provide sufficient analgesia. This has led to
increased pre- and intraoperative use of analgesia: “bal-
anced anaesthesia”.
Use of isoflurane in combination with a continuous rate
infusion of medetomidine, or lidocaine for colic surgery,
has been adopted widely. However, despite these im-
provements in anaesthetic protocols, fractures during
recovery remain a risk. Rope recovery has been shown
to reduce the incidence of fracture rate. Nevertheless,
there is a move within equine surgery towards more
procedures being performed in the standing horse for
example for sinus surgery, laryngoplasty and laparos-
copy [11–13]. Standing arthroscopic procedures are also
becoming more common with fetlock arthroscopy and
diagnostic stifle arthroscopy being easily performed
[2,14]. Distal limb fracture repair is also now common
and allows for easier access and intraoperative radio-
graphs allowing a much more detailed approach to frac-
ture repair [15,16].
Clinical highlights: There is an ongoing need to improve
anaesthetic protocols and reduce the risk of anaesthetic
associated morbidity and mortality. Performing proce-
dures standing removes anaesthetic risk.
Infectious diseases
Prof James Gilkerson highlighted the importance of the
appropriate and judicious use of antimicrobials while
emphasising that increased global travel of horses cre-
ates challenges for the spread of infectious diseases.
Polymerase chain reaction assays have revolutionised
diagnosis, disease monitoring and facilitated improved
quarantine policies. In part, these advances have also
helped in identifying a link between vaccination and the
recent African horse sickness-like disease outbreak in
the Western Cape. Genomic studies have the potential
to change the way we look and treat infectious diseases
in the future.
Clinical highlights: The appropriate and judicious use of
antimicrobials is essential in the veterinary profession to
support global antimicrobial stewardship. Modern dis-
ease monitoring techniques are essential for appropri-
ate measures to be put in place to control and monitor
diseases as horses travel globally.
Tendinopathy
Traditional ultrasonography of the distal limb has con-
centrated on the standard weightbearing incidence
views. Prof Roger Smith stated that there is strong evi-
dence to suggest that, to enhance our understanding
of tendon injury significance and help in the diagnosis
and management of more subtle tendon pathologies,
the use of lesion oriented views may add significant
information to diagnosis and management. These can
include weightbearing, nonweightbearing, appropriate
oblique views and offincidence views [17]. Ultrasound
contrast media can also be helpful [18]. The additional
use of colour Doppler allows the differentiation of acute
and chronic lesions. In addition, it is able to highlight
small lesions, particularly where there is sensitivity on
palpation but no abnormalities on traditional greyscale
images. With respect to treatment of tendinopathy, it
remains essential to reduce inflammation in the acute
phase of injury with a controlled exercise regime dur-
ing the recovery phase. Stem cell therapy, in the form
of bone marrow-derived mesenchymal stem cells seems
to be able to modulate the inflammatory process within
the tendon with minimal deleterious effects [19]. Leg-
islative and cost implications still limit its use in some
parts of the world.
Clinical highlights: Off-incidence views of deep digital
flexor tendon lesions helps to highlight chronic fibrous
tissue enabling monitoring of healing. Doppler ultra-
• Volume 19 no 3 • September 2017 •
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