Equine Health Update EHU Vol 19 Issue 3 - Page 9

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 • 9