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Equine Veterinary Journal ISSN 0425-1644 DOI: 10.1111/evj.12257

International online survey to assess current practice in equine anaesthesia F. D. WOHLFENDER*†, M. G. DOHERR†, B. DRIESSEN‡, S. HARTNACK§, G. M. JOHNSTON# and R. BETTSCHART-WOLFENSBERGER¶ †

Veterinary Public Health Institute, Vetsuisse Faculty, University of Berne, Berne, Switzerland Department of Clinical Studies-New Bolton Center, University of Pennsylvania, School of Veterinary Medicine, Kennett Square, USA § Section of Epidemiology, Vetsuisse Faculty, University of Zurich, Zurich, Switzerland # Vetstream Ltd, Cambridge, UK ¶ Equine Department, Section of Anaesthesiology, University of Zurich, Zurich, Switzerland. ‡

*Correspondence email: [email protected]; Received: 31.05.13; Accepted: 25.02.14

Summary Reasons for performing study: Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1–3, 20 years ago. Objectives: To collect data on current practice in equine anaesthesia and to recruit participants for CEPEF-4. Study design: Online questionnaire survey. Methods: An online questionnaire was prepared and the link distributed internationally to veterinarians possibly performing equine anaesthesia, using emails, posters, flyers and an editorial. The questionnaire included 52 closed, semiclosed and open questions divided into 8 subgroups: demographic data, anaesthetist, anaesthesia management (preoperative, technical equipment, monitoring, drugs, recovery), areas of improvements and risks and motivation for participation in CEPEF-4. Descriptive statistics and Chi-squared tests for comparison of categorical variables were performed. Results: A total of 199 questionnaires were completed by veterinarians from 14 different countries. Of the respondents, 43% worked in private hospitals, 36% in private practices and 21% in university teaching hospitals. In 40 institutions (23%) there was at least one diplomate of the European or American colleges of veterinary anaesthesia and analgesia on staff. Individual respondents reported routinely employ the following anaesthesia monitoring modalities: electrocardiography (80%), invasive arterial blood pressures (70%), pulse oximetry (60%), capnography (55%), arterial blood gases (47%), composition of inspired and expired gases (45%) and body temperature (35%). Drugs administered frequently or routinely as part of a standard protocol were: acepromazine (44%), xylazine (68%), butorphanol (59%), ketamine (96%), diazepam (83%), isoflurane (76%), dobutamine (46%), and, as a nonsteroidal anti-inflammatory drug, phenylbutazone (73%) or flunixin meglumine (66%). Recovery was routinely assisted by 40%. The main factors perceived by the respondents to affect outcome of equine anaesthesia were the preoperative health status of the animal and training of the anaesthetist. Conclusions: Current practice in equine anaesthesia varies widely, and the study has highlighted important topics relevant for designing a future prospective multicentre cohort study (CEPEF-4). The Summary is available in Chinese – see Supporting information. Keywords: horse; anaesthesia; current practice; online survey

Introduction Two decades ago the first series of Confidential Enquiries into Perioperative Equine Fatalities (CEPEF-1 and 2) were initiated and identified a death rate of 0.9% in noncolic cases within 7 days [1,2]. The use of total intravenous anaesthesia (TIVA) was among several factors associated with a significantly reduced risk of perioperative fatalities. A subsequent multicentre randomised controlled trial, CEPEF-3, compared halothane and isoflurane (at the time newly introduced) for maintenance of anaesthesia. The results showed no overall benefit of either drug [3]. No further multicentre enquiries have been conducted, despite advancements such as increased monitoring and changes in equine anaesthetic practice recently summarised in a special edition on equine anaesthesia [4]. Major changes are an increased pre- and post operative use of analgesic drugs and the use of partial intravenous anaesthesia (PIVA) and balanced anaesthesia [5–7]. Therefore a new CEPEF is considered necessary first to identify these changes in anaesthesia care and thereafter to collect data that may help to identify current problems in clinical practice that have an influence on equine fatality rates. In order to assess the current situation in equine anaesthesia and to gather relevant baseline data, a new phase of CEPEF was initiated. In this first phase, the current study collected information on actual anaesthetic practices in equine teaching hospitals as well as private hospitals and practices using an internationally distributed online questionnaire. Besides giving an overview about current anaesthetic practices, this survey provided data that allowed a comparison of some methods used by equine anaesthetists with and without diplomate status in either the North Equine Veterinary Journal •• (2014) ••–•• © 2014 EVJ Ltd

American (American College of Veterinary Anesthesia and Analgesia [ACVAA]) or European (European College of Veterinary Anaesthesia and Analgesia [ECVAA]) specialty colleges. The survey’s additional objectives were to: 1) raise awareness of an impending broader study (CEPEF-4) and recruit participants; and 2) investigate current opinions on which factors are considered to have an impact on the outcome of anaesthesia in the equine species.

Material and methods Data collection An online survey (Item S1) on current anaesthesia practices in equine private practices (PPs), private hospitals (PHs) and university teaching hospitals (UHs) was prepared within the open source tool LimeSurveya. An institution was defined as an equine hospital when inpatient facilities were available and regularly used. The questions were partly based on the ACVAA’s guidelines for equine anaesthesia [8]. The questionnaire was critically reviewed by all coauthors and then tested on 2 ECVAA diplomates, one ECVAA resident and 2 equine practitioners prior to release. It could be completed anonymously, i.e. without providing contact details. To those providing details, confidentiality was assured. Due to the lack of a worldwide list of equine practices and hospitals a complete sampling frame could not be defined. Therefore, the link to the questionnaire was actively disseminated employing a journal editorial [5], flyers and posters at equine veterinary congresses and emails to recipients

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Current practice in equine anaesthesia

within the equine veterinary profession (personal email to individual veterinarians and impersonal emails to equine practices and hospitals, respectively). In addition, the survey was placed on the project’s webpage (http://www.cepef.info). The objective was to reach as many equine veterinarians as possible worldwide. At least one reminder was sent to all whose email addresses were known. Data were collected from November 2011 to April 2012. The questionnaire included a total of 52 closed, semiclosed and open questions divided into 8 subgroups including demographic data, information about anaesthetist(s), anaesthesia management (preoperative), technical equipment and monitoring, drugs, recovery, areas of improvements and potential areas of risk (equipment, monitoring, practice management, working hours, physical status of the horse to be anaesthetised, drugs and training of personnel) and contact details including motivation for participation in CEPEF-4. None of the questions was mandatory.

Data analysis Answers were exported from the online survey database into a spreadsheet. Data analysis was performed using the statistical software package NCSSb. Interval-measured variables were tested for normality using the Kolmogorov–Smirnov test, skewness and kurtosis estimates as well as evaluating the histogram and normal probability (q-q) plot, and means and standard deviations or, when not normally distributed, medians, ranges and interquartile ranges (IQR) were reported. Categorical variables were described using frequencies and proportions. The Chi-square test or Fisher’s exact test (for small samples) were used to compare 2 (or more) independent study groups. The overall level for statistical significance was set to P

International online survey to assess current practice in equine anaesthesia.

Multicentre Confidential Enquiries into Perioperative Equine Fatalities (CEPEF) have not been conducted since the initial CEPEF Phases 1-3, 20 years a...
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