IN-DEPTH: COLIC


based on multiples of maintenance require- ments. Whereas maintenance requirements were established on fed horses, most colic patients are not fed and the water needs of food-deprived horses are 13% of the needs for fed horses (Freeman, unpublished data). Overhydration can cause anastomotic and in- cisional edema and related complications,83 salt-induced diuresis, and unnecessary ex- pense. The consequences of overhydration are well recognized in human gastrointestinal surgery83 and are more likely after prolonged anesthesia for colic surgery.84


● Horses should be administered flunixin meglu- mine (1.1 mg/kg) twice daily, for postoperative analgesia and inflammation30 because poten- tial adverse effects41 of this drug have not been demonstrated in clinical use.12,30


● Common errors with time-dependent drugs (IV penicillin) should be avoided, such as giving too far in advance of surgery, failure to read- minister at an appropriate interval during a long surgery, and continued use of antimicro- bial drugs in the postoperative period when they might not be indicated.85 Complications from such inappropriate use can include fail- ure to prevent incisional infections, increased risk of antimicrobial-induced postoperative colitis, and increased risk of antimicrobial resistance.85


● Improved accuracy with clinical or adjunctive methods to correctly assess intestinal viability can identify when resection is needed and avoid unnecessary intestinal resection and the associated risk of complications and increased cost.


● Postoperative management should include early reintroduction to oral food intake, start- ing 18 to 24 hours after surgery (Fig. 6).12,17–19 This approach is not intended to provide main- tenance energy needs for an adult horse, but to restore normal gastrointestinal function and to improve attitude,86 provided that surgery has produced a patent gastrointestinal tract. Healing of an anastomosis is enhanced by the physical presence of food material pass- ing through it.87


● The value of repeat celiotomy as an effective means of dealing with postoperative complica- tions should be recognized. Horses can toler- ate the second surgery well, especially if done promptly.49 Repeat celiotomy can be more cost-effective than protracted and ineffective medical treatments, but methods to reduce the associated high rate of incisional infections also need to be evaluated.


● Surgeons need to be sensitive to the cost of colic surgery. Overuse of intraoperative and postoperative medications that lack evidence- based support for their use in the colic patient


Fig. 6. Feeding hay or hand grazing in very small amounts at 18 to 24 hours after small intestinal surgery will stimulate motility and improve the horse’s overall attitude. This is a critical step in hastening recovery.


can rapidly consume the owner’s financial re- sources without improving survival.


● Both in the field and in the hospital, we should be selective with diagnostic procedures on oc- casions when they may not contribute to case management in a meaningful way or would not change our clinical approach to the case. If a veterinarian feels the need to do an abdomino- centesis in the field, he or she must be aware of the limitations and risks, including any asso- ciated delays in referral. Referral might be a more efficacious alternative.


● Future clinical trials should place greater em- phasis on long-term survival after particular treatments because effective treatments should allow horses to reach the end of their lifespans. These studies should also include age-matched controls, to control for attrition through a variety of reasons that could shorten lifespan or limit performance, other than colic.


● Owners and referring veterinarians should be aware that old horses (16 years), even those in their late 20s to early 30s can handle gen- eral anesthesia and colic surgery well and have postoperative survival rates comparable


AAEP PROCEEDINGS  Vol. 60  2014 201


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