8 – RAID NR 1 – 2025 ANESTHESIA JOURNALS One issue with the anesthesia journals at this hospital is that the quality of the recovery is not included. One improvement that could be made with respect to the anesthesia journals is the amount of data in the anesthesia journal considering breathing or complications, for example recovery scoring. Only when complications are known, changes can be made for specific patients. STAKEHOLDERS AND RESOURCES The stakeholders are everyone involved in the patients – the surgeon, anesthesiologist, healthcare staff etc. If the risk of complications can be reduced, the amount of costs for treatment of these complications also can be decreased/reduced. The resources needed for this intervention are small in comparison to the possible complications that may occur during the recovery phase. In respect to time, this intervention will not prolong neither the anesthesia time nor the time spent in the recovery for the staff. Economically, a small increase in costs per patient will be made (£22), but the expectation is that as many hoses as possible will recover without inspiratory complications. Since the recovery period implicate less monitoring as well as the behavior and anatomy of horses may cause problems, it is difficult to avoid complications completely (Laurenza et al., 2020). Constant and accurate monitoring by experienced personnel and immediate intervention if complications occur is the most essential factor for a safe recovery (ClarkPrice, 2013). PLANNED INTERVENTION Following measures are suggested for this intervention referring to improvements regarding nasal congestion in horses during the recovery phase after general anesthesia; • Ensure that everyone gets the same introduction and intern education when learning how to anesthetize horses. • Create a step-by-step document for the routines in the recovery. This document should be printed and pinned to the wall outside the recoveries and e-mailed to everyone at the hospital, to make sure everyone knows what to do in an emergency situation. • All horses should be clipped and washed prior to surgery as long as they tolerate it. • Draft horses and other big horses with increased anesthetic risk should be operated standing if possible. • The operation room should be completely prepared before the horse enters. • Phenylephrine (3mg/100kg) diluted in saline should be given intranasally to all patients approximately 15 minutes prior to the end of surgery. It should not be given to horses suffering from hypertension or hypovelemia during anesthesia. • The use of a nasal tube when indicated should be continued. • Recovery scoring will be a part of the anesthesia journals, as well as what type of eventual complication that occurred. CONCLUSION The incidence of complications at the hospital was relatively high compared to complications reported in the literature. This may be due to the chosen approach in selection of criteria for complications. The literature was reviewed to evaluate which factors that affect the incidence of nasal congestion, and were considered applicable to make an intervention for. References: Auckburally A and Senior M (no date). Anesthesia: recovery – complications. Vetacademy [Online]. Available from: www.vetstream. com/treat/equis/freeform/anesthesia-recovery-complications [2021-09-05]. Auckburally A and Flaherty D (2009). Recovery from anaesthesia in horses 1. What can go wrong? In Practise 31, pp. 340-347. Clark-Price SC (2013). Recovery of Horses from Anesthesia. Veterinary Clinics Equine 29, pp. 223–242. Doherty T and Valverde A (2006). Chapter 3: The Respiratory System. In: Manual of Equine Anesthesia and Analgesia 1st ed. Oxford: Blackwell Publishing Ltd, pp. 37-66. Dugdale AH and Taylor PM (2016) Equine anesthesia-associated mortality: where are we now? Vet Anaesth Analg 43, pp. 242–255. Johnston GM, Eastment JK and Wood JLN et al. (2002). The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of Phases 1 and 2. Vet Anaesth Analg 29, pp. 159–170. Laurenza C, Ansart L and Portier K (2020). Risk Factors of Anesthesia-Related Mortality and Morbidity in One Equine Hospital: A Retrospective Study on 1,161 Cases Undergoing Elective or Emergency Surgeries. Frontiers in Veterinary Science 6, pp. 1- 10. Lukasik VM, Gleed RD, Scarlett JM, Ludders JW, Moon PF, Ballenstedt JL and Sturmer AT (1997). lntranasal phenylephrine reduces post anaesthetic upper airway obstruction in horses. Equine Veterinary Journal 29 (3), pp. 236-238. Muir WW and Hubbel JAE (2009). Monitoring and Emergency Therapy, 2nd ed. St. Louis, Missouri: Saunders Elsevier. Southwood LL, Baxter GM and Wagner AE (2003). Postanesthetic upper respiratory tract obstruction in horses. [abstract]. Vet Surg 32, p. 602. Thomas SJ, Corbett WT and Meyer RE (1987). Risk factors and comparative prevalence rates of equine postanesthetic respiratory obstruction at NCSU. [abstract]. Vet Surg 16, p. 324. Wagner AE (2009). Complications in equine anaesthesia. Vet. Clin. N. Am.: Equine Pract. 24, pp. 735-752. Text: Joanna Sjöberg, Foto: Maria Elverson RAID publicerar Har du uppmärksammat ett arbete eller en skrift som passar att publiceras i RAID? Kontakta tidningen RAIDs redaktör: Ida Grönvall Nilsson på mail redaktion@raid.se
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