Veterinary Anaesthesia and Analgesia 2019, 46, 458e465 https://doi.org/10.1016/j.vaa.2019.03.

006

RESEARCH PAPER

A retrospective study of fecal output and postprocedure

colic in 246 horses undergoing standing sedation with
detomidine, or general anesthesia with or without
detomidine

Christopher J Thibaulta, Deborah V Wilsona, Sheilah A Robertsonb, Dhruv Sharmac & Marc A Kinsleyd
a
Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA
b
Lap of Love Veterinary Hospice, Lutz, FL, USA
c
Center for Statistical Training and Consulting, Michigan State University, East Lansing, MI, USA
d
Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, MI, USA

Correspondence: Deborah V Wilson, Small Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, 784 Wilson Road, East
Lansing, MI, USA. E-mail: wilsondv@cvm.msu.edu

Abstract the number of fecal piles in the first 24 hours postprocedure.

Objective To determine time to first passage of feces, total
fecal piles and incidence of colic in the first 24 hours post-
procedure in horses undergoing standing sedation with
detomidine, or general anesthesia with or without
detomidine.
Study design Retrospective cohort study.
Animals A total of 246 horses.
Methods Records of all horses that underwent standing
sedation or general anesthesia between December 2012
and March 2016 were reviewed. Horses aged <6 months,
admitted for colic or cesarean section, with inadequate data,
and those not administered xylazine and/or detomidine
were excluded. Records included patient signalment, fasting
duration, procedure performed, drugs administered, time to
first feces, number of fecal piles during 24 hours post-
procedure and mention of colic. Chi-square, Fisher’s exact
and Tukey’s post hoc comparison tests were used. Para-
metric data were reported as mean ± standard deviation
with significance defined as p <0.05.
Results In total, 116 and 57 horses underwent general
anesthesia without detomidine (group GA) and with deto-
midine (group GAeD), respectively, and remaining 73
horses underwent standing sedation with detomidine
(group SeD). Detomidine dose was significantly higher in
group SeD than in group GAeD. Time to first feces was
longer (7.1 ± 4.2 hours), and group SeD horses passed one
fewer fecal pile (6.3 ± 2.4) than group GA horses. There
was no interaction between detomidine treatment and
preprocedure food withholding and the time to first feces or
Overall, seven horses (2.8%) showed signs of colic (five, one
and one in GA, GAeD and SeD, respectively).
Conclusions and clinical relevance Detomidine adminis-
tration, as part of an anesthetic protocol or for standing
sedation procedures, should not be expected to contribute to
postprocedural colic.
Keywords detomidine, fasting, fecal output, horse, post-
procedure colic, sedation.
Introduction
Gastrointestinal (GI) dysfunction induced by pain, stress,
changes in management or drugs can manifest as reduced GI
motility, delayed intestinal transit times and reduced post-
procedural fecal output, and contributes to the development of
postprocedural colic (PPC) in horses (Roger & Ruckebusch
1987; Little et al. 2001; Roussel et al. 2001; Cohen et al.
2004; Senior et al. 2004, 2006; Andersen et al. 2006;
Boscan et al. 2006; Nelson et al. 2013; Scherrer et al. 2016;
Curto et al. 2018). One study reported abdominal pain in
2.8% (12 out of 416) of horses after anesthesia, with risk
factors for developing signs of abdominal pain including time to
passage of first feces
7 hours and production of less than four
fecal piles in the first 24 hours (Nelson et al. 2013). Routine
monitoring of these variables in horses after anesthesia should
allow early identification of a problem and therapeutic
intervention.
PPC increases morbidity, mortality, hospitalization time and
cost of treatment in affected horses. Colic has been reported
following general anesthesia in 1.5e12% of horses (Little et al.

458
Retrospective study of postanesthetic colic CJ Thibault et al.
2001; Mircica et al. 2003; Senior et al. 2004, 2006; Andersen
et al. 2006; Nelson et al. 2013; Bailey et al. 2016; Scherrer
et al. 2016; Secor et al. 2018). Since 1987, there have been
over 20 studies published evaluating the risk factors associated
with PPC. Perioperative administration of specific medications,
including non-steroidal anti-inflammatory drugs (NSAIDs),
sodium benzylpenicillin, ceftiofur sodium and anesthesia with
isoflurane, have been reported to increase the risk of PPC,
whereas romifidine administration is associated with a reduced
risk (Mircica et al. 2003; Andersen et al. 2006; Boscan et al.
2006; Jago et al. 2015; Scherrer et al. 2016).
Suppression of GI motility is a well-recognized side effect of
a2-adrenergic agonist drugs (Daunt & Steffey 2002; Elfenbein
et al. 2009). Studies have demonstrated decreases in gastric
emptying, duodenal contractions, cecal motility and colonic
activity following administration of these drugs (Roger &
Ruckebusch 1987; Merritt et al. 1998; Sutton et al. 2002;
Elfenbein et al. 2009). Xylazine, an a2-adrenergic agonist,
reduced the spike burst duration of smooth muscle contraction
in the ileum, right ventral colon and small colon, and
decreased the cecal emptying rate of radiolabeled markers
(Lester et al. 1998). Xylazine reduced intestinal motor activity
in a dose-dependent manner, especially in the left ventral colon
(Roger & Ruckebusch 1987).
Detomidine produces a dose-dependent slowing of gastric
emptying that is not reported with xylazine; the addition of
butorphanol increases this delay (Sutton et al. 2002). An
intravenous (IV) detomidine bolus produced a treated with topical ophthalmic atropine were excluded from
non-doseedependent decrease in the amplitude of duodenal
contractions for 50 minutes after administration, and based on
real-time volumetric movement, the effects were both imme-
diate and profound (Elfenbein et al. 2009). Activity in the
entire large intestine was inhibited for 60e180 minutes
following detomidine (0.1 mg kg1) IV and abolished cecal
electrophysiologic activity for 10e15 minutes (Roger &
Ruckebusch 1987). After detomidine (0.02 mg kg1) admin-
istration, motility resumed within 120 minutes (Elfenbein et al.
2009). The left dorsal colon, left ventral colon and cecum have
a greater sensitivity than the jejunum to a2-adrenergic agonist
drugs, with detomidine being a more potent inhibitor of
motility than xylazine (Adams et al. 1984; Sasaki et al. 2000).
Detomidine is used as a bolus or infusion in many clinical
scenarios; because of its potency and duration of action on the
GI tract, investigation of its impact on PPC and fecal produc-
tion in horses seems warranted. Within our hospital, there was
a clinical impression that detomidine administration was a
cause of PPC. In a literature search, no published clinical
studies were found on the relationship between detomidine
and development of PPC.
The aim of this retrospective study was to determine the time
to passage of feces, total fecal piles observed in the first 24
hours postprocedure and the incidence of colic in horses
© 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 46, 458e465
undergoing standing sedation with detomidine or general
anesthesia with or without detomidine. Our hypotheses were
1) that detomidine administration by infusion for standing
sedation or as part of an anesthetic protocol was associated
with increased time to passage of feces and a reduction of total
observed fecal piles, and 2) that detomidine was associated
with an increased risk for developing PPC. The objectives were
to calculate time to passage of first feces postprocedure, record
total observed fecal piles in the 24 hours postprocedure and the
risk of PPC in three groups of horsesdthose undergoing gen-
eral anesthesia without detomidine (group GA), and those
undergoing general anesthesia with detomidine administra-
tion (group GAeD) and those undergoing standing sedation
with detomidine infusion (group SeD).
Materials and methods
The study was designed as a retrospective, cohort study.
Clinical records of horses at the College of Veterinary Medicine,
Michigan State University, MI, USA, that underwent general
anesthesia or sedation between December 2012 and March
2016 (40 months) were electronically searched and manually
reviewed. Institutional approval was not required for medical
records review. Any horse aged <6 months, that underwent
emergency abdominal surgery, was admitted for colic as the
primary complaint, not administered xylazine and/or detomi-
dine and records with inadequate data were excluded. Horses
statistical analysis. All included horses were American Society
of Anesthesiologists (ASA) physical status I or II.
Data collected from the patient records included signalment
(age, breed and sex), ASA status, type of procedure, preanes-
thetic weight, heart rate (HR), respiratory rate (fR), tempera-
ture, duration of food (hay) withholding prior to the procedure,
time of first feces and number of fecal piles observed during the
first 24 hours postprocedure. Every medical record was
manually checked for the word colic after the procedure. De-
tails of medical and surgical treatment of colic were extracted.
All periprocedural sedatives, tranquillizers, opioids, NSAIDs,
antibiotics and lidocaine infusions were recorded.
Normal practice management within the hospital is that
grain is withheld from all horses starting 24 hours prior to
anesthesia or sedation. Hay is always provided until the time of
surgery (0 hour food withholding) unless otherwise directed by
the primary clinician, and this was noted in the record. Based
upon clinician preferences, some horses have hay withheld for
different periods before a procedure. Access to water is never
restricted. The duration of fasting was calculated as the in-
terval between the time during which all food was withheld
until the time of induction of anesthesia or sedation. Feeding
after anesthesia or sedation follows a standard protocol. At 30
minutes after the horse is returned to its stall, a handful of hay
459

is initially offered, followed by a one-half flake (approximately
0.71 kg) every 2 hours for two feedings, and finally one flake of
hay every 4 hours until discharge from the hospital. When a
part of the individual’s normal diet, grain is reintroduced after
discharge from the hospital. Neither total food nor water intake
is quantified.
Antibiotics and NSAIDs were administered to all horses prior
to surgery. The standard premedication for all horses under-
going general anesthesia is xylazine (XylaMed; MWI Animal
Health, ID, USA) IV or detomidine (Dormosedan; Zoetis Inc.,
MI, USA) intramuscularly. Additional xylazine IV is adminis-
tered to any horse immediately before induction of general
anesthesia if not adequately sedate. This means the majority of
horses (170/173) were administered xylazine IV. Before re-
covery from anesthesia, small doses of xylazine, or occasionally
detomidine, are administered IV. A combination of ketamine
(VetaKet; Akorn Animal Health Inc., IL, USA) and diazepam
(Diazepam; Hospira Inc., IL, USA) or midazolam (Midazolam
Injection USP; West-Ward Pharmaceutical Corp., NJ, USA) IV
was used to induce general anesthesia, and anesthesia was
maintained with isoflurane (Isoflurane Inhalation Agent USP;
Akorn Animal Heath Inc.) and oxygen with intermittent pos-
itive pressure ventilation. During general anesthesia, horses
were administered lactated Ringer’s solution (Vetivex; Dechra
Veterinary Products LLC, KS, USA) at 5 mL kge1 houre1. For
procedures performed standing, detomidine was diluted to a
concentration of 0.05 mg mLe1 in 0.9% saline, quantitated
based on graduated markings on the bag, which was admin-
istered through IV administration tubing delivering lactated
Ringer’s solution during the procedure. The sedation protocol
was administration of detomidine (0.006 mg kge1) IV as a
bolus, followed by an infusion (0.003e0.024 mg kge1 houre1)
with the rate adjusted by the anesthetist as needed (Van Dijk
et al. 2003).
Horses with PPC all had specific mention of colic in the
medical record. The medical records of the horses with PPC
were reviewed by two clinicians (MAK and CJT) to confirm
their inclusion. Hospital protocol requires that all animals are
closely monitored postoperatively: observation every hour by a
licensed veterinary technician who records HR, fR, presence/
absence by auscultation of GI sounds in any/all four quadrants,
animal behavior indicating abdominal discomfort and the
number of fecal piles in the stall, after which the stall is cleaned.
Neither fecal weight nor volume is quantified. Horses are also
routinely assessed by a clinician after the procedure when
returned to the stall, again the next morning before 08:00
hours and at any other time as required. Rectal temperature is
measured and recorded every morning.
The duration of anesthesia was defined as the time from
induction until the horse was extubated. Duration of standing
sedation was the time from bolus administration of detomidine
until the detomidine infusion was stopped. Interval between
460 © 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
Retrospective study of postanesthetic colic CJ Thibault et al.
extubation, or discontinuation of detomidine infusion and the
first fecal pile was calculated, and the number of fecal piles in
the 24 hours postprocedure was recorded.
Statistical analysis
All data management and analysis were performed using R
statistical software Version 3.5.0 for Windows [R Core Team
(2018) R Foundation for Statistical Computing, Austria]. The
distribution of continuous variables was assessed with skew-
ness and kurtosis tests for normality. Chi-squared (or Fisher
small sample size exact) tests were used to study the associa-
tion between two categorical variables, and analysis of vari-
ance models were used to test the effects of treatment on
continuous outcomes. Where significant differences were pre-
sent, Tukey’s post hoc comparison was used. For analysis,
fasting duration was categorized as none (0 hours), short (12
hours), or extended (>12 hours) (Senior et al. 2004, 2006;
Schoster et al. 2016). Parametric data were reported as
mean ± standard deviation. The level of significance was
defined as p-value of <0.05. Overall, three groups were iden-
tified; general anesthesia without (group GA) and with deto-
midine administration (group GAeD) and standing sedation
with detomidine (group SeD). Descriptive data from seven
horses treated with topical ophthalmic atropine were retained
in the case series, but their data were excluded from analysis.
Results
The preliminary electronic medical search identified 364
horses that underwent general anesthesia or standing sedation
for procedures during the selected study period. Of these, 118
horses did not meet the criteria for inclusion in the study: 75
were presented to the hospital with colic, 25 were discharged
the same day or did not have enough data for inclusion, nine
were aged <6 months, one required caesarean section, seven
were euthanized under general anesthesia and one was
administered romifidine only.
During the study period, 225 horses had 246 general
anesthesia or sedation events; two procedures on 13 horses
and three procedures on four horses. Median time between
procedures on these 17 horses was 30 days (range, 1e455
days), and 10 horses were discharged from the hospital be-
tween procedures. Of the 246 procedures performed, there
were 116 horses in GA, 57 horses in GAeD and 73 horses in
SeD. Breeds represented were 62 Warmbloods, 55 Quarter
Horses, 39 Thoroughbreds, 18 Arabians, 13 Standardbreds
and 59 mixed breed horses. The age and weight were 9.1 ± 6.0
years and 539 ± 135 kg, respectively. Procedures included soft
tissue surgery (GA: 23, GAeD: 24, SeD: 61), orthopedic sur-
gery (GA: 58, GAeD: 26, SeD: 1), advanced imaging
(computerized tomography or magnetic resonance imaging;
GA: 31, GAeD: 4, SeD: 0) and ophthalmic surgery (GA: 4,
reserved., 46, 458e465
Retrospective study of postanesthetic colic CJ Thibault et al.
GAeD: 3, SeD: 11). The procedure duration was significantly
longer in SeD (2.05 ± 0.83 hours) versus GA (1.70 ± 0.50; p <
0.01) and GAeD (1.81 ± 0.51 hours; p ¼ 0.07).
The time to first passage of feces was longer in SeD (p ¼
0.03) and fewer total fecal piles were recorded during the first
24 hours postoperatively (p < 0.01) than in GA (Table 1). PPC
was observed in seven out of 246 horses (2.8%; Table 2). Of
these horses, two had been administered detomidine (one each
in SeD and GAeD). All horses survived to hospital discharge;
six horses responded to medical management, and in one
horse, exploratory laparotomy revealed gas distension and no
mechanical obstruction.
Hay was not withheld before the procedure for 157 out of
246 horses, 55 horses had a short fast and 34 had an extended
fast. Duration of food withholding was not correlated with the
time to first feces (p ¼ 0.10). There was also no correlation
between detomidine administration and food withholding on
the time to first feces or the number of fecal piles in the first 24
hours postprocedure.
Where results of abdominal auscultation were reported,
borborygmi were present in all four quadrants in 85% of horses
(GA, 100/112 horses; GAeD, 46/56 horses; SeD, 59/72
horses) when evaluated 5.6 ± 2.6 hours either after tracheal
extubation or stopping the detomidine infusion. Borborygmi
were present in all four quadrants in 90% of horses on the
following morning (GA, 104/111 horses; GAeD, 50/57
horses; SeD, 63/73 horses). Results of auscultation were
missing at the first time point from four horses in GA and from
one horse in both GAeD and SeD. Results of auscultation
were missing at the second time point from five horses in GA.
Cumulative detomidine dose in SeD was 0.030 ± 0.030 mg
kge1, significantly higher than that in GAeD (0.019 ± 0.007
mg kge1; p < 0.01). Total detomidine dose was not reported for
15 horses in SeD, but all 15 horses underwent a prolonged
detomidine infusion to facilitate their surgical procedure.
Detomidine was administered prior to recovery in an unspec-
ified dose in one horse in GAeD.
Xylazine IV was administered to every horse in GA (0.95 ±
0.31 mg kge1), to 54 horses in GAeD (0.62 ± 0.31 mg kge1)
Table 1 Observed fecal piles in 239 horses after general anesthesia without detomidine (group GA), after general anesthesia that included
detomidine (group GAeD) and after sedation with detomidine (group SeD). Data from seven horses treated with topical ophthalmologic
atropine were excluded from statistical analysis
Variable Group
GA (n ¼ 115)
Time to first feces (hours) 5.5 ± 3.9*
Fecal piles in 24 hours 7.7 ± 3.3*
n, number of horses.
Data are mean ± standard deviation.
*
GA significantly different from SeD (p < 0.01).
© 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 46, 458e465
and to 12 horses in SeD (0.38 ± 0.24 mg kge1). Xylazine dose
differed significantly among groups with all pairwise compar-
isons significantly different from each other (p < 0.01).
A total of 164 horses (67%) were administered an opioid
during the procedure. In GA, 68 horses were administered
butorphanol (Butorphic; Akorn Animal Health Inc.) and one
was administered morphine (Morphine Sulfate Injection USP;
West-Ward Pharmaceutical Corp.). In GAeD, 30 horses were
administered butorphanol, one morphine and four methadone
(Methadone Hydrochloride Injection USP; Akorn Animal
Health Inc.). In SeD, 22 horses were administered butorpha-
nol, 26 morphine and nine methadone. Multiple opioids were
administered to three horses during the same procedure: two
horses were administered morphine and butorphanol and one
horse methadone and butorphanol. Of the seven PPC horses,
five horses were administered butorphanol and two horses
were administered no opioid.
Lidocaine (Lidocaine 2%; MWI Animal Health) was
administered as an infusion to 61 horses; 31 (26.9%) in GA, 20
(35.7%) in GAeD and 10 (14.7%) in SeD. Of the seven horses
with PPC, three were administered a lidocaine infusion during
the procedure.
Of the 18 horses undergoing ophthalmologic procedures, 17
were enucleations with bilateral enucleations in two horses,
and one horse underwent third eyelid removal. Ocular disease
resulting in enucleation included corneal diseases in 12 horses,
intraocular disease in four horses and exophthalmos in one
horse. During the procedure, 10 horses were administered
peribulbar bupivacaine (Bupivacaine Hydrochloride Injection
USP; AuroMedics Pharma LLC, NJ, USA).
Topical ophthalmic atropine (ISOPTO Atropine 1%, Alcon,
TX, USA) was administered to seven of 12 horses with corneal
disease (1 mg per horse) every 12e24 hours, and only one eye
was treated in each case. Treatment was for 4 days in two
horses, 7 days in four horses and for 3 weeks in one horse
before the surgical procedure. In the latter horse, topical
ophthalmic atropine was administered prior to unilateral
enucleation and continued postoperatively in the other eye
with no PPC. No atropine-treated horses displayed signs of colic
GAeD (n ¼ 56) SeD (n ¼ 68)
6.3 ± 3.2 6.8 ± 4.1
7.0 ± 3.2 6.3 ± 2.4
461
 Retrospective study of postanesthetic colic CJ Thibault et al.

Table 2 Descriptive information from seven horses that underwent general anesthesia or sedation procedures that developed postprocedural
colic (PPC)

Horse number Group Procedure Food withholding (hours) Adjunctive drugs Time to first feces (hours) Fecal piles/24 hours

1 GA
2* GAeD
3 GA
4 SeD
5 GA
6 GA
7 GA
P1 Fracture 0 B 5 6
Enucleation 0 B 13 5
Arthroscopy 0 None 3 8
Sinusotomy 5 B 2 9
Bursoscopy 2 L 3 8
Enucleation 0 B, L 6 9
P1 Fracture 0 B, L 5 6

Group: GA, general anesthesia; GAeD, general anesthesia including detomidine; SeD, sedation with detomidine. Procedure: P1, first phalanx. Food withholding: 0, hay was
provided until the time of surgery (horses 1e3, 6, 7); 2, 5, hay withheld for 2 hours (horse 5) or 5 hours (horse 4) before surgery. Adjunctive drugs, drugs administered during
procedure; B, butorphanol; L, lidocaine. *Horse 2 required medical and surgical treatment for PPC.

before anesthesia; one developed PPC after enucleation
(Table 2). Of the atropine-treated horses, six were also
administered topical ophthalmic voriconazole (Voriconazole;
Alvogen Inc., NJ, USA); no other antifungals were
administered.
Discussion
The results of this retrospective study indicate that when added
to an anesthetic protocol, detomidine administration does not
influence the time to first fecal passage or number of piles in the
first 24 hours. Detomidine infusion for standing sedation was
associated with prolonged time to first fecal passage and
approximately one less fecal pile in 24 hours. The number of
horses developing PPC was at the low end of previously pub-
lished incidence (Little et al. 2001; Mircica et al. 2003; Senior
et al. 2004, 2006; Andersen et al. 2006; Nelson et al. 2013;
Bailey et al. 2016; Scherrer et al. 2016; Secor et al. 2018).
The hypothesis that administration of detomidine would be
associated with an increased incidence of PPC was not
supported.
Detomidine is commonly used for its analgesic properties in
horses (Daunt & Steffey 2002). Despite profound effects on
gastric emptying, duodenal contractions, cecal and colonic
activity (Roger & Ruckebusch 1987; Merritt et al. 1998;
Sutton et al. 2002; Elfenbein et al. 2009), the duration of
these effects appears to be dose-dependent and unlikely to
extend much beyond the period of drug administration. A
single bolus of detomidine (0.005 mg kge1) IV in horses pro-
vided sedation for 30 minutes and reduced intestinal motility
for up to 75 minutes (Gozalo-Marcilla et al. 2017). In another
study, a single bolus dose of detomidine (0.02 mg kge1)
reduced intestinal motility for 4 hours (Pimenta et al. 2011).
Standing procedures avoid administration of general anes-
thesia but require higher doses of sedative agents administered
over a longer period, potentiating increases in dose-dependent
side effects. The cumulative detomidine dose was high in the
sedation group, and approximately double than that adminis-
tered to horses during general anesthesia.
In the present study, time to passage of the first feces post-
procedure was approximately 6 hours. This is similar to that
previously reported in 376 horses (Nelson et al. 2013). How-
ever, horses in all groups in the present study produced three to
four more fecal piles in the first 24 hours after a procedure than
those in previously published studies (Little et al. 2001; Nelson
et al. 2013). This is likely the result of differences in dietary
management among institutions.
Results of two other retrospective studies reporting data
from horses that fasted for either 6 hours (Nelson et al. 2013)
or over 12 hours (Little et al. 2001) suggested that increased
time of food withholding prior to a procedure would be asso-
ciated with reduced fecal output in the first 24 hours. However,
results of the present study suggest that withholding hay for up
to 24 hours did not impact time to first fecal passage or number
of piles produced in 24 hours postprocedure, particularly when
combined with the specific and regimented refeeding protocol
in our hospital.
An opioid was administered to 68% of the horses in the
present study during the procedure. None of the PPC horses in
this study were administered morphine, which is the drug most
investigated regarding its contribution to colic in horses.
Several studies have shown that morphine (0.5e1.0 mg kge1)
IV is linked to delays in GI transit and increased incidence of
colic (Kohn & Muir 1988; Senior et al. 2004; Boscan et al.
2006). However, morphine administered in the dose used in
this study (0.1 mg kge1 IV) has been reported to have no effect
on the incidence of PPC (Mircica et al. 2003; Andersen et al.
2006; Senior et al. 2006).
Lidocaine exerts an anti-inflammatory (Cook & Blikslager
2008), anesthetic-sparing and mild analgesic effect in horses
(Robertson et al. 2005; Doherty & Seddighi 2010), but does
not act as an intestinal prokinetic (Milligan et al. 2007; Cook &
Blikslager 2008; Okamura et al. 2009) and may even reduce

462 © 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 46, 458e465
Retrospective study of postanesthetic colic CJ Thibault et al.
intestinal motility (Salem et al. 2016). In the present study,
lidocaine was administered during the procedure to 25% of all
horses, 30% of horses during general anesthesia and 43% of
horses that developed PPC. The administration of this drug is a
confounder and highlights the limitations of a retrospective
study.
Between 8% (Scherrer et al. 2016) and 21% (Patipa et al.
2012) of horses hospitalized for ophthalmologic procedures
have been reported to manifest PPC. Horses hospitalized for
ophthalmic disease may experience pain, stress and adminis-
tration of drugs decreasing GI motility. In the present study,
the incidence of PPC in the horses undergoing ophthalmologic
procedures was 11% (two/18), similar to the incidence pub-
lished in earlier studies.
Some controversy persists regarding the role of topical
ophthalmologic atropine and PPC in horses, perhaps owing
to differences in dosing between institutions and over the
years. An early study reports colic in four out of six (60%)
horses when high doses of topical ophthalmologic atropine
(1 mg houre1 per horse for 24 hours) were administered
(Williams et al. 2000). For this reason, and despite the low
doses of topical ophthalmologic atropine administered, in
the present study, descriptive data from seven atropine-
treated horses were reported but were removed from data
analysis.
Multivariate analysis in three studies reporting data from
299 atropine-treated horses undergoing ophthalmologic pro-
cedures determined that atropine treatment was not a risk
factor for PPC (Little et al. 2001; Patipa et al. 2012; Scherrer
et al. 2016). Only one of these studies (Scherrer et al. 2016)
reported the dose of topical ophthalmologic atropine adminis-
tered, namely 1 mg per horse every 12 hours. A separate study
reported that double this dose administered to horses induced
no delay in the passage of ingesta, no ileus and no measurable
serum levels of atropine (Wehrman et al. 2017).
In the present study, topical ophthalmologic antifungal
treatment was used in six horses, including one PPC horse.
Systemic, but not topical, administration of fluconazole reduces
GI motility and results in PPC in horses (Curto et al. 2018).
Most of the horses in the present study had borborygmi
present when assessed. It should be noted, however, that in-
tensity and presence or absence of borborygmi are subjective
assessments and have been shown to poorly predict GI func-
tion (Little et al. 2001; Roussel et al. 2001; Cohen et al. 2004;
Boscan et al. 2006; Naylor et al. 2006).
Previous studies have reported that increased procedure
duration is associated with either an increased risk (Little et al.
2001; Roussel et al. 2001; Cohen et al. 2004), no association
(Senior et al. 2004; Nelson et al. 2013; Bailey et al. 2016) or a
decreased risk (Andersen et al. 2006) of PPC. Procedure
duration in the SeD group in the present study was
© 2019 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights
reserved., 46, 458e465
approximately 0.3 hours longer than that in the GA and
GAeD groups, contributing to the increased total dose of
detomidine administered. This difference in procedure duration
was statistically but not clinically significant.
Retrospective studies are associated with several inevitable
biases related to collection of historical data, use of clinical
patients with confounding conditions and accuracy of report-
ing. Additional highly-powered prospective studies, ideally
placebo-controlled or paired group observational studies are
recommended to better understand the impact of detomidine
administration on PPC and postprocedural fecal output. Po-
tential confounding factors, such as surgical pain, the duration
of fasting and adjunct drug administration, including lidocaine
and atropine, could then be controlled.
Another limitation of the present study is that fecal output of
these horses was not accurately quantified because fecal piles
were counted but fecal mass, volume or water content were
not measured. Use of a fecal collection device (Elfenbein et al.
2011, 2014) would allow accurate weighing of fecal output.
Pain scoring is not routinely performed within our hospital,
and implementation of a recognized pain scoring system would
enhance animal care and allow assessment of the effects of
pain on many variables including colic (van Loon & Van
Dierendonck 2018).
Conclusion
Detomidine administration for sedation for standing proced-
ures prolonged the time to first feces and reduced fecal output
by one pile during the 24 hours postprocedure. However,
associated with our described refeeding protocol, this is not
associated with PPC and has little clinical relevance. Detomi-
dine administration, as part of an anesthetic protocol or for
standing sedation procedures, should not be expected to
contribute to PPC. The results of this study can be used to
support sample size calculations and design issues for future
studies.
Acknowledgements
The authors thank Dr Joe G Hauptman for early statistical
and study design advice.
Authors' contributions
CJT: study design, data acquisition and interpretation. DVW:
study design, data interpretation. SAR and MAK: study design.
DS: statistical analysis. All authors contributed to preparation
of the manuscript and approved the final submission.
Conflict of interest statement
The authors report no conflict of interest.
463

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Received 28 August 2018; accepted 25 March 2019.
Available online 4 May 2019
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