Mirra Alessandro, Klopfenstein Bregger Micaël David, Levionnois Olivier Louis
Division of Anesthesiology and Pain Therapy, Department of Clinical Veterinary Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
Swiss Institute for Equine Medicine, Vetsuisse Faculty, University of Bern, Bern, Switzerland.
Front Vet Sci. 2018 Feb 7;5:12. doi: 10.3389/fvets.2018.00012. eCollection 2018.
A 15-year-old Selle Francais gelding was presented to the equine referral hospital for treatment of a left guttural pouch mycosis previously diagnosed. After induction, the horse was shortly hoisted by all four feet, moved on a padded surgical table, and positioned in right lateral recumbency. In order to reduce the risk of bleeding during surgical manipulation of the carotid and maxillary arteries, a mean arterial pressure between 60 and 70 mmHg was targeted. After surgery, the horse was moved in a padded recovery box keeping the same lateral recumbency. Four unsuccessful attempts were performed, with the horse always returning to sternal recumbency keeping the left hind limb up. At the fifth attempt, performed 120 min after the end of the general anesthesia, the horse stood up correctly but moderate ataxia and absence of weight bearing on the left hind limb were shown. Both the stifle and the fetlock joint were held in a flexed position and could not be extended properly in order to set the foot on the ground, resulting in a very short step. The horse was calm, not sweating, and willing to move; the muscles of the affected limb were relaxed, and the limb was neither warm nor painful at palpation. Occasionally, the horse flexed the affected hind limb in an exaggerated motion with marked abduction. No additional laboratory analyses were performed. Due to a strong suspicion of neuropathy, a sling support was initiated and a supportive bandage associated with flunixine administration was performed until resolution of the symptoms. The horse fully recovered after 3 days. This case report does not clarify the pathogenesis of the possible postanesthetic neuropathy accounted on the non-dependent limb, highlighting the need for future research in this field. Non-dependent limb neuropathy should be an expected problem even after having ruled out the most commonly known causes predisposing to postanesthetic lameness.
一匹15岁的法国塞尔黑马被送至马科转诊医院，以治疗先前诊断出的左侧咽鼓管真菌病。诱导麻醉后，这匹马很快被四脚吊起，转移到铺有软垫的手术台上，并置于右侧卧位。为降低在颈动脉和上颌动脉手术操作期间出血的风险，目标平均动脉压为60至70 mmHg。手术后，这匹马被转移到铺有软垫的恢复箱中，保持相同的侧卧位。进行了四次尝试均未成功，这匹马总是恢复到胸骨卧位，左后肢抬起。在全身麻醉结束后120分钟进行的第五次尝试中，这匹马正确站立，但表现出中度共济失调，左后肢无法负重。膝关节和跗关节均处于屈曲位置，无法正常伸展以使脚着地，导致步幅非常短。这匹马很平静，不出汗，愿意移动；患肢肌肉松弛，触诊时肢体既不发热也不疼痛。偶尔，这匹马会以夸张的动作过度外展屈曲患肢。未进行额外的实验室分析。由于强烈怀疑是神经病变，开始使用吊带支撑，并进行了与氟尼辛给药相关的支持性包扎，直至症状缓解。这匹马在3天后完全康复。本病例报告未阐明非依赖肢体可能出现的麻醉后神经病变的发病机制，凸显了该领域未来研究的必要性。即使排除了导致麻醉后跛行的最常见已知原因，非依赖肢体神经病变仍应是一个预期问题。
