From the difficult horse to the demanding surgeon: How effective sedation has revolutionised what is achievable in equine clinical practice.

Firstly, I am honoured to be asked to give the Hickman lecture. I was fortunate enough to be taught by Col Hickman when I was a student, and worked with him for some years while I was training in veterinary anaesthesia. In those days we did not have alpha-2 adrenoceptor agonist sedatives (alpha-2 agonists) such as xylazine, detomidine and romifidine. Col Hickman was of an age (as I am now) when he preferred not to be pushed around by the horse, and, despite the anaesthetic risk, he did most of his surgery under general anaesthesia, rather than standing sedation. Alpha-2 agonists are wonderful drugs – the reliable sedation they produce, in particular when in combination with opioids, has revolutionised our ability to carry out surgery in the standing horse. However, they have many side effects, some of which interfere with use. The actions for the available agents are not identical and the drugs may be used in many different ways – single doses, infusions, plus or minus opioids etc ...