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Medical Treatment of Horses with Colic
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The cornerstones of medical treatment of horses with abdominal pain include withholding food and possibly water, administration of analgesic drugs, antispasmodics, administration of IV or oral fluid therapy, administration of laxatives via nasogastric tube, and controlled exercise. In some cases, it is necessary to administer medications to enhance or modify intestinal motility. This discussion will focus on laxatives and methods and drugs to modify intestinal motility.
ANALGESIC THERAPY
Analgesic therapy is an important component of medical treatment of horses with colic. Horses may not only cause self trauma or injure people when experiencing abdominal pain, but pain also causes release of catecholamines which can have inhibitory effects on intestinal motility.
The most common analgesic medications used in horses with abdominal pain are the nonsteroidal anti-inflammatory drugs (NSAIDs), •"2 agonists, and opioids. NSAIDs are the principle analgesics drugs used to control abdominal pain; flunixin meglumine appears to have the superior inhibitory effect on visceral pain; however, ketoprofen (2.2 mg/kg, IV once daily) also apparently is useful to control abdominal pain. Phenylbutazone has the least analgesic effect for pain associated with colic. The recommended dose of flunixin meglumine is 1.1 mg/kg IV or IM once or twice daily. It is important to remember if a horse does not respond to the first dose of flunixin meglumine it is not likely to respond to multiple doses. However, it will increase the likelihood of toxicity. There is the potential concern of masking abdominal pain associated with a surgical colic when flunixin meglumine is administered. If flunixin meglumine is administered at the recommended dose and frequency and the horse is closely examined (including complete physical examination, rectal examination, passage of nasogastric tube) and monitored, then it is unlikely that a surgical disease (or at least one that is an emergency) will be masked. Repeated administration of flunixin meglumine without re-examining the horse can certainly mask appreciable pain associated with a surgical disease. Lower doses of flunixin meglumine can be used for their anti-inflammatory effects and to ameliorate the effects of endotoxin. Dosages of 0.25 to 0.5 mg/kg are administered IV every 6-8 hours. Phenylbutazone has also been shown to be more effective than flunixin meglumine in ameliorating the effects of endotoxin on intestinal motility, and may be added to the treatment regimen at a dose of 0.5-2.2 mg/kg twice daily. Caution should be used in administering as combination of NSAIDs, and particular attention should be given to hydration status to prevent deleterious toxic effects on the gastrointestinal tract and kidneys.
The •"2 agonists commonly used in horses with abdominal pain include xylazine and detomidine. Xylazine is commonly used in horses to control moderate to marked abdominal pain for relatively short periods (20-30 minutes). This may be helpful when passing a nasogastric tube or performing a rectal examination. The heart rate should be evaluated prior to administering these drugs because of their bradycardic effect. Xylazine is often administered at a dose of 0.2 to 0.5 mg/kg IV, which will provide potent analgesia for 20-30 minutes or 0.6 to 1.0 mg/kg IM, which will prolong the analgesic effects for approximately 1-2 hours. Detomidine is an "•2 agonist with more potent analgesic effects than xylazine; it has the potential to mask abdominal pain associated with a surgical disease for extended period, particularly if administered repeatedly. It should probably be reserved for horses with marked abdominal pain in which surgical exploratory is not an option or those which must be transported long distances to a referral hospital for surgical intervention. The dose of detomidine is approximately 0.01-0.02 mg/kg IV or IM. The "•2 agonists can have inhibitory effects on gastrointestinal motility, which can be deleterious in horses being treated for intestinal impactions.
Butorphanol tartrate is an opiate agonist-antagonist that is useful in providing analgesia for horses with moderate to marked abdominal pain. It is most often administered (0.01-0.02 mg/kg, IV) in combination with xylazine (as it can result in excitement IV if administered alone) or by itself (0.02 to 0.1 mg/kg, IM). A continuous rate infusion dose of 13 •g/kg/hour has been reported to decrease cortisol concentration and improved recovery characteristics when administered to post-operative colic patients compared to horses not receiving butorphanol. In the study however, butorphanol was found to significantly delay the time to first passage of feces. Therefore judicious use of butorphanol is warranted as deleterious effects on intestinal motility may occur if administered at high doses or repeatedly.
ANTISPASMODIC MEDICATION
Treatment of spasmodic colic can be aided by the use of anti-spasmodic. N-butylscopolammonium bromide (Buscopan) has anticholinergic and antispasmodic properties. Although commercially available in Europe for many years (in combination with hyoscine) it has been fairly recently approved for use in the United States (without hyoscine). When administered to ponies in a cecal balloon distention study, a brief analgesic effect and a transient decrease in cecal contractions were observed. A typical dose is 0.3 mg/kg IV once.
It is important to evaluate the heart rate prior to administration as due the drug’s parasympatholytic response increase after administration has been noted. The administration of 3 ml IV to 1000 lb horse can also be useful for relaxation during the rectal examination. Buscopan’s effects are relatively brief, lasting for approximately 30 minutes, and therefore should not have a significant masking effect in horses with surgical lesions. [...]
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