Proceedings of a Workshop on - The Havemeyer Foundation

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Havemeyer Foundation Monograph Series No. 11 Treatment complications are a critical factor to evaluate in the author’s opinion. One <strong>of</strong> the first benefits <strong>of</strong> a multicentre trial could be the knowledge obtained about complications and their management, which have not been well addressed historically. For example, data collected could show whether immediate re-operation or patience is best for handling acute dysphagia. The ERLN group could make recommendations such as those shown in Figure 1 based on their review <strong>of</strong> current evidence. Aside from diagnosis and treatment considerations, blood samples could be used for genomic testing, histopathological samples could be sent to different laboratories with different focuses, etc, and the understanding <strong>of</strong> the heritability <strong>of</strong> RLN could be increased. ADVANTAGES IN ESTABLISHING RESEARCH CRITERIA AND PRIORITIES Most researchers use different exercise protocols and testing criteria. The group should establish recommended exercise protocols in order to obtain consistent data. For example, they could discuss the pros and cons for: 1) using exercise protocols at maximal heart rate on an incline at lower speeds vs maximal heart rate at maximal speed; 2) different research protocols for sprinters compared to horses that perform at longer distances; 3) the best indices <strong>of</strong> airway mechanics data (ie arterial blood gases, flow volume loops and their indices, pressure flow curves and their indices, pulse oximetry); 4) standardising sound collection procedures for sound analysis; and 5) setting priorities in the treatment: method <strong>of</strong> anchoring the prosthesis, degree <strong>of</strong> abduction targeted, best post operative feeding protocol, post operative diet, etc. The ERLN group could help identify areas that have been researched enough and those in need <strong>of</strong> further investigation. WHAT ARE THE HURDLES? The needs for an agency to fund the establishment <strong>of</strong> the ELH group, organise a meeting, set up data collection, and maintain a website. The organisational procedures <strong>of</strong> similar organisations, such as the Cochrane Collaboration (www.cochraneconsumer.com), could be Acute dysphagia post operatively Can the horse drink without nasal regurgitation? Yes No Feed small amount <strong>of</strong> hay from ground No Scope the horse: is the arytenoid hyperabducted? No Sedate horse, NPO, administered IV fluids, re-operated if no improvement in 48 h Pass stomach tube, check for choke Fig 1: Example <strong>of</strong> guidelines to be established by the ERLN group. 91
Equine Recurrent Laryngeal Neuropathy followed. Distances to be travelled by an international group would be an issue. It is not a trivial issue to establish criteria that truly assess performance. There have been multiple studies <strong>of</strong> horses’ performance post laryngoplasty, but even objective performance indices are affected by subjective issues, such as track surface, degree <strong>of</strong> fitness, race availability, etc. It is difficult to evaluate a 2-year-old racehorse that has not raced or has only had one start or to apply objective criteria to non-racehorses. Perhaps only horses that have measurable success parameters (racehorses, grand prix jumping, etc) would be evaluated, but this is a difficult issue that must be resolved. The methods for collecting data must be established. It is perhaps easier with racehorses, but how are complications evaluated, who reports it, and who contacts the owners? POTENTIAL BENEFITS The establishment <strong>of</strong> an equine health group that focuses on the equine larynx and could coordinate multicentre trials whose design and sample size would allow accumulation <strong>of</strong> a large data set so confounding variables are more likely to be circumvented. This group could review and promote the best evidence for effective treatments and management <strong>of</strong> their complications. The group’s study would allow veterinarians and horse owners to make informed decisions in managing their horses based on evidence-based medicine. REFERENCES Dixon, P.M., McGorum, B.C., Railton, D.I., Hawe, C., Tremaine, W.H., Pickles, K. and McCann, J. (2003a) Long term survey <strong>of</strong> laryngoplasty and ventriculocordectomy in an older mixed-breed population <strong>of</strong> 200 horses. Part 1: Maintenance <strong>of</strong> surgical arytenoid abduction and complications <strong>of</strong> surgery. Equine vet. J. 35, 389-396. Dixon, P.M., McGorum, B.C., Railton, D.I., Hawe, C., Tremaine, W.H., Pickles, K. and McCann, J. (2003b) Long term survey <strong>of</strong> laryngoplasty and ventriculo-cordectomy in an older mixed-breed population <strong>of</strong> 200 horses. Part 2: Owners’ assessment <strong>of</strong> the value <strong>of</strong> surgery. Equine vet. J. 35, 397-401. Derksen, F.J., Stick, J.A., Scott, E.A., Robinson, N.E. and Slocombe, R.F. (1986) Effects <strong>of</strong> laryngeal hemiplegia and laryngoplasty on airway flow mechanics in exercising horses. Am. J. vet. Res. 47, 16-26. Hawkins, J.F., Tulleners, E.P., Ross, M.W., Evans, L.H. and Raker, C.W. (1997) Laryngoplasty with or without ventriculectomy for treatment <strong>of</strong> left laryngeal hemiplegia in 230 horses. Vet. Surg. 26, 484-491. Kidd, J.A. and Slone, D.E. (2002) Treatment <strong>of</strong> laryngeal hemiplegia in horses by prosthetic laryngoplasty, ventriculectomy and vocal cordectomy. Vet. Rec. 150, 481-484. Russell, A.P. and Slone, D.E. (1994) Performance analysis after prosthetic laryngoplasty and bilateral ventriculectomy for laryngeal hemiplegia in horses: 70 cases (1986-1991). J. Am. vet. med. Ass. 204, 1235-1241. Shappel, K.K., Derksen, F..J., Stick, J.A. and Robinson, N.E. (1988) Effects <strong>of</strong> ventriculectomy, prosthetic laryngoplasty, and exercise on upper airway function in horses with induced left laryngeal hemiplegia. Am. J. vet. Res. 49, 1760-1766. Strand, E., Martin, G.S., Haynes, P.F., McClure, J.R. and Vice, J. (2000) Career racing performance in Thoroughbreds treated with prosthetic laryngoplasty for laryngeal neuropathy: 52 cases (1981-1989). J. Am. vet. med. Ass. 217, 1689-1696. Tetens, J., Derksen, F.J., Stick, J.A., Lloyd, J.W. and Robinson, N.E. (1996) Efficacy <strong>of</strong> bilateral prosthetic laryngoplasty with and without bilateral ventriculo-cordectomy as treatments for laryngeal hemiplegia in horses. Am. J. vet. Res. 57, 1668- 1673. 92
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