Pain
Surgical procedures will lead to a pain response. It is well supported that the more invasive a procedure is, the more pain the patient will experience. Horses are typically stoic animals when it comes to exhibiting pain. It is thought that they mask signs of pain from predators, including humans, to minimize possible predation [86]. In one study, it was determined that horses undergoing surgery paid decreased attention toward novel objects and decreased responsiveness to auditory signals [87]. The relationship between pain, behavioral distress and physiological stress is complex and difficult to determine. Consequently, endocrine measures may not be accurate indicators of pain alone. It is also difficult to separate the inflammatory process associated with surgery and surgical complications from the pain response associated with surgery and surgical complications. The measurement of equine pain is probably best accomplished with multidimensional pain scales [88]. The Horse Grimace Scale has been recently described and is easy to use and has a high reliability between observers [89].
Impact of Host Factors and Comorbid Conditions
Blood loss impairs the body’s ability to deliver oxygen to the tissues and oxygen delivery to the tissues is important during injury [84]. Lack of oxygen impairs the body’s ability to heal. Diagnosing blood loss in the horse can be challenging due to the large reservoir of red blood cells stored in the spleen. Splenic contraction can maintain packed cell volume and total protein in the acute stages of hemorrhage [90]. Fluid volume expansion can actually reduce the effectiveness of oxygen delivery, making blood transfusions an important aspect of improving oxygen delivery.
Pituitary pars intermedia dysfunction is thought to impair corneal wound healing in horses [91]. There also appears to be an association between PPID and degenerative suspensory ligament desmitis [92]. It seems reasonable then that horses with PPID may have difficulty in healing. This should be considered when operating on horses with PPID.
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