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Treating Choke with Oxytocin

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Treating Choke with Oxytocin Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS MEDICINE I Treating Choke with Oxytocin Stephen R. Hance, DVM; Joe Noble, DVM; Sue Holcomb, VMD, MS; Bonnie Rush-Moore, DVM, MS; and Warren Beard, DVM, MS Oxytocin administered as an intravenous bolus at a dose of 1.1–2.2 units/kg can assist with the resolution of proximal esophageal obstructions in horses. Authors’ addresses: Rood and Riddle Equine Hospital, P.O. Box 12070, Lexington, KY 40580 (Hance); 206 Reece Lake Rd., Washington, OK 73093 (Noble); Michigan State University, East Lansing, MI 48824 (Holcomb); Dept. of Clinical Science, College of Veterinary Medicine, 1800 Denison Ave., Kansas State University, Manhattan, KS 66506 (Rush-Moore); and Dept. of Clinical Science, The Ohio State University, 2389 Cranford Rd., Columbus, OH 43221 (Beard). ௠ 1997 AAEP. 1. Introduction performed with sedation to lessen the anxiety of the Horses with choke or esophageal obstruction usually horse and decrease the likelihood of aspiration pneu- demonstrate excessive salivation with feed contami- monia by keeping the horse’s head lower than the nation from both the mouth and nares, dysphasia, thoracic inlet. In the majority of cases, this will and coughing, and some will retch while extending resolve the obstruction. If the choke is not resolved the head and neck. Although a horse of any age can by this method, it has been recommended that an develop an esophageal obstruction, it is more com- endotracheal tube with an inflatable cuff be inserted mon in geriatric patients. The obstructive mass is into the trachea and a second endotracheal tube be inserted into the esophagus with the cuff inflated. usually some form of feed roughage (i.e., hay cubes, A nasogastric tube is then inserted into the end of beat pulp) but can also be caused by foreign bodies the endotracheal tube that has been inserted into the such as wood, a tooth, medical bolus, or wire. esophagus, and fluid is pumped under pressure. The diagnosis of an esophageal obstruction is This method is useful in that it decreases the likeli- usually made by the inability to pass a nasogastric hood of aspiration pneumonia and allows for a tube or endoscopy. However, other diagnostic tools greater mechanical advantage in propulsion of the that may be useful include ultrasound, radiographs, mass into the stomach. This procedure can be done and digital palpation. In addition, with any choke in the standing horse but is greatly facilitated with it is important that the horse be examined to deter- general anesthesia. mine if aspiration pneumonia has occurred as a Oxytocin has been used almost exclusively for sequlea to the dysphasia. obstetrical and reproductive procedures. However, The treatment of esophageal obstructions with a this hormone administered at higher doses may food mass usually involves the passage of a nasogas- have profound effects on the esophagus and can tric tube and intraluminal lavage. This is usually assist in the alleviation of esophageal obstructions. NOTES 338 1997 @ Vol. 43 @ AAEP PROCEEDINGS Proceedings of the Annual Convention of the AAEP 1997 Reprinted in the IVIS website with the permission of the AAEP Close window to return to IVIS MEDICINE I 2. Materials and Methods resolved with systemic antibiotic therapy. Two All of the horses in this study were referred for the horses developed or had other problems not associ- treatment of an esophageal obstruction. The infor- ated with the obstruction or oxytocin administra- mation gathered was on a retrospective basis and tion. One horse developed salmonella diarrhea included the signalment, duration of the choke, immediately prior to its release, and although this location of the obstruction, material causing the horse became severely debilitated and was eutha- obstruction, duration of clinical signs, the type of nized, no evidence of choke was noted. In the treatment that was initially tried to resolve the second horse with nonassociated problems, it was obstruction, and the amount of time this treatment determined to have abdominal pain once the obstruc- was attempted. In addition, the dose of oxytocin tion was relieved. Upon transrectal examination administered, the time from administration of oxyto- the horse was determined to have a large colon cin to resolution of the choke, any adverse effects, displacement that was confirmed at surgery. All of and any complications as a result of the choke or the horses having an endoscopic examination after oxytocin administration were recorded. resolution of the choke had mucosal edema in the location of the choke, but there was no evidence of 3. Results mucosal ulceration or lacerations. Ten horses were included in the study, with a mean age of 12 years with a range of 18 months to 30 years. 4. Discussion Four of the horses were females and six were geld- Oxytocin administration appears to be a practicable ings. The breeds represented included (two) Thor- conservative treatment for esophageal obstructions oughbreds, (two) Paints, (two) ponies, (one) in horses. In the two cases that had distal obstruc- Saddlebred, (one) Quarter Horse, and (one) Lippi- tions, the use of oxytocin was not as beneficial. This zaner. The range for the duration of the choke was may be related to the fact that the proximal two 1.5–36 h with a mean duration of 20 h. The obstruc- thirds of the esophagus is striated muscle, and the tive mass was considered food obstruction in nine distal one third is smooth muscle. Oxytocin may horses, and one had evidence of a foreign body not be as effective in distal obstructions because it consisting of wood and tree bark. Of the ten horses, has a different pharmaceutical effect on the smooth eight had proximal esophageal obstructions, one had muscle. an obstruction just caudal to the heart, and one had Although oxytocin may prove to be a quick and an obstruction extending from the diaphragm to the effective method of resolving choke and may de- proximal esophageal sphincter. Seven of the horses crease the chance of aspiration pneumonia by allevi- received treatment for choke in the form of sedation ating the need for esophageal lavage, there are with nasoesophageal intubation and lavage prior to several precautions. In this study, oxytocin was oxytocin administration. The duration of this treat- administered to four mares. However, none were ment lasted from 10 min to 3 h; these horses received pregnant or lactating at the time of administration. oxytocin at the end of this procedure. Oxytocin was Because of the drug’s profound effect on the uterus administered to all ten horses by intravenous bolus and mammary tissue, it is not recommended that it at a dose of 1.1–2.2 units/kg. Of the ten horses be used for the resolution of choke in pregnant mares receiving the oxytocin, eight resolved the obstruction or immediate postfoaling mares, as this could cause without further treatment. The two horses in which premature foaling or severe pain. An endoscopic the oxytocin did not resolve were the two horses with examination should also be performed prior to the caudal obstructions. Mild effects of the oxytocin administration of oxytocin in the event there is a were noted in several of the horses and included foreign body that may cause additional tissue trauma anxiety and sweating. No long-term effects were or esophageal lacerations with the increased motility noticed. Complications associated with the choke of the esophagus. It is probably also wise to avoid were aspiration pneumonia in two horses, which the use of oxytocin in severely debilitated horses. AAEP PROCEEDINGS @ Vol. 43 / 1997 339 Proceedings of the Annual Convention of the AAEP 1997.
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