Anesthesia in a horse with diaphragmatic hernia

An eight-year-old Thoroughbred mare was presented with acute colic symptoms. Clinical and ultrasonographic examination revealed a suspicion of diaphragmatic hernia, which was confirmed during an emergency midline laparotomy performed the same day. Patients with diaphragmatic hernia pose a challenge for the surgeon and the anesthesiologist, because of the disturbed function of the diaphragm and the displacement of the abdominal organs into the thoracic cavity. Achieving optimal ventilation and oxygenation without causing damage to the lungs is not simple. In this case, assisted-controlled, intermittent positive pressure ventilation with a low tidal volume, low pressure and relatively high respiratory rate was applied. Alongside the difficulties during ventilation, the patient was cardiovascularly compromised. Due to the extent and position of the hernia, euthanasia was performed after obtaining the owner's consent during surgery.