Anaesthetic management of a horse with acute kidney injury

Summary Anaesthetic management of animals with acute kidney injuries (AKI) is complex and poses considerable risk. There are no publications describing management of anaesthetised horses with AKI. Perioperative and anaesthetic care of a Thoroughbred filly presented with traumatic injuries and subsequent AKI is described. Management of this case emphasised maintaining renal perfusion via restoring euvolaemia and normotension, along with mitigation of the systemic derangements in electrolytes and pharmacokinetics resulting from AKI. Maintaining euvolaemia was logistically challenging due to the large volume deficits from both initial losses and subsequent polyuria. Hyperkalaemia and hypocalcaemia were encountered and treated intra‐operatively. Anaesthetics and analgesics that were short acting and not dependent on renal elimination were prioritised while potential nephrotoxic medications were minimised. Sedation and induction of anaesthesia was accomplished with medetomidine and ketamine followed by maintenance of anaesthesia with desflurane and medetomidine infusion. This drug combination could provide cardiovascular stability and possibly direct renal protection.