For horses undergoing general anaesthesia, are rope recoveries or free recoveries better?



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PICO question

In horses undergoing general anaesthesia, does assistance with ropes result in better recoveries when compared to no assistance (‘free’ recovery)?


Clinical bottom line

Category of research question


The number and type of study designs reviewed

One randomised, non-blinded controlled trial and two retrospective cohort studies

Strength of evidence


Outcomes reported

The three studies reviewed arrive at different conclusions regarding the utility of rope assistance in recovery from general anaesthesia in horses, but examine very different populations. The randomised controlled trial provides weak evidence that rope assistance can shorten recovery and improve recovery quality in healthy (American Society of Anesthesiologists (ASA) I–II) horses. One retrospective cohort study provides weak evidence that rope assistance confers a reduction in fatality in both healthy and sick horses. The other retrospective cohort study provides weak evidence that rope assistance confers no benefit to horses undergoing emergency colic surgery. Both assisted and unassisted groups in each study had fatalities and all studies reported complications related to the rope recovery system


Insufficient evidence is available to permit a full recommendation regarding rope assistance during recovery from general anaesthesia in horses. Rope assistance may improve recovery time and quality in some horses. The decision to perform a rope-assisted recovery must be made considering individual patient, team and clinic factors. Rope assistance cannot prevent fatalities in recovery


How to apply this evidence in practice

The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources.

Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.


Open Access Peer Reviewed


Arndt, S., Hopster, K., Sill, V., Rohn, K. & Kästner, S.B.R. (2019). Comparison between head-tail-rope assisted and unassisted recoveries in healthy horses undergoing general anesthesia for elective surgeries. Veterinary Surgery. 49(2), 329–338. DOI:

Auer, U & Huber, C. (2013). A comparision of head/tail rope-assisted versus unassisted recoveries of horses after patrial intravenous general anaesthesia. Abstracts presented at the Association of Veterinary Anaesthetists Spring meeting, 22nd–23rd March 2012, Davos, Switzerland. (2013). Veterinary Anaesthesia Analgesia. 40(1), 1–28. DOI:

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da Silva, D.R.P., Silva, G.B., de la Côrte, F.D., Brass, K.E., Pozzobon, R., Dau, S.L., de Gasperi, D, & Freitas, G.C. (2018). Anesthetic recovery assisted by rope at three points in horses. Ciéncia Rural. 48(11), 1–6. DOI:

de Miguel Garcia, C., Campoy, L., Parry, S., Miller, J.E., Martin-Flores, M. & Gleed, R.D. (2021). Questionnaire on the process of recovering horses from general anesthesia and associated personnel injury in equine practice. Veterinary Anaesthesia and Analgesia. 48(2), 223–229. DOI:

Dugdale, A.H., Obhrai, J. & Cripps, P.J. (2016). Twenty years later: a single-centre, repeat retrospective analysis of equine perioperative mortality and investigation of recovery quality. Veterinary Anaesthesia and Analgesia. 43(2), 171–178. DOI:

Dugdale, A.H.A. & Taylor, P.M. (2016). Equine anaesthesia-associated mortality: where are we now? Veterinary Anaesthesia and Analgesia. 43(3), 242–255. DOI:

Gozalo-Marcilla, M., Redondo, J.I., Johnston, M., Taylor, P. & Bettschart-Wolfensberger, R. (2020). A new equine anaesthetic mortality study two decades after CEPEF2: CEPEF4 is going live! Equine Veterinary Journal. 52(6), 891–892. DOI:

Johnston, G.M., Eastment, J.K., Wood, J.L.N. & Taylor, P.M. (2002). The confidential enquiry into perioperative equine fatalities (CEPEF): mortality results of Phases 1 and 2. Veterinary Anaesthesia and Analgesia.29(4), 159–170. DOI:

Johnston, G.M., Taylor, P.M., Holmes, M.A. & Wood, J.L.N. (1995). Confidential enquiry of perioperative equine fatalities (CEPEF‐1): preliminary results. Equine Veterinary Journal. 27(3), 193–200. DOI:

Laurenza, C., Ansart, L. & Portier, K. (2020). Risk factors of anesthesia-related mortality and morbidity in one equine hospital: a retrospective study on 1,161 cases undergoing elective or emergency surgeries. Frontiers Veterinary Science. 6, 1–10. DOI:

Nicolaisen, A.S.K., Bendix Nygaard, A., Christophersen, M.T., Jensen, D.B. & Lindegaard, C. (2020). Effect of head and tail rope-assisted recovery of horses after elective and emergency surgery under general anaesthesia. Equine Veterinary Education. 1–8. DOI:

Niimura Del Barrio, M.C., David, F., Hughes, J.M.L., Clifford, D., Wilderjans, H. & Bennett, R. (2018). A retrospective report (2003–2013) of the complications associated with the use of a one-man (head and tail) rope recovery system in horses following general anaesthesia. Irish Veterinary Journal. 71(1), 1–9. DOI:

Rüegg, M., Bettschart-Wolfensberger, R., Hartnack, S., Junge, H.K., Theiss, F. & Ringer, S.K. (2016). Comparison of non-assisted versus head and tail rope-assisted recovery after emergency abdominal surgery in horses. Pferdeheilkunde. 32(5):469–478. DOI:

Young, S.S. & Taylor, P.M. (1993). Factors influencing the outcome of equine anaesthesia: a review of 1,314 cases. Equine Veterinary Journal. 25(2), 147–151. DOI:





Vol. 6 No. 3 (2021): The third issue of 2021

Section: Knowledge Summaries

Categories :  Small Animal  /  Dogs  /  Cats  /  Rabbits  /  Production Animal  /  Cattle  /  Sheep  /  Pig  /  Equine  / 

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