Nitric oxide and its role in the management of hypoxaemia in the anaesthetised horse-a narrative review.

Pulsed inhaled nitric oxide effectively treats hypoxaemia in anesthetised horses.

This narrative review examines nitric oxide's historical discovery and biological mechanisms, with focus on inhaled nitric oxide (iNO) applications in veterinary anesthesia. Inhaled NO is FDA-licensed for treating hypoxic respiratory failure in human neonates and refractory hypoxaemia in select adult patients. The review synthesizes evidence demonstrating that pulsed inhaled nitric oxide (PiNO) effectively manages hypoxaemia during equine general anesthesia by redistributing pulmonary blood flow from poorly ventilated dependent lung regions to better-ventilated nondependent areas. This mechanism reduces intrapulmonary shunting and improves oxygenation indices and systemic oxygen delivery. Evidence includes substantial experimental data and clinical case descriptions in horses undergoing surgical procedures including colic repair and arthroscopy. With recent redevelopment of delivery systems, PiNO represents a promising near-future treatment modality for managing perioperative hypoxaemia in anesthetized horses, though further clinical validation is warranted.

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