Sixty years of equine anaesthesia – are we getting better at it?

Objective: To present the essence of the presentation “CEPEF – What we knew then and what we know now” given at the autumn meeting of the Association of Veterinary Anaesthetists in 2025, celebrating its 60th anniversary. Databases used (this is not a formal systematic review): PubMed, Scopus, Google Scholar and the 4th Confidential Enquiry into Equine Perioperative Fatalities (CEPEF4). Search terms used: horse; pony; equine; anaesthesia; anesthesia; recovery; morbidity and mortality. Conclusions: It is well recognized that general anaesthesia carries a greater risk of mortality in horses than in other domestic species and humans. The history of equine anaesthesia, whose beginnings were not far removed from those of human anaesthesia, is traced from its start in the 19th century. The extent of the risk of equine anaesthesia-related mortality was first formally documented in the 1980s. Subsequent studies have evaluated developments including new drugs and methods of their administration, enhanced monitoring and a range of handling procedures. These changes appear to be associated with a decrease in the mortality risk in healthy horses from around 1% in 2002 to 0.6% in 2024. However, the risk of mortality is still serious, and the results of CEPEF4 outline potential areas for improvement and for further research via the proposed CEPEF5.