Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Feeding Before Surgery Helps Horses
We sit down with award-winning equine researcher Dr. Charlie Barton to unpack a controlled randomized trial from Colorado State University that challenges the tradition of fasting horses before general anesthesia—and the results are hard to ignore. Horses allowed hay before anesthesia passed manure much sooner post-op, often within three hours, while fasted horses took up to eight. Even better, careful intraoperative monitoring showed no difference in oxygenation or other key anesthesia parameters.
We walk through how the team designed the study and learn how the data point toward a protocol change with real-world benefits: faster GI recovery, shorter hospital stays, lower exposure to hospital pathogens, and calmer patients who aren’t fighting muzzles or playing in water buckets out of boredom. Along the way, Charlie shares surprises in the data, how behavior can skew water measurements, and why aligning practice with species biology can be helpful.
This conversation also opens the curtain on collaborative research in a busy hospital—how a residency project became a catalyst for protocol change and sparked interest from other clinics reevaluating their feeding plans. We close with practical takeaways for veterinarians, clear guidance for horse owners, and a few personal notes about career pivots, coffee before rounds, mountain trails, and the joy of seeing horses munch hay on their way to safer, smoother recoveries.
If you care about equine anesthesia, postoperative colic risk, and evidence-based protocols, you’ll want to hear this. Subscribe, share with your surgery and anesthesia teams, and leave a review to let us know your hospital’s approach—and whether you’re ready to feed before general anesthesia.
JAVMA article: https://doi.org/10.2460/javma.24.04.0235
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SPEAKER_01:Welcome to Veterinary Vertex, the AVMA Journal's podcast, where we delve into behind-the-scenes look with manuscript authors. I'm editor-in-chief Lisa Fordier, and I'm joined by Associate Editor Sarah Wright. Today we're exploring an absolute mythbuster, and that is how fasting horses perioperatively actually decreases manure production and increases the time for manure output postoperatively, with the journal award winner and hot dog equine researcher Charlie Barton.
SPEAKER_02:Charlie, thank you so much for being here today. Thank you guys so much for having me. So before we dive in, could you share a little about your background and what brought you to this project?
SPEAKER_03:Yeah, absolutely. So at the time we were doing this project, I was a surgery resident at CSU. I've since finished residency last year, and I stayed on at CSU as a postdoc to focus on research, but this study was one of my residency research projects. So we were collecting data for it kind of throughout my whole residency. And then we got the final manuscript published in Javma just before I finished last year.
SPEAKER_01:Charlie, your JAVMA article talks about how basically test the dogma, why we always fasted horses preoperatively. We thought it was going to have all these negative impacts on anesthetic parameters. But as I said in the introduction, it's a complete myth buster. And you show how the horses with continued access to hay prior to and fallen recovery actually pass more manure and pass more manure sooner. Again, please walk us through the motivation behind this research. It's really, we say research, but it's clinical research. And this is really super important for our field.
SPEAKER_03:Yeah, so in the hospital, we were previously fasting the horses for six to eight hours before general anesthesia across the board for all of our elective cases. And then at that time, our horses were also on straw bedding, so they had to be muzzled. And this fasting protocol had been the same since forever. Um, it was just kind of what everybody had done. And we started to question if really fasting them and muzzling them was really going to be the best practice. And then looking into the literature that we had, they initially thought that if we fasted horses, it would reduce the incidence of colic. It would improve the oxygenation of these horses under GA as well, as they thought that a very full colon was going to press against the diaphragm and that would reduce the oxygenation. And then in other species in which some of this fasting data was extrapolated from, vomiting and regurgitation is a big problem. So obviously, horses can't vomit, so that's not really a concern for us, and also their continuous grazes. So we started to think that actually, if they were able to have access to hay, that would actually improve and give them some benefit from a GI colic perspective. Um, so we wanted to create a prospective controlled study that looked at these variables, and then that would provide some evidence-based recommendations that we could use, at least in our hospital moving forwards, and uh hopefully other people would read and start thinking about and also start questioning in their hospitals too.
SPEAKER_01:Yeah, amazing that you got this done. And prospective studies are also really difficult to do. Uh, tell me more about how you designed the study to ensure that there was safety under anesthesia. And honestly, the conversations with anesthesia, how do you get them on board for to design and implement this prospective study?
SPEAKER_03:So we have an amazing um anesthesia team at CSU. They were involved in the study from the start. Um, and there was a very specific protocol that we followed to ensure that the study was adequately controlled because we know that anesthetic drugs can impact their GI function. So Dr. Rachel Hector was one of the anesthesiologists who really helped drive this. Um, and from looking at the literature, we hypothesized that other retrospective studies and um wouldn't affect the oxygenation of these horses. And then whenever they were under GA, we monitored a lot of intraoperative parameters. So we looked at hypoperfusion throughout the course of surgery, and then also the PAO2, just to make sure that they were adequately oxygenating. We didn't actually end up finding any difference between the fasted or fed horses in terms of the anesthetic variables. But if we had seen a difference, we would have stopped this study earlier. Um, but thankfully there was no difference at all.
SPEAKER_01:Fascinating. I went to CSU, as you probably know, and I I remember debating did I want to specialize in anesthesia surgery because both teams were and still are very, very strong at CSU, a very thoughtful uh forward thinking.
SPEAKER_03:Yeah, it's really lucky, and everyone works together so well. Like this whole study was truly a team effort. So it was it was awesome to see all come together.
SPEAKER_01:Were there any things that surprised you or aspects of it that went differently than what you thought might happen?
SPEAKER_03:So we had hypothesized initially that there was going to be a difference in water intake between the groups. Interestingly, we didn't actually find a statistical significance between the groups in terms of water intake. Uh, one of the things that we had noticed in our horses that were muzzled is that they tended to play in their water buckets um just because they didn't have their hay to munch on. So um they would play in kind of the water a lot. So potentially we lost some water from those groups from them playing, so that could have affected our results. Um, but that's definitely something that I found interesting and would um would like to look into more. Uh and then I guess the other um thing that I was surprised about was the speed of manure passage in the horses that were fasted compared to the ones that were fed. Um it was actually a really big difference. So the horses that we fed pass manure within three hours after recovery. But the fasted horses, it took up to eight hours for them to pass manure. So it was actually a really big difference. And I don't think I really appreciated how big that difference would be.
SPEAKER_01:And clinically that's so important because as equine surgeons, we don't want a horse to go home until they have normal manure output. So that may mean another day or two in the hospital, which is obviously higher cost and more chances for catching other infections from other patients in the hospital. Just a really, really stunning manuscript.
SPEAKER_03:Yeah, thank you. It's I'm really happy with how it's changed and everything in our hospital. Um, and also to provide some evidence for some of the things that we thought. Um, so I'm pretty excited by it. And it makes me happy to see all the horses in the hospital kind of munching on the hay before surgery.
SPEAKER_02:So, Charlie, what are some of the key take-home messages that you hope veterinarians and clients will remember?
SPEAKER_03:So, in our population, we found that horses that were fed before general anesthesia pass more manure and pass manure more quickly following recovery than the horses that were fasted. Um, so I'm hoping that uh people will think about their anesthetic feeding protocols and uh hopefully start feeding horses before GA.
SPEAKER_01:Yeah, super important. Also, it's hard to ask a client like, please don't feed your horse all night. And I had a lot of horses that would trailer in for same-day outpatient arthroscopy. You're like, you have to trailer the horses used to munching on hay, and you're like, no, can't have any hay. So I think it's uh it's just super impactful.
SPEAKER_03:Yeah, definitely. And we uh we noticed we, as I said, we had all the um horses on straw. So whenever you take away the hay, they start trying to eat their straw and then kind of like playing and sharing some of those boredom behaviors. So uh eating, I think keeps them happy, both from a GI perspective and also mentally, too.
SPEAKER_01:Yeah, makes total, it makes total sense. All right, let's switch gear and talk about you winning one of the Aviumate Journal Awards. How did it feel when you found out you're nominated and then you won the award?
SPEAKER_03:I was really excited for the award. The the project had been really cool, but like very challenging at times, especially with the data collection. Um, so every time a horse was enrolled, there was um round-the-clock manure collection and measuring and water measurements and pain scoring. So there was a lot of sleepless diets involved on top of the residency on call. So I was really excited that um the research was impactful in the hospital. Um, and then to get the further recognition and the additional visibility through the award was awesome. Like seeing uh how impactful that their study um was to other places as well. So it's been awesome.
SPEAKER_01:That's great. Uh when you heard, was there one part of your team that you immediately thought of?
SPEAKER_03:I was pretty excited to share the news with everyone. It was such a big team effort. Um so as I said, Dr. Rachel Hector really drove the project from the anesthesia side, setting up the protocol and the data collection that was performed interoperatively. And then the whole of the elective surgery team were also on board and they took the time to enroll their cases and were really supportive of the project. Um, and then of course, Dr. Laura Goodrich was my mentor uh throughout this. So I was really excited to share it with her, and she was really excited by the project. Um, and then she also really drove the implementation of the findings from the study into the hospital. Um, so it led to us changing uh all of our feeding protocols in the hospital for elective cases. Um so I was super excited for everyone to hear the news.
SPEAKER_01:That's great. If you could go back, Charlie, uh, based on your residency, if you go back and tell your younger self or a student who's looking at a residency one thing about that journey, what would it be?
SPEAKER_03:Um, I always find this really hard. So I think just to embrace all the opportunities you get along the way. Um, so I went into residency thinking. I hadn't had much research um experience. So I kind of went into residency thinking all about the surgery and um kept an open mind and then was really excited to be involved in the research too. So I think um one of the big things I would tell myself going back was just to keep an open mind. Um, kind of take all the opportunities you can, kind of figure out what you like, and then uh follow that path and don't keep like a set path in mind, just be open to change and and opportunities.
SPEAKER_02:Yeah, always a good idea to keep those doors open because you never know where they're gonna lead. Yeah, absolutely. Charlie, how has receiving the award influenced your research or your career since then?
SPEAKER_03:So I think the award really helped this study gain and its findings too, gain some visibility. And so getting more people talking about feeding protocols and just thinking about what they're doing in their hospital and if they can uh make improvements or adjustments to that. So it's been really cool to have had people from other hospitals reach out and ask us what we're doing and uh kind of talking about what they're doing and how they might change that. And so seeing the impact of the study and then its extra visibility has been really exciting. And then it's also given us some follow-up ideas of things that we might do to um get more evidence in this area too.
SPEAKER_01:Charlie, looking back, uh, what were some pivotal moments that uh really sparked your interest in veterinary medicine?
SPEAKER_03:So I think my whole first year of residency, in a way, was kind of a pivotal time. It was certainly very challenging as well, but it was when I first got exposure to research and I started to be involved in my own projects and was when I actually started realizing how much I really liked the research as well as surgery, too. So that was a time that I started rethinking where I saw my career going. And then the rest of my residency really reinforced that as I finished up some projects and saw the impact that research can make and change how we care for our patients and also improve the standard of care that we can offer to our patients. Um, so I think that whole time totally changed the direction that I saw myself going.
SPEAKER_01:And what sparked your original interest in veterinary medicine?
SPEAKER_03:Uh, so I wanted to be a vet as long as I can remember. Um, I always loved horses growing up. I grew up riding and I was working at a bar and whenever I could too. So I knew I wanted to be an equine vet, but my interests in kind of the veterinary world changed as I went through the process. So it wasn't until I was in vet school that I realized how much I loved surgery. And then as I went through the process of going towards surgery residencies, um, kind of my the surgeries that I liked changed. And then in residency, I started really liking research too. So I think my interest has definitely changed um throughout the path.
SPEAKER_02:So now we're gonna boil it down to one important piece of information, Charlie. So the first is gonna be dealing with the veterinarian's perspective. So, Charlie, what is one piece of information the veterinarian should know about fasting horses perioperatively?
SPEAKER_03:So, from the findings of our research that horses that are um not fasted before general anesthesia passed more manure and manure more quickly uh following recovery. So uh definitely consider not fasting the horses prior to elective surgery.
SPEAKER_02:Now, on the other side of the relationship for clients, what's one thing that you wish more horse owners understood about this topic?
SPEAKER_03:I think the same that potentially not fasting horses prior to general anesthesia could be beneficial, um, but definitely something that they should discuss with their vet um on the best practice for their horse. Um and yeah, hopefully we can get more horses eating before surgery.
SPEAKER_01:Perfect. Okay, Charlie, before we wrap up, just a few fun questions. Are you a coffee person? Coffee before rounds, coffee all day person? Which one are you?
SPEAKER_03:Coffee before rounds, definitely. Before residency, I'd wake up with that caffeine headache and then I'd need my coffee to kind of make it go away. Um so definitely before rounds. Excellent.
SPEAKER_01:We talk about a lot about wellness and well-being and work-life balance. What's your go-to stress relief?
SPEAKER_03:I love being outdoors. So living in Colorado is a pretty great place. Um, so um, taking my dog for a hike in the mountains, and I also love running, so going on a trail run, um, kind of anything that gets me outside, um, I really enjoy doing.
SPEAKER_01:Charlie loves running so much she recently had a stress fracture in her foot.
SPEAKER_03:Yes, I probably should have mentioned that. Can't run right now, but walking the dog, but yeah, definitely did a little bit too much running.
SPEAKER_01:Yeah, Colorado's beautiful. If you weren't in veterinary medicine, what other career do you think you'd love?
SPEAKER_03:Um, so both my parents are in the aviation industry. My mom's an airline pilot. Um, and I think I would really love to do something with aviation, maybe even a pilot. I just find that side of things so interesting. And so I think I would have gone down that route.
SPEAKER_02:Very cool. Well, Charlie, thank you so much for joining us. Really appreciate you being here today. And congratulations again on being a journal award winner. Thank you so much, and thank you for having me. And for our listeners, you can read Charlie's award-winning article in Javma. I'm Sarah Wright here with Lisa Fortier. Be sure to tune in next week for another episode of Veterinary Vertex. And don't forget to leave us a rating and review on Epic Podcast or wherever you listen.
