Many surgical procedures of the head and neck can be safely performed in the standing horse, with easy access to all aspects of the surgical field. Some procedures, such as tracheotomy, are easier to perform with the horse standing with the head in a more natural position than with the horse under general anesthesia. Procedures of the neck and thorax that require evacuation of purulent and necrotic material from confined spaces, such as occur in horses with esophageal ruptures and extensive intrathoracic abscesses, can be done as standing procedures to avoid the risks of general anesthesia on severely debilitated patients.