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To characterize pulmonary gas exchange and arterial lactate in horses with gastrointestinal disease undergoing anesthesia, compared with elective surgical horses, and to correlate these variables with postoperative complications and mortality.Prospective clinical study.Horses undergoing emergency laparotomy for acute intestinal disease (n=50) and healthy horses undergoing elective surgery in dorsal recumbency (n=20).Arterial blood gas analysis was performed at predetermined intervals on horses undergoing a standardized anesthetic protocol. Alveolar–arterial oxygen gradient was calculated. Predictive factors for postoperative complications and death in colic horses were determined.Arterial oxygen tension (PaO2) varied widely among horses in both groups. PaO2 significantly increased in the colic group after exteriorization of the ascending colon. PaO2 and alveolar–arterial oxygen gradient were not significantly different between groups, and neither were correlated with horse outcome. Arterial lactate in recovery ≥5 mmol/L was associated with a 2.25 times greater relative risk of complications and lactate ≥7 mmol/L was associated with a 10.5 times higher relative risk of death.Colic horses in this population were not more likely to be hypoxemic than elective horses, nor was gas exchange impaired to a greater degree in colic horses relative to controls. Arterial lactate sampled immediately after anesthetic recovery was predictive for postoperative complications and death.