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5 May 2000
Evaluating and
FOCAL POINT Stabilizing the
★Ferrets have a number of
diseases that require prompt
recognition; familiarity with
Critical Ferret:
specific diagnostic and
therapeutic techniques is
Basic Diagnostic and
necessary to ensure adequate
critical care.
Therapeutic Techniques*
University of California, Davis Indianapolis Zoo, Indianapolis, Indiana
KEY FACTS Keith G. Benson, DVM Jan C. Ramer, DVM
■ Ferret phlebotomy is most easily University of Wisconsin
achieved using the jugular vein Joanne Paul-Murphy, DVM
or cranial vena cava.
■ Thoracic radiography is a crucial ABSTRACT: Understanding the differences and similarities between ferrets and other domestic
diagnostic tool for evaluating carnivores facilitates rapid acquisition of diagnostics as well as administration of life-saving
ferrets that are weak, coughing, measures. Restraint, phlebotomy, and tracheal wash techniques vary from those traditionally
lethargic, and/or dyspneic. used in small animal medicine. Interpretation of radiographs and diagnostic ultrasonography
requires familiarity with normal ferret anatomy. Furthermore, intravenous and intraosseous
■ The urethral opening of male catheterization, urethral catheterization, fluid therapy, and nutritional support all have ferret-
ferrets is located on the ventral specific caveats; appreciation of these differences can ensure that ferrets receive high-quality
care in a timely fashion.
aspect of the penis several
millimeters proximal to the
glans.
D
omestic ferrets represent a healthy portion of small animal patient loads.
■ When placing intravenous
Therefore, veterinarians must not only provide ferret owners with pre-
catheters, prepuncturing the
ventive care for their pets but also be able to deliver quality emergency
skin is often recommended.
care. This article describes some common diagnostic and therapeutic techniques
used in emergency medicine, with focus on how the methodologies are adapted
■ Intraosseous catheters in the
to the specific requirements of domestic ferrets.
tibia or femur are useful in
ferrets, particularly small animals
RESTRAINT
where intravenous access may
Most ferrets are amenable to simple, gentle, manual restraint. However, ferrets
be difficult to achieve.
that are highly mobile or fractious or are in pain may require special handling to
successfully restrain them. One technique involves grasping the ferret’s skin on
the scruff of its neck and lifting all four limbs off the table; most ferrets immedi-
*A companion article entitled “Evaluating and Stabilizing the Critical Ferret: Initial As-
sessment, Differential Diagnosis, and Diagnostic Plan” appeared in the March 2000 issue
(Vol. 22, No. 3) of Compendium.
Compendium May 2000 Small Animal/Exotics
TABLE I
Chemical Restraint Agents for Domestic Ferrets
Protocol Dose and Route of Administration
29
Acepromazine 0.1–0.3 mg/kg IM
Isoflurane 2% to 3% in O2 1 L/min, 3% to 3.5% in O2 induction, 0.5% to 2.5% in O2
maintenance
Ketamine 10–20 mg /kg8 IM, short duration; 30–60 mg/kg8 IM
Xylazine 1 mg/kg8 SC, IM
Ketamine–diazepam 10–20 mg/kg ketamine,1–2 mg/kg diazepam7 IM; 25–35 mg/kg ketamine, 2–3 mg/kg
diazepam30 IM
Ketamine–midazolam 20–30 mg/kg ketamine, 0.2 mg/kg midazolam IM
Ketamine–acepromazine 10–30 mg/kg ketamine, 0.05–0.3 mg/kg acepromazine29 SC, IM
Ketamine–xylazine 25 mg/kg ketamine, 2 mg/kg xylazine31 IM; 30 mg/kg ketamine, 0.3 mg/kg
xylazine31 IM
Ketamine–medetomidine 5 mg/kg ketamine, 0.08 mg/kg medetomidine32 IM
Tiletamine–zolazepam 12–22 mg/kg each33 IM
Reversal Agents
Yohimbine 0.5 mg/kg8 IM
Atipamazole 0.4 mg/kg32 IM
Naloxone 0.04–0.1 mg/kg8 SC, IM, IC
ately cease struggling when held in this position. An- mean arterial pressure of ferrets is less than 60 mm Hg.
other approach is to place the ferret in dorsal recum- Thus the degree of hypotension is dose related.4
bency, using one hand to hold the scruff of its neck and
the other hand to hold its pelvic limbs and pelvis and DIAGNOSTICS
then straightening the ferret’s body. In addition to Phlebotomy
physically restraining fractious ferrets, offering them a Because ferrets have small superficial vessels and
small amount of preferred pet food (Prescription Diet® tough skin, phlebotomy becomes more challenging
a/d; Hill’s Pet Nutrition, Topeka, KS), Nutrical® (Evsco than it is in other companion animals. In ferrets, phle-
Pharmaceuticals, Buena Vista, NJ), or chicken baby botomy sites include the cephalic vein, lateral saphe-
food on a tongue depressor (held rostral to the nose) nous vein, femoral vein, jugular vein, cranial vena cava,
often distracts the animal during certain procedures, and ventral tail artery.5–7 Small (0.1- to 0.3-ml) samples
such as jugular or cranial vena caval venipuncture. of blood can be withdrawn from the cephalic or lateral
Various chemical restraint protocols (Table I) can saphenous vein similar to the same procedure used in
also be used for domestic ferrets. Isoflurane and a ket- dogs and cats. Small needles (25 to 30 gauge) and sy-
amine–benzodiazepine combination are the most com- ringes (0.5 to 1.0 ml) are recommended for these sites.
mon anesthetics used. Advantages of using sedation Because withdrawing samples from the cephalic vein
must be weighed against the potential complications likely precludes subsequent catheterization of the vessel,
that can occur in compromised patients. The rapid in- veterinarians should consider whether the cephalic vein
duction, recovery, and controlled depth of anesthesia may be needed to administer fluids or medication.
make isoflurane an excellent choice for many critically Withdrawing blood from the jugular vein is more com-
ill ferrets. Inhalation anesthetics should be administered mon for larger sample volumes. The jugular vein has a
to ferrets using a nonrebreathing system. Because narrow diameter and is superficial. This vein can be
isoflurane reduces the number of circulating erythro- easily traversed when inserting a needle; thus bending it
cytes via splenic sequestration in ferrets, this agent at an angle of 20˚ to 30˚ can facilitate venipuncture.
should be used with caution in severely anemic ani- Blood can also be collected from the cranial vena
mals.1–3 Isoflurane administration to domestic ferrets is cava; fractious ferrets may require general anesthesia. A
associated with substantial decreases in arterial blood 1-inch, 22-gauge needle on a 3- or 5-ml syringe should
pressure. At 1.0 minimum alveolar concentration, the be used to collect blood from this vessel. The ferret
pulmonary edema,
pulmonary infil-
trates, and soft tis-
sue masses can be
determined from
standard radiograph-
ic views of the tho-
rax. The status, size,
and shape of the
heart, however, can
Figure 1B be difficult to evalu-
Figure 1—(A) Lateral and ate. The cardiac silhouette of ferrets is naturally globoid
(B) ventrodorsal radio- (Figure 1) and thus cannot be scrutinized with the
graphs showing the normal same criteria used to judge canine and feline hearts.9 A
ferret thorax. contrast esophagram may be helpful to confirm a diag-
nosis of megaesophagus.10
should be restrained in Abdominal radiography can identify accumulations
dorsal recumbency with of fluid, organomegaly, space-occupying masses, and
its neck extended. The gastrointestinal foreign bodies. The intestine of normal
notch between the man- ferrets should not contain intraluminal gas. Spleno-
ubrium and first rib should megaly is a common, nonspecific finding in older fer-
be palpated—this is the rets because the splenic size gradually increases with
site of entry for the nee- age. The causes of splenomegaly include neoplasia, ane-
Figure 1A dle. The needle should mia, sepsis, chronic illness, and extramedullary hemato-
be angled approximately poiesis.11 Whereas 5% of ferrets with splenomegaly
10˚ from the horizontal plane and directed toward the have splenic disease, most have extramedullary hemato-
contralateral coxofemoral joint. Slight negative pressure poiesis and/or congestion.12 Plain radiography and con-
should be applied to the syringe and the needle ad- trast studies of the urinary tract can help veterinarians
vanced slowly until blood begins to flow. After the sam- evaluate markedly enlarged prostates, cystic and ure-
ple has been withdrawn, some veterinarians opt to ap- thral calculi, cystic kidneys, and bladder cysts.13
ply direct pressure at the notch of the manubrium and
first rib. Ultrasonography
Cardiac
Tracheal Wash Ferrets in cardiac failure require minimal restraint for
Because ferrets have a small-diameter trachea, the echocardiography. However, ferrets that are not in car-
transglottal approach should be used for tracheal wash- diac failure may be too fractious for thorough evalua-
es. Ferrets should be anesthetized and intubated using a tion without anesthesia; isoflurane administered in oxy-
sterile 2.5- to 4-mm diameter endotracheal tube.8 A gen via facemask is a safe and effective restraint method.
sterile 3.5-Fr red rubber or polypropylene catheter Two-dimensional echocardiography should be used to
should be advanced through the endotracheal tube to measure chamber size, wall thickness, and shortening
the level of the third to sixth intercostal space. From 2 fraction and assess valvular function. Pleural effusions
to 3 ml of sterile 0.9% sodium chloride or lactated and masses in the cranial mediastinum are best evaluat-
Ringer’s solution should be injected into the catheter ed using thoracic ultrasound imaging. Echocardio-
and the fluid immediately withdrawn while the thorax graphic values for ferrets have been reported.12
is coupaged. The sample should be submitted for cyto-
logic and microbiologic evaluations. If practitioners Abdominal
suspect systemic mycosis, fungal cultures should be Ferrets are excellent subjects for abdominal ultrasonog-
specifically requested. raphy because they usually can be manually restrained
for the procedure. Linear-array probes are ideal, and a
Radiography frequency of 7.5 MHz is recommended. The abdominal
Thoracic radiography is a crucial diagnostic tool for cavity can be evaluated for effusion, size, and architecture
evaluating ferrets that are weak, coughing, lethargic, of the liver, spleen, adrenal glands, intestinal tract, re-
and/or dyspneic. The presence of thoracic effusions, gional lymph nodes, reproductive tract (prostate in male
23. Harrenstien LA: Critical care of ferrets, rabbits, and rodents. Semin 31. Moreland AF, Glaser C: Evaluation of ketamine, ketamine-
Avian Exotic Pet Med:217–226, 1994. xylazine and ketamine-diazepam anesthesia in the ferret. Lab
24. Benson K, Carr A, Steinberg S, Paul-Murphy J: Non-endo- Anim Sci 35:287–290, 1985.
scopic placement of percutaneous gastrostomy tubes in nor- 32. Ko JCH, Heaton-Jones TG: Anesthetic effects of medetomi-
mal domestic ferrets (Mustela putorius furo). Lab Anim, ac- dine, medetomidine-butorphanol, medetomidine-ketamine,
cepted for publication. and medetomidine-butorphanol-ketamine in the ferret. Vet
25. Hillyer EV: Blood collection and transfusion in ferrets, in Anesth 26:159, 1997.
Bonagura JD (ed): Kirk’s Currrent Veterinary Therapy XII. 33. Payton AJ, Pick JR: Evaluation of a combination of tile-
Philadelphia, WB Saunders Co, 1995, pp 1341–1344. tamine and zolazepam as an anesthetic for ferrets. Lab Anim
26. Manning DD, Bell JA: Lack of detectable blood groups in Sci 39:243–246, 1989.
domestic ferrets: Implications for transfusion. JAVMA 197: 34. Brown SA: Ferret drug dosages, in Bauk L, Boyer TH,
703–707, 1990. Brown SA (eds): Exotic Animal Formulary. Lakewood, CO,
27. Orcutt CJ: Emergency and critical care of ferrets. Vet Clin American Animal Hospital Association, 1995, pp 5–11.
North Am Exotic Anim Pract 1:99–126, 1998.
28. Davis JA, Greenfield RE, Brewer TG: Benzocaine-induced
methemoglobinemia attributed to topical application of the About the Authors
anesthetic in several laboratory animal species. Am J Vet Res Dr. Benson is a resident in Zoological Medicine, School of
54:1322–1326, 1993. Veterinary Medicine, University of California, Davis, Cali-
29. Mason DE: Anesthesia, analgesia and sedation for small mam-
fornia. Dr. Ramer is a staff veterinarian at the Indianapolis
mals, in Hillyer EV, Quesenberry KE (eds): Ferrets, Rabbits,
and Rodents: Clinical Medicine and Surgery. Philadelphia, Zoo, Indianapolis, Indiana. Dr. Paul-Murphy is the chief of
WB Saunders Co, 1997, pp 378–391. service of the Special Species Health Service at the
30. Brown SA: Ferrets, in A Practitioner’s Guide to Rabbits and School of Veterinary Medicine, University of Wisconsin,
Ferrets. Lakewood, CO, American Animal Hospital Associa- Madison, Wisconsin.
tion, 1993, pp 43–111.