Tracheostomy in the Giant Anteater (Myrmecophaga tridactyla)

Author(s): Benjamin M. BrainardV.M.D., Dipl. A.C.V.A., Dipl A.C.V.E.C.C., Alisa NewtonV.M.D.,

Dipl. A.C.V.P., Keith C. HinshawD.V.M., M.P.V.M., Dipl. A.C.Z.M., and Alan M. KlideV.M.D., Dipl.
A.C.V.A.
Source: Journal of Zoo and Wildlife Medicine, 39(4):655-658. 2008.
Published By: American Association of Zoo Veterinarians
DOI: 10.1638/2007-0124.1
URL: http://www.bioone.org/doi/full/10.1638/2007-0124.1

BioOne (www.bioone.org) is an electronic aggregator of bioscience research content, and the online home to over
160 journals and books published by not-for-profit societies, associations, museums, institutions, and presses.
Your use of this PDF, the BioOne Web site, and all posted and associated content indicates your acceptance of
BioOne’s Terms of Use, available at www.bioone.org/page/terms_of_use.
Usage of BioOne content is strictly limited to personal, educational, and non-commercial use. Commercial inquiries
or rights and permissions requests should be directed to the individual publisher as copyright holder.

BioOne sees sustainable scholarly publishing as an inherently collaborative enterprise connecting authors, nonprofit publishers, academic institutions, research
libraries, and research funders in the common goal of maximizing access to critical research.
 Journal of Zoo and Wildlife Medicine 39(4): 655–658, 2008
Copyright 2008 by American Association of Zoo Veterinarians

TRACHEOSTOMY IN THE GIANT ANTEATER (MYRMECOPHAGA

TRIDACTYLA)

Benjamin M. Brainard, V.M.D., Dipl. A.C.V.A., Dipl A.C.V.E.C.C., Alisa Newton, V.M.D., Dipl.
A.C.V.P., Keith C. Hinshaw, D.V.M., M.P.V.M., Dipl. A.C.Z.M., and Alan M. Klide, V.M.D.,
Dipl. A.C.V.A.

Abstract: Anesthesia in the giant anteater (Myrmecophaga tridactyla) may be complicated by apnea. Although
emergent orotracheal intubation may be possible in other species, the particular anatomy of the anteater prevents a
smooth intubation. A technique, developed on a cadaver model, is described for a surgical approach to the trachea of
the giant anteater that may be used to secure an airway in an anesthetized animal under emergent conditions. The
approach is complicated by the presence of the large paired submaxillary salivary gland and the relatively deep and
caudal position of the larynx relative to the ramus of the mandible. This procedure, however, appears to be a feasible
method to achieve endotracheal intubation in the anteater.
Key words: Anesthesia, giant anteater, Myrmecophaga tridactyla, tracheostomy.

BRIEF COMMUNICATION unlikely to be of benefit in the giant anteater, given

the length of the mouth and nasal passages. Ag-
Anesthetic drugs that have been used for im-
gressive mask ventilation may also result in gas in-
mobilization in the giant anteater (Myrmecophaga
sufflation into the stomach, which may stimulate
tridactyla) include ketamine, combinations of tile-
gastroesophageal reflux or regurgitation.
tamine and zolazepam, combinations of ketamine
The use of laryngeal mask airways, which are
with xylazine or medetomidine, and combinations
inserted into the oropharynx, has been reported in
of etorphine and diazepam.1–3,7,9 Anesthesia of the
veterinary species as an alternative to endotracheal
giant anteater is often accomplished with drugs ad-
intubation.4,10 Because of the limited size of the oral
ministered by remote delivery systems (e.g., pole
opening, the use of the laryngeal mask airway is
syringe, blow-dart, or dart rifle), although hand-in-
not possible in the anteater. In apneic animals that
jection has also been described.7
are unable to be mask-ventilated, another option is
Because remote delivery of anesthetics often re-
tracheal intubation via tracheostomy. The position
quires an estimation of body weight, both over- and
of the larynx of the anteater (deep into the thoracic
underdosing of anesthetic agents is a possibility. A
inlet) has raised questions about the feasibility of
common sequela of anesthetic overdose is apnea,
tracheostomy in this species, because of concerns
which may lead to adverse effects including hyper-
about iatrogenic pneumothorax and inaccessibility
capnia, acidosis, hypoxemia, and death. Respiratory
of the trachea.
arrest or hypoventilation are commonly seen with
Sublingual doxapram has been used to treat ap-
the use of potent inhalant anesthetics.8
nea in an anesthetized giant anteater.9 Doxapram is
The most effective treatment for anesthetic-in-
a general stimulant of the sympathetic nervous sys-
duced apnea in most mammalian species is endo-
tem, and can cause arousal and the resumption of
tracheal intubation and manual ventilation, al-
respiration in animals that have stopped breathing.
though in some species (e.g., primates) adequate
If narcotics have been used for immobilization,
ventilation may be obtained through the use of a
their effects may be reversed using naloxone or nal-
tight-fitting mask. Assisted ventilation via mask is
trexone if hypoventilation occurs.
A 25-yr-old female giant anteater, euthanized be-
From the Department of Clinical Studies, Veterinary cause of progression of a rectal adenocarcinoma,
Hospital of the University of Pennsylvania, 3900 Delan- provided a cadaver model for an approach to a tra-
cey Street, Philadelphia, Pennsylvania 19104, USA cheostomy in the giant anteater (Fig.1).
(Brainard, Klide); and the Department of Veterinary Ser- With the animal in dorsal recumbency, the larynx
vices, Philadelphia Zoo, 3400 W. Girard Avenue, Phila-
was palpated approximately between the shoulders.
delphia, Pennsylvania 19104, USA (Newton, Hinshaw).
Present address (Brainard): Department of Small Animal
The distance between the larynx and the manubri-
Medicine and Surgery, College of Veterinary Medicine, um was 11.5 cm. The trachea was not easily pal-
University of Georgia, Athens, Georgia 30602, USA. Cor- pable. After aseptic surgical preparation, a 10-cm
respondence should be directed to Dr. Brainard (brainard@ incision was made on midline between the larynx
uga.edu). and the manubrium. Immediately on incision of the

655
656 JOURNAL OF ZOO AND WILDLIFE MEDICINE

Figure 1. Tracheostomy procedure in the giant anteater (Myrmecophaga tridactyla). A. A midline incision is made
just caudal to the larynx. B. The salivary gland is incised and retracted, along with the sternothyroideus, which is
separated along the median raphe. C. Blunt dissection reveals the trachea. D. A 40% circumference incision is made
in the trachea between rings, after placement of stay sutures cranial and caudal to the incision. E. An endotracheal
tube is placed into the tracheal lumen and secured in place. (Illustrated by Brad Gilleland, The University of Georgia.
Reprinted with permission from Educational Resources, College of Veterinary Medicine, The University of Georgia,
Athens, Georgia, USA).
 BRAINARD ET AL.—ANTEATER TRACHEOSTOMY
skin, large amounts of saliva filled the incision,
arising from the paired submaxillary salivary
glands, which occupy much of the thoracic inlet
area.6 In a living specimen, suction or gauze spong-
es should be available to evacuate the saliva from
the incision. Dissection continued, to reveal the
paired sternothyroideus muscles dorsal to the sali-
vary gland. These muscles were separated along the
median raphe to reveal the larynx. Adventitial tis-
sue was then removed from the larynx to expose
the paired cricothyroideus muscles, the cricoid car-
tilage, and the trachea.
The trachea was retracted cranially to allow ex-
posure for a surgical approach. A pneumothorax
was not created during the dissection of the adven-
titial tissue or manipulation of the trachea; this was
confirmed by the presence of negative pressure in
the pleural space on completion of the necropsy.
Tracheal rings were narrow, but easily palpated.
The trachea was not friable, and was amenable to
surgical manipulations. Stay sutures of 2-0 PDS
(PDS II, Ethicon, Johnson & Johnson, Somerville,
New Jersey 08876, USA) were placed around rings
2 and 4 of the trachea, and an incision comprising
approximately 40% of the tracheal circumference
was made in the ventral aspect of the trachea be-
tween tracheal rings 2 and 3, exposing the tracheal
lumen. At this point, the tracheal lumen measured
2 cm in diameter, and the distance from the cricoid
cartilage to the tracheal bifurcation measured 12
cm, indicating that an 8- or 9-mm ID endotracheal
tube (11–12.2 mm OD) with a high-volume, low-
pressure cuff would be adequate to secure the air-
way for ventilation, although one was not placed
during the dissection.
The giant anteater has many specialized mecha-
nisms suited to its diet and lifestyle. The extended
hyoid apparatus has no bony attachments to the
skull or vertebral column. This allows the muscu-
lature of the neck to counterbalance the long tongue
when it is fully extended. The oral cavity of the
anteater is elongated, with a mouth opening that
measured only 2.75 cm in diameter in our speci-
men. The opening to the mouth was located 30 cm
from the ramus of the mandible, which was 21 cm
cranial to the cricoid cartilage. These measurements
are consistent with those of other specimens.5 This
unique anatomy limits the ability to secure endo-
tracheal intubation.
Endotracheal intubation is desirable during in-
halant anesthesia because it limits the exposure of
personnel to anesthetic gas, in addition to allowing
the use of lower oxygen flows. In the event of re-
spiratory arrest or hypoventilation, endotracheal in-
tubation permits assisted ventilation. End-tidal car-
657
bon dioxide and anesthetic levels may be sampled
from the anesthetic circuit of an intubated animal.
Maintaining anesthesia using a mask requires high-
er fresh gas flows, and may compromise the accu-
racy of end-tidal gas measurements.
Endotracheal intubation in many patients with
difficult airways can be achieved with the use of
endoscopy to directly image the larynx. Using the
endoscope, an endotracheal tube or small-diameter
stylet can be placed into the trachea under direct
visualization. A properly placed stylet can be a
guide for an endotracheal tube, threaded through
the tube itself or the Murphy eye at the distal end
of the endotracheal tube. In this anteater, an endo-
tracheal tube of medium diameter, but with a length
exceeding 60 cm, would have been necessary for
orotracheal intubation.
Other limiting factors to orotracheal intubation in
the anteater may stem from the copious amounts of
tenacious saliva that the anteater produces. Without
adequate lubrication, it may be difficult to slide a
tube through the long oral cavity, and obstacles
such as the tongue base may prevent easy intuba-
tion. For this technique to work, the patient must
be adequately anesthetized, with a relaxed larynx.
Laryngospasm may occur if the endotracheal tube
irritates the arytenoid cartilages, or if the animal
resists intubation.
Retrograde intubation is another, more invasive
option for endotracheal intubation in animals with
difficult airways. The trachea is palpated, and a
needle is inserted percutaneously into the tracheal
lumen, with the bevel facing orad. Through the nee-
dle, a wire is passed until it emerges from the oral
cavity. An endotracheal tube may then be slid over
the wire, and the needle and wire removed once
endotracheal intubation is achieved. This technique
does not appear to be feasible in the anteater be-
cause of difficulties in percutaneous palpation and
stabilization of the trachea for introduction of a
needle with the appropriate angle. The depth and
angle of the trachea suggests that a needle with a
curve, such as a Touhy needle, might be helpful to
direct the wire in the appropriate (cranial) direction.
In animals with long soft palates, however, the wire
may be misdirected into the nasopharynx rather
than the oropharynx. Alternatively, a needle or
catheter may be placed into the trachea through the
cricoid cartilage of the larynx (which was palpable
percutaneously in this specimen), to provide sup-
plemental oxygen to diminish the hypoxemia that
may occur during apnea.
Because of the relatively caudal (almost intratho-
racic) location of the larynx and trachea, signs of
pneumothorax were anticipated during surgical dis-
658 JOURNAL OF ZOO AND WILDLIFE MEDICINE
section. The trachea in this specimen was success-
fully isolated and prepared for endotracheal tube
placement without compromising the pleural cavity,
as determined by the preservation of negative pleu-
ral pressure. This approach does not appear to trau-
matize any of the muscles involved with retraction
or control of the tongue, and for this reason may
be preferable to pharyngostomy for intubation of
this species.
Once a tracheostomy has been performed, it is
necessary to carefully monitor the site to prevent
accidental extubation and to prevent contamination
of the surgical area. Stay sutures are always placed
in the trachea cranial and caudal to the tracheotomy
site and extending from the skin incision so that the
site may be rapidly located for reintubation. The
endotracheal tube may be secured to the neck via
sutures placed through a tape butterfly attached to
the tube.
Although the specific circumstances of this in-
vestigation precluded observation of the healing of
the tracheostomy site, it is recommended to reap-
pose the median raphe of the sternohyoideus mus-
cles after extubation to discourage leakage of saliva
into the healing trachea. It is unclear whether the
incision should be partially or completely closed,
but the decision should be made by the attending
veterinarian, taking into account the temperament
and environment of the animal. An absorbable
monofilament suture is recommended for reappo-
sition of the sternohyoideus.
Despite the sheltered location of the larynx and
trachea in the giant anteater, emergency tracheos-
tomy is a simple and feasible intervention to secure
an airway and treat hypoventilation in this species.
Acknowledgment: The authors thank Brad Gil-
leland, M.S., for the illustration.
LITERATURE CITED
1. Deem, S. L., and C. V. Fiorello. 2002. Capture and
immobilization of free-ranging edentates. In: D. Heard
(ed.). Zoological restraint and anesthesia. Available from:
International Veterinary Information Service
(www.ivis.org), Ithaca, New York. Accessed 2007 Jul 15.
2. Ferrigno, C. R. A., F. Futema, D. L. Fedullo, V.
Kyan, D. Tabacchi Fantoni, D. C. B. Baccarin, and M. A.
Romano. 2003. Treatment of radius, ulna and humerus
fractures with the aid of a bone morphogenetic protein in
a giant anteater (Myrmecophaga tridactyla). Vet. Comp.
Orthop. Traumatol. 16: 196–199.
3. Gillespie, D. S. 2003. Xenarthra: Edentata. In: Fow-
ler, M. E., and R. E. Miller (eds.). Zoo and Wild Animal
Medicine, 5th ed. W. B. Saunders Co., Philadelphia, Penn-
sylvania. Pp.397–407.
4. Goldmann, K, M. Kalinowski, and S. Kraft. 2005.
Airway management under general anaesthesia in pigs us-
ing the LMA-ProSeal: a pilot study. Vet. Anaesth. Analg.
32: 308–313.
5. Naples, V. L. 1999. Morphology, evolution, and
function of feeding in the giant anteater (Myrmecophaga
tridactyla). J. Zool. Lond. 249: 19–41.
6. Owen, R. 1854. On the anatomy of the great anteater
(Myrmecophaga jubata). Trans. Zool. Soc. Lond. 4: 117–
140.
7. Shaw, J. H., J. Machado-Neto, and T. S. Carter.
1987. Behavior of free-living giant anteaters (Myrmeco-
phaga tridactyla). Biotropica 19: 255–259.
8. Steffey, E. P. and K. R. Mama. 2007 Inhalation an-
esthetics. In: Tranquilli, W. J., J. C. Thurmon, and K. A.
Grimm (eds.). Lumb and Jones’ Veterinary Anesthesia
and Analgesia. Blackwell Publishing, Ames, Iowa. Pp.
355–394.
9. Strom, H. Kan man intubere en myresluger? 2003.
Dan. Vet. Tidsskr. 86: 19–21.
10. Wiederstein, I., U. Auer, and Y. Moens. 2006. La-
ryngeal mask airway insertion requires less propofol than
endotracheal intubation in dogs. Vet. Anaesth. Analg. 33:
201–206.
Received for publication 29 December 2007