Avian and Exotic Animal Anesthesia

Javier G Nevarez DVM jnevarez@vetmed.lsu.edu

Objectives

Know the avian respiratory anatomy

Air sacs

Know the avian breathing cycle Know the respiratory stimuli for birds and reptiles Know how methods for thermoregulation during anesthesia Know how to monitor birds and reptiles during anesthesia

Avian Respiratory Anatomy

No diaphragm

Rely on movement of keel bone

Do not inflate ET tube cuff

Complete tracheal rings

Syrinx No epiglottis

ocw.tufts.edu/Content/5/lecturenotes/215768

Avian Respiratory Anatomy

Pneumatic Bones

Humerus, clavicle, keel, ribs, +/- femur

Attached to ribs and dorsal body wall

Non expandable lungs

Air Sacs

Cranial air sacs

Interclavicular (1) Cervical (2) Cranial thoracic (2)

Caudal thoracic (2) Abdominal (2)

Caudal Air Sacs

http://www.paulnoll.com/Oregon/Birds/Avian-Respiratory-2.html

Breathing Cycle

1st Inspiration

Trachea Bronchi Cd. Air sacs

Cd. Air sacs Lungs Lungs Cr. Air sacs

1st Expiration

2nd Inspiration

2nd Expiration

Cr. Air sacs Bronchi Trachea

http://www.faculty.biol.ttu.edu/schmidt/web_site/ORNITH%20avian%20physiology.htm

Inspiration

Expiration

Ventilation Mechanics

Inspiration

Sternum: cranio-ventral Ribs: cranial Increases volume of coelomic cavity Allows air sac expansion

Ventilation Mechanics

Expiration

Sternum: caudo-dorsal Ribs: caudal Decrease volume of coelomic cavity Compresses air sacs

Gas Exchange

Counter current mechanism

Simple diffusion of O2 and CO2

Parabronchi (3o bronchi) Capillaries

Breathing stimulus

O2 and CO2

http://sps.k12.ar.us/massengale/bird_notes_bi.htm

Reptile Respiratory Anatomy

No diaphragm

Rely on rib/coelomic expansion

chelonians and crocodilians lizards and snakes

Complete tracheal rings

Incomplete tracheal rings

No epiglottis

Reptile Lungs

Varied anatomy

Spongy mammal-like Thin air sac-like Intermediate/combination Most only have right lung Boids may have two

Snakes

Expandable

Gas Exchange

Counter current mechanism

Simple diffusion of O2 and CO2

O2

Breathing stimulus

Indications for Anesthesia

Radiographs Surgery Biopsy Physical exam

Anesthetic Agents

Injectable

Used less frequently in birds

Inhalants

Used routinely for induction in birds Used for maintenance in other species

Pain Management

Opioids

Butorphanol
Meloxicam (Metacam), Carpofen (Rimadyl) lidocaine

NSAIDS

Local/topical

Equipment
Anesthetic machine Anesthetic masks ET tubes

2.0 6.0 i.d. Non-cuffed and cuffed 14g 16g IV catheters Paper clip/hemostats as speculum

Equipment

Heat source

Heating pads Heat lamps Forced-air warmers Warm fluid bags Rice/bean bags

Equipment

IV catheters 26g 22g Emergency drugs IV/SQ fluids Monitoring

Doppler Temperature probe ECG Etc.

Incubators

IV Access

Birds

Jugular vein Ulnar vein Medial tarsometatarsal vein

Jugular vein Ventral coccygeal vein Ventral abdominal vein Sub-carapacial

Reptiles

IO Access

Birds

Use non-pneumatic bones only!!

Ulna Tibiotarsus

Reptiles

Femur Tibia Carapace/plastron

IO access can be used the same as IV but with slower volume of infusion

Pre-medication - birds

Opioids

Respiratory depression?? Give 30min to 1 hr before anesthesia

NSAIDS Diazepam

Pre-medication/induction -reptiles
Opioids NSAIDS Ketamine Medetomidine Telazol Propofol

Induction - birds

Isoflurane/sevoflurane

Mask down Start at 5% with 1L/min O2 Asses depth

Flaccid wings and legs Eyes closed HR/RR Righting reflex

Maintenance

Isoflurane

0.5% - 2% 500ml 1L/min O2 DO NOT EXCEED 15 20mmHg POP-OFF valve MUST REMAIN OPEN after breathing 6 12 breaths/min

IPPV

Determining plane of anesthesia

Reflexes

Righting reflex Corneal reflex Tongue withdrawal Toe pinch

Monitoring

Stethoscope Reflexes Doppler Temperature probe ECG Pulse oximeter Capnograph

Monitoring Birds

Heart Rate

> 100 bpm is normal < 100 bpm is of concern

6 12 bpm during anesthesia IPPV if shallow or inconsistent Birds: 105oF is normal

Respiratory Rate

Temperature

Monitoring Reptiles (NEW SLIDE)

Heart Rate

Varies with species, temperature 30-60 bpm is normal <30 bpm is of concern
4 6 bpm during anesthesia IPPV in most instances Reptiles: aim for 90 - 95oF during anesthesia

Respiratory Rate

Temperature

Hypothermia

Heat loss

Convection

Air exchange at body surface Heat loss to surfaces and environment Heat loss from contact (i.e. cold table)

Radiation

Conduction

Evaporation

Heat loss from lungs, skin, exposed tissues

Preventing Hypothermia

Forced-air warmers

Can reduce convection, conduction, and radiation losses depending on the blanket type
Reduce conduction losses Reduce radiation losses Reduce conduction, radiation losses Reduce radiation losses

Heating pads

Heat lamps

Water bath

Bean/rice stockings

Preventing Hypothermia
Convection Forced-air warmer Heating pads Heat lamp Rice/bean stockings Water baths Conduction Evaporation Radiation

X
X X X X

Recovery
Wean off gas before the end of procedure Maintain O2 at low flow rate KEEP WARM!!!!!!!!!!!!!!!! Breathing stimulus

Birds: CO2 and O2 Reptiles: O2

What can go wrong?

Hypothermia Respiratory arrest Cardiac arrest death

How to fix/prevent it? Have heat source IPPV, doxapram Atropine, epi., CPR BE PREPARED!!!!

If you run into problems, turn off the inhalant anesthetic and proceed to treat the patient

Why do things go wrong?

LACK of PREPARATION!!!!! Lack of monitoring Patient kept too deep IPPV not provided on time Underlying disease Unknown physiological reasons

Challenging species

Waterfowl

Prone to bradychardia
Hypothermia Critical recovery period Excitatory phase during induction Bradychardia May require higher % for maintenance

Budgies and Cockatiels

Eagles and large birds

Challenging Species

Reptiles

Usually require IPPV Unpredictable anesthesia Difficult to maintain plane of anesthesia

Conclusion
Understand anatomy and physiology in order to design anesthetic plan and emergency responses Perform active, aggressive monitoring Proper thermoregulation is essential Be prepared!!!