Anaesthesia of Exotics

Pregunta	Respuesta
Induction - Reptiles	Conscious intubation of snake Iso via facemask/chamber i/m drugs - medetomidine & ketamine, alfaxalone i/v drugs - alfaxalone, propofol
Intubation - Reptiles	Rostrally positioned glottis Tortoises & lizards have large tongues Uncuffed tube, mech vent Can use iv catheters as tubes for smalls V. small lizards maintained with tight mask
Induction - Small Mammals	iv catheter if poss Iso by mask in small rodents Premed herbivores with metoclopramide Inj agents - med & ket +/- butorphnl, propofol, alfaxan
Intubation - Small Mammals	Rabbits - blind technique or direct visualisation, intubeaze, pre-O2, 3 attempts - risk laryngospasm/oedema Ferrets - direct visulation of larynx
Maintenance - Birds	Volatile agents Always intubate unless v short procedure Mechanically ventilate - reduces mortality Maintain temp
Maintenance - Birds	Air sac cannula Useful if working around head/beak Ventilates abdominal or caudal thoracic air sac Maintained in short term post op
Maintenance - Reptiles	Volatile agent Intubate Always mechanically ventilate Maintain temp
Maintenance of Small Mammals	Volatile agents Intubate if poss Close fitting mask O2 flow rate 1-3.5l/min Raise upper body
Maintenance - Small Mammals	Maintain body temp Bubble wrap Ensure scrub solution at body temp
Monitoring - Birds	Corneal reflex, resp rate & depth Heart rate – Doppler ultrasound Mechanical ventilator - Resp arrest precedes cardiac arrest Capnograph, Pulse ox Bp, body temp
Monitoring - Reptiles	Muscle relaxation from head to tail during induction, reverse on recovery (especially snakes) Jaw tone, toe/tail pinch Heart rate - Doppler ultrasound on thoracic girdle Capnography, body temp
Monitoring - Small Mammals	Withdrawal reflex - toe pinch Palpebral reflex = misleading Heart rate - doppler/stethoscope Pulse ox, capnography Bp
Emergency Drugs Cardiac Arrest:	Adrenaline - i/v, intratracheal, intracardiac Cardiac massage
Emergency Drugs Bradycardia:	Atropine: i/v, some rabbits have atropinesterase, i/m as premed to reduce mucus production
Emergency Drugs Respiratory Arrest:	Stop volatile agents Check ET tube position Ventilate Doxapram
Recovery - Birds	Warmth Support in sternal - towel in donut shape O2 if needed Fluid therapy Analgesia
Recovery - Reptiles	SLOW!!! Ventilate with room air - ambu-bag Maintain at optimal temp for species Fluids Analgesia
Recovery - Small Mammals	Reverse alpha-2 agonists - atipamezole Warmth - propagator ideal Fluids O2 if needed Analgesia Gut motility drugs if needed
Post-Operative Care	Analgesia Wound care Ongoing fluids/nutritional support Monitor bw at least once daily Return to normal function
Nutritional Support - Birds	Crop tubing Self feeding - usual recognised diet
Nutritional Support - Reptiles	Herbivore/Carnivore? Omnivore Insectivore Gavage tube Oesophagostomy tube
Nutritional Support - Herbivores	Regular feeding, maintain gut function, rabbits prone to hepatic lipidosis Gut stasis tx - force feeding, analgesia, prokinetics (metoclop, ranitidine, cisapride), exercise
Nutritional Support - Small Carnivores	Oxbow Carnivore Support Hills a/d or convalescence support Ferrets prone to GI ulceration when stressed Ferrets also get insulinomas - prone to hypoglycaemia
Clinical Audit	What went wrong? What went right? How/What can we improve next time?
Patient Assessment	Initially assess from distance Clinical history Signs of illness? - prey species Immediate O2 or further exam
Restraint - Birds	Darkened room Wrap in towel to secure wings Pillowcase can be useful - swans Avoid pressure over thorax Care re talons & beak
Restraint - Reptiles	Zoonotic disease risk - salmonella Bite/constrict/whip tails Multiple operators for large animals Some species can shed tails
Vasovagal reflex in Lizards	Restraint for minor procedures - b/s, xrays No analgesia! Cotton wool over eyes Apply firm, even pressure using vetwrap
Restraint - Small Mammals Hazards:	Rabbits - lumbar spine trauma (Ca deficit) Chinchillas - fur slip Gerbil - tail deglovning injuries Hedgehogs - shallow water bath, hold back legs once uncurled
Patient Prep/Stabilisation	Warmth, O2, Fluids, Analgesia, Nutritional support
WEIGH PATIENT	Small grams out with make huge difference - overdose
Fluid Therapy - Birds	Maintenance = 50-100ml/kg/day Assume 10% dehydrated Replace 50% deficit in first 24hours Remainder over 2-3days Oral fluids - crop tube, Vetark critical care, Lectade, 3-5% bw per feed
Parental fluids - Birds	Lactated Ringers/Glucose saline Colloids if needed s/c - inguinal or between scapulae, +/- hyaluronidase, 1% bw per site i/v - medial tarsal vein, basilic, cutaneous ulna vein
Intraosseous Fluids - Birds	Avoid pneumatised bones & air sacs in proximal humerus Distal ulna Proximal tibia
Fluid Therapy - Reptiles	Maintenance = 10-30mls/kg/day Warm baths - encourages drinking, water absorption via cloaca Oral fluids - gavage tube, Vetark critical care, Lizards=10-20ml/kg, Snakes=15-30ml/kg, Chelonians=5-15ml/kg
Parental Fluids - Reptiles	Hypotonic (saline + 5% dextrose) s/c or epicoelomic - 10/kg over several sites Intracoelomic - air sacs, 1-2% bw/day i/v - jugular, ventral tail vein Intraosseous - prox femur, plastrocarapacial bridge (chelonians)
Parental Fluids - Reptiles	Hypotonic (saline + 5% dextrose) s/c or epicoelomic - 10/kg over several sites Intracoelomic - air sacs, 1-2% bw/day i/v - jugular, ventral tail vein Intraosseous - prox femur, plastrocarapacial bridge (chelonians)
Fluid Therapy - Small Mammals	Maintenance = 80-120ml/kg/day Assume 10% dehydrated if sick Replace 50% of deficit in 12hours, remainder over 2-3days +maint Oral - water, lectade, vetark cc, rabbits/large rodents=10ml/kg, smaller=5-10ml/kg
Parental Fluids - Small Mammals	s/c - painful, scruff/scapulae, flanks/over thoracic wall, 10ml/kg Intraperitoneal - lower lateral abdo iv - EMLA, cephalic, saphenous, marginal ear vein, lateral tail vein Intraosseous - prox femur/tibial crest
PreAna Considerations - Birds	Complete tracheal rings No diaphragm - rely on keel movement Air sac system Dive reflex in waterfowl High metabolic rate Do not starve for long period - remove food 1h before GA, starve raptors O/N
PreANA Considerations - Reptiles	No diaphragm, Use short ET tube in Chelonians Low metabolic rate, capable of breath holding - mech vent, Stimulus for breathing is high CO2 Environmentall dependent (temp affects drug efficacy) Starve for 24h if fed live prey, snakes-2-3days
PreANA Considerations - Small Mammals	Rabbits/rodents can't vomit - starve 1h Rabbits/rodents = obligate nasal breathers - avoid blocking nares Ferrets can V+ so starve for 4h - insulinoma Herbivores - heavy abdominal contents High metabolic rate, Prone to hypothermia
Induction - Birds	Close fitting mask - modified with vetwrap Pre-O2 5% iso/8% sevo Ayre's T-piece O2 flow rate = 1-1.5l/min
Intubation - Birds	Intubate as soon as possible with uncuffed tube Cook tubes have ‘shoulders’ to sit snugly around glottis Blue and gold macaws - prone to tracheal stricture

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