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anesth
tomasic
introduction to lg animal anesth

we're 
going to focus mostly on healthy animals, but if you want more 
information about this topic, you can take lg animal surgery in lg animal 
block, and lg animal elective lecture course in spring, and so forth. 


we're not always dealing with really large animals. some are large - 
draft horses, cows - but pygmy goats are dog sized, kids are small; foals 
aren't so big - usually under 200 lbs. also there are intermediate sized 
llamas and so forth. they aren't just large animals. 

one thing you 
should know is there isn't anything special about lg animal anesthesia - 
everything so far applies to the large animals. sure, they tend to be 
more willful than a dog or cat, but that's ...

for lg animal 
anesthesia/anesthesia in general, there are some principles to follow. a 
patient is presented to you and:

-make sure it is stable.  for most 
elective surgeries, this will be true. 
-if animal is sick, and you are 
stabilizing it, and this is taking a long time, and surgery might 
correct/address the problem, don't delay longer than really necessary. do 
not delay anesthesia

choose anesthetic protocol that is least depressant 
for that animal. 
airway control, ventilation, and oxygenation are very 
very important. "of prime importance."

when you induce, first you ensure 
a patent airway, then you ensure breathing, then you address 
cardiovascular function. those are things that should be assessed all 
through anesthetic period. regularly monitor body systems during the 
anesthesia. try to do this - make a legal, written record q 5 min. 
monitor temperature, position, HR, RR, etc constantly.

prior to 
induction, anticipate problems that may occur during anesth or post 
anesth. maintain your vigilance until recovery is complete. have 
everything ready to go for any situation that might arise. if your horse 
starts moving on the table, you have to address that right away!! have 
your drugs and stuff drawn up ahead of time. if an unplanned situation 
comes up, well, it shouldn't b/c you will plan ahead, but...

recovery is 
considered to be complete when animal is standing and able to leave 
recovery area.

drugs we use aren't that different from those used in 
small animals.
sedatives, muscle relaxants, and anesthetics. 

sedatives 
- used as preinduction medication, or to provide restraint during minor 
procedures.
muscle relaxants, anesthetics - induction and maintenance of 
anesthesia.

sedatives:
acepromazine, xylazine, these two are most 
commonly used in all the spp we deal with. detomidine is used as well, 
when it first came out thought it would replace xylazine, but it didn't, 
has advantages/disadvantages of its own related to depth of sedation; 
medetomidine is new, not used that much yet; diazepam is cheap now, 
prices btw are listed in cost/mg on one of the handouts; midazolam has 
some advantages over diazepam - water soluble, better absorbed - more 
expensive though; pentobarbital adn chloral hydrate are things that are 
not used anymore really. pharmacy at NBC had one bottle of pentobarb, but 
it expired in 1989... sometimes you might use it though. chloral hydrate 
again is a useful sedative in some instances, when these other drugs 
aren't effective sometimes it will be, but it isn't a first choice.


adjunctive agents: 
all opioids - listed as adjunctive b/c in farm spp, 
opioids/narcotics are not effective by themselves, in faact many cause 
excitement if given alone. so they are used with sedatives to enhance 
degree of restraint and control.
butorphanol, morphine, meperedine, 
pentazocine - that last one may be used in practice, but not at NBC. when 
butorphanol came out, it supplanted the not so effective pentazocine.


antagonist agents:
atipamezol
yohimbine
flumazinil
those are A2 agonist 
antagonists
naloxone - opioid antagonist
these do not see a lot of 
regular use in our practice, but you might find them effective for horses 
that become recumbent after xylazine sedation, or are heavily sedated and 
you need to reverse your sedative. more often we want to maintain 
sedation, not reverse it. in cattle, tolazilene is the one we use??? 


muscle relaxants - used mainly in induction
guafenesin, diazepam, 
midazolam - all centrally acting.
NMBAs used so rarely that we're not 
listing them. 
guafenesin is most common muscle relaxant used at NBC - 
comes in a bottle as guailaxin to be mixed with 1 L sterile water to give 
5% solution. the problem with that - relatively minor problem - is that 
osmolality of that solution is a bit under 200 mOsm. so we reconstitute 
with 5% dextrose, making sl hyperosmolar solution, reducing risk of 
hemolysis.
diazepam is used a lot b/c it is cheap, under $1.50/bottle

midazolam is expensive, not usually used.
diazepam is commonly considered 
to be a sedative, but in horse it isn't - more effective in young foals, 
but foals over 1 month won't really be sedated. it's a great muscle 
relaxant though. in adult horse if you give diazepam only, horse is 
likely to fall down - and he won't like it - mental status isn't affected 
- will be frightened, disenchanted with the whole thing, trying to leave, 
etc. so we use it with an induction agent.

anesthetics:

injectable: 
thiopental and ketamine most commonly used; propofol not so much, 
expensive; telazol not routinely used at NBC or in practice - b/c while 
induction is good and there is reasonable time of anesth, the recovery is 
often prolonged, and for a horse in a field, that is a problem, horse may 
injure itself during recovery and there is time wasted waiting for 
recovery. 

inhalants: halothane and isoflurane are what we use 
routinely. sevoflurane and desflurane are new, used in some studies, not 
used yet clinically but eventually probably will.

monitoring:
when 
monitoring large animals under anesthesia, we use the same euipment as in 
small animals and we monitor cardiac function, pulmonary function, and 
body temperature.
the best monitoring tools are eyes, nose, ears and 
hands. look at the patient, touch the patient, feel pulses, check 
positions, etc. listen for some of your mechanical alarms or your heart 
sounds or whatever. stay alert, watch and listen to what is going on. 
nose isn't just for smelling trouble but smelling acetone, halothane, 
whatever. use all your senses. those are the most important monitors you 
have. all these should be connected to a brain. hopefully yours.

cardiac 
function:

arterial pressure is looked at. if we can, we do direct 
measurement of arterial pressure - put in an A line, attach it to a 
transducer, look at waveform, systolic, diastolic and mean pressures, 
etc. if you don't have a cool monitor, use a regular pressure gauge, a 
mercury or water manometer, etc. indirect pressure is also used - 
multiple oscillometric devices, ultrasound doppler devices. however you 
do it, measure arterial pressure and do it repeatedly. 
arterial pressure 
isn't a measure of cardiac function per se, it is a measure of potential 
for blood flow. but we don't measure flow directly. 

central venous 
pressure - if we think there is goign to be a problem with volume 
loading, or there is heart or kidney disfunction or mumble mumble

EKG is 
also done - looks at electrical conductance of heart, mumblemumble
this 
and arterial pressure are the two main things we use

esophageal 
stethescope - not really in horse - hard to put in, there aren't any made 
in right size anyway. can use in foal. but it is an important, cheap 
monitoring tool. 

pulmonary function:

blood gas analysis - we have our 
A line in, so we can get arterial blood easily.

capnograph- every 
patient now is also hooked up to capnograph to monitor ETCO2.

esophageal 
steth if possible to hear lung sounds, respiratory rate, esp in noisy 
room - great tool

lung compliance - measured indirectly - in large 
patients on mechanical ventilator, the ventilators have airway pressure 
gauges on them. if there are changes in airway pressure during the course 
of ventilation and you have'nt changed anything else it may indicate 
change in compliance.

pulse oximetry - O2 saturation, pulmonary function


Body temparature: measured in various sites - rectal, nasal most common. 
groin - if lg animal in lateral recumbency can put probe b/w thighs - 
that's usually 1-2 degrees below other temperatures and is slower to 
change; esophageal temperature - if esoph steth is put in, as is common 
with people, some have temperature probes in them; pulmonary artery - 
right now strictly a research tool for monitoring central temperatures. 
probably in a few years core temps like this will be measured with PA 
catheters.

some things - this is some show and tell - here is a monitor 
used with EKG, arterial pressure waveform; another screen shows 
capnogram, pulsox, ETCO2, RR, O2 sat, MAP, systolic/diastolic pressure  - 
seems like a lot of things to look at all the time but you get used to 
it.

choosing an anesthetic protocol for a patient - a number of things 
to consider:

surgical procedure - perhaps - often you're dealing with 
aniamls, esp in food animal industry - animals where cost is a huge 
concern, less time spent and fewer drugs used the better. if you can use 
light or heavy sedation +/-local anesth, that's probably better. if you 
can't do that, maybe regional anesthesia - and your last choice is 
general anesthesia.

you need to consider required equipment - before you 
start, you want to be prepared prior to induction - there will be a need 
for some patient restraint, sometimes a chemical restraint, or often 
mumble mumble mumble. positioning requirements are important - recumbency 
can cause ischemia - need padding, need to minimize problems from lying 
still in weird positions. also cardiovascular effects. 
also need 
equipment for delivery of anesthesia

inhalant - need O2 supply with 
pressure and flow regulation. need enough O2 for whole procedure. you 
also need your anesthetic agent and a vaporizer for that. you need ET 
tube, breathing circuit, and a method of restraint and positioning.


injectable: +/- O2 supply with pressure and flow regulation - sometimes 
this is needed. +/- ET tubes - you may choose to just enhance O2 by 
providing O2 in the area. you also need facility for restraint and 
padding.

you need that ahead of time.
slide of hobbles to restrain and 
position legs. typically animals once induced will have a set of hobbles 
placed on them to restrain the legs or to aid in moving them - they have 
handles. for cows, soft rope models are used, legs are thin and leather 
hobbles slide off. the rope hobbles are used for positioning, mainly. for 
horses or cows under anesth - you are also a heavy equipment operator ! 

you might also need a table, need to move that around. need to use a 
hoist to get animal on the table - hook animal onto hoist with the 
hobbles. you need padding on the table. you need all this stuff and you 
need to know how to use it.

mouth gags are used in cattle to intubate, 
hold the mouth open. often you have to pass your hand into the mouth to 
get tube in, so you need this. for horse, youdo blind intubation and gag 
isn't required unless you need it for a particular surgical procedure.


large animal anesthesia machine - has ventilator attached.

ET tubes - 
multiple sizes - from 5 mm or smaller on up to 30 mm tube. 
laryngoscope 
blades - small to large.
catheters - same range of sizes - small animal 
ones plus much larger ones as well. long ones for jug caths in big 
animals.

physical status - another thing to look at and determine type 
of anesth to do. breed, age, gender, size of patient may affect what you 
do. temperament especially - you may have horse or cow that is mild 
mannered, easy to work with, doesn't need much drug - but may also have 
willful or nasty animal that you can't handle without general anesthesia. 

recent medications may affect what's going on - drugs that affect ANS, 
drug metabolism, etc. do a history!
pathophysiology of disease process - 
you need to know what is going on, if things are affecting cardiovacular, 
pulmonary, other system. 

Horses - general considerations:
at NBC, the 
most general anesthesias are in horses. things we worry about are


temperament - need adequate sedation provided before induction


preoperative/preinduction meds - in horses, we almost always give 
something 
there are 4 reasons - 1. to increase tractability, ability to 
handle animal safely ad put in catheter and so forth, rinse out mouth, 
clip animal, etc. 2. to reduce the amount of induction agent required, 3. 
to smooth the induction, mask the excitement horse may experience and 4. 
the one people forget about is it will smooth recovery, especially with 
short field anesthesias. 

intubation in horse is oral or nasal, and that 
depends on the procedure or the airway. the horse is probably the easiest 
to intubate. most often we intubate them via nose with large tube while 
under light sedation. pretty easy. 

big problem in horses under anesth 
is V/Q problem, shunting. this is mostly due to size of animal, pressure 
on lungs while recumbent, can be major problem. it's essentially a bypass 
of lungs - blood doesn't go through areas of good ventilation, no gas 
exchange occurs. as shunt increases can get into steep part of O2/Hb 
dissociation curve and have profound effects on arterial oxygenation. so 
dont' underestimate the effects of shunting. we worry about it a lot. O2 
sat can drop way down, very fast.

the other thing we worry about in 
horse due to size is neuropathy, myopathy - reduce risk by trying to 
maintain perfusion
use proper positioning and padding
keep MAP over 55 
mmHg to reduce risk. 
myopathy during anesth can be bad enough to require 
euthanasia -so don't let it happen - monitor pressure and so forth.


special horse considerations:

eye protection, lubrication of eye, 
provide a smooth surface for the down eye, and protect eyes from direct 
sunlight. . 

neuropathy/myopathy - prevent as above - use mats for 
positioning, keep legs in "natural" type position, avoid legs hanging 
over edges. 
in dorsal recumbency, lift legs, avoid pressure on sides 
against poles used to support legs, some universities do not use poles on 
hind limbs. 

neuropathies usually aren't painful. usually affect 
extensors. you have to assess it, provide mechanical support like 
splints, heavy bandages, ensure adequate perfusion, address any 
hypovolemia, maybe use steroids? horse doesn't like being recumbent so 
it's important to ensure horse can safely get up and move around. 


myopathy often is painful, always really. 
we can't usually treat the 
pain and end up euthanizing the animal. NSAIDS and anxiolytics are often 
used. tx maintain perfusion, maintain blood volume. 

note: it is 
9:56....no end in sight, either.

malignant hyperthermia - not that 
common in horse but can happen. remove trigger, cool animal. dantrolene 
is only treatment along with symptomatic tx. 

kirsten tried to tell him 
about our 10 minute break but he blew it off. he said we will get a break 
"soon"

ventilation-perfusion inequalities - big prolbem in ruminants. 
also regurgitation is a big problem in ruminants. intubation is 
important. during light anesthesia, active regurgitation occurs. it's 
really important to ensure adequate planes of anesthesia and that 
intubation is done correctly. there will almost always be passive 
regurgitation during general anesthesia. 

so in ruminants, try to get 
animal intubated with cuff inflated as fast as possible secure the 
airway- prime importance. witholding food does NOT prevent regurgitation. 
we try to do it for about 24 hrs to reduce the amount of tympany (bloat) 
that occurs during anesthesia that adversely affects cardiac and 
pulmonary function. 
salivation is also a problem - doesn't decrease 
during anesth - cows really really slobber a lot and that means you need 
head position to allow saliva to come out. salivation in bovine isn't a 
problem as far as base loss, though water loss has to be made up. 


ruminants are very sensitive to xylazine. use 1/10 the dose in cattle, 
sheep, goats that you would in dog/cat. goats are more sensitive to 
sheep. xylazine causes uterine contractions, may cause abortion of late 
term pregnancy, warnings abound. 

drug residues - are in handout, don't 
have to know it - just know that in US there are no withdrawal guidelines 
for anesthetics but there are in other countries. 

uh, it's 10:01

rule 
of thumb - 10 half lives. usually that's about 4 days. 
benzodiazepenes - 
do not use in lactating animals or animals going for food production 
soon. withdrawal probably 30 days after diazepam. 

he is now apologizing 
for going over time limit. I guess it is up to Dr. Klide, the next 
lecturer, if we get a break. personally, I treasure my 10 minute 
breaks....

---break--

Klide

[note to self: phenobarb 2-4 mg/kg for 
sedation of dog]
ok. 
exotic animal anesthesia in a very very small 
nutshell.

many basic principles apply regardless of spp, but nondomestic 
spp present some problems. 

so, we'll talk about restraint - several 
problems to consider- first, know something about the animal you are 
dealing with and how much theyare likely to hurt you or not. pre-set your 
response to the animal.

eg - parakeet in cage - if you reach in to grab 
it, and you have it in your hand, it may bite you. it will probably bite 
you. be mentally prepared. you know it won't really damage you, but it 
will hurt. if you aren't prepared, you may squeeze it and kill it. resist 
that temptation!

also how much or how little can you depend on the 
person who belongs to the animal. in general do not let client restrain 
animal - vets get sued....
also client may be unable to restrain animal 
but refuse to admit it.

an ocelot came in - wt about 30 lbs, temperament 
unpleasant. owner said he could restrain it for an injection. but cat 
hissed at owner and owner left.

in zoos, curators and handlers are more 
likely to be able to restrain the animals, but you have to ask if they 
can or not.
another consideration is where you are, and people forget 
this or do not consider it enough.
room must have doors - should be 
closed.windows should be closed. those things are obvious but also, 
animals esp wild ones can instantaneously find exits that were not there  
before. often there is space b/w pipe and wall and depending how big that 
space is, if animal gets loose it will disappear in that hole and then it 
will be in your duct system for a long time. there are practices around 
here with cats in the walls for this reason. so keep these things sealed.

mechanical devices to protect you do exist =- gloves are sold of varying 
thicknesses of leather, or chain mail, they are useful. one thing that 
people forget is - how long the animal is. you may reach into space to 
grab it and not grab head but just get hind end, and then a foot or two 
of loose animal can go up on your arm higher than the glove.

rabies 
poles are helpful. 
there are shields to compress animal against wall.

nets for smaller animals may be useful too.

other methods for getting 
around initial restraint.
this one is sometimes very useful. in several 
forms.
some come in a carrier - and it is hard to get them out of the 
carrier. one way to deal with it - can pull out of carrier and inject but 
this may take an hour or so, is really stressful and gets excrement on 
everyone - so, they now take carrier, put it in garbage bag, put hose 
from anesth machine w/nonrebreathing system on it into carrier, then seal 
bag around hose. problems: you can't see the animal so risk of going too 
deep and getting hypotension - but if relatively healthy this works 
pretty well. try to assess state by tilting box and if animal is not 
under yet you will hear it try to right itself, if it is under it will 
not respond. this is useful for animals in containers that fit into 
trashbags.

also wild child box, plastic chamber with cover that fits 
inside the box and can be pushed down on the animal. there are holes of 
different shapes in different places so you are usually able to give an 
IM injection through the hole. many scared animals or aggressive animals 
will move to the back of the cage when approached in a cage - with these 
animals, when you approach them with the box, they go against a wall and 
you can trap them and slide the box cover b/w box and wall. 

another 
system is similar but the top instead of sliding down into box fits into 
the top and has ports that connect to the anesthesia machine. then you 
can use it as an induction chamber with inhalant - useful in cats, small 
dogs, other. 

Cap-Chur syringe with projectile dart, or similar type of 
thing. parts include needle that screws onto drug barrel, plunger, behind 
which is explosive charge, then a tail piece. inside the charge is a 
weight and cap that goes off on impact. when it hits patient, weight 
moves forward, sets off charge, produces hot rapidly expanding gas which 
pushes plunger forward to inject drug. i see ther eis an O-Ring seal in 
here. hmmm. could be a disaster. if you put the charge in backwards, it 
will go off when you fire it and you are likely to inhale the drug and 
unlikely to have an enjoyable trip. it is large and heavy, this device. 
modern versions are made of plastic and are more like syringes, and 
instead of explosive they have compressed gas . the needle instead of 
having normal end, has a sealed end with an opening on the side. a small 
silicone sleeve is placed over the opening - when it's covered, the 
plunger can't move. when dart enters animal, skin pushes sleeve back as 
needle enters animal, uncovers hole, and drug is injected. 

darts are 
delivered by guns (original type) that look like rifles or pistols. 
modern darts are delivered by blow gun manually or with compressed air 
source. another consideration when firing a dart is the environment. you 
need to think of where dart may end up if patient moves or your aim 
sucks. if in zoo, what if you hit a spectator? what if it bounces off 
patient and lands on person?

for bigger species, drugs that are used are 
very potent, dose in there is really large, compared to the dose for 
adult human, andresponse if human was hit would be liefe threatening.


choice of drugs - many are available.
slide: a young dr. klide and a 
blonde woman with some drugs. the bottle contains M99, which as you 
should know is a potent opioid. handling the drug like this is stupid, 
but long ago these people thought they were immortal. these days, people 
would wear gloves and full face mask to prevent getting this stuff on you 
b/c uptake through mms and abraded skin is large and rapid and the 
concentration in here is about a mg/ml which would make a person die. 10 
micrograms in a person may cause euphoria. 100 micrograms is only 1/10 ml 
and that will make you stop breathing.

how much and what to use depends 
on spp and weight of animal. some animals you have to guess the wt. hard 
to do in birds. almost always you grossly overestimate. so try to weigh 
them if possible.
another factor is the state of animal at time of drug 
admin - if animal is sleeping, you need less drug than if animal is 
snarling and attacking. 

after you administer the drug esp by dart, you 
have to wait and see what happens, and decide if you have to give more. 
many things can fail with the darts - dart may not fire for various 
mechanical reasons. site it goes into may have lots of fat there and 
absorption may be poor - esp with old darts and large gauge needles, 
large hematoma may forma nd impede absorption. you have to watch and 
figure out what is going on. 

a few drugs -
first two are potent opiates 
- edorphine and carfentanil. they are both mainly used in large 
hoofstock, large grazing animals, elephants, zebra, giraffe, antelopes. 
edorphine was first developed and used for many years around world. 
unavailable for a few years here, now available again. carfentanil became 
available in meantime - but not equivalent. in zebras, edorphine is 
better.
in pharm notes, warning says - if you find old package insert for 
edorphine, it lists a lot of spp and has drug doses in them, but those 
are not the right doses !! FDA required company to list the highest 
survivable doses. these are much higher than the required doses. in fact 
for other drugs too, if dealing with unusual spp, best thing to do is 
find people who have restrained animals with that drug and ask them about 
it. 

another thing used in fish, amphibians, is tricaine. also MS222. 
it's an old local anesthetic put into water to produce general anesthesia 
in these animals. most commonly used anesth for fish, amphibs.

recently 
an interest in using propofol in reptiles has come up . IV access is 
difficult. have tried intraosseously in tibia of lizards, or 
intraceolomically. some good results obtained per some reports.

an 
interest in using clove oil, or eugenol (which is clove oil) which is an 
old remedy used for dental pain, which people are trying to use to anesth 
fish by putting it in alcohol and adding to water. not sure how well this 
works. 

in restraint of carnivores - dissociatives useful - most common 
are tiletamine (in telazole with zolazepam) and ketamine. in tigers, 
tiletamine acts different from ketamine. recovery is different. 
w/tiletamine, about half the time, the drug is given say in AM, animal 
recovers later, seems normal the next day, and the day after becomes 
abnormal again,a s if it had a small dose - ataxic, hyperesthetic, etc - 
lasts a few days. doesn't happen with ketamine. most likely this is due 
to an active metabolite, or due to enterohepatic recirculation. those are 
just guesses, it's not really clear why that happens.

the reason people 
would use telazol at all then is b/c of solubility. it comes as a soluble 
powder, so can use small volume. with commercial ketamine volume is much 
larger. you can overcome this by getting freeze dried ketamine and 
reconstituting it. usually comes 100 mg/ml but you can make 200 mg/ml 
solu'n. 

medetomidine - alpha2 agonist - markedly lowers amount of 
ketamine required. in many spp, ketamine alone causes rigidity, 
excitation, or convulsions. with tranquiilizers, that won't happen. but 
if you want to wake animal up after by reversing sedative, then you see 
it. but with this drug you can us less ketamine so you don't have such 
problems from ketamine after reversing the medetomidine. note ketamine 
works faster - you see the stiffness after darting, then the medetomidine 
kicks in and you see relaxation. 

clearly, patients come in different 
sizes. so, if you are using inhalants, consider your machine. the 
standard adult human anesth machine will be adequate over a wide range of 
patient sizes. you may have to improvise. if a large exotic shows up in 
your small animal practice and you need to do sx on 300 lb jaguar, your 
breathing bag may be too small, but you can put several bags onto that 
single site - take off your 5 L bag, put a Y piece on, and hang two bags 
on the Y. and so forth. you can get by this way. also you may need more 
sodalime. but if you increase O2 flow, you will depend less and less on 
CO2 absorbent, b/c you are flushing exhaled gases out of the circuit. 
if 
really small, use nonrebreathing systems.

basics still apply. sight, 
sound, hearing, etc are key. shape of animal is irrelevant. arteries are 
in similar locations, you can palpate them, feel rate, pressure, rhythm, 
listen to animal. if you need more advanced monitoring you can measure 
arterial pressures. ears of animals may have big artery - can attach 
manometer there with tubing and sterile saline. no electricity required.


EKG can be done in all spp - wires most people have have alligator clips 
on the end - may or may not attach to the skin well - for reptiles, wrap 
gauze soaked in saline or gel around the body part, and clip the lead 
onto the sponge. doppler flow meter also is very useful for monitoring 
cardiac function other than BP =- here it is under chest, over surface of 
heart, of this lizard. EKG doesn't guarantee CO, only electrical 
activity. with doppler flow meter, we sense flow. this means heart is 
actually pumping at least to some degree. we get rate and rhythm too. 


carnivores - many sizes. watch that drug is effective before entering 
cage. after that, intubate, connect to machine, monitor.
NHPs - come in 
many sizes. ketamine is really really useful for restraint of many spp of 
NHP. then intubate, hook up to machine, there you go. 
really big NHPs 
need bigger equipment but otherwise the same.

hoofstock - several 
problems. it's a tossup if more people are killed by zebras or elephants. 
zebras are cute but difficult - can bite you while kicking you with all 
four legs. potent opiates like edorphine have markedly changed handling 
of these patients. makes them a tad excited and they trot around but they 
are able to be handled and you can put them into recumbent position, then 
place IV cath and go from there, intubate, etc.

potent opiates do cause 
some strange responses in some individuals - in this camel, top of head 
is put back onto hump with nose pointing up. giraffes do this too. 


birds - ostrich - most birds not hard to intubate, can see glottis. some 
are harder. can induce with injection or inhalant. small birds are 
induced and maintained with inhalants. injectables used to be used. 
ketamine has rapid onset but recovery is long and has lots osf associated 
excitation and flapping around and broken wing could occur. small bird 
can be intubated with IV cath. larger birds use regular ET tubes. EKG in 
birds - important to measure this b/c it is difficult to count HR - 
normal HR in small birds is about 300-600 so changes are very hard to 
assess. ventricular arrhythmias are not rare in birds under anesth so EKG 
useful. usually use leads connected to hypodermic needles - but most 
needles have plastic hubs and putting clips on there won't work, so you 
need metal hub needles or connect alligator clips to proximal part of 
needle. psittacines hard to intubate b/c large tongue - but can pull 
tongue out of the way and do it.

reptiles - present two major problems. 
one, nonvenemous reptiles are large and strong - slide of snake eating 80 
lb antelope. restraining these animals requires a person per 3 feet of 
snake. without that many people, one person will get wrapped up and this 
can be life threatening. induction and maintenance yb inhalation.


venemous reptiles usually induced in chamber with inhalant.

intubation 
easy - trachea/glottis mobile since they have to breathe while swallowing 
big things. remember where teeth and fangs are. if you stick yourself on 
a fang you can envenomate yourself. be careful. 

fish- bubble halothane 
into water - connect aerator to gas outlet of machine :)
some problems 
with this - one is the gas comes out into the room from the water. but, 
it is readily available and you can use it if you rarely anesthetize 
fish. this goldfish is getting a gill tumor removed. tricaine is most 
commonly used anesthetic in fish, is put into water. etomidate is being 
looked at. CO2 has also been used directly or by putting in alka seltzer 
or bicarb into the water. but tricaine is most common. for long 
procedures, can take fish out of water and use pump to pump water over 
the gills, keeping body moist with moist towels. 

that was a rapid run 
through...
sometimes special techniques are needed but hopefully you can 
handle it.

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