MVDr. Viktor Tukač, CSc. 9. 12. 2013

MVDr. Viktor Tukač, CSc. 9. 12. 2013

Výživa a poruchy metabolismu u exotických

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Anaesthesia and surgery

of exotic birds

Anaesthesia

General anesthesia however, with appropriate agents, can

enable clinicians to safely and rapidly perform fluid administration, emergency procedures, blood collection and radiography, or to perform prolonged invasive surgical procedures in avian patients

Anesthesia – indication

Surgical intervention

Bandaging

Investigation of organs systems

Emergency

Sample colection

Aplication of treatment

Anaesthesia

The goal of anesthetizing a patient is to

select the safest drug that allows the

minimum amount of physiologic changes.

Injectable anesthetics are far inferior to

gas anesthetics for use in avian patients,

and for private avian practice, isoflurane is

the only recommended anesthetic.



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Risk Classification of Potential

Anesthesia Patients Class I (minimal risk) Young, healthy patient undergoing an elective procedure.

Class II (some risk) Young, healthy patient undergoing a non-elective procedure, or a healthy

patient undergoing an elective procedure.

Class III (risky) Patient with an ongoing health problem undergoing a procedure for this or

another problem.

Class IV (very risky) Patient with a major health problem (unstable in nature) undergoing a

procedure.

Class V (moribund) Last ditch effort to save bird’s life.

Anesthesia - contraindication

Obesity

Lipidosis

Failure of liver, kidney

Anemia, shock

Dehydratation

Dyspnoea

Fluid content of crop

A commonly encountered

complication of anesthesia

Hepatopathies

Liver dysfunction may reduce a patient’s

ability to metabolize anesthetic agents and

may also be associated with coagulopathy.

Obesity

Egg-related peritonitis

Anesthesia - injection

was been used first

+ technically easier

+ can be used by surgery on the head region

- it not possible regulated course anesthesia

- by prolongation is heightened risk

- individually and species specific difference !!!



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I.M. mainly pectoral musculature, in watter bird is possible aplicated too in the leg musculature

I.V. v. basilica, v. media metatarsalis

(fragile wall – possibility of bleeding)

v. jugularis (heart, CNS)

I.OS. I.V. is not possible, acute causes

distal part of ulna, proximal part of tibiotarsus


I.P. rare using – high risk of damage of liver, posible

penetration to the air sac and to the lungs

S.C. rare using – we not realy now the

metabolisation of anestetic drugs

Anesthesia - inhalation

+ quickly start and quickly recovery

+ quickly changes of anestetic deep

+ without side efect to other organs systems (isofluran,

sevofluran)

- cost of inhalation device and cost of anestetic drugs

- by active supplementation of oxygen is not stimulated

respiratory centrum - possibility of apnoe



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Anesthesia - inhalation

Mask

shape depend on the width and long of head and beak

it is posible used the plastic cup or PET bottle

to 10 minute long surgical procedure

Tracheal intubation

trachea is curved depend of species bird,

tracheal rings are closed

over 10 minute long surgical procedure

Air sac cannula

operation on the head, trachea can be used - clavicular air sac, caudal troracal air sac, abdominal air sac

Surgical acces for placement of air sac cannula to air sac caudally to

last ribs on left body side in Blue and Gold Macaw (Ara ararauna).

Schema of position of cannula in air sac



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An air sac cannula in a lovebird

Seminars in Avian and Exotic Pet Medicine, Vol 13,

No 3 ( July), 2004: pp 154-159

Anesthesia – course

1. Preanestetic care

2. anesthesia – monitoring

3. Postanestetic care

Preanestetic care

Try prevent the complications !!!

Suportive therapy can take hours, days, weeks

Nutritional therapy – recuction of body fat (lipoma in galah, budgie

reason - decreasing possibility of ventilation

Aplication of diuretic – retention of egg with peritonitis (budgie, cockatiel, lovebird)



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Preanestetic care

Hepatopatiaclinically no specific sings, yellow urates

Biochemistry – low total protein

- high level ALT, AST

- high level of bile acid

RTG – hepatomegalia, microhepatia

Coagulopatia

Preanestetic care

Fluid therapy

in ill birds assumption of 10% dehydratationbody weight in g x 0,1 = deficite in ml

aplication I.V., I.OS., S.C., heated solution Ringeri

Dextrosis no!!– by metabolization is able binding free water max. 90 ml/kg/hour

cockatiel 9 ml/hour = 0,15 ml/min

Preanestetic care

Fasting

Ensuring that the crop is empty prior to anesthesia is very important due to the hazards associated with regurgitation.

Always palpate the crop before anesthesia

small bird 4 – 6 hours

great birds over night

raptors 12 – 24 hours

Preanestetic care

Clinical investigation

- Intervention to the 10 minute : history, clinical exam, parasitology, cytological investigation of feaces

- Intervention over the 10 minute : -“- +adspection of choan, PVC, TP, count of leucocytes, leucogram, AST, urid acid, bile acid



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Preanestetic care

PCV over 55% = dehydratation

below 20% = necessary of blood transfusion

Glucosis below 11,10 mmol/l = hypoglycemia

I.V. aplikation of 5% dextrosis

+ fluid

Decreasing of salivation and respiratory secretion

atropin 0,04 – 0,1 mg/kg

Preanestetic care

Premedication

Proper in wildness living bird and bird from aviary. Efect - sedation, muscular relaxation.

Possibility of easier manipulation, non- painfull intervention.

Diazepam 2,5 mg/kg

- ataxia, diferential species specific sensibility

Midazolam 2 mg/kg

Anesthesia - monitoring

1. Reflexes

2. Heart function

3. Breathing

4. Body temperature

5. Blood pressure – not commonly

6. Blood gases – not commonly


Reflexes

Evaluated plantar sensitivity,

palpebral and corneal reflex,

tonus muscles of pelvic limg and wings.



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The ideal anesthetic level

is when the bird’s eyelids were completely closed and mydriatic, the pupillary light reflex (pupillary response to light) was delayed and the nictitating membrane moved slowly over the entire cornea.

The muscles were relaxed and all pain reflexes were absent.

The loss of a corneal reflex (no reflex closure of the lid after touching the peripheral cornea with a dry swab) was considered to indicate deep anesthesia


heart rate breathing

Budgie 600-750 55-75

Cockatiel 450-600 30-40

Pigeon 90 15-25

Parrot 120-780 10-20

Ostrich 60-72 2-20


Body temperaturePhysiological great diferences between species

Ostrich 38,1o C

Pigeon 42 o C

During anesthesia always going the decreasing of body temperature. Compensation is possible heating mat, heating of inhalated air.

Decrease to 5 degree make heart arytmia

bellow 5 degree can be fatal.



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! By intubation increased tension of oxygen and

decreased tension of CO2 can finish to the a

apnoea.

Doxapram 5 – 10 (40) mg/kg

p.o.,i.m.,s.c.,i.v.

! Heart arrest – prognosis poor

indirect massage 60/min + ventilation

! Lose blood– fluid teraphy, blood transfusion

Postoperative care

placed into a temperature - controlled incubator once

it is able to stand without ataxia. Temperature should

be set according to each individual’s optimal

requirements (27-30° C) and supplemental

humidified oxygen is beneficial to those patients at

risk for hypoxia/hypercapnea during recovery

perches should be avoided until the bird has

recovered sufficiently to balance and grip well.

Postoperative care

past using injection anesthesia is longer

recovery – the birds is placed in termoneutral

enviroment, semidarkness, soft (possible

excitation), regulary control of regurgitation

Inhalation anesthesia

Methoxyfluran

In organismus is metabolisated until 50%,long

induction and long recovery (hours), depresion

of function of heart and respiration. Metabolites

are toxic for liver and kidney. Is not suitable by

nefropathy and hepathopathy. Not used in

same time aminoglykosid ATB.



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Halotan

Shor time for induction and recovery. Posible

complication are hypotensia, bradycardia,

hypotermia.

Metabolisation from 15%, hepatotoxicity.

3 – 5% induction

0,5 – 1,5% course


Isofluran

Most safe, metabolisation only 0,3%.

It is posible used in critical patient with disease

of liver and kidney.

Quick induction (1-2min.), quick recovery

(minuts).

5% induction

1 – 2,5% course of anesthesia

Injectable anesthetics

Ketamine

Disociative anestheticum. Patient is apparently in full sense (open eyes), but is lacking the reaction on the stimules.

Advantage is rapid induction, disadvantage is possible excitation. Is metabolisated in liver and excreted by kidney.

For prolongation of aplication is possible aplicated 30 – 50% starting dosis.

In bird dosis 20 – 40 mg/kg

Very rare is used only, better in the combination.


Ketamine – xylasine

Xylasine help with myorelaxation efect, excitation

are not arised

In bird 5 – 20 mg/kg ketamine

1 – 4 mg/kg xylasine

Efect of xylasine is posible reverse by using

nespecifical antagonist

yohimbine 0,1 – 0,3mg/kg



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Ketamine – diazepam

Anesthesia with muscular relaxation. Muscular

relaxation in the combination ketamine –

xylasine is higher, but have not so adverse

efect on the function of hearth and lungs.

Birds generally 25 – 30 mg/kg ketamine

1 – 1,5 mg/kg diazepam


Ketamine – medetomidine

Medetomidine = alfa2 agonista, deepen anesthesia, reduce dosis of ketamine and his efect is posible reverse with specific antagonist – atipamezol.

Duration of anesthesia 20 – 40 minute, past aplication of atipamezol recovery to

3 – 10 minute.

Dosis of atipamezol is 3 – 6 x higher as dosis of medetomidine.


Ketamin Medetomidin

mg/kg ug/kg

Parrots I.M. 3 – 7 75 – 150

Parrots I.V. 2 – 5 50 – 100

Raptors I.M. 3 – 5 50 – 100

Raptors I.V. 2 – 4 25 – 75

Waterfowl I.M.,I.V. 5 – 10 100 - 200


Tiletamin – zolazepam

Tiletamin = disociative anestheticum with analgetic effect

Zolazepam = benzodiazepin with myorelaxation effect

Metabolisation in liver, excreting via kidney

Commercially accessible mixture have two component in same quantum



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Tiletamin-zolazepam mg/kg I.M.

Budgerigard 21

Macaw 12

Cockatoo 2,6

Eagle 10

Owl 14

Emu 17

Duck 40


Propofol I.V.

Nonbarbiturated anestheticum. Iniciation of efect and recovery

without excitation, application is posible repeated (without

cumulative efect).

Adverse efect on cardiopulmonal function is low. Perivascular

reaction without inflamation. Induction past 2 – 6 minute, duration

of efect 15 – 25 minute.

Bird of prey minimally 1,2 mg/kg I.V.


Acute cases – performing of presurgeric investigation is

limited (small volume of blood), risk of time delay

Chronical cases – RTG, hematology, biochemistry,

bacteriological and mycological cultivation,

parasitology, cytology …

In complicated cases is usefull the consulation

Fluid terapy is obligatory

Lower risk of bacterial infection as in the mammals


Skeleton- Fractures of long bones – pneumatisation have impact

on the method of fixacion and healing

Invasive treatment of hypocalcemic syndrome in

African greys

Skin- Constriction and Avascular Necrosis of the Digits

- Bumblefoot

- Feather cyst

- Lesion of gl. uropygii



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Osteosyntesis in female of blue fronted amazona



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Osteosyntesis of golden eagle



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Bumblefoot

Bumblefoot, a combination of pressure sores

and infection of the plantar aspect of the foot,

is a common condition of captive birds of prey

and waterfowl and also is seen in psittacines,

primarily cockatiels and Amazon parrots.

Predisposing factors include obesity, poor diet,

inactivity, inappropriate perches and uneven

weight bearing, as is often the case in pelvic

limb injuries

Bumblefoot

Type I hyperemia and flattening of the skin of the digital and metatarsal

pads

Type II Bacterial invasion of the subcutis occurs, resulting in a scab and

mild swelling

Type III caseous abscess with marked swelling and pain

Type IV Infection of the tendon sheaths results in an infection and corresponding cellulitis tracking toward the intertarsal joint and the digits, flexor tendon rupture

Type Vosteoarthritis of the sesamoid bone ventral to digit II, and septic

arthritis of the tarsometatarsal-phalangeal joints

Surgical treatment of pododermatitis



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Amputation of finger in pergrine falcon



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Constriction and Avascular Necrosis of the Digits



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Wound on the Amazon parrot

Feather cyst



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Repair of Ulcerative Lesions of the Sternum



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Surgical removing of lipoma in galah



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Surgery

Respiratory system

- infraorbital exploration

- rupture of the cervicocephalic air sac

GIT

- crop burn repair

- ingluviotomy

- cloacal papillomas

- cloacal prolapse repair



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Crop fistula in falcon

Crop burn repair



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Pioning



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Thanks to attention!!

Documents

MVDr. Viktor Tukač, CSc. 9. 12. 2013