10. Ruminant and Swine Anesthesia

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  • The same principles apply to ruminants as to small animal anesthesia.
  • IM induction is not used in ruminants.
  • Selection and preparation of the endotracheal tube are the same as for small animals and horses.
  • 10. Ruminant and Swine Anesthesia

    1. 1. Ruminant and Swine Anesthesia Chapter 10
    2. 2. Ruminant Anesthesia <ul><li>Temperament and economics </li></ul><ul><ul><li>Ruminants don’t undergo general anesthesia as often as horses and small animals </li></ul></ul><ul><ul><li>Don’t require general anesthesia because of their calm nature </li></ul></ul><ul><ul><li>Many surgeries are performed using local or regional anesthetic techniques and physical restraint </li></ul></ul><ul><ul><li>Must consider drug withdrawal times in food and milk-producing animals </li></ul></ul><ul><ul><li>General anesthesia in production animals is not often economical </li></ul></ul>
    3. 3. Ruminant Anesthesia (Cont’d) <ul><li>Equipment </li></ul><ul><ul><li>Special equipment is needed because of their size </li></ul></ul><ul><ul><li>Tilt tables, head gates, hoists, transporters </li></ul></ul><ul><ul><li>Small animal equipment can be used for small ruminants (lambs and kids) </li></ul></ul><ul><li>Anatomy and physiology </li></ul><ul><ul><li>Ruminants produce more saliva, which can be aspirated during anesthesia </li></ul></ul><ul><ul><li>Ruminants are prone to regurgitation and bloat during general anesthesia </li></ul></ul>
    4. 4. Patient Preparation <ul><li>Use the same principles as with small animals </li></ul><ul><ul><li>Assess, prepare, and weigh the patient </li></ul></ul><ul><ul><li>Make sure the patient is fasted to prevent bloat </li></ul></ul><ul><ul><li>Prepare equipment for and place IV catheter </li></ul></ul><ul><ul><li>Calculate the volume of each agent to give including fluid administration rates </li></ul></ul><ul><ul><li>Review the oxygen flow rates </li></ul></ul><ul><ul><li>Prepare equipment required to administer drugs and fluids, equipment for endotracheal intubation, and monitoring equipment </li></ul></ul><ul><ul><li>Assemble and test the anesthetic machine and ventilator </li></ul></ul>
    5. 5. Selecting an Anesthetic Protocol <ul><li>Factors to consider </li></ul><ul><ul><li>Minimum patient database </li></ul></ul><ul><ul><li>Patient physical status class </li></ul></ul><ul><ul><li>Type and duration of procedure </li></ul></ul>
    6. 6. Ruminant General Anesthesia <ul><li>Equipment preparation </li></ul><ul><ul><li>Make sure all equipment is present before induction begins </li></ul></ul><ul><ul><li>Check circle system and ventilator of the anesthetic machine </li></ul></ul><ul><ul><li>Make warming equipment available for small ruminants and calves </li></ul></ul><ul><ul><li>Crash cart for emergency drugs and equipment </li></ul></ul>
    7. 7. Ruminant General Anesthesia (Cont’d) <ul><li>Premedication or sedation </li></ul><ul><ul><li>Tranquilizers are generally not needed prior to IV catheterization and induction in calm and tractable animals </li></ul></ul><ul><ul><li>May need tranquilizers for aggressive, excited, or stressed animals </li></ul></ul><ul><ul><li>Anticholinergic drugs cause saliva to become thick and ropy </li></ul></ul>
    8. 8. IV Induction <ul><li>In a special padded area, in a transporter, on a tilt table </li></ul><ul><li>Goal </li></ul><ul><ul><li>Get to unconsciousness rapidly with minimal injury </li></ul></ul><ul><ul><li>Get immediate control of the airway </li></ul></ul><ul><li>Administration </li></ul><ul><ul><li>Double drip: ketamine and guaifenesin IV to effect </li></ul></ul><ul><ul><li>Larger ruminants: IV agent bolus </li></ul></ul><ul><ul><li>Smaller or compromised ruminants: IV agent to effect </li></ul></ul>
    9. 9. IV Induction (Cont’d) <ul><li>Position </li></ul><ul><ul><li>Sternal recumbency for intubation </li></ul></ul><ul><ul><li>Watch for regurgitation to prevent aspiration </li></ul></ul><ul><li>Check vital signs and intubate </li></ul>
    10. 10. Equipment for Endotracheal Intubation <ul><li>Appropriately sized endotracheal tubes (22-mm, 26-mm, or 30-mm tube) </li></ul><ul><li>Stylette (small ruminants and calves only) </li></ul><ul><li>Mouth gag to hold the jaws apart (adult cattle only) </li></ul><ul><li>Laryngoscope (small ruminants and calves) </li></ul><ul><li>Gauze sponge to grasp the tongue (optional) </li></ul><ul><li>A syringe to inflate the cuff </li></ul><ul><ul><li>10 mL for small ruminants and calves </li></ul></ul><ul><ul><li>60 mL for adult cattle </li></ul></ul>
    11. 11. Intubation of Small Ruminants and Calves <ul><li>Small oral opening and thick caudal tongue make visualization of larynx challenging </li></ul><ul><li>Use of a stylette protruding beyond the end of the tube results in better visualization of the larynx </li></ul><ul><li>Head extended, tongue gently pulled forward, laryngoscope is placed to visualize the larynx </li></ul><ul><li>Pass stylette into airway </li></ul><ul><li>Pass endotracheal tube over stylette and into the larynx </li></ul><ul><li>Inflate the cuff </li></ul>
    12. 12. Intubation of a Calf
    13. 13. Intubation of Adult Cattle <ul><li>Intubation is done blindly </li></ul><ul><ul><li>Mouth gag is placed and head is extended by the assistant </li></ul></ul><ul><ul><li>Anesthetist protects endotracheal tube cuff with nondominant hand </li></ul></ul><ul><ul><li>Using nondominant hand, the anesthetist palpates the larynx with the fingers and directs the endotracheal tube into the larynx, while advancing the tube with the dominant hand </li></ul></ul><ul><ul><li>Inflate the cuff and remove the mouth gag </li></ul></ul>
    14. 14. Maintenance of Anesthesia with Inhalant Agent <ul><li>Small ruminants and calves </li></ul><ul><ul><li>Similar to small animals </li></ul></ul><ul><li>Adult cattle </li></ul><ul><ul><li>Similar to horses </li></ul></ul><ul><li>Ruminants tend to hypoventilate </li></ul><ul><ul><li>Place on ventilator if necessary </li></ul></ul>
    15. 15. Intravenous Maintenance of Anesthesia <ul><li>Reserved for short (<20 minute) procedures in healthy patients </li></ul><ul><li>Can also be used to extend anesthesia in intubated patient </li></ul><ul><li>Double drip commonly used </li></ul>
    16. 16. Patient Positioning, Comfort, and Safety <ul><li>Use same principles as for small animals </li></ul><ul><li>Additional concerns </li></ul><ul><ul><li>Position ruminants with mouth lower than pharynx </li></ul></ul><ul><ul><li>Provide padding to prevent neuropathy and myopathy as in horses </li></ul></ul>
    17. 17. Ruminant Anesthetic Recovery <ul><li>Ruminants tend to have a smooth recovery </li></ul><ul><ul><li>Patient transferred to padded recovery stall </li></ul></ul><ul><ul><li>Place in sternal recumbency </li></ul></ul><ul><ul><li>Make sure mouth is lower than pharynx </li></ul></ul><ul><ul><li>Monitor for signs of excessive bloating </li></ul></ul><ul><ul><li>Keep cuff inflated or partially inflated to prevent aspiration </li></ul></ul><ul><ul><li>Extubate when strong swallowing movements or coughing appear </li></ul></ul>
    18. 18. Ruminant Anesthetic Recovery (Cont’d) <ul><li>Ruminants tend to have smooth recovery (Cont’d) </li></ul><ul><ul><li>Remove more air from the cuff if extubation is difficult </li></ul></ul><ul><ul><li>Leave unattended after patient is lying in sternal recumbency without support </li></ul></ul><ul><ul><li>Don’t need to withhold food or water </li></ul></ul>
    19. 19. Positioning a Ruminant for Recovery
    20. 20. Swine Anesthesia
    21. 21. Physical Examination of Swine <ul><li>General observation </li></ul><ul><ul><li>Assess respiratory rate and character </li></ul></ul><ul><ul><li>Observe obvious problems </li></ul></ul><ul><li>Swine are difficult to restrain for a more involved physical examination </li></ul><ul><li>Rely on patient history to determine health status </li></ul><ul><li>Assessing cardiovascular status and drawing blood samples are difficult to impossible </li></ul>
    22. 22. Sedation of Swine <ul><li>Sedatives administered IM </li></ul><ul><ul><li>No readily available peripheral veins </li></ul></ul><ul><ul><li>Thick layer of subcutaneous fat </li></ul></ul><ul><ul><ul><li>Must use at least 1.5-inch needle </li></ul></ul></ul><ul><ul><li>Inject muscles of neck caudal to ear and 3-5 cm lateral to dorsal midline </li></ul></ul>
    23. 23. Sedation of Swine (Cont’d) <ul><li>Swine are resistant to sedative drugs </li></ul><ul><ul><li>Use a combination of tranquilizer or sedative, an opioid, and a dissociative </li></ul></ul><ul><ul><li>May produce sedation enough for short surgical or nonsurgical procedures </li></ul></ul><ul><ul><li>TKX: Telazol ® , ketamine, and xylazine </li></ul></ul>
    24. 24. Pig Sedated with TKX
    25. 25. IM Injection in Swine
    26. 26. Anesthetic Induction <ul><li>TKX often induces anesthesia </li></ul><ul><li>Eyes are not suitable for information regarding depth of anesthesia </li></ul><ul><li>Relaxation of mouth muscles (so mouth can be opened without resistance) is best indicator </li></ul><ul><li>If patient isn’t deep enough more anesthetic must be administered </li></ul><ul><ul><li>IV catheter in aural vein and administer IV induction drug in small increments </li></ul></ul><ul><ul><li>Administer inhalant anesthetic via a face mask </li></ul></ul>
    27. 27. Aural Vein Catheter Placement
    28. 28. Use of a Face Mask in a Pig
    29. 29. Swine Intubation <ul><li>Challenging because of poor visualization </li></ul><ul><ul><li>Small mouth opening </li></ul></ul><ul><ul><li>Narrow dental arcade </li></ul></ul><ul><ul><li>Anatomy of larynx: ventral laryngeal diverticulum </li></ul></ul><ul><ul><li>Proximal trachea </li></ul></ul><ul><ul><li>Laryngotracheal junction at angle </li></ul></ul><ul><ul><li>Laryngospasm </li></ul></ul>
    30. 30. Swine Intubation (Cont’d) <ul><li>Methods </li></ul><ul><ul><li>Patient in sternal or dorsal recumbency </li></ul></ul><ul><ul><li>Using a straight stylette and laryngoscope </li></ul></ul><ul><ul><li>Using a curved stylette </li></ul></ul>
    31. 31. Swine Intubation (Cont’d)
    32. 32. Maintenance of and Monitoring Swine Anesthesia <ul><li>Use small animal anesthetic machine and circle system </li></ul><ul><li>Can use large animal machine on very large pigs </li></ul><ul><li>Monitoring </li></ul><ul><ul><li>Palpate pulse in the ear or on inside of the carpus </li></ul></ul><ul><ul><li>Brachial artery in smaller pigs </li></ul></ul><ul><ul><li>Doppler signal from tail artery </li></ul></ul><ul><ul><li>Pulse oximeter transmission probes on tongue or snout and ears of pink pigs </li></ul></ul><ul><ul><li>Respiratory monitoring with breathing bag and capnometry </li></ul></ul>
    33. 33. Doppler Probe and Blood Pressure Cuff
    34. 34. Pulse Oximetry Probe Placement
    35. 35. Porcine Stress Syndrome <ul><li>Malignant hyperthermia </li></ul><ul><ul><li>Can be associated with inhalant anesthesia </li></ul></ul><ul><ul><li>Mutation in one gene that controls calcium metabolism in muscle </li></ul></ul><ul><li>Symptoms </li></ul><ul><ul><li>Muscle rigidity </li></ul></ul><ul><ul><li>Rapid rise in body temperature </li></ul></ul><ul><ul><li>Hypercapnia and hyperkalemia </li></ul></ul><ul><ul><li>Death </li></ul></ul><ul><li>Treatment </li></ul><ul><ul><li>Terminate anesthesia, deliver oxygen, dantrolene </li></ul></ul>
    36. 36. Anesthetic Recovery <ul><li>General principles for extubation and recovery are the same as for small animals </li></ul><ul><li>Leave IV catheter in place if pig is to be hospitalized </li></ul>

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