This document discusses anaesthetic and surgical management in birds. It covers key advances in avian anaesthesia and surgery over the last two decades including safer anaesthetics and improved monitoring of cardiovascular and respiratory parameters. Five key elements for successful avian surgery are outlined: minimizing time, limiting blood loss, maintaining blood pressure/hydration/glucose, maintaining body temperature, and using an experienced surgeon/anaesthetist. Specialized equipment for avian surgery and anaesthesia is also described.

1. Presented by:
Dr. Urfeya Mirza
Department of Veterinary Surgery &
Radiology
ANAESTHETIC AND SURGICAL
MANAGEMENT IN BIRDS

2. Introduction
• There has been a lot of advances in the field of avian anaesthesia
and surgery in the last 2 decades.
• A variety of inhalation and injectable anesthetics have been
documented,which have been found to be safe in widely diverse
taxonomic groups.
• In addition, the ability to maintain and monitor cardiovascular and
respiratory parameters within normal physiologic ranges has
improved.
• The survival rate in birds has drastically increased due to the use of
safe anaesthetics and also due to advancements related to surgical
techniques in birds.

3. Five Key Elements for Successful Avian Surgery
Time: The anaesthetic and surgical time should be kept minimum, the vet surgeon
needs to work quickly and efficiently and all equipments should be prepared and
kept ready beforehand.
Limiting bleeding and blood loss:The bird patient should not loose much blood
during surgery and for this radiosurgical unit,laser surgery and electrocautery
should be used.
Maintaining blood pressure,hydration and blood glucose levels.
Maintaining body temperature: Birds have high metabolic rate,high body
temperatures of about 400 C and are small in size so they loose heat easily when
under the the knife. So they should be kept warm before ,during and after surgery.
The anaesthetist and surgeon should be an experienced one.

4. Specialized Equipments Required for Avian Surgery
Vaporizers for Isoflurane and Sevoflurane anaesthetic agents.
Smaller sized endothracheal tubes or air sac tubes to maintain patent airways.
Smaller surgical instruments as developed for ocular surgery.
Operating microscope or special magnifying loupes as some sort of magnification is very helpful for better
visualization of the surgical field.
Bright focused shadow less light to illuminate surgical field.
Radiosurgical Unit: It gives focussed radio waves to cut and coagulate bleeding tissue and causes very little
lateral tissue damage as compared to electrocautery.
Laser Surgery: It decreases surgical and anaesthetic time and prevents blood loss but limitation is the high cost
of the instrument.
Endoscopy Unit: Various types of Endoscopes have been developed which provides cool light ,magnification and
excellent visualization of internal organs. Additionally visualization on monitor facilitates surgery.

5. Pre-anaesthetic and Pre-operative considerations
• History and thorough physical examination should be carried out
prior to surgery.
• Weight of the bird should be taken in grams in order to calculate the
exact dose of the anaesthetics and other drugs.
• The heart and the respiration rates should be auscultated.
• Fasting prior to anaesthesia is necessary.Large sized birds-8to 12
hours,small birds – 3 to 6 hours.
• The crop should be palpated for food and liquid.
• The abdomen palpated for organ enlargement ,eggs or other masses.
• The nutritional and hydration status should be assessed. Supportive
nutrition should be given to the birds with high metabolic rates.
• Laboratory tests like CBC and blood biochemistry should be done
prior to surgery.

6. • Diagnostic procedures like radiological and ultrasonographic
examination should be done as and when required prior to
surgery.
• Warmth – all patients are at risk of hypothermia from the point
of pre- medication onwards so they should be provided with
warm fluids and supplemental heat before and during surgery.
• A blood transfusion is necessary in some cases during and
after surgery.
• Small birds may benefit from the administration of intravenous
dextrose during surgery to prevent low blood sugar.

7. Heating chamber for hypothermic birds

8. Weighing of Birds

9. Risk of reflux!
Supportive nutrition for Hypoglycemic birds

10. Gentle handling of birds

11. Avoiding hypothermia
Heating Pad provided to the patient during and after surgery

12. Injection Sites
Intraosseous catheters for small birds
Site for Intramuscular
injection(Pectoral muscles)
Common site for I/M injection – Pectoral
muscles
Common site for I/V injection - right
jugular vein, brachial vein or medial
metatarsal vein or Intraosseous route.

13. Benzodiazepines
• Highly advantageous with dangerous birds such as large raptors,
and long-legged birds such as cranes and ratites.
• Diazepam and Midazolam - reduce anxiety during anaesthetic
induction and recovery.
• Sedatives work best if given 10 - 20 min prior to manipulations.
• Birds appear to struggle less during restraint.
• Dose
• Diazepam @ 0.5 - 1 mg/kg IM
• Midazolam @ 0.5 - 2 mg/kg IM

14. Alpha-2-adrenergic agonists
• Xylazine, Detomidine and Medetomidine are usually used in
combination with ketamine.
• Provides muscle relaxation, analgesia and sedation which
smoothes induction and recovery.
• Xylazine -causes respiratory depression, excitation, convulsions
and prolonged recovery.
• Medetomidine – has sedative effect but does not immobilize
the birds.
• Dose
• Xylazine @ 1-4 mg IM (0.2-0.5 mg IV).

15. • Xylazine and Ketamine -Blood pressure is elevated, heart rate
decreased, hypoxemia, hypoventilation, and hypercapnia occur.
• Xylazine and Medetomidine - Decrease HR, RR, blood pH,
hypoxemia and hypercarbia .

16. Dissociatives
• Ketamine- follows the principles of allometric scaling
• - large birds (>1 Kg) respond to 10 - 20 mg/kg.
• - small birds (< 50 grams) requires 70 - 80 mg/kg.
• There is inter-species variability in the response to ketamine.
• - e.g. Ketamine causes salivation, excitation and
convulsions when given to vultures but these signs are rare in
other birds.
• Effective, anesthesia occurs- within 5 - 10 min of I/M injection
and may last 5 - 20 min.
• Ketamine not be used alone and be combined with
benzodiazepines or alpha2-adrenergic agonists to improve
relaxation and depth of anesthesia.

17. • Tiletamine and Zolazepam- Telazol® combines the effects of a
dissociative (tiletamine) and a benzodiazepine (zolazepam)
drug.
• Similar to ketamine plus midazolam
• Dose: 5 or 10 mg/kg is an effective and safe anesthetic.

18. Propofol
• Propofol – on i/v administration has rapid onset, smooth
induction, short duration of effect and smooth rapid recovery.
• Intravenous catheters are highly recommended for its
administration because the drug must be given slowly for
induction and often given repeatedly to maintain anesthesia.
• Dose
• Induction - 2 mg/kg IV
• Maintainance- 0.5 - 1.0 mg/kg/min
• Propofol has a narrow margin of safety in birds and
supplemental oxygen and respiratory assistance must be
provided to counteract apnea, hypoventilation and hypoxemia.

19. Emergency Drugs
•Because of the rapid rate at which avian surgical emergencies
can develop, it is always good to have standard emergency drugs
at hand like -
Doses
Atropine SO4 (0.4 mg/ml) @ 0.01-0.25 ml.
Epinephrine (1 mg/ml; 1:1000) @ 0.01-0.33 ml.
Doxapram HCl (20 mg/ml) @ 0.01-0.33 ml.

20. Inhalant Anaesthetics
Advantages
 Rapid induction and recovery.
 Ability to regulate the plane of anesthesia throughout
procedure.
 Not generally metabolized by the liver or kidney.
 Actual drug costs are low.
Disadvantages
 Initial cost of anesthetic vaporizer can be high.
 Some pets may become stressed during induction phase.
 In species that cannot be intubated, working on the head or
mouth can be difficult.
 Contraindicated in respiratory disease.

21. Equipments required for Inhalation Anaesthesia
• Face masks
• Proper sized endotracheal tubes.
• Valveless non –rebreathing circuit.(Bain circuit)
• Anaesthesia machine with an out-of –circuit precision
vapourizer for isoflurane.
• Standard 0.5 litre Reservoir bag can be used but better control
and monitering of respiration can be achieved with a smaller
volume bag designed for birds.
• Proper scavenging system .

22. Induction
• Induction can be achieved by using
• - Face mask or cone
• - Anesthetic induction chamber
Mask induction is performed easily and quickly with adequate
manual restraint and an appropriate sized mask.
• Most birds mask down easily with an oxygen flow rate of 1L/min
and at3% isoflurane.Once the bird is sufficiently relaxed it can be
intubated.
• Birds can be maintained on a mask alone for short
procedures.Endotracheal intubation is recommended for longer
procedures( i.e.more than 10 min.) or when ventilation is required.

23. Face Mask application

24. Intubation
 Helps in reviving a patient in the event of
respiratory arrest.
 Paediatric intubation tubes as small as: 1.5
mm
 General Guidelines:
i. Induce anesthesia with cone or anesthetic
chamber.
ii. Use mouth speculum to open mouth and
cotton tip applicator to depress tongue.
iii. Visualize glottis .
iv. Place the endotracheal tube inside trachea
v. Tape it securely with the lower beak

25. Endotracheal Intubation

26. Air sac Intubation
• It is alternative sight for
intubation when tracheal
intubation is not possible.
• Anaesthetia can be delivered
by placing short endotracheal
or red rubber tube into the
caudal thorasic or abdominal
air sacs.
• Studies have shown that
isoflurane can be safely
administered through air sacs
to maintain surgical
anaesthesia. Different air sacs in birds

27. Air sac Intubation

28. Maintanance on Non-rebreathing circuits
• Non-rebreathing circuits, such as the Bain circuit or Norman
elbow, are ideal for birds weighing < 7 kg because they offer
minimal resistance to patient ventilation.
• A reasonable fresh gas flow rate for the Bain circuit is 500
ml/min.
• A standard 0.5 litre reservoir bag is used in large avian patients.
• Standard circle systems can be used for larger birds.

29. Closed circuits

30. Effect on Blood Pressure
• Isoflurane consistently causes peripheral vasodilatation.
• Increased concentrations of,
- Halothane - Decrease in mean arterial blood pressure.
- Isoflurane - Dose-dependent decrease in mean arterial
blood pressure.
- Sevoflurane Dose-dependently decreases blood pressure
during controlled ventilation, but not during spontaneous
ventilation
• The phenomenon is probably due to hypercarbia- due to
increase in sympathetic tone which causes hypertension.

31. Effect on Heart
• Halothane - Cardiac arrhythmias.
• Isoflurane - Cardiac stability is one of the perceived
advantages

32. Recovery
• Provide warmth and subcutaneous fluids (up to 30ml/kg in divided
sites) if intraoperative fluids not administered.
• Wrap the bird in a towel to control wings and recover in a dark
and quiet area.
• If a bird shows signs of excitation, hand-hold the wrapped bird
until it fully recovers.
• Analgesics can be administered immediately postoperatively to
produce a smooth recovery.

33. Recommendations
• Provided external warmth during any anesthetic procedure.
• Allow a recovering bird to breath oxygen until fully recovered.
• Small birds rapidly become hypoglycemic, especially if the bird
was fasted prior to anesthesia.
• Provide calories with nutrical water or glucose water in small
amounts as soon as possible after recovery until danger of
hypoglycemia is past.

34. Soft tissue surgery

35. Anatomy of different organs in birds

36. Ingluviotomy
• Indications
• biopsy
• Repair of fistulas (crop burn)
• Removal of foreign bodies (from the crop or
proventriculus)

42. Crop Fistula
• Most commonly occur in neonates being
hand fed food warmed in microwave or
being tube fed
• Severe cases
– metabolic compromise
– absorption of toxins from necrotic
tissue
• Shock therapy and stabilization often
indicated

43. • If treating a crop burn, all necrotic tissue must be removed
– postpone surgery for 5 days after insult so demarcation
between viable and non-viable tissue is observed

44. Crop Fistula
• Once fistula has formed, the skin and ingluvies
which have healed together must be separated
– sharply dissect edge of fistula
– bluntly separate skin and ingluvies
– closure - same as ingluviotomy

45. Crop Fistula
• closure - same as ingluviotomy

46. Proventriculotomy
• A proventriculotomy can be performed via the left lateral
approach.
• It is also possible to perform this procedure from a ventral
approach.
• Species and accessibility varies.
• In owls for example there is a far larger soft tissue space between
the leg and the rib cage.
• This is not so in parrots or sea birds.

47. Why do it?
• A proventriculotomy is indicated typically for the removal of
foreign bodies or for repair.
• The entry point in psittacines is between the proventriculus and
the gizzard at the isthmus.
• In other species where the gizzard is less muscular this is less
critical.

48. Closure
• 1.5 metric PDS is used in a simple interrupted fashion to close the
proventriculus.
• No flushing is performed.
• The body wall is closed including the two ribs and then simple
interrupted sutures are placed in the skin.

50. Cloacopexy
• Indications
– For management of chronic cloacal prolapse due to egg laying
in females.
– In Male cockatoos—for management of chronic masturbation
– Dystocia
– Parasitism

55. Salpingohysterectomy
Salpingohysterectomy is the removal of oviduct along wih the uterus.
• Indications:- Persistent egg laying,
• some cases of egg binding,
• feather plucking birds or egg peritonitis cases.

56. Salpinghysterectomy
• Dorsal recumbancy.
• Tape the leg laterally.
• Left paramedian/lateral coeliotomy without rib transection.
• Does not interfere with superficial femoral artery.
• Good visualisation of kidneys and reproductive tract.

58. Avian orthopaedics

59. General considerations
• Pneumatic, large medullary canal, thin cortices, high calcium
content , thin and brittle - Prone to shattering upon impact (multiple
fractures).
• When a pneumatic bone is fractured, often subcutaneous
emphysema occurs, but it usually resolves within a day, without
treatment.
• Soft tissues are not strongly adhered to bones (the distal portion of
the leg, below the tibiotarsus, and the proximal half of the
humerus) - open and comminuted and make iatrogenic fracture
during repair.

60. • Biological healing: Natural healing with minimal disturbance is
advocated especially in birds.
• Time since fracture: within 24 hours of their occurrence have the
best outcome and prognosis.
• The longer the fracture spends broken, the more muscle
contraction, drying of tissues, and progression of infection that
occurs. The ends of the bone have begun to heal over by 48
hours.

61. Age fractures by looking at the colour
of the bruising
• Red - < 24 hours
• Blue-purple - older than 24 hours but < 5 days
• Green - 5 – 7 days
• Yellow - Greater than 8 days,
• No colour - older than 2 weeks

62. Rate of healing
• Faster in birds.
• Under optimum conditions the gap between the fractured ends is
filled with fibrous tissue within five days and cancellous bone
within nine days.
• True bony union takes 22 days and complete remodelling takes
six weeks.

63. Prognosis
• If one bone is affected, the prognosis is better.
• If two bones are affected – such as the radius and ulna of a wing,
then surgical intervention is a necessity and a poor prognosis
results.
• If two discreet bones are broken – say humerus and femur, then
euthanasia is preferred as the bird cannot use its wing to balance
its leg or vice versa.
• If the bone has a comminuted fracture, then the there are many
pieces of bone. With loss of the length of bone, prognosis is poor
as it is difficult to put several pieces back together as bird bone is
more thin and brittle than mammalian bone.

64. Humerus
•Midshaft or at the junction of the middle and lower thirds of the bone
•These fractures tend to be open, spiral and unstable.
•Techniques:
– Figure-of-eight bandage
– IM Pin with figure-of-eight bandage
– Professor Redig’s ‘tie in’ technique
– External fixation
– Short intramedullary pegs

65. Figure-of-eight bandage
• Bandages are changed on the wing
every 3 days, and every 5 – 7 days
for leg fractures.
• The frequency of bandage changes is
dependent on the presence of open
wounds – daily changes for first 3
days with saline dressings, reduced
to changes every 3 – 5 days depend
on the wound.
• Check bandages daily for swelling,
pain or lack of use on limb.

66. Intramedullary pinning

67. Professor Redig’s ‘tie in’ technique
• A modification of simple intramedullary
pinning.
• Intramedullary pin can be smaller in
diameter and lighter in weight (50% of
medullarycavity).
• At the pin’s exit it is bent at 180°.
• One or two transverse pins are rigidly
connected using any suitable epoxy
resin fixative such as Aradite, car body
• Repair material or Technovite (horse
hoof repair material) etc.

68. Kirschner splints or external skeletal
fixators (ESF)
• The pins pass at an angle of
30–45° through the skin and
then cortex of the bone from
one side to the other.
• half-pin method
• full-pin technique
• The technique is relatively
rapid and it allows endosteal
regeneration of the bone.

69. Short intra-medullary pegs
• Short intra-medullary pegs are
held in place by a figure-of-
eight stainless steel wire
suture.
• Materials used
– Short lengths of a
steinmann pin
– Hypodermic needles
– Polypropamide rods

70. Fractures of the radius and ulna
• The prognosis is good when a single bone is fractured.
• For small birds-a figure-of-eight bandage combined with cage
rest.
• External splinting
• KE splinting
• Rush pinning

71. External splinting
• Also applicable to the
smaller birds
• Method of external splinting
is to suture a piece of
lightweight plastic material,
such as a length of hexcelite
or vetcast casting tape,
padded with polyurethane
foam, over the fracture site.

72. • Rush pinning of a
fractured ulna using a
suitable K wire bent
into shape.
Internal fixing (Rush pin)

73. Fractures of the carpus, metacarpus &
digits
• External coaptation using
X-ray film or acetate sheet
• Very helpful in small and
medium sized birds.
• Film is bent over the
leading edge of the wing
and then sutured

74. Fractures of the femur and the
tibiotarsal bone
• The surgical approach to femur is from the lateral aspect.
• The tibiotarsal bone is approached from the cranio-medial aspect
to avoid the nerves and blood vessels.
• For small birds-----cage rest
• For larger ones: By one of the methods described for internal
fixation of the fractured humerus----
– Intramedullary Pinning
– External Splinting
– External Skeletal Fixation And
– Tie In

75. External splinting
(“sandwich” tape splint)
Splints for small birds using adhesive tape crimped
together with artery forceps or sutured at the ends

76. External skeletal fixation
• Femur stabilized with external
skeletal fixation
• Half pin type or full pin type
can be used depending upon
the size of the bone and
location of fracture.
• Acrylic ESF or epoxy ESF are
very useful for birds, due to
their light weight as compared
to metal fixators.

77. Post operative management
• Antibiotics –are required for a minimum of two weeks.
• Pain relief should be provided for the first 3 – 5 days. Metacam or
carprofen is suitable for birds.
• Follow up is required - 3 days - physiotherapy and bandage
change. Repeat x-rays are taken at 10 days, 21 days and further if
required.
• Feed a balanced diet – consider supplementing with calcium to
help the bone to heal.
• Implants may be removed around the 14 day mark – depending on
the individual and fracture.
• Wild birds destined to be released must be able to fly, catch prey
and perch normally.

78. Thank
you