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Giraffe Anesthesia Presentation-Emily Hall-2
- 1. Calgary Zoo Vet Student Extern Presentation Emily Hall
- 2. • Unique anatomy and physiology • Considerations before you start • Drug options • Monitoring and maintaining • Reversal and concerns
- 3. • Kidney damage if MAP <130mmHg • Limits physical control • Heart more prone to injury from O2 debt dung hypoxemic events • Vomiting Aspiration pneumonia Fatalities • Unique cardiovascular physiology • Danger • Malposition Fatalities • Elevated kidney pressure • “G Suit” + ground impact • Posterior position of larynx in pharynx • Long neck • Large Size • Regurgitation Aspiration pneumonia Fatalities
- 5. • Improper substrate • Blood volume is unusually low fluid overload • Hyperthermia • Myopathy • Secondary trauma • Hypothermia • DON’T FORGET TO FAST!!!
- 7. • Etorphine + Xylazine • Staged (details later) • Carfentanil + Xylazine • Staged same for X • C: Adult- 1.2-2.1 mg IM • C: Yearling- 0.2-0.9 mg IM • Thiafentanil + Medetomidine + Ketamine • T: 5.8 (+/-) 1.5 μg/kg IM • M: 12.9 (+/-) 5.1μg/kg IM • K: 0.65 (+/-) 0.18 mg/kg IM With good analgesia
- 8. • Vomiting • Regurgitation • Respiratory depression • Cardiac depression • Lack of control Self- induced trauma • Prolonged induction and/or stormy recovery secondary self-induced trauma, hyperthemia, capture myopathy • >10% mortality
- 9. Your Giraffe is in the chute, everything is ready, everyone knows their jobs…
- 10. Xylazine IM 70-100 mg/adult 30-40 mg/ yearling Atropine IM 1.0-8.0 mg/adult 2.0-3.0 mg/ yearling
- 11. • Stargazing • Slight ataxia • Tongue protrusion • Slight salivating Manipulation at this time is contraindicated
- 12. Etorphine IM 1.5-2.5 mg/adult 0.5-1.25 mg/yearling
- 13. • Supplement Etorphine (0.5- 1.0 mg IM or IV) • Cast it • 5% guafenesin solution IV to effect • Ketamine (100-400mg) IV
- 15. >15min procedure
- 16. Neck extended Head above rumen Nose down Blindfolded & earplugs Angle neck support
- 17. Arterial blood gas site and invasive blood pressure monitoring
- 18. • Etorphine + Xylazine • E: Naltrexone (50-100mg/mg etorphine) ½ IV ½ IM or all IM • X: Yohimbine (0.10- 0.20 mg/kg IM or IV) or Atipamezole (50- 100mg total ¼ IV ¾ IM or all IM • Carfentanil + Xylazine • C: Naltrexone 100mg/mg carfentanil IV or IM • Thiafentanil + Medetomidine + Ketamine • T: Naltrexone 30 mg/mg thiafentanil IV or IM • M: Atipamezole 3-5X medetomidine dose IV or IM • K: nope
- 19. • Head supported in elevated position • Nose pointed down • 2 people to support head and neck & prevent premature rising • Earplugs removed • Blindfold removed after animal begins to respond • “lifting one person off the ground” • Rope around shoulders + pulling = giraffe in sternal
- 20. • Give enough space for the rocking to standing • Reversal to standing 10- 20min • Beware resedation!!!
- 21. • Brondum, E., J. M. Hasenkam, N. H. Secher, M. F. Bertelsen, C. Grondahl, K. K. Petersen, R. Buhl, C. Aalkjaer, U. Baandrup, H. Nygaard, M. Smerup, F. Stegmann, E. Sloth, K. H. Ostergaard, P. Nissen, M. Runge, K. Pitsillides, and T. Wang. "Jugular Venous Pooling during Lowering of the Head Affects Blood Pressure of the Anesthetized Giraffe." AJP: Regulatory, Integrative and Comparative Physiology 297.4 (2009): n. pag. Web. 12 June 2015. • Bush, M., D.G. Grobler, and J.P. Raath. "The Art and Science of Giraffe (Giraffa Camilopardalis) Immobilization/ Anesthesia."Zoological Restraint and Anesthesia (n.d.): n. pag. International Veterinary Information Service. Web. 7 June 2015. • Cooper, D.v., D. Grobler, M. Bush, D. Jessup, and W. Lance. "Anaesthesia of Nyala (Tragelaphus Angasi) with a Combination of Thiafentanil (A3080), Medetomidine and Ketamine." Journal of the South African Veterinary Association 76.1 (2005): n. pag. Web. 3 July 2015. • Howard, Lauren L., DVM, ACZM. Giraffe and Okapi Medicine and Anesthesia: Overview. Proc. of ACZM Short Course, Texas, College Station. N.p.: n.p., n.d. Print. • Napier, Julia E., Naida M. Loskutoff, Lee G. Simmons, and Douglas L. Armstrong. "Comparison of Carfentanil-Xylazine and Thiafentanil- Medetomidine in Electroejaculation of Captive Gaur ( Bos Gaurus )." Journal of Zoo and Wildlife Medicine 42.3 (2011): 430-36. Web. 3 July 2015. • Miller, R. Eric., and Murray E. Fowler. "Giraffidae/ Mammal Groups." Fowler's Zoo and Wild Animal Medicine. Vol. 8. Saint Louis: Elsevier, 2015. 602-09. Print. • Smith, Kristine M., David M. Powell, Stephanie B. James, Paul P. Calle, Robert P. Moore, Heidi S. Zurawka, Sabrina Goscilo, and Bonnie L. Raphael. "Anesthesia Of Male Axis Deer (Axis Axis): Evaluation Of Thiafentanil, Medetomidine, And Ketamine Versus Medetomidine And Ketamine." Journal of Zoo and Wildlife Medicine 37.4 (2006): 513-17. Web. 3 July 2015.
- 22. Special thanks to Dr. Lauren Howard for generously providing a plethora of information.
- 23. Questions?
Editor's Notes
- Large Size (height more than 5m, mature males weighing 850-1950kg and females 700-1200kg) limits physical control during critical times of induction and recovery as well as limits opportunity for manipulation once the giraffe is down. Their 7 long vertebrae can be very problematic in that, if not controlled, it can act as a long, strong hammer creating danger to itself or staff. In addition a mal-positioned neck leads to airway obstruction and/or the neck muscles cramping, which can be fatal. Their tendancy to vomit or regurgitate can lead to fatal aspiration pneumonia. -The posterior position of the larynx in the pharynx hampers draining of any fluid (rumen/saliva). -The skin and muscle over the abdomen are very tense functioning as a “G Suit” to help prevent the accumulation of interstital fluid and therefore preventing peripheral edema along with lymphatics, abrupt narrowing of the arterial lumen at the level of the elbow and stifle, and well developed valves in veins and lymphatics. The increased abdominal pressure that happens when the animal hits the ground plus the very tense abdomen creates a high chance for vomiting to occur The giraffe kidney deals with much higher pressures comparatively, and it copes wit that through a fibrous capsule and increased interstitial pressure. The take home being that normal kidney perfusion in a giraffe depends on a mean arterial pressure of at least 130mmHg Because of the giraffe’s unique cardiovascular physiology, which we will hit on a little more on the next slide, the giraffe heart may be prone to injury from oxygen debt during periods of hypoxemia
- Lets talk blood pressure just briefly because that is all we have time for: -The giraffe heart generates a blood pressure 2x that of other mammals (100mmHg arterial pressure at head, 450+mmHg in lower leg). However both stroke volume and cardiac output are lower than in similar sized mammal with blood volume being unusually low. The narrow, rigid veins in the leg have low compliance but the large veins in the neck region have high compliance. This all gives rise to the phenomenon of, when the head of the anesthetized giraffe is lowered, blood pressure at the head spikes very briefly before returning to much lower values which coincides with pooling of the blood in the jugular veins hence decreasing the cardiac preload which in turn lowers the systemic blood pressure as defined by the Frank-Starling Mechanism.
- -Improper substrate potentiates self-induced injury due to slipping induction and recovery, also nerve considerations -As mentioned earlier the giraffe blood volume is unusually low. Keep that in mind when administering fluids during anesthesia so as to decrease your likelihood of fluid overloading -Prolonged induction/recovery lead to hyperthermia, myopathy and secondary trauma but if the ambient temperature is low, they and okapis tend to drop temp fast -One paper says to fast for 48-72hrs with withholding water for 24-48hrs, but the most recent edition of Zoo Animal & Wildlife Immobilization and Anesthesia says fast for no longer than 12 hours and witholding water for 2-6hours depending on weather conditions.
- The Bush technique is visualizing the glottis with the laryngoscope, passing a tracheal exchange catheter through the glottis, threading the exchange catheter through Murphey’s eye of the endotracheal tube, and passing the tube through the glottis using the exchange catheter as a guide. Another way is to digitally palpate the glottis and manually place the ET tube Also, a fiberoptic endoscope through the ET tune into the trachea then using the endoscope as a stylet has been described
- Regardless of what drugs you used to get you there, there are standard procedures for an anesthetized giraffe in lateral recumbency. The neck must be extended to ensure a patent airway. The neck has to be supported with the head above the rumen and nose pointed down. It should be blindfolded and have earplugs placed. You can use a long board or ladder placed under the entire length of the neck for support and positioning. The angle of the neck has to be changed every 10-15min to minimize the muscle spasms that can occur.
- Venipuncture Jugular vein most common More accessible closer to head Auricular and facial veins blood gas site Auricular artery on dorsal ridge of ear Catheter-jugular vein Through the needle catheter Partial cut down Pulse oximetry Scraped ear Vulvar Mammary Prepucial Scrotal skin End-Tidal CO2 ET tube Small tube placed in nostril Noninvasive blood pressure Tail cuffs Electrocardiography Needles placed through thick skin
- There are several authors that warn to make sure the giraffe has enough room to rock forwards like it needs to stand up. Resedation can be a potentially life threatening problem in giraffe and has particularly been seen with medetomidine requiring additional supplementation of atipamezole