MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 1
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.
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 2
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 !!!
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 3
Anesthesia - injection
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
Anesthesia - injection
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 4
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 5
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)
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 6
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 7
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
Anesthesia - monitoring
Reflexes
Evaluated plantar sensitivity,
palpebral and corneal reflex,
tonus muscles of pelvic limg and wings.
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 8
Anesthesia - monitoring
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
Anesthesia - monitoring
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
Anesthesia - monitoring
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.
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 9
Anesthesia - monitoring
! 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.
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 10
Inhalation anesthesia
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
Inhalation anesthesia
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.
Injectable anesthetics
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 11
Injectable anesthetics
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
Injectable anesthetics
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.
Injectable anesthetics
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
Injectable anesthetics
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 12
Injectable anesthetics
Tiletamin-zolazepam mg/kg I.M.
Budgerigard 21
Macaw 12
Cockatoo 2,6
Eagle 10
Owl 14
Emu 17
Duck 40
Injectable anesthetics
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.
Surgical intervention
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
Surgical intervention
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 13
Osteosyntesis in female of blue fronted amazona
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 14
Osteosyntesis of golden eagle
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 17
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
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 22
Amputation of finger in pergrine falcon
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 23
Constriction and Avascular Necrosis of the Digits
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 24
Wound on the Amazon parrot
Feather cyst
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 25
Repair of Ulcerative Lesions of the Sternum
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 27
Surgical removing of lipoma in galah
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 30
Surgery
Respiratory system
- infraorbital exploration
- rupture of the cervicocephalic air sac
GIT
- crop burn repair
- ingluviotomy
- cloacal papillomas
- cloacal prolapse repair
MVDr. Viktor Tukač, CSc. 9. 12. 2013
Výživa a poruchy metabolismu u exotických
ptáků. 31
Crop fistula in falcon
Crop burn repair