Zoo and Wild Animal Anesthesia & Critical Care Medicine

Transcription

1 Zoo and Wild Animal Anesthesia & Critical Care Medicine

2 Disclosure We have nothing to disclose

3 Karen

4 OR

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6 Challenges of Veterinary Anesthesia Uncooperative patients Uncontrollable/ Difficult to control environment Increased risk of regurgitation and aspiration despite adequate NPO time Patient may be dangerous to care takers Difficult airways, vascular access Difficult to monitor at all points of the case Unique biological requirements and physiology Social behavioral issues

7 Challenges of Veterinary Intensive Care Lack of knowledge of Inter/intra species response to physiologic stress, medications Difficult anatomy and anatomic differences from humans Challenging physiologic obstacles Lack of technical support and resources Unavailability of suitable blood products Differences in ideology Social order and group issues

8 Endangered Giant Panda<1200 Cross River Gorilla<300 Sumatran Rhino <100 Northern White Rhino 4

9 Species Groups Felines Odd toed Ungulates Even toed Ungulates Primates Bears Canines Marsupials

10 I should have said no to dessert

11 Red Shanked Douc Langur (Pygathrix nemaeus nemaeus) - Old world - Leaf eating - Native to Vietnam and Laos - Endangered

12 Range Map Red Shanked Douc Langur (Pygathrix nemaeus nemaeus) - Eastern Northern Viet Nam - Central Laos - Northern Cambodia Number left in the wild: unknown, probably <700

13 Red Shanked Douc Langur (Pygathrix nemaeus nemaeus) Folivors, feeding on young plants, fruits and seeds Have fermenting multistage stomach, Not ruminants Can get GI dysfunction in captivity: TPN, exlap, fecal transplants

14 Red Shanked Douc Langur (Pygathrix nemaeus nemaeus) - Folivors have complex sacculated stomachs w/ enlarged alkaline forestomach chamber to promote cellulitic bacterial growth - The bacteria dissolve cellulose and releases glucose and Volatile fatty acids for energy and glucose production - Bacteria also detoxify plant poisons - Bacteria then pass to 2 nd stomach and get digested into protein

15 Red Shanked Douc Langur (Pygathrix nemaeus nemaeus) Concerns for Anesthesia - Full stomach, no mask ventilation - Upright intubation, air sac - Gastric drainage can be harmful - Upright extubation - May need a cast to preserve IV access

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17 Cute Baby Gorilla gets delivered by C-section

18 Western lowland gorilla (Gorilla gorilla gorilla) Inhabitants of west Africa Forest and lowland swamps Most common gorilla found in zoos Critically endangered

19 Range Map Western lowland gorilla (Gorilla gorilla gorilla) - Angola - Cameroon - Central African Republic - Republic of the Congo - Democratic Republic of the Congo - Equatorial Guinea - Gabon Number Cross River Gorilla subspecies: <300 Number mountain Gorilla subspecies:

20 Mom & Dad Imani was born at 830g, SGA, preterm She was unable to be breastfed, and was near death before she was taken from mom Hand raised and re-introduced to an elderly female for assimilation back into the group Father is Winston, the groups silverback

21 Western Lowland Gorilla (Gorilla gorilla gorilla) -Breed w/ Silverback -Gestation is appx 9 months -Typical Labor 30 min-4hrs -Birth weight kg -Baby carried (on their backs) by mother for first 2 3 years -Juveniles stay w/ family and participate in play

22 Delivery and Resuscitation

23 Right lung collapse Intubation/Suction & Re-expansion

24 Challenges Incubator Positioning Uncontrolled Pre-op environment Need for GA for C/S Need to try and re-unite mother & infant Somewhat limited ICU setting Need to arrange nursing/rt care Somewhat limited access to equipment Media attention Surrogate Nursing

25 Re-introduction: Meeting Mom A baby will be nursed by the mother for first 2-3 years Human raised primate infants present significant logistical problems Human contaminated primates, will usually not be accepted by the group Re-introduction can be a complicated, risky and prolonged process

26 Re-introduction: Mom gets to hold her baby girl

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28 Dr, I think I m having a problem with my air sacs

29 Sumatran Orangutan (Pongo abelii) One of 2 Organutan species Forest / Tree dwellers Omnivorous Critically endangered

30 Range Map Sumatran Orangutan (Pongo abelii) - Found only on the island of Sumatra, Indonesia - Found only on the northern tip of the island Number left in the wild: 7,300

31 Laryngeal Air Sacs

32 Laryngeal Air Sacs

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34 Airway: Intubation

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36 Tube positioning

37 Positioning

38 Positioning

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40 Help me, I have a nose bleed

41 Endemic to China Giant Panda (Ailuropoda melanoleuca) Unique in the order of carnivora, eats 99% bamboo China s national emblem Logo for WWF Endangered

42 Giant Panda (Ailuropoda melanoleuca) - The giant panda was once widespread throughout southern and eastern China, as well as neighboring Myanmar and northern Vietnam. - Now restricted to around 20 isolated patches of bamboo forest in six mountain ranges in China's Sichuan, Shaanxi and Gansu provinces. Number left in the wild: 1,864

43 Induction and Transport

44 Mask Anesthesia

45 Intubation

46 Vascular Access

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48 Challenges Critically endangered Regurgitation risk No blood products Bamboo requirements Male Shi Shi was elderly and not interested in breeding Hypertension during EEJ

49 `

50 I have a tummy ache

51 Koala (Phascolarctos cinereus) - Marsupial from continent of Australia - Completely arboreal - Eats Eucalyptus leaves Drinks very little - Slow, Sleeps >20h/day

52 Koala (Phascolarctos cinereus) - Shot for fur and as a nuisance - Population decreased from millions to - Vulnerable to habitat destuction Number left in the wild: 80,000

53 Anesthetic Issues with the Koala - Koalas are hindgut fermenters and can get phytobezoars - Dental issues - Infections Difficult airway Large inscisors Short HMD Inferior larynx -Very slow metabolism -Low water intake and requirements -Slightly lower body temperature -Very sensitive to volatile anesthetics

54 Koala Extubation

55 Koala ICU/PACU Tree - Most comfortable in trees - Become agitated when placed in any other position - Very sensitive to excess water

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57 Walking with a limp after having a baby

58 Ugandan Giraffe (Giraffa camelopardalis rothschildi) - Also called Rothschild, or Baringo - Have ossicones (ossified cartilage covered w/ skin) not horns. - Tallest land mammal - Same number of cervical vertebrae (7) as humans - Even toed ungulate - Only 2 species in Giraffidae family Giraffe and okapi - Endangered

59 Ugandan Giraffe (Giraffa camelopardalis rothschildi) - Most rare of Giraffe species - Found only in Kenya and Uganda - Extinct in Sudan Number left in the wild: <1500

60 Left Ventricular Morphology of the Giraffe Heart The Anatomical Record Volume 296, Issue 4, pages , 19 FEB 2013 DOI: /ar

61 Drinking Water

62 Ultrasound image showing the carotid artery (arrow) and the jugular vein (arrowhead) in the cranial part of the neck of an anesthetized giraffe suspended in the upright position (left) and with the head lowered to heart level (right). E. Brøndum et al. Am J Physiol Regul Integr Comp Physiol 2009;297:R1058-R by American Physiological Society

63 Giraffe Anesthesia: Intubation

64 Giraffe Anesthesia: Ventilator

65 Transport

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67 Giraffe Anesthesia

68 Zuclopenthixol (Acuphase) Antipsychotic drug of the thioxanthene class Long lasting decanoate form has up to 3 weeks duration in humans Acts as a mild sedative 1-2 days before surgery to decrease anxiety and allow entrance into the boma

69 Giraffe Anesthesia: Challenges - Many obstacles - Requires experienced team - Multiple anatomic features Large Size/Shape Thick skin High blood pressure Difficult to position Dangerous to personnel Difficult to monitor Difficult to ventilate Ruminant> Risk of regurgitation Prone to MH like reaction Anxiety around caretakers

70 BIG ETT

71 Giraffe Anesthesia

72 Giraffe Anesthesia: Emergence - Critical point during anesthetic. - Give first chance your best chance - Make sure all anesthetic agents have Worn off - Reverse opioid, alpha-2 - Have adequate room to prevent injury to animal or staff - Control head with ropes. They can use It as a weapon

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74 I m the last one.

75 Sumatran Rhinoceros (Dicerorhinus sumatrensis) - Most endangered Rhino Species - Hairy Rhino - Asian 2 horned Rhino - Smallest Rhino Critically endangered

76 Sumatran Rhinoceros (Dicerorhinus sumatrensis) - Extinction is likely in the next 5 years - Likley only left in Sumatra in the wild - Last individual in vietnam was poached Number left in the wild: <100

77 Dart Induction

78 Intramuscular Dart

79 Compressed Gas Dart

80 Rhino Airway

81 Anesthesia Delivery Systems

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83 Flagship Species - Flagship Species Iconic animals that provide a focus for raising awareness and stimulating action and funding for broader conservation efforts Extinction of any one of these species will profoundly change the inhabitants of this planet

84 Flagship Species

85 Why?

86 What Can I do to help?

87 What Can I do to help? One Health initiative Your Local Zoologic Society s Conservation programs World Wildlife Fund The IUCN Red List of Threatened Species