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14.09.2008
ANAESTHESIA IN CAMELIDS
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
EAZWV Summer School 2008
Know your animal species!
•  Order Artiodactylids
•  Suborder Tylopoda
Anaesthesia in Camelids as an
example of how to avoid
problems
•  Family Camelidae (Camelids)
–  Genus Camelus (Old World Camelids)
•  2 species, one domesticated form
•  Camel or Bactrian Camel
•  Dromedary
–  Genus Lama (New World Camelids)
Dr. Christine E. Lendl, Tierärztliche Klinik, Gessertshausen
•  2 species, 2 domesticated forms
•  Vicugna
•  Guanaco, Lama, Alpaca
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Know your species` biology and physiology
Copyright 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Know your species` biology and physiology
•  adapted to rough climate
•  feeding on poor grounds
•  body temperature changes between 36,5 – 42°C
•  domestication since 5000 to 7000 years
•  tolerate 25% loss of body weight due to
exsiccation
•  „Tylopoda“:
– 2 toenails with sole pad
– distal and medial phalanx of the 3rd and 4th digit are
weightbearing
– no rudimentary other digits
•  forearm fused
•  elliptic erythrocytes,
may increase volume up to 240%
•  urine can be concentrated very much
•  very dry faeces
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Old world camelids
Know your species` biology and physiology
•  upper lip with cleft
old world camelides: nares can be closed
•  typical humps
•  no skin fold at the knee
•  humps are energy reservoir!
•  development of proventriculi and chewing the cud
(regurgitation) parallel to true ruminants
•  males:
– „Dulaa“ = excavation of palate
– scent gland in neck
•  3-compartment-stomach: C1, C2, C3
•  regurgitate for defense
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14.09.2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
New world camelids
Identify your enemy: camels` teeth
•  Tylopods of Southern America
•  susceptible to heat
•  hypsodont (with high crowns) buccal teeth
•  thin, long legged, no humps
•  upper incisor shaped like canine tooth!
•  long neck
•  lower jaw with sharp incisors
•  scent glands on Mt
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EAZWV Summer School 2008
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Teeth of old world camelids
Teeth of new world camelids
•  I 1/3 – C 1/1 – P 3/2 – M3/3
•  I 1/3 – C 1/1 – P 1-2/1-2 – M3/3
•  upper I and P1 as well as lower P1 are like canine teeth!!!
•  upper I is shaped like canine tooth!!!!
•  mouth can be widely opened!
•  very narrow mouth
•  Llama: big canine teeth
CARE!!!
•  for your fingers
•  CARE!
•  for et-tube
•  Difficult to intubate
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Handling and restraint of camelids:
cause or reduce pre-OP stress
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Handling and restraint of camelids
•  halter of advantage
•  depending on training
•  mood shown by ear and tail movements
 ears down, tail up
•  cover head with sheat
•  regurgitation and spitting, biting (hold tight!!), kick
in every direction!
•  NWC: hold around neck and flank region
•  camels will step on people
•  never walk them alone !
•  twist ears
„à genou“
•  Chukker
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14.09.2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Pre-anaesthetic management
Indications for sedation and general
anaesthesia of camelids
•  better diagnostics
– blood samples, x-ray
– skin tests (biopsy)
– dental work up
Off food
Off water
Camels
36 h
10 – 12 h
Lamoids
12 – 18 h
8 – 12 h
•  surgery
– wounds, abscesses,
fractures
– dental correction
– castration
• around 25% regurgitate despite fasting
• do not starve crias
• ideal: sternal recumbency
• preferrably right lateral recumbency
• allow regurgitation
• positioning of the head
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Pre-anaesthetic management
Pre-anaesthetic management
•  weigh the animal, very difficult to estimate!!!
– unusual body shape
– plenty of hairs
•  thorough clinical examination
•  definitely weigh crias!!!!
•  if you are in doubt: hematology, serum chemistry
•  Llama
•  weight loss  hepatolipidosis
 anaesthetic problem
♂
125 – 160 (- 180) kg
100 – 150 (- 180) kg
♂
55 – 80 kg
45 – 70 kg
♀
•  Alpaca
♀
•  body condition (faeces sample)
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Administraion of drugs
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Euipment for anaesthesia in camelids
•  canulas, i.v.lines
•  infusion pump
•  syringes 1 – 20 ml
•  et tubes, stilett, laryngoscope
•  by hand, with pole syringe
•  alcohol (swabs)
•  syringe for cuff, bandage
•  blow pipe, gun
•  infusion sets
•  anaesthetic machine
•  s.c.: difficult, very tight
•  towel, head cover
•  bedding
•  tape
•  gastric tubes
•  i.m.: triceps muscle
•  scissors
•  i.v.: needs experience
–  jugular vein: difficult esp. in stallions, anatomical problems
–  saphenic vein
–  tail vein in old world camelids
DR. CHRISTINE LENDL
•  eye ointment
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Fluid therapy
Monitoring
•  heart and pulse rate:
–  palpation, auscultation
•  electrolyte solutions, ringer`s, hartmann`s
•  respiratory rate:
•  sodium bicarbonat (salivation)
–  counting
•  others according to demand
•  muscle relaxation:
jaw, legs
•  infusion rate 5 - 10 ml/kg/h
•  palpebral refelex
•  body temperature
•  ECG, pulsoximetry, capnographie
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EAZWV Summer School 2008
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedatives in Camelides
Anticholinergic premedication
•  tranquillizers/sedatives
– Phenothiazins, Butyrophenons, Benzodiazepines,
α2-Adrenergics
•  dissociative anaesthetics
– Ketamin, Tiletamin
•  reason: reduces…
–  risc of aspiration
–  ketamine induced secretion
–  likelihood of arrhythmias at intubation
•  side effect: mydriasis
•  atropine 0,02 – 0,04 mg/kg i.v. or i.m.
•  barbiturates
•  glycopyrrolate 2 – 5 – 10 µg/kg i.v. or i.m.
•  opioides
– Butorphanol, Carfentanil, Etorphin
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EAZWV Summer School 2008
Sedation of camelids
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedation of camelids: acepromacine
•  for diagnostics or minor surgery together with locals
•  before general anaesthesia
•  minor sedation
•  literature: 0,03 – 0,15 mg/kg i.v. or i.m.
•  together with ketamine or etorphine (Immobilon™ LA)
•  to calm aggresive camels
•  side effect: hypotension
•  not in patients at risk or hypovolaemia
•  alpaca: 2,5 mg ACP + 5 mg butorphanol i.m.
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14.09.2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedation of camelids: benzodiazepines
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedation of camelids: α2-Adrenergics
•  On ist own: ataxias, no good sedation
•  xylazine, detomidine, medetomidine, romifidine
•  Antikonvulsive
•  most common sedatives
•  0,1 – 0,5 mg/kg, rather i.v.
•  together with ketamine (2 – 5 mg/kg)
•  alone or in numerous combinations with dissociative
anaesthetics or opioids
•  slow metabolism in liver
•  sedative, analgetic, muscle relaxation
•  duration of effect 60 – 90min
•  effect dose dependent
•  antagonist: flumazenil
•  antagonists
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EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedation of camelids: xylazine
•  typical effects as well as side effects
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Sedation of camelids: xylazine
•  llama „standing sedation“ (for 1 h)
0,1 mg/kg i.v. or 0,2 mg/kg i.m.
•  alpacas less susceptible than lamas
•  llama „sedation with recovery“
0,2-0,3mg/kg i.v. oder 0,2-0,4 mg/kg i.m.
•  routine sedation 0,1–0,25 mg/kg i.v.
(0,35-0,45 mg/kg i.m.)
•  onset of effect 3-5 min after i.v., 10-15 min after i.m.
•  analgesia lasts 15-30 min, sedation 1-2 h!!!
•  alpacas: + 10 – 15 %
•  NWC 0,1-0,2 mg/kg xylazine + 0,02-0,1 butorphanol i.v.
•  Side effect:
optimal effect only if undisturbed
induction
no dange of abortion (as in bovine)
DR. CHRISTINE LENDL
•  adult OWC: 0,1 mg/kg xylazine + 0,2 mg/kg ketamine
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EAZWV Summer School 2008
Sedation of camelids: Detomidine
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Sedation of camelids: Medetomidine
•  more potent and longer lasting than xylazine
•  alone 40 – 80µg/kg i.v. or i.m.
•  typical effects and side effects
•  most common withaketamine
•  20 – 40 (-80) µg/kg i.v. or i.m.
•  llamas:
–  10 µg/kg i.m.  standing sedation for 35 min.
–  20 µg/kg i.m.  recumbency after 10-15 min, duration 60 min
–  30 µg/kg i.m.  recumbency after 10-15 min, may last 2 h
•  quickly into recumbency
•  antagonists: atipamezol, yohimbin
•  antagonist: atipamezol
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14.09.2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Injectable anaesthesia in camelids
•  numerous combinations
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Injectable anaesthetics in OWC
•  xylazine 0,25 – 0,4 mg/kg + ketamine 2 – 5 mg/kg
•  combinations make it more difficult to judge depth
•  Hellabrunn Mixture 1 – 2,5 ml/animal
•  i.v. top ups
•  increased risk of aspiration
•  etorphin 2 – 4 mg per animal + xylazin 0,2 – 0,5 mg/kg
•  proper positioning!
•  Immobilon LA™ 1,8 ml + Xylazin 30 - 50 mg per animal
•  reversal Diprenorphine, Revivon ™
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EAZWV Summer School 2008
Injectable anaesthetics in NWC
•  α2-Adrenergics + ketamine
– ketamine burns i.m., good analgesia, goes to placenta
– Xylazin 0,25mg/kg + Ketamin 2 - 5mg/kg i.v.
(minor surgery)
– medetomidine 40 - 50 µg/kg + ketamine 1 - 2 mg/kg i.m.
(minor surgery, induction of GA)
– alpaca, vicugna: HBM 0,2 – 0,5 ml i.m.
llama, guanaco: HBM 1 – 1,5 ml i.m.
DR. CHRISTINE LENDL
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Injectable anaesthetics in NWC
•  α2-adrenergics + ketamine +/- Butorphanol
– xylazine 2% + ketamine 10%ig mixed at 1:1 ratio
i.e. 10 mg/ml xylazine + 50 mg/ml ketamine
from this mixture 1 ml/50 kg i.v.
– 1 ml xylazine 10% + 10 ml ketamine 10% + 1 ml
butorphanol 1%, i.e. 8,3 mg/ml xylazine + 83 mg/ml
ketamine + 0,83 mg/ml butorphanol;
from this mixture 1 ml/20 kg llama i.m.
– (Jane Vaughan, 2004)
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EAZWV Summer School 2008
Inhalationanaesthesia in camelids
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Inhalation anaesthesia - induction
•  i.v. – catheter!
•  get prepared
•  „every“ injectable combination
•  wash mouth cavity
•  ketamine might complicate intubation
•  regurgitation!!! (reflux after attempt oft intubation)
•  llama:
– sedation
– 120 – 180 ml GGE 10% i.v.
– ketamine 3,5 mg/kg i.v.
– intubation
•  positioning (dorsal recumbency only after intubation)
•  endotracheal intubation
(recommended in GA)
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Inhalation anaesthesia - maintenance
•  adequate anaesthetic machine
Local anaesthesia
•  infiltration - indication
–  for tx of abscesses, wounds
–  Thoracocentesis, abdominocentesis, laparoscopy
–  castration
•  non-rebreathing system in Crias
•  circle system: right size of tubes, bagsetc.
•  breathing: spontaneous, assisted,controlled
•  regional nerve blocks?
•  carrier gas: oxygen, oxygen-air-mixture
•  procain, lidocain, bupivacaine, mepivacaine
•  Inhalant:
•  lidocaine w/o adrenaline, > 4,5 mg/kg toxic!!!
–  halothane
–  isoflurane
–  sevo- or desfluran
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EAZWV Summer School 2008
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EAZWV Summer School 2008
Epidural anaesthesia
Epidural anaesthesia
•  indications:
•  L7 – Os sacrum to collect liquor
–  perineal surgery
–  vaginal or rectal prolaps
–  rectal exams
•  median 90° or slightly pointed cranially
•  surgical preparation
•  identify S5 – C1
•  canula 20G, in a 130 kg animal approx. 2 cm down
•  1 -2 ml lidocaine 2% or xylazine
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EAZWV Summer School 2008
Analgesics in camelids: NSAID
•  add cimetidin (2 mg/kg) to prevent ulcers
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ANAESTHESIA IN CAMELIDS
EAZWV Summer School 2008
Analgesics in camelids: NSAID
•  aspirine
–  for musculo-sceletal plane
–  cheap
–  5 -100 mg/kg twice daily
•  flunixine-meglumin
–  Musculo-skeletal and abdominal pain
–  Lama:1,1 mg/kg i.v. 1 x daily
•  metamizole/dyperone
•  phenylbutazon
–  abdominal pain, colic
–  gastric ulcers
–  max. 50mg/kg 2 x tgl.
–  esp. in musculo-skeletal pain
–  2 – 4 mg/ kg 1x daily
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