14.09.2008 Anaesthesia in Camelids as an example of how to avoid problems
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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 2 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 3 4 Copyright 2008 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 DR. CHRISTINE LENDL Copyright 2008 DR. CHRISTINE LENDL 5 Copyright 2008 6 Copyright 2008 1 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 7 8 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Copyright 2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 9 10 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Handling and restraint of camelids: cause or reduce pre-OP stress Copyright 2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 11 Copyright 2008 12 Copyright 2008 2 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 13 14 Copyright 2008 Copyright 2008 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) DR. CHRISTINE LENDL DR. CHRISTINE LENDL 15 16 Copyright 2008 Copyright 2008 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 DR. CHRISTINE LENDL 17 Copyright 2008 18 Copyright 2008 3 14.09.2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 19 20 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Copyright 2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 21 22 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Sedation of camelids Copyright 2008 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. DR. CHRISTINE LENDL DR. CHRISTINE LENDL 23 Copyright 2008 24 Copyright 2008 4 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 25 26 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Sedation of camelids: xylazine • typical effects as well as side effects Copyright 2008 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 DR. CHRISTINE LENDL 27 28 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Sedation of camelids: Detomidine Copyright 2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 29 Copyright 2008 30 Copyright 2008 5 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 ™ DR. CHRISTINE LENDL DR. CHRISTINE LENDL 31 32 Copyright 2008 ANAESTHESIA IN CAMELIDS 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 Copyright 2008 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) DR. CHRISTINE LENDL 33 34 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Inhalationanaesthesia in camelids Copyright 2008 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) DR. CHRISTINE LENDL DR. CHRISTINE LENDL 35 Copyright 2008 36 Copyright 2008 6 14.09.2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 37 38 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Copyright 2008 ANAESTHESIA IN CAMELIDS 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 39 40 Copyright 2008 ANAESTHESIA IN CAMELIDS EAZWV Summer School 2008 Analgesics in camelids: NSAID • add cimetidin (2 mg/kg) to prevent ulcers Copyright 2008 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 DR. CHRISTINE LENDL DR. CHRISTINE LENDL 41 Copyright 2008 42 Copyright 2008 7
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