Captive Giraffe Surgical Anesthesia

Calgary Zoo Vet Student Extern PresentationEmily Hall

Objectives• Unique anatomy

and physiology• Considerations

before you start• Drug options• Monitoring and

maintaining• Reversal and

concerns

Unique Anatomy and Physiology

• 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

Blood pressure ↓ SV

↓ CO

↑ BP

↓ compliance

↑ compliance

↓ BV↑ BP↓↓BP

Considerations before you start

• Improper substrate • Blood volume is

unusually low fluid overload

• Hyperthermia• Myopathy• Secondary trauma• Hypothermia• DON’T FORGET TO

FAST!!!

Pick the drugsSo lets get to it!!!

• 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

DrugsWith good analgesia

• 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

Opioid Concerns

Your Giraffe is in the chute, everything is ready, everyone knows their jobs…

Step by Step, here we go…

Initial sedationXylazine IM70-100 mg/adult30-40 mg/ yearlingAtropine IM1.0-8.0 mg/adult2.0-3.0 mg/ yearling

0:00

• Stargazing• Slight ataxia• Tongue protrusion• Slight salivating

Signs of sedationManipulation at this time is contraindicated

0:05

Time for narcotizing doseEtorphine IM1.5-2.5 mg/adult0.5-1.25 mg/yearling

0:15

Recumbent or nor recumbent, that is the ????

0:30

• Supplement Etorphine (0.5- 1.0 mg IM or IV)• Cast it• 5% guafenesin solution

IV to effect• Ketamine (100-400mg) IV

Hooray it’s down…

now what?!

Endotracheal tube>15min procedure

40-60cm laryngoscope bladeET tube 24-30mm internal diameter

“Bush technique”

Digitally palpate & manually placeFiberoptic endoscope stylet

Standard proceduresNeck extendedHead above rumenNose downBlindfolded & earplugsAngle neck support

VenipunctureArterial blood gas site

and invasive blood pressure monitoringCatheterPulse oximetryEnd-Tidal CO2Noninvasive blood

pressureELECTROCARDIOGRAPHYTEMPERATURE!!!

• 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

Time to reverse

• 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 position

Reversal procedures

• Give enough space for the rocking to standing• Reversal to standing 10-

20min• Beware resedation!!!

Possible Concerns

Works Cited• 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.

• West, Gary, Darryl J. Heard, and Nigel Caulkett. "Giraffe/Mammal Anesthesia." Zoo Animal and Wildlife Immobilization and Anesthesia. 2nd ed. Ames, IA: Blackwell Pub., 2014. 809-20. Print.

In loving memory of

Neema

Special thanks to Dr. Lauren Howard for generously providing a plethora of information.

Questions?

Thank you all for an amazing month!!!