Anesthesia and Surgery · restraint, induction 25 - 40 mg/kg IM surgery Lizards Lizards Lizards. Hematology blood smears - immediately following the sample-taking air-dried Pappenheim

Anesthesia and SurgeryAnesthesia and Surgeryuniv. prof. univ. prof. ZZdenek denek KnotekKnotek, DVM, PhD, DVM, PhD

University of Veterinary and Pharmaceutical Sciences Brno Czech Republic

Anesthesia Injection or inhalation anesthesia for reptiles?

Injectionoptimal site ?active metabolism (kidney, liver) !!!recovery (long-lasting) !!!antidote - regulation !!!BW influenceprice (drug, equipment)

Inhalantmetabolism +equipment !!!price ?technique (intubation in agressive - dangerous animals)

Sedation

big tranquillisers (chlorpromazine 10 mg/kg IM) small tranquillisers (diazepam 0.20 – 0.60 mg/kg IM)

tiletamine/zolazepam efficient

Tiletamine

2 (ethylamino)-2-(2thienyl)cyclohexanonphencyclidine derivat (50 % of the phenc. effect)

2 - 3x stronger than ketamine dissociative anaesthetics

Dissociative anesthetics

+ induce diminished tone and reduced impulse transmission

- without muscle relaxation

- have a limited capacity of inducing visceral analgesia

- are not appropriate for use as stand-alone anesthetic in larger and abdominal surgeries

Zolazepam

4 - (-o- Fluorophenyl)-6, 8-dihydro-1,3,8, - trimethyl-pyrazolo(3,4e)(1,4)diazepin-7(1H)-one)

benzodiazepin-family

Tiletamine - zolazepam

+ safetyanalgesia and myorelaxation free of side effects

- dependence on metabolismeliminated by liver + kidneys

Tilest, Telazol, Zoletil 1 : 1

- zolazepam Tiletamine

1 - 2 mg/kg IM Lloyd (2003)

4 - 8 mg/kg IMinduction

Fleming (2001)

5 mg/kg IM immobilization

Haagner and Reynolds (1992)

Crocodiles

Crocodiles

Crocodiles

Crocodiles5 - 10 mg/kg IM sedative

10 – 40 mg/kg IM surgery Lloyd (1999)

- zolazepam Tiletamine

1 - 2 mg/kg IM Lloyd (2003)

4 - 8 mg/kg IMinduction

Fleming (2001)

5 mg/kg IM immobilization

Haagner and Reynolds (1992)

Crocodiles

Crocodiles

Crocodiles

Crocodiles 2 - 8 mg/kg IMinduction

Crocodiles5 - 10 mg/kg IM sedative

10 – 40 mg/kg IM surgeryLloyd (1999)

Raphael (2003)5 - 10 mg/kg IMgood muscle relaxation

Chelonians

- zolazepam Tiletamine

3 - 14 mg/kg IM not enough

Schobert (1987)

10 - 30 mg/kg IMgood muscle relaxation

Frye (1991)

4 - 88 mg/kg IM not enough for surgery

3 - 5 mg/kg IMinduction

45 mg/kg IM intubation 90 mg/kg IM minor surgery

Boever and Caputo (1982)

Heard (2001)

Chelonians

Chelonians

Chelonians

Chelonians

Chelonians Apelt (1993)

Raphael (2003)5 - 10 mg/kg IMgood muscle relaxation

Chelonians

- zolazepam Tiletamine

3 - 14 mg/kg IM not enough

Schobert (1987)

10 - 30 mg/kg IMgood muscle relaxation

Frye (1991)

4 - 88 mg/kg IM not enough for surgery

3 - 5 mg/kg IMinduction

45 mg/kg IM intubation 90 mg/kg IM minor surgery

Boever and Caputo (1982)

30 - 50 mg/kg IMrestraint, intubation

Heard (2001)

Chelonians

Chelonians

Chelonians

Chelonians

Chelonians

Chelonians

Apelt (1993)

60 - 90 mg/kg IMRisk – kidneys/liver

Mitchell (2003)3 - 5 mg/kg IMminor surgery

Snakes

- zolazepam Tiletamine

25 mg/kg IMrapid and safe sedation Stirl (1997)

15 mg/kg IM Schobert (1997)

15 - 29 mg/kg IM minor surgery

3 - 5 mg/kg IMinduction

Gray et al. (1974)

Heard (2001)

Snakes

Snakes

Snakes

Snakes

Mitchell (2003)3 - 5 mg/kg IMminor surgery

Snakes

- zolazepam Tiletamine

25 mg/kg IMrapid and safe sedation Stirl (1997)

15 mg/kg IM Schobert (1997)

15 - 29 mg/kg IM minor surgery

3 - 5 mg/kg IMinduction

5 - 10 mg/kg IM immobilization

Gray et al. (1974)

15 - 30 mg/kg IMminor surgery

Heard (2001)

Snakes

Snakes

Snakes

Snakes

Snakes

Snakes

Heard (2001)4 - 8 mg/kg IM handling

Lizards

- zolazepam Tiletamine

4 - 6 mg/kg IM immobilization

Schumacher (2003)

Lizards

Heard (2001)4 - 8 mg/kg IM handling

Lizards

- zolazepam Tiletamine

4 - 6 mg/kg IM immobilization

Schumacher (2003)

10 - 15 mg/kg IMrestraint, induction

25 - 40 mg/kg IMsurgery

Lizards

Lizards

Lizards

Hematology

blood smears - immediately following the sample-taking

air-dried

Pappenheim method (May-Grünwald, Giemsa/Romanowski)

RBC, WBC manually using haemocytometer Natt and Herrick’s solution

PCV microhematocrit methodHb cyanmethemoglobin method

Plasma chemistry

TP CobasMira analyzer (Roche)ALPALTASTGlucoseTAGUric acidCholesterolP Ca Atomspec analyzer (Hilger 1550)

Na-heparinplasma separation - immediately following the sample-taking

Plasma biochemistry – green iguana

Tiletamine-zolazepamn = 35

activen = 40

n.s.5.7 – 6.66.0 – 6.9mmol/lCholesterol

n.s.1.8 – 2.41.6 – 2.5mmol/lPhosphorus

n.s.2.0 – 2.42.1 – 2.5mmol/lCalcium

n.s.0.27 – 0.590.26 – 0.80μkat/lALP

n.s.3.12 – 5.352.80 – 6.13mmol/lTAG

n.s.9.4 – 10.88.1 – 11.0mmol/lGlucose

n.s.51.1 – 65.049.1 – 55.8g/lTP

CommentsIguanas

UnitsVariable

Indications for tiletamine-zolazepam anaesthesia in reptiles

safe handling and transportation of aggressive lizards

sedation and immobilization during some examinations (radiography, MRI, endoscopy, USG, biopsy)

preparing intubation before inhalation anaesthesia (crocodiles, chelonians

aggressive lizards, poisonous snakes)

CommentDosageCombination

anesthesia immobilisation / Chemical

2 - 8 mg/kg IM crocodiles

TILETAMINE 15 - 30 mg/kg IM snakes

+ 15 - 20 mg/kg IM

15 -20 mg/kg IM

60 - 90 mg/kg IM

lizards

tortoises-restraint

tortoises-anesthesia

ZOLAZEPAM

Propofol

short-lasting effect (20 minutes)

IV

chelonias 5 mg/kgsnakes 10 mg/kglizards 5 (10) mg/kg

Isoflurane

0.3% of the substance is metabolised in the body

fast onset of deep surgical anaesthesiafast recovery - free of complicationsexcellent myorelaxation in patients with renal or hepatic damagedoes not irritate the myocardium

Isofluraneonly 0.3% is metabolised in the body

fast onset of deep surgical anaesthesia

fast recovery - free of complications

excellent myorelaxation

in patients with renal or hepatic damage

does not irritate the myocardium

Premed. Form Induction SurgeryLizards< 1 kg - mask 5% 1,5 - 2,5%> 1 kg + intubation 4 - 5% 1,5 - 2,5%

Snakes +/- intubation 5% 1,5 - 2%Turtles + int./mask 5% 3 – 4 %Crocodiles + intubation 4% 1 – 2 %

Isoflurane

Crocodiles

Trachea closed with the valve

CrocodilesIntroduction tiletamine/zolazepam

Surgery isoflurane

Turtles, tortoises, terrapins

Glottis base of the tongue

Turtles, tortoises, terrapins

Introduction tiletamine/zolazepam

Surgery isoflurane

Glottis opens in the floor of the mouth cavity

Direct intubation easyMask not feasible method!

Snakes

Snakes

Introduction tiletamine/zolazepam

Surgery isoflurane

Lizards

Introduction tiletamine/zolazepam

Surgery isoflurane

Patient monitoring and control - chelonians

reflexeshead, neck, and leg/tail reflex jaw tone - turtles and terrapins

skin sensitivity - disappear in deep palpebral reflex - anaesthesia

righting reflex - fast correction of position

Patient monitoring and control - chelonians

reflexeshead, neck, and leg/tail reflex jaw tone - turtles and terrapins

skin sensitivity - disappear in deep palpebral reflex - anaesthesia

righting reflex - fast correction of position

Patient monitoring and control - chelonians

reflexeshead, neck, and leg/tail reflex jaw tone - turtles and terrapins

skin sensitivity - disappear in deep palpebral reflex - anaesthesia

pulse oximetry

Patient monitoring and control - snakes

reflexeshead, neck, and frontal body lifting reflex righting reflex - fast correction of position skin sensitivity - disappears in deep

anaesthesia

pulse oximetry

Patient monitoring and control - lizards

reflexeshead, neck, and frontal body lifting reflex skin sensitivity - disappears in deep

anaesthesia

pulse oximetry

Patient monitoring and control

temperature

blood pressure

SpO2

heart frequence

ventilation

TCO2

Patient monitoring and control

temperatureblood pressure

SpO2

heart frequenceventilation

TCO2

Patient monitoring and control

temperatureblood pressure

SpO2

heart frequenceventilation

TCO2

Reptilian Surgery

Soft tissue surgerylaparotomy - crocodile

Orthopaedic surgeryfractures - lizard legs

- turtle shell

Reproductive surgery OHE - boid snakecoeliotomy- turtle

REPTILIAN SURGERY

Crocodylus niloticus

History

Clinical examination

Blood profile

REPTILIAN SURGERY

Crocodylus niloticus

laparotomy

REPTILIAN SURGERY

Crocodylus niloticus

laparotomy

Turtles and Tortoises

REPRODUCTIVE DISORDERSREPRODUCTIVE DISORDERS

EGG RETENTIONEGG RETENTION

THERAPY

- mineral saturation- cloacal stimulation - hormonal treatment

COELIOTOMYCOELIOTOMY

COELIOTOMY – EGG RETENTIONCOELIOTOMY – EGG RETENTION

COELIOTOMY – EGG RETENTIONCOELIOTOMY – EGG RETENTION

COELIOTOMY - OHECOELIOTOMY - OHE

COELIOTOMY - OHECOELIOTOMY - OHE

COELIOTOMYCOELIOTOMY

after 3 – 4 months

SHELL FRACTURESHELL FRACTURE

SHELL FRACTURESHELL FRACTURE

SHELL FRACTURESHELL FRACTURE

SHELL FRACTURESHELL FRACTURE

SHELL FRACTURESHELL FRACTURE

FOREIGN BODIESFOREIGN BODIES

Traumatic lesions

Iguana iguanainsufficient nutrition poor husbandry

chronic metabolic problems secondary hyperparathyroidism

renal disease POFS POOS pre-ovulatory follicle stasis post-ovulatory egg stasis

REPTILIAN SURGERY

Iguana iguana

POFSpre-ovulatory follicle stasis

POOS post-ovulatory egg stasis

Symptoms limited movement, general weakness, lethargy, anorexiacolon constipation

Laboratory TP, Ca, P, uric acid, ALT, AST

REPTILIAN SURGERY

  Iguanas - POFS + POOS Healthy iguanasKnotek et al.

(2003)Knotek et al. (1999)

TP g/l 38,2 - 72,2 22,0 – 78,2

Gluco mmol/l

6,24 - 24,6 8,3 – 16,5

Uricacid

µmol/l

61,35 - 815,6 70,2 – 145,3

ALT µkat/l 0,48 - 4,54 0,1 – 1,2AST µkat/l 0,77 - 17,78 0,1 – 1,6ALP µkat/l 0,0 - 0,3 0,7 – 4,9

Ca mmol/l

2,06 - 7,14 2,2 – 3,5

P mmol/l

1,61 - 11,9 1,4 – 3,1

POOS x POFS ??????

gentle palpation, X-ray - USG, plasma biochemistry

POOS x POFS ??????

gentle palpation, X-ray - USG, plasma biochemistry

Ovarian follicles

spherical shapelocated proximaly

POOS x POFS ??????

gentle palpation, X-ray - USG, plasma biochemistry

Ovarian follicles

spherical shapelocated proximaly

POOS x POFS ??????

gentle palpation, X-ray - USG, plasma biochemistry

Oviductal eggs

oblong shapelocated caudaly

Anesthesia

Introduction± (tiletamin-zolazepam, 10mg/kg bw IM)± (propofol, 10mg/kg bw IV)

Direct intubation isoflurane 5 % 1 - 2 %

Monitoring - pulse-oxymeter (cloaca)Doppler device (taped over the chest)

POFSiguana is positioned in dorsal recumbency ventral midline incision fat bodies exteorisedyellow-orange follicles gently manipulated out

vessels ligated (suture or vascular clips)

POFS

POFS

POOS salpingotomy

ligation

POOS salpingectomy

ligation

POOS salpingotomy x salpingectomy

+ ovariectomy

Care

• Sterile box• Optimal temperature - 25 - 30 °C• ATB• Suture control (povidon iodine ung.)• Energy, nutrition, fluids• Patient control - after 4 - 6 weeks (suture)

LIZARDS – agamid lizards, chamaeleons

FRACTURE

FRACTURE + ?

FRACTURE + ?

FRACTURE

FRACTURE

FRACTURE

External fixation

FRACTURE

Boa constrictorinsufficient nutrition poor husbandry

dystocia, foetal mortality

stress drugs (side effects)

REPTILIAN SURGERY

REPTILIAN SURGERY

Boa constrictor

salpingotomysalpingectomyovario-hysterectomy (OHE)

HistoryClinical examinationBlood profile

REPTILIAN SURGERY

Boa constrictor

Incision

second lateral line

REPTILIAN SURGERYOviductgently manipulatedout of the incision site ...

REPTILIAN SURGERYOviductto reveal vascular supply

REPTILIAN SURGERYOviduct

vessels ligated

oviduct ligated