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