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Zoo and Wild Animal Anesthesia & Critical Care Medicine
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Disclosure
We have nothing to disclose
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Karen
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OR
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Challenges of Veterinary Anesthesia Uncooperative patients
Uncontrollable/ Difficult to control environment
Increased risk of regurgitation and aspiration despite adequate NPO time
Patient may be dangerous to care takers
Difficult airways, vascular access
Difficult to monitor at all points of the case
Unique biological requirements and physiology
Social behavioral issues
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Challenges of Veterinary Intensive Care
Lack of knowledge of Inter/intra species response to physiologic stress, medications
Difficult anatomy and anatomic differences from humans
Challenging physiologic obstacles Lack of technical support and resources Unavailability of suitable blood products Differences in ideology Social order and group issues
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Endangered
Cross River Gorilla<300
Giant Panda<1200
Sumatran Rhino <100
Northern White Rhino 4
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Species Groups
Bears Canines
Felines
Odd toed Ungulates
Even toed Ungulates
Marsupials
Primates
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I should have said no to dessert…
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Red Shanked Douc Langur (Pygathrix nemaeus
nemaeus)
- Old world - Leaf eating - Native to Vietnam and
Laos - Endangered
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Range Map Red Shanked Douc Langur (Pygathrix nemaeus nemaeus)
- Eastern Northern Viet Nam - Central Laos - Northern Cambodia
Number left in the wild: unknown, probably <700
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Folivors, feeding on young plants, fruits and seeds
Have fermenting multistage stomach,
Not ruminants Can get GI dysfunction
in captivity: TPN, ex-lap, fecal transplants
Red Shanked Douc Langur (Pygathrix nemaeus nemaeus)
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Red Shanked Douc Langur (Pygathrix nemaeus nemaeus)
- Folivors have complex sacculated stomachs w/ enlarged alkaline forestomach chamber to promote cellulitic bacterial growth - The bacteria dissolve cellulose and releases glucose and Volatile fatty acids for energy and glucose production - Bacteria also detoxify plant poisons - Bacteria then pass to 2nd stomach and get digested into protein
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Red Shanked Douc Langur (Pygathrix nemaeus nemaeus)
Concerns for Anesthesia
- Full stomach, no mask ventilation - Upright intubation, air sac - Gastric drainage can be harmful - Upright extubation - May need a cast to preserve IV access
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Cute Baby Gorilla gets delivered by C-section
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Western lowland gorilla (Gorilla gorilla gorilla)
Inhabitants of west Africa
Forest and lowland swamps
Most common gorilla found in zoos
Critically endangered
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Range Map Western lowland gorilla (Gorilla gorilla gorilla)
- Angola - Cameroon - Central African Republic - Republic of the Congo - Democratic Republic of the Congo - Equatorial Guinea - Gabon
Number Cross River Gorilla subspecies: <300 Number mountain Gorilla subspecies: 880
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Mom & Dad
Imani was born at 830g, SGA, preterm She was unable to be breastfed, and was near death before she was taken
from mom Hand raised and re-introduced to an elderly female for assimilation back into
the group Father is Winston, the groups silverback
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Western Lowland Gorilla (Gorilla gorilla gorilla)
-Breed w/ Silverback -Gestation is appx 9 months -Typical Labor 30 min-4hrs -Birth weight 1.5-2 kg -Baby carried (on their backs) by mother for first 2—3 years -Juveniles stay w/ family and participate in play
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Delivery and Resuscitation
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Intubation/Suction & Re-expansion
Right lung collapse
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Challenges
Uncontrolled Pre-op environment Need for GA for C/S Need to try and re-unite mother & infant Somewhat limited ICU setting Need to arrange nursing/RT care Somewhat limited access to equipment Media attention
Surrogate Nursing
Incubator Positioning
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Re-introduction: Meeting Mom
A baby will be nursed by the mother for first 2-3 years Human raised primate infants present significant logistical problems Human contaminated primates, will usually not be accepted by the group Re-introduction can be a complicated, risky and prolonged process
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Re-introduction: Mom gets to hold her baby girl
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Dr, I think I’m having a problem with my air sacs…
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Sumatran Orangutan (Pongo abelii)
One of 2 Organutan species
Forest / Tree dwellers
Omnivorous
Critically endangered
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Range Map Sumatran Orangutan (Pongo abelii)
Number left in the wild: 7,300
- Found only on the island of Sumatra, Indonesia
- Found only on the northern tip of the island
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Laryngeal Air Sacs
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Laryngeal Air Sacs
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Airway: Intubation
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Tube positioning
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Positioning
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Positioning
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Help me, I have a nose bleed
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Giant Panda (Ailuropoda melanoleuca)
Endemic to China
Unique in the order of carnivora, eats 99% bamboo
China’s national emblem
Logo for WWF
Endangered
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Giant Panda (Ailuropoda melanoleuca)
- The giant panda was once widespread throughout southern and eastern China, as well as neighboring Myanmar and northern Vietnam.
- Now restricted to around 20 isolated patches of bamboo forest in six mountain ranges in China's Sichuan, Shaanxi and Gansu provinces.
Number left in the wild: 1,864
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Induction and Transport
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Mask Anesthesia
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Intubation
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Vascular Access
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Challenges
Critically endangered Regurgitation risk No blood products Bamboo requirements Male ‘Shi Shi’ was
elderly and not interested in breeding
Hypertension during EEJ
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`
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I have a tummy ache
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Koala (Phascolarctos cinereus)
- Marsupial from continent of Australia - Completely arboreal - Eats Eucalyptus leaves Drinks very little - Slow, Sleeps >20h/day
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Koala (Phascolarctos cinereus)
Number left in the wild: 80,000
- Shot for fur and as a nuisance - Population decreased from millions to - Vulnerable to habitat destuction
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Anesthetic Issues with the Koala
- Koalas are hindgut fermenters and can get phytobezoars
- Dental issues - Infections
Difficult airway Large inscisors Short HMD Inferior larynx -Very slow metabolism -Low water intake and requirements -Slightly lower body temperature -Very sensitive to volatile anesthetics
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Koala Extubation
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Koala ICU/PACU Tree
- Most comfortable in trees - Become agitated when placed in any other position - Very sensitive to excess water
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Walking with a limp after having a baby
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Ugandan Giraffe (Giraffa camelopardalis rothschildi)
- Also called Rothschild , or Baringo - Have ossicones (ossified cartilage
covered w/ skin) not horns. - Tallest land mammal - Same number of cervical
vertebrae (7) as humans - Even toed ungulate - Only 2 species in Giraffidae family
Giraffe and okapi - Endangered
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Ugandan Giraffe (Giraffa camelopardalis rothschildi)
- Most rare of Giraffe species - Found only in Kenya and Uganda - Extinct in Sudan
Number left in the wild: <1500
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Left Ventricular Morphology of the Giraffe Heart
The Anatomical Record Volume 296, Issue 4, pages 611-621, 19 FEB 2013 DOI: 10.1002/ar.22672 http://onlinelibrary.wiley.com/doi/10.1002/ar.22672/full#ar22672-fig-0002
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Drinking Water…
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Ultrasound image showing the carotid artery (arrow) and the jugular vein (arrowhead) in the cranial part of the neck of an anesthetized giraffe suspended in the upright position (left) and
with the head lowered to heart level (right).
E. Brøndum et al. Am J Physiol Regul Integr Comp Physiol 2009;297:R1058-R1065
©2009 by American Physiological Society
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Giraffe Anesthesia: Intubation
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Giraffe Anesthesia: Ventilator
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Transport
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Giraffe Anesthesia
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Zuclopenthixol (Acuphase)
Antipsychotic drug of the thioxanthene class
Long lasting decanoate form has up to 3 weeks duration in humans
Acts as a mild sedative 1-2 days before surgery to decrease anxiety and allow entrance into the boma
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Giraffe Anesthesia: Challenges
- Many obstacles - Requires experienced team - Multiple anatomic features
Large Size/Shape Thick skin High blood pressure Difficult to position Dangerous to personnel Difficult to monitor Difficult to ventilate Ruminant> Risk of regurgitation Prone to MH like reaction Anxiety around caretakers
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BIG ETT
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Giraffe Anesthesia
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Giraffe Anesthesia: Emergence
- Critical point during anesthetic. - Give first chance your best chance - Make sure all anesthetic agents have Worn off - Reverse opioid, alpha-2 - Have adequate room to prevent injury to animal or staff - Control head with ropes. They can use It as a weapon
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I’m the last one….
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Sumatran Rhinoceros (Dicerorhinus sumatrensis)
- Most endangered Rhino Species
- Hairy Rhino
- Asian 2 horned Rhino
- Smallest Rhino Critically endangered
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Sumatran Rhinoceros (Dicerorhinus sumatrensis)
- Extinction is likely in the next 5 years
- Likley only left in Sumatra in the wild
- Last individual in
vietnam was poached
Number left in the wild: <100
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Dart Induction
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Intramuscular Dart
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Compressed Gas Dart
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Rhino Airway
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Anesthesia Delivery Systems
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Flagship Species
- Flagship Species – Iconic animals that provide a focus for raising awareness and stimulating action and funding for broader conservation efforts
Extinction of any one of these species will profoundly change the inhabitants of this planet
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Flagship Species
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Why?
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What Can I do to help?
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What Can I do to help? One Health initiative http://www.onehealthinitiative.com
Your Local Zoologic Society’s Conservation programs http://zoo.sandiegozoo.org
World Wildlife Fund http://wwf.panda.org
The IUCN Red List of Threatened Species http://www.iucnredlist.org