Zoo and Wild Animal Anesthesia & Critical Care Medicine

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Karen

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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

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

Endangered

Cross River Gorilla<300

Giant Panda<1200

Sumatran Rhino <100

Northern White Rhino 4

Species Groups

Bears Canines

Felines

Odd toed Ungulates

Even toed Ungulates

Marsupials

Primates

I should have said no to dessert…

Red Shanked Douc Langur (Pygathrix nemaeus

nemaeus)

- Old world - Leaf eating - Native to Vietnam and

Laos - Endangered

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

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)

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

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

Cute Baby Gorilla gets delivered by C-section

Western lowland gorilla (Gorilla gorilla gorilla)

Inhabitants of west Africa

Forest and lowland swamps

Most common gorilla found in zoos

Critically endangered

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

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

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

Delivery and Resuscitation

Intubation/Suction & Re-expansion

Right lung collapse

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

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

Re-introduction: Mom gets to hold her baby girl

Dr, I think I’m having a problem with my air sacs…

Sumatran Orangutan (Pongo abelii)

One of 2 Organutan species

Forest / Tree dwellers

Omnivorous

Critically endangered

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

Laryngeal Air Sacs

Laryngeal Air Sacs

Airway: Intubation

Tube positioning

Positioning

Positioning

Help me, I have a nose bleed

Giant Panda (Ailuropoda melanoleuca)

Endemic to China

Unique in the order of carnivora, eats 99% bamboo

China’s national emblem

Logo for WWF

Endangered

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

Induction and Transport

Mask Anesthesia

Intubation

Vascular Access

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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I have a tummy ache

Koala (Phascolarctos cinereus)

- Marsupial from continent of Australia - Completely arboreal - Eats Eucalyptus leaves Drinks very little - Slow, Sleeps >20h/day

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

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

Koala Extubation

Koala ICU/PACU Tree

- Most comfortable in trees - Become agitated when placed in any other position - Very sensitive to excess water

Walking with a limp after having a baby

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

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

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

Drinking Water…

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

Giraffe Anesthesia: Intubation

Giraffe Anesthesia: Ventilator

Transport

Giraffe Anesthesia

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

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

BIG ETT

Giraffe Anesthesia

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

I’m the last one….

Sumatran Rhinoceros (Dicerorhinus sumatrensis)

- Most endangered Rhino Species

- Hairy Rhino

- Asian 2 horned Rhino

- Smallest Rhino Critically endangered

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

Dart Induction

Intramuscular Dart

Compressed Gas Dart

Rhino Airway

Anesthesia Delivery Systems

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

Flagship Species

Why?

What Can I do to help?

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