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How to
anaesthetize a bird
Joanna Hedley, Clinician in
Rabbit, Exotic Animal and Wildlife
Medicine at the Royal (Dick)
School of Veterinary Studies, talks
us through avian anaesthesia
Figure 1:
Subcutaneous fluids
may be easily
administered in the
inguinal region
A
naesthesia of birds has often been viewed
as a high-risk procedure, to be avoided if
possible. Birds have minimal functional
residual capacity, so even a brief period of
apnoea may rapidly lead to hypoxia and cardiac
arrest. Having a higher metabolic rate than mammals
of a similar size also leads to rapid drug metabolism,
heat loss and, potentially, hypoglycaemia. However,
by understanding the relevant differences between
birds and mammals, it should be possible to minimize
these risks and provide the same standard of
anaesthetic care for birds as for our traditional
companion animal patients.
Preparing your patient for general
anaesthesia
Most birds undergo general anaesthesia for
investigations or treatment of underlying disease. Birds
have adapted to hide signs of disease; this means that
they may often have been sick for some time, but just
present to the veterinary surgeon once the disease is
advanced and the problem can no longer be hidden. It
is therefore important to perform at least a basic
clinical examination and stabilize the avian patient
before proceeding to general anaesthesia.
A full clinical examination may require sedation
or anaesthesia, especially in the stressed patient,
and handling should be limited in these cases.
Stress can result in the release of catecholamines,
causing hypertension, reduced renal perfusion and
even predisposition to cardiac arrhythmias and
sudden death. This is unlikely in a well socialized
parrot or raptor, but is a higher risk in small birds
less accustomed to handling, such as canaries or
finches. Observations from a distance are generally
more useful than a prolonged physical examination
in these cases.
After initial assessment, the avian patient should be
stabilized in a warm (2530C), quiet enclosure, ideally
away from the sights and sounds of predator species
such as cats and dogs. Hydration deficits should be
corrected, although assessment of hydration status
can be difficult in the avian patient. Severely
dehydrated patients may have skin turgor and sunken
eyes, but any bird which has undergone a period of
anorexia should be assumed to be 510% dehydrated
even if this is not obvious on clinical examination.
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Drug Dose Route of
administraton
Meloxicam 0.20.5 mg/kg q24h
or half dose q12h
s.c., i.m., orally
Lidocaine <2 mg/kg Applied to
afected area
Bupivacaine <2 mg/kg Applied to
afected area
Butorphanol 12 mg/kg q24h i.m.
Table 1: Examples of analgesic agents used in birds Figure 2: Birds should be held firmly in a towel for mask induction to prevent struggling
Maintenance fluid requirements for most birds are
estimated to be 50 ml/kg/day, although smaller birds
such as passerines, with a higher metabolic rate, may
require volumes up to 100 ml/kg/day.
Fluid therapy may be provided in a variety of ways
but oral and subcutaneous routes are preferred for the
initial management of most cases. Oral fluids may be
administered into the crop or proventriculus at 1020
ml/kg. Subcutaneous fluids may be administered into
the inguinal fold (Figure 1). Subcutaneous space is
limited but warming the fluids to approximately 30C
and the addition of hyaluronidase (1500 IU/l) should
increase fluid absorption. Intravenous or intraosseous
routes should be considered for more critical patients,
but cannulas are generally placed under sedation or
anaesthesia unless the patient is collapsed. In
addition to restoring hydration status, nutritional
support should also be provided. This may be in the
form of the birds normal diet or via tube feeding a
commercial recovery formula.
Once the patient is stabilized, pre-anaesthetic
fasting is recommended to reduce the risks of
regurgitation and aspiration. Parrots will generally need
to be fasted for 24 hours until their crop is empty.
Raptors may need to be fasted up to 12 hours until
they have cast up the undigestible parts of their last
feed. Birds smaller than 100 g are at much higher risk
of hypoglycaemia due to their rapid metabolic rate and
so should only be fasted for less than 30 minutes or in
the case of very small patients not at all.
Analgesia should always be provided for any bird
with a potentially painful condition, ideally before the
painful stimulus (Table 1). Signs of pain can be difficult
to detect so evaluation of analgesics can be difficult.
NSAIDs appear effective but should be avoided in
dehydrated patients or those with renal compromise.
Opioids may also be used, but birds appear to have
more kappa than mu opioid receptors, so butorphanol
is thought to be a more effective analgesic than mu
opioid agonists. Local anaesthesia should be
considered for surgical procedures, although care
should be taken to avoid exceeding the toxic threshold
in smaller patients.
Induction of anaesthesia
Induction of general anaesthesia is usually performed
by administration of volatile agents such as isoflurane
or sevoflurane via a mask. The patient should be firmly
restrained during this process (Figure 2) to prevent
accidental self-trauma, which has been known to
occur during chamber induction. Masks may need to
be adapted for particularly small patients or those with
a long beak, or created from bottles or syringe cases.
Premedication with midazolam (0.51 mg/kg i.m.),
butorphanol (12 mg/kg i.m.) or a combination of
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How to anaesthetize a bird
Figure 3: Induction via the medial metatarsal vein may be easily performed in swans
Figure 4: Intubation may be performed in small birds using an intravenous catheter
these has been advocated in recent years to
reduce both stress at induction and the anaesthetic
gas concentration required for maintenance.
Disadvantages include the stress of increased
handling to premedicate the bird and the potential for
a longer recovery, so premedication will not be
appropriate in every case but should definitely
be considered.
Some birds, such as waterfowl, have developed a
considerable capacity for breath-holding and will
almost always require premedication or injectable
induction agents for a smooth induction. An
intravenous catheter may be placed in the medial
metatarsal vein for administration of the induction
agent (Figure 3). Various protocols may be used,
including induction with alpha-2 agonist/ketamine
combinations, alfaxalone or propofol.
How to maintain anaesthesia
For a short procedure, such as blood sampling,
intubation may not be necessary but in most cases
once a suitable plane of anaesthesia is achieved,
intubation should be performed (Figure 4). Birds have
no epiglottis so the glottis is easily visualized by pulling
the tongue forwards with atraumatic forceps. The avian
trachea has complete cartilaginous rings and the
mucosa is easily damaged, so the use of a non-cuffed
tube is recommended to avoid pressure necrosis. The
tube should be carefully secured in place using a tie or
tape to minimize movement, that could lead to the
formation of tracheal strictures following the
anaesthetic. Some species such as Blue and Gold
Macaws seem particularly prone to tracheal strictures
following intubation. It may be preferable to maintain
these birds on a mask for shorter procedures or place
an air sac tube for longer procedures to avoid potential
tracheal trauma. Small birds (<100 g) may also need to
be maintained on a mask if intubation is not practical
due to the diameter of the trachea. However,
specialized small endotracheal tubes are commercially
available; alternatively, urinary or intravenous catheters
may be adapted for the purpose.
Once intubated, birds should be maintained on
gaseous anaesthesia and often require intermittent
positive pressure ventilation (IPPV) performed either
manually or, ideally, by a mechanical ventilator.
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Figure 5: An intravenous catheter may be placed in the
basilic vein
Figure 6: Fluids may be given via an intraosseous cannula placed in the ulna
Care should be taken to maintain the temperature
of the bird during anaesthesia. Due to their high
surface area-to-volume ratio and rapid metabolism,
hypothermia can be a significant problem. The
background room temperature should be kept warm
and supplementary heating aids such as circulating
water blankets, warm towels and microwaveable heat
pads may help to maintain the animals temperature.
Warm scrub solutions should be used to prepare
surgical sites, and plucking should be minimized if
possible. Intravenous or intraosseous fluids should
also be warmed prior to administration.
How to monitor anaesthesia
Anaesthetic monitoring is critical in birds, as changes
in the depth of anaesthesia, breathing and heart rate
can happen quickly. Respiratory rate and rhythm
should be monitored constantly and IPPV provided as
necessary, as even a brief period of apnoea may
rapidly lead to cardiac arrest. Even if the bird is
breathing, it may not be ventilating adequately due to
body position under anaesthesia, tube position or
reduced respiratory rate.
Respiratory rates may be set at 1015 breaths/
minute. The appropriate pressure will depend on the
size of the individual patient, but it is best to start with
a low pressure and then to increase this slowly until
small breathing movements are seen, resembling
those of the conscious bird. Apnoea is such a
common and significant complication of avian
anaesthesia, that many practitioners prefer to
mechanically ventilate their patients throughout the
procedure to prevent problems.
Fluid therapy should be continued throughout
anaesthesia and intravenous or intraosseous access
should be established for longer procedures.
Intravenous catheters may be placed in the basilic
(Figure 5), right jugular or medial metatarsal veins. The
choice of location may depend on the species of bird
and procedure being performed.
Catheters can be sutured in place for the duration
of the anaesthesia but may be difficult to maintain in
recovery, so are often removed at this point to avoid
self-removal by the bird and potential haemorrhage.
Intraosseous cannulas may be placed in the distal ulna
(Figure 6) or proximal tibiotarsus. Spinal needles may
be used or, for smaller patients, hypodermic needles
may be of more appropriate size. Needles should be
placed aseptically and will need to be taped or
sutured in place.
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How to anaesthetize a bird
Figure 8: The corneal reflex may be checked with a damp
cotton bud and should remain present throughout
anaesthesia
Capnography is therefore very useful to
assess the effectiveness of ventilation. End-tidal
carbon dioxide should be monitored throughout
anaesthesia and ideally maintained between 35 and
45 mmHg. Pulse oximetry may also be used but
readings are not consistently accurate in avian
patients and so generally just provide a guide to
whether levels of oxygenation are increasing,
decreasing or constant.
The heart may be auscultated using a
paediatric stethoscope and a pulse may be
palpated over the brachial artery (Figure 7).
A Doppler probe can also be secured in this
location to provide a constant audible monitor of
heart rate and potentially to allow indirect blood
pressure monitoring. Indirect monitoring may
underestimate blood pressure, especially if the cuff
size is too big, but can be used to reflect trends in
pressure. Systolic blood pressure should ideally be
Figure 7: The brachial pulse may be easily palpated in the axillary region
maintained at >90 mmHg; if levels fall below this,
fluid therapy should be tailored accordingly.
Reflexes which can be assessed include jaw
tone, toe pinch and the cloacal reflex. However, care
should be taken when checking the toe pinch of a
raptor or jaw tone of a large parrot. Eye position
generally stays central during anaesthesia, but the
corneal reflex can be checked with a damp cotton
bud and should remain as indicated by the nictitating
membrane moving across the eye (Figure 8). The
speed of this response will indicate the depth of
anaesthesia although the reflex may be abolished if
checked too frequently.
In the event of an avian anaesthetic emergency,
the speed of response is critical. Emergency drugs
should be easily accessible and for critical patients,
appropriate dosages should be drawn up in syringes
ready for use prior to the induction of anesthesia
(Table 2).
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Figure 9: Birds should
be monitored closely
throughout recovery
and held in an upright
position
Drug Dose Indicaton
Adrenaline 0.11 mg/kg i.v.,
i.o., intratracheal
Cardiac arrest
Atropine 0.010.5 mg/kg i.v.,
i.o., intratracheal
Suspected
supraventricular
bradycardia
Diazepam 0.11 mg/kg i.v.,
i.m.
Seizures
Doxapram 520 mg/kg i.v., i.o.,
intratracheal
Respiratory arrest
Table 2: Examples of emergency drugs used in birds. Lower
doses are suggested initially, with incremental increases if
no response is seen
Recovery
Recovery following anaesthesia is generally thought
to be the time of highest risk for avian patients, so
careful monitoring is required throughout this
period. If IPPV has been given, this should be
continued during recovery until the bird is self-
ventilating normally. The endotracheal tube should
remain in place until jaw movements increase and
voluntary breathing occurrs. The bird should be
held upright, with the head supported and the body
only gently restrained (Figure 9) to prevent any
restriction of breathing, until the bird is able to
perch. At this point it can be placed in a
pre-prepared warm incubator and should be
closely monitored until movement is coordinated.
Analgesia should be continued in the
post-anaesthetic period for any painful procedure,
even if the bird is not showing any obvious signs of
pain. In addition to NSAIDs and opioids, the use of
tramadol may also be considered for those animals
likely to need longer term analgesia. Food should be
offered as soon as the bird is no longer ataxic, and if
not eating within 2 hours, tube feeding should be
carried out to prevent hypoglycaemia. n
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