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1. Learning Objectives
Be familiar with the anesthetic options in avian medicine, including the necessary equipment required for safe administration Understand the importance of anesthetic monitoring in birds and know the techniques used Be familiar with the supportive therapies employed during avian anesthetic and surgical procedures Know the three main principles of avian surgery Understand the main differences in fracture healing between birds and mammals Online, color coded topics also indicate learning objectives that the student should become familiar with. Cases will be presented in class to illustrate some of these topics.
2. Anesthesia review
2.1. Injectable anesthetics vs. inhalants (gas)
In general, inhalant anesthesia is used almost exclusively for anesthetic procedures by most avian practitioners today. This is because of the great speed, safety, and predictability of inhalation anesthesia in birds. The avian respiratory system is a very efficient gas exchange system. The uptake and excretion of inhalation anesthetic agents is more rapid in birds than in mammals. The use of injectable agents in birds is still widespread, but is usually reserved for situations where a vaporizer is not available (in the field). The major drawback of injectables include Dose response is variable Most drugs are non-reversible Questionable safety - higher risk Difficult recovery With isoflurane or sevoflurane the patient is likely to be perching and looking for its next meal in 10-15 minutes after withdrawal of the gas. With an injectable agent (e.g. ketamine/xylazine) a patient may have to be restrained for hours before it is able to perch and/or stand comfortably without injuring itself.
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Mask
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2.3.2. Intubation
Intubation in birds is very simple, since the glottis is generally very accessible. Most birds have complete tracheal rings. The use of a cuffed endotracheal tube can lead to pressure necrosis if the cuff is inflated too much since there is no elastic ligament to accommodate the expansion. Traditional ET tubes can be used in larger birds, but the cuff should not be inflated. With smaller birds, a Cole endotracheal tube is used. Cole tubes are used because of their small size (the traditional tubes are not available in the smaller sizes) and because they do not have a cuff (see image below).
Glottis
ET tube
Cole tubes
Once the bird is intubated, the endotracheal tube is secured to the lower beak with tape and connected to a Baines circuit. The bird is then maintained on isoflurane anesthetic at very low flow rate (<1L/min) and usually at 1-2%.
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2.3.4. Recovery
Recovery from isoflurane anesthesia is normally very rapid and uneventful. The anesthetist must monitor the patient very closely during this period of time since the bird may wake up and jump off the table unexpectedly. Once the gas has been turned off and the anesthetic lines purged of residual anesthetic, the bird should receive oxygen for a few minutes, until it wakes up. The bird will begin chewing, shaking its head, and/or attempt to flap its wings when it is ready to be extubated. The patient should then be held in a towel or wrapped securely and placed in the cage until it is ready to perch (usually about 5-10 minutes). Recovery may be prolonged due to hypothermia, hypoglycemia, blood loss, anesthetic overdose, or a prolonged procedure.
Recovery
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The respiratory system can be monitored by simple visualization of the patient, a stethoscope, or a special respiratory monitor attached to the Baines circuit. Respiratory rate and depth should be monitored.
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Avian surgery
Small surgical instruments are essential when working with the tiny structures encountered in avian surgery. A special pack of fine surgical instruments should be compiled for use in avian patients. Some ophthalmology instruments can be very useful in an avian surgical pack. Magnification is also very useful in many instances. Hemostasis can be promoted with the use of several different tools, depending on the situation at hand. Very small hemoclips can be used in certain situations. Electrical cautery instruments must have a very small tip such as that found with micro-ophthocautery instruments and electrosurgical tools (e.g. Ellman Surgitron). Thrombin preparations can be very useful in very delicate areas. Sterile Q-tips are a must for daubing, etc. in place of the usual 4x4 sponges. Electrosurgical/cautery instruments (Ellman Surgitron, see end of chapter) are extremely useful in avian surgery. They allow for precise cutting with simultaneous hemostatic control. This type of instrument is relatively expensive and may be justifiable only if a fair number of avian surgeries are routinely performed. It is not an essential item.
Magnification
Microcautery
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Electrosurgery
Suture options for birds usually involve fine monofilament synthetic materials, such as PDS II. When suturing the skin, a taper needle is best, since cutting needles rip right through the delicate tissue paper thin skin. Cutting or taper/cut needles can be used for heavily keratinized areas. Rigid and flexible endoscopes are very useful in avian surgery. A rigid arthroscope is routinely used for avian laparoscopy. Several models are available. The Wolf scope and the Storz rigid endoscope are both popular. (See the end of this chapter for details on these products)
Avian endoscopy
3.4. Laparoscopy
Laparoscopy is a technique commonly employed in avian medicine to visualize, examine and even sample internal structures of the bird without performing a full laparotomy. The equipment used may vary, but usually involves a small rigid arthroscope, such as the Wolf or Stortz scopes mentioned above. Less expensive and less accurate instruments are available, and in some cases merely an otoscope will suffice. This technique is most commonly employed for surgical sexing and examination of a birds reproductive organs, general exploration of abdominal structures and thoracic structures (e.g. liver, lungs and airsacs), and for biopsy or culture of some of these structures.
Laparoscopy
3.5. Laparotomy
The most common indications for a laparotomy in a bird include removal of a gastrointestinal foreign body (esp. lead fragments), a hysterectomy or reproductive exploratory for unresponsive egg-binding, to perform a liver (or diagnostic) biopsy, and to perform an exploratory.
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There are several acceptable approaches for a laparotomy in a bird. The choice of approach will depend on the nature of the problem, the size of the bird, and the surgeon's personal preference. Approaches commonly made include a ventral midline approach, a midline-L approach, a midline-T approach, and an oblique approach. Avian Laparotomy Approaches
Avian Laparotomy Approaches
Laparotomy
3.6.2. Proventriculotomy
Indications for a proventriculotomy include removal of proventricular or ventricular foreign body (e.g. heavy metal), or to acquire a full-thickness biopsy for Proventricular Dilatation Syndrome. Proventricular approach is preferable to ventriculotomy due to the thick musculature of the ventriculus. Incision is made through left 7th and 8th ribs, or on the midline with flap to the left. Blunt dissection of proventricular suspensory ligaments Enter proventriculus at isthmus with stab incision Two layer inverting closure Postop antibiotics, feed small amounts
3.6.3. Cloacapexy
Cloacapexy may be needed to resolve chronic, recurring or severe cloacal prolapse that may occur with diarrhea, chronic egg laying, etc. Midline ventral abdominal incision Incise caudal abdominal air sacs Stay sutures placed through cloaca and around posterior rib on both sides
3.6.4. Salpingohysterectomy
Salpingohysterectomy may be indicated for chronic egg laying, complicated eggbinding, or pathologic uterine conditions. Left lateral approach Locate oviduct, ovary, infundibulum Ligate dorsal suspensory ligament Cut ligament and oviduct close to ovary Follow oviduct/uterus to vagina, ligating blood vessels along the way
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Ligate uterus at the vagina close to cloaca Cut ventral ligament attachments
3.7.4. Complications
Complications of fracture healing may occur when the fracture involves a joint or is very close to a joint (especially the elbow joint). Incorporation of the joint in the healing callous will likely render the joint immobile and the bird non-flighted. As with mammal fractures, infection will delay or prevent healing. In birds, especially those intended to regain functional flight, muscle contraction secondary to the repair or confinement of a wing can render the bird temporarily or even permanently non-flighted. In addition, due to the compact arrangement of the muscles and nerves in the avian wing, any significant soft tissue damage can result in compromised blood or nerve supply and result in a devitalized or nonfunctional wing.
http://ocw.tufts.edu/Content/60/lecturenotes/796181
2/29/2012
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