Clinical Topic: Analgesia & Anesthesiology

Article Video Webinar

Exotic small mammals can be challenging to safely induce, maintain and recover from general anesthesia. View the recording of this RACE-approved webinar, which explores clinical anesthesia in exotic companion mammals from patient assessment and anesthetic induction to monitoring and recovery. This recording discusses the importance of proper physical examinations, the pharmacology of common anesthetic drugs or fluids, including the use of constant rate infusions and locoregional anesthesia techniques, intravenous and intraosseous catheterization, intubation techniques, and how to choose monitoring equipment in common companion exotic small mammal species.

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Le site Lafervet.com est conçu pour une utilisation par les vétérinaires. Il est ouvert aux vétérinaires diplômés, aux techniciens vétérinaires diplômés, aux […]

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Pour les vétérinaires. Par les vétérinaires.

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Article Video Webinar

This RACE-approved webinar recording was presented by Douglas Whiteside,DVM, DVSc, DACZM, DECZM (ZHM). Similar to other vertebrate species, sedation or anesthesia may be required in amphibians for various diagnostic, clinical, and surgical interventions. An understanding of clinically relevant anatomy and physiology, a pre-anesthetic protocol, the selection of appropriate anesthetic drugs to safely conduct a desired procedure, appropriate anesthetic monitoring, and post-anesthetic planning all are key to successfully managing the amphibian patient through an anesthetic event…

Article Information sheet

The birds of family Ramphastidae are found in South and Central America, from central Mexico to southern Brazil, and include the large toucans, the smaller aracaris, and the very small toucanets. This information sheet reviews natural history and taxonomy, as well as diet, housing, normal physiologic data and anatomy, restraint, behavior, and important medical conditions seen in family Ramphastidae.

Article Webinar

The 2019/2020 wildfires put the plight of Australian wildlife and the realities of climate change on the international stage. This RACE-approved webinar recording consists of two, 1-hour seminars that explore the impact of Australian bushfires on wildlife. Part 1, presented by Dr Talbot, explores the basics of patient assessment and triage as well as management of pain, smoke inhalation, and burns for the unique species found in Australia. Part 2 summarizes Dr. Campbell-Ward’s research evaluating the key rescue/rehabilitation-related wild animal welfare outcomes and ethical dilemmas encountered during the Australian bushfires.

Article Video Webinar

View the RACE-approved webinar recording, presented by Douglas Whiteside, DVM, DVSc, DACZM, DECZM (Zoo Health Management). Topics covered include clinically relevant anatomy and physiology, obtaining a detailed history, triage and emergency therapies, clinical examination, diagnostic testing, analgesia, nutritional support, hospitalization, and euthanasia.

Article Video Webinar

Exotic companion small mammals, such as rabbits, rodents, and ferrets, are popular pets, and are frequently presented to veterinary practitioners for several medical reasons. The RACE-approved recording of this live, 1-hour webinar was presented by Dario d’Ovidio, DVM, MS, SpecPACS, DECZM (Small Mammals). Dr. d’Ovidio first compares the value of chemical versus physical restraint and anesthesia versus sedation before discussing the use of specific sedative agents in exotic companion mammals. The presentation then moves to pain management, discussing systemic analgesia and locoregional anesthesia or analgesia.

Article Video

A dedicated anesthetist should be assigned to monitor every patient during the perianesthetic period. The anesthetist is fundamental to patient safety because she assures the patient is not aware, not moving, and not in pain, all while maintaining stable anesthetic depth. A deep plane of anesthesia can lead to hypoventilation and hypoxemia, reduced cardiac output, hypotension, inadequate tissue perfusion, central nervous system (CNS) depression, and prolonged recovery. This review article first explores the stages of anesthesia and then discusses assessment of anesthetic depth in exotic companion mammals, birds, and reptiles.

Article Teaching Module

Upon completion of this RACE-approved learning aid, the participant will have a basic clinical understanding of anesthetic monitoring of exotic animal patients: birds, exotic companion mammals, and reptiles.

Quiz

The Anesthetic Monitoring Teaching Module was reviewed and approved by the American Association of Veterinary State Boards (AAVSB) Registry of Approved Continuing Education (RACE) program for 1 hour of continuing education, in jurisdictions which recognize AAVSB RACE approval.

Article

Both males and female pigs possess modified upper and lower canine teeth or tusks, however, the tusks of the male retain an open root that allows these teeth to grow throughout life. Tusks can become long and extremely sharp and trims may be necessary to prevent injury to humans, other animals, household furniture, flooring, or even the pig itself. This brief article discusses relevant anatomy, equipment needed, potential complications, sedation, and step-by-step advice for successfully completing this clinical technique.

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Article Video Webinar

Dr. Lorenzo Crosta present this live webinar on the clinical perspectives of avian anesthesia. View the RACE-approved webinar recording, then take a brief quiz to earn 1 hour of continuing education credit. After briefly reviewing clinically relevant avian anatomy and physiology, Dr. Crosta touches upon injectable anesthesia, then discusses in detail preanesthesia and inhalation anesthesia in clinical practice. The discussion then moves onto monitoring the avian patient, from vital parameters to capnography, doppler, electrocardiography, and pulse oximetry. Dr. Crosta also discusses analgesia, intra-operative fluid therapy, as well as specific concerns related to avian anesthesia, such as positioning the patient, hypocalcemia, air sac cannulation, as well as management of diving birds. This seminar concludes with practical tips for safe and uneventful patient recovery.

Article Video Webinar

Dr. Heather Barron presented this webinar on avian critical care. View a recording of the live, interactive event, then take the brief post-test to earn 1 hour of continuing education credit. The goal of wildlife medicine is always eventual release and therefore triage of avian wildlife may vary based on case load, regulations, and the presenting situation. Dr. Barron examines the guidelines used to set triage policy and the reasons a bird may not be releasable or have a good quality of life in captivity. She then discusses practical measures intended to alleviate suffering and improve the odds of patient survival, such as fluid support, analgesia, evaluation of blood volume, and transfusion. This presentation concludes with a brief discussion on assessing life and euthanasia.

Article Information sheet

The term “miniature pig” is used to describe a variety of smaller pig breeds as well as crossbreeds. There are at least 14 recognized breeds of miniature pigs, including the Vietnamese potbellied pig, the Juliana pig, the KuneKune, and others. This information sheet reviews natural history and taxonomy, as well as a number of clinically relevant information including (but not limited to) diet, housing, behavior, normal physiologic data and anatomy, restraint, preventive medicine, zoonoses, and important medical conditions seen in the mini pig.

Article

Capnometry measures the maximum value of carbon dioxide (CO2) obtained at the end of expiration or end-tidal carbon dioxide (ETCO2). There is good correlation between ETCO2 and arterial CO2 in birds and mammals and capnography can be used as a reliable tool to evaluate the adequacy of ventilation in these species. Capnography can only be used to identify trends in reptiles because of cardiac shunting of blood past the reptilian lungs.

Article

Even the most steadfast and seasoned veterinary anesthetist can find themselves intimidated by exotic animal patients. Standard veterinary anesthesia monitors are not designed to read the extremely high (or extremely low) heart rates and respiratory rates of some exotic animal patients. Despite these challenges, valuable information can be gathered from monitoring tools as well as hands-on techniques. Essential vital signs, such as heart rate and rhythm, respiratory rate and depth, body temperature, and mucous membrane color should all be evaluated.

Article

Arterial blood pressure is a function of heart rate, blood volume, stroke volume, and arterial compliance. Indirect arterial blood pressure is most commonly measured by Doppler ultrasound or non-invasive oscillometric monitors. What are the limitations of indirect blood pressure measurements in exotic animal patients? How is this technique unique in exotic companion mammals when compared to dogs and cats? How is this technique performed in birds and can this procedure be used in reptiles?

Article

Electrocardiography can be used to detect and diagnose arrhythmias and conduction abnormalities, particularly during long-term anesthesia. How are leads attached to exotic animal patients? And what is the normal appearance of normal electrocardiogram tracings in birds or reptiles?

Article

Heart rate and oxygenation should ideally be monitored during every anesthetic event. Patient size can limit the accuracy of pulse oximetry readings in exotic companion mammals and this technique has not been validated in birds or reptiles, however trends during the course of anesthesia can still provide useful clues to patient clinical status.

Form-Questionnaire

Created by veterinary technician specialist, Katrina Lafferty, this anesthesia monitoring record is available for download as as both a Word document and PDF.

Form-Questionnaire

Download this anesthetic record, available as a PDF, and recommended by veterinary technician specialist, Katrina Lafferty.

Form-Questionnaire

Download this anesthesia & recovery record, suggested by veterinary technician specialist, Katrina Lafferty. This anesthetic record was created by the Association of Veterinary Anaesthetists and is from a collection of online resources recommended by the Royal College of Veterinary Surgeons Practice Standards Scheme.

Form-Questionnaire

Download this anesthesia monitoring sheet, available as a PDF, and recommended by veterinary technician specialist, Katrina Lafferty.

Article

There is little empirical information available on cardiopulmonary resuscitation in most exotic animals. Fortunately, the basic principles of CPR are the same for all species, however there are important species-specific considerations. This review article explores techniques for establishing airway control, ventilation and cardiac compression recommendations as well as considerations for emergency drug selection.

Article

The approach to analgesia and sedation in exotic companion mammals faces special challenges, including small patient size and unique features of the prey species mentality. Recognition of pain is more difficult in rabbits and rodents because many small mammals are very good at hiding the signs of pain commonly observed in predator species. Instead pain in a rabbit or rodent is often inferred from the patient’s clinical condition as well as the absence of normal behaviors. The diagnostic and therapeutic plan frequently requires some form of chemical restraint in exotic mammal medicine. When compared to general anesthesia, sedation is a safer option for the debilitated or critically ill small mammal.

Article

Rabbit intubation can be accomplished using either an orotracheal or nasotracheal technique. Both intubation methods can be challenging in rabbit patients and require patience and practice. Nasotracheal intubation may be the preferred approach in situations where maximum access and maneuverability is required in the oral cavity. Nasotracheal intubation is also preferred where an extended recovery is expected.

Quiz

The Reptile Anesthesia and Analgesia webinar was reviewed and approved by the American Association of Veterinary State Boards (AAVSB) Registry of Approved Continuing Education (R.A.C.E.) program for 1 hour of continuing education, in jurisdictions which recognize AAVSB R.A.C.E. approval…

Article Video Webinar

This live webinar event was presented by Javier Nevarez, DVM, PhD, DACZM, DECZM (Herpetology). View a recording of Dr. Nevarez’s web-based seminar and earn 1 hour of R.A.C.E.-approved continuing education credit. Lecture objectives include a review of the principles and concepts of reptile analgesia, recommended analgesics, signs of pain and pain recognition, and a review of analgesic protocols. The presentation also reviews principles and concepts of reptile anesthesia, popular anesthetic agents and anesthetic protocols, monitoring, as well as keys to success.

Article

The approach to a prey species like the rabbit often calls for a profound paradigm shift for clinicians used to dealing only with cats and dogs. Rabbits can stress very easily in a clinical setting and the challenge of managing a small mammal like the rabbit increases exponentially when they are presented for illness or injury.

Article Video Webinar

In 2023, Ms. Nugent-Deal shared an updated video recording on this topic: Exotic Small Mammal Anesthesia. View this new, RACE-approved webinar recording.

Form-Questionnaire

The Vets Now Surgical Safety Checklist includes a list of safety issues that should be read aloud, with both the veterinarian and veterinary nurse or veterinary technician present. This checklist is divided into three categories: induction of anesthesia, before the skin incision, and before the patient leaves the operating room…

Article

Released for National Veterinary Technician Week 2014, Nursing Care for Exotic Companion Mammals is part of an Exotic ICU series providing advice on the management of small exotic companion mammals in a critical care setting. Specific recommendations on caging, medicating, feeding, and monitoring the critical small mammal are explored as well as important potential sequelae to the stress of hospitalization.

Article

One of the most valuable items in avian practice is a reliable formulary. Although pharmacokinetic and pharmacodynamic data is slowly growing, the vast majority of drug doses in companion parrot medicine rely on extrapolation and/or clinical experience. It is crucial that the clinician have access to this wide range of information and experience.

Article

As in other species, to manage pain successfully, one must know when pain might occur. Several common medical disorders can result in acute pain such as otitis, conjunctivitis, and acute gastrointestinal disease. Chronic pain can arise from conditions such as arthritis, which commonly develops in older…

Article

Air sac cannulas are routinely used to ventilate birds by a route other than endotracheal intubation. Air sac tubes are used for oxygenation and anesthesia, especially during surgery of the head or trachea where tracheal intubation would be cumbersome. In addition, air sac cannulas provide a means to medicate air sacs directly, and they are also used to aid dyspneic birds with tracheosyringeal obstruction from foreign bodies, granulomas, or tumors.

Article

This brief article was created to serve as a synopsis of LafeberVet’s longer, more detailed “Analgesia in Small Mammals” authored by veterinary anesthesiologist, Dr. Paul Flecknell.

Article

In no way, should the reader believe the use of tracheostomy tubes is common in exotic companion mammals like the guinea pig. This technique is exceedingly rare. However given the frequent lack of airway control and the particular concerns when anesthetizing guinea pigs, those concerned with emergency and critical care should be aware of this technique as a “back up” option. In most instances, use of this surgical approach would mean that the clinician has failed to exercise foresight and planning for their patient’s airway control. Nevertheless anyone who sees rodents, particularly on an emergency basis, should consider compiling a tracheostomy kit and practicing this technique on cadavers.

Article

Waterfowl belong to Order Anseriformes. Virtually all anseriforms belong to family Anatidae, which consists of ducks, geese, and swans. If you are comfortable with psittacine anatomy and physiology, then many features of waterfowls will be familiar. LafeberVet has listed twelve interesting and clinically significant facts about waterfowl…

Article

At the Ontario Turtle Conservation Centre, previously the Kawartha Turtle Trauma Centre, we encourage private practices, emergency clinics, and rehabilitation centers to aid in the initial treatment of these injured turtles. We admit turtles from across the province, and it is extremely beneficial to the turtle to get immediate care locally before transfer. Snapping turtles are incredible in their ability to heal (albeit slowly!) and we cannot stress enough that the injuries can appear horrific, and yet can go on to heal, with subsequent release of the turtle back into the wild…

Article

Are you prepared to see herptiles in your clinical practice? This equipment list, created by a veterinarian board-certified in reptiles and amphibians, provides recommendations for basic equipment needs as well as tools for advanced reptile care including amphibians and even crocodilians.

Article Presenting Problem

Stomatitis, also known as “mouth rot”, ulcerative stomatitis, necrotic stomatitis, and/or periodontal disease is a common problem in snakes and lizards. Stomatitis is less common in chelonians and crocodilians, and often presents as a stomatitis-rhinitis complex in tortoises. This presenting problem article explores the pertinent anatomy involved, key points of urgent care, as well as tips for case management.

Form-Questionnaire

Do you have everything? Shared by registered veterinary technician and veterinary technician specialist, Jill Murray of Oklahoma State University, review our collection of procedure equipment checklists. Checklists are used in clinical practice to make preparation for procedures more efficient and more consistent, thereby improving the quality of care. Use these equipment checklists to train students and staff, or simply to jog your memory for procedures performed only sporadically.

Article Video

Are you using epidurals in your practice? The epidural is a neuroaxial technique that provides preemptive analgesia by injecting drug into the epidural space surrounding the spine. Epidurals can be used for abdominal surgery, perineal surgery, and orthopedic procedures involving the pelvic limb or spine. Some opioids can also travel cranially to provide supplemental analgesia for chest and thoracic limb procedures. Epidurals serve as an adjunct to systemic analgesia, and epidural analgesia also reduces the amount of anesthetic drug needed. Epidurals can also shorten recovery time.

Article Video

Endotracheal intubation of the rabbit is challenging because it difficult to directly visualize the tracheal opening in all but the largest individuals. Rabbits have a long, narrow oral cavity and the larynx, which sits on a ventral slope, is prone to spasm.

Use this video clip or text with still images to review equipment needed, potential complications as well as the techniques involved for blind intubation and intubation using visualization.

Article

An important differential for lumps and bumps: Mammary gland tumors are relatively common in rats and mice, and are also seen in African pygmy hedgehogs and guinea pigs. Get the facts about mammary tumors in small mammals. Review diagnostics, management, prognosis and prevention of this important condition.

Article

Pain assessment in birds is very complex because it requires consideration of differences in age, gender, species, individual behaviors and environmental factors. Birds may exhibit different behaviors or may hide painful behaviors when outside of their home cage. Predatory species may exhibit painful behaviors more readily than prey species. Many clinical signs may be associated with pain in birds including…

Article

Arterial blood pressure measurement is an important tool in the management of the critically ill bird. Systolic blood pressure is the pressure exerted against the blood vessel wall during contraction of the heart. Although direct arterial pressure measurement is ideal, it is not commonly used because of the need for specific technical skill, invasive nature of the procedure, and cost of equipment.

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