Bird 7

Question 1

• Common signs of pain in birds

Answer 1

o Lethargy, fluffed up
o Anorexia
o Tachypnea, tachycardia
o Lameness
o Over-preening over-painful areas
o Alteration of species ethogram

Question 2

is it hard or easy to for us to assess pain in birds? why? what should we keep in mind?

Answer 2

Harder to assess in birds because:
o Tends to hide signs of pain
o Minimal facial expression (no grimace scoring possible)
o Hard to extrapolate from mammals

Question 3

• Why do we treat pain in birds?

Answer 3

oEthical reasons
oTo improve prognosis
- Pain is immunosuppressant
- Better appetite, less weight loss
- Better attitude, comfort

Question 4

• Complete pain management plan

Answer 4

o Decrease stress
o Improve comfort
o Stabilize fractures
o Decrease handling
o Drugs

Question 5

antiinflammatories that we should and should not use in birds:

Answer 5

Only NSAID
- NO corticosteroids in birds!

Question 6

can we use the same analgesics for all birds?

Answer 6

A bird is not a bird is not a bird
o Every species is different
o Would you give the same drug plan to cows and dogs because they are both mammals?

Question 7

use of opiods in birds? what should we use for parrots? raptors?

Answer 7

o Most parrots respond more to κ-agonists
- Butorphanol 1-5 mg/kg IM q2-4h
- Butorphanol 1-2 mg/kg/h CRI IV
o Most raptors respond more to μ-agonists
- Hydromorphone 0.1-0.3 mg/kg IM q2-4h
- Buprenorphine 0.1-0.6 mg/kg q6h IM
- Fentanyl 5-15 ug/kg/h CRI IV

Question 8

analgesic of choice for birds?

Answer 8

NSAID
* Meloxicam
o Drug of choice
o Safe even at high dose and long term >Ensure bird is well hydrated
o Most birds: 1 mg/kg q12h PO
> 10 times higher than dogs!

• Alternatives
  o Carprofen (cheaper, use in big birds)
  o Celecoxib (more cox-2 specific but no data)
  o Some NSAID toxicity reported in birds
   Diclofenac in old world vultures

Question 9

non NSAID options for analgesia in birds

Answer 9

• Tramadol
  o Useful for chronic treatment at home when meloxicam is
  not enough or contraindicated o Several studies in birds
  o Can be combined with NSAID o 5-30 mg/kg PO q12h
• Gabapentin
  o Neuropathic pain
  o Can cause sedation at high doses
  o Great inter-individual variability
   Start “low” and gradually increase dosage

Question 10

local anesthetics used in birds? are epidurals used often?

Answer 10

• Lidocaine
  o Block, splash
  o 1-2 mg/kg total
   Careful with small species
• Epidural
  o Very difficult in birds and risky

Question 11

metabolic consideration for bird anesthesia

Answer 11

small size and much higher metabolism than mammals

Question 12

pre anesthetic considerations for birds:

Answer 12

• Acclimation
• Pre-anesthetic work-up
  o Ensure crop is empty
  o CBC/Biochemistry/Physicalexamination
  o May need to stabilize first
• Major contraindications

Question 13

how do we ensure clip is empty? for surgery? keep i nmind?

Answer 13

• If not, fast for 12h
• Standard fasting: 6-12h (until crop is empty)
• Do not fast passerines for too long

Question 14

major contraindications for anesthetic in birds

Answer 14

o Crop distension
o Hypovolemic/severe dehydration
o Severe dyspnea
o Cardiovascular compromise
o Severe anemia

Question 15

how to use premed / sedation in birds?

Answer 15

• Either use alone (sedation) or as pre- medication for long anesthesia/surgery

Question 16

goals of premed / sedation in birds

Answer 16

o Sedation
o Pre-emptive analgesia
o Potentiate isoflurane
- Decreases MAC
- Decreases side-effects of isoflurane

Question 17

combination for premed / sedation in parrots

Answer 17

midazolam & butorphanol

Question 18

combination for premed / sedation in birds of prey

Answer 18

Midazolam & Fentanyl (or hydromorphone)

Question 19

when do we place IV and monitoring for birds under anesthesia

Answer 19

• Typically the IV and monitoring are placed after induction
  o Except in larger birds (chicken, ducks…)

Question 20

mask induction methods in birds

Answer 20

• Mask induction with isoflurane 5% (less if very sedated or compromised)
  o Fairly rapid, <5 minutes
  o Different size/shape masks
  o Mild differences with sevoflurane, equivalent in parrots

Question 21

problem with mask induction in large birds, and solution

Answer 21

• Large birds may struggle with mask induction and have prolonged induction times (turkeys, ducks, swans)
• Solution
  o IV propofol induction (5-10 mg/kg slow IV)

Question 22

when will we want to keep on the mask for bird anesthetic? drawbacks?

Answer 22

o Very short anesthesia
o Tiny birds (see later)
o Repeated anesthesia (see later)
o Drawbacks
- Cannot support ventilation and monitor end- tidal CO2
- No glottal protection if regurgitation
- Will become hypercapnic over time

Question 23

endotracheal intubation method for birds? materials? what to expect?

Answer 23

o Glottis easy to visualize
o Uncuffed tube
- Complete tracheal rings
- Various sizes / models
- Expect some leakage

Question 24

• Drawbacks of intubation

Answer 24

o Small birds: increase in airway resistance
(varies with radius)
- 5 to 3 mmincrease resistance by 7
- 5 to 1 mmincrease resistance by 625!!
o Tube obstruction with mucus
- Especially ducks, needs to be changed
every hour
o Risks of post-intubation tracheal stenosis
- About 10-14 days after intubation
- Clean, atraumatic, (sterile), tubes
- Don’t intubate too deep (first line of tube)
- Avoid repeated intubations
- Be careful when moving head/neck

Question 25

when will tracheal stenosis appear after intubation, sometimes? how do we avoid?

Answer 25

- About 10-14 days after intubation - Clean, atraumatic, (sterile), tubes - Don’t intubate too deep (first line of tube) - Avoid repeated intubations - Be careful when moving head/neck

Question 26

when should we go with IV access for bird anesthesia?

Answer 26

* Only for long anesthesia

Question 27

surgical rate of fluids for birds?

Answer 27

o 10 ml/kg/h crystalloids (Plasmalyte)

Question 28

type of circuit for birds?

Answer 28

Use a non- rebreathing circuit oBain circuit

Question 29

MAC isofluorane for birds?

Answer 29

Differs by species, but: -need about 1.3-1.5 MAC for surgical anesthesia (without balanced anesthesia) o 2.5-3% frequently needed clinically

Question 30

* Side-effects of isoflurane

Answer 30

o **Respiratory depressant** - More marked in birds than in mammals o **Hypotension** - IV fluids surgical rate - Balanced anesthetic protocol (reduces MAC as much as possible) o Induces arrhythmias in some species - Second-degree AV blocks - Atropine, glycopyrrolate

Question 31

purpose of balanced anesthesia in birds?

Answer 31

o Potentiates effects of isoflurane and provide analgesia o Reduce the isoflurane MAC

Question 32

is anesthetic depth very stable in birds? what will they lose when too deep? what with they be missing under anesthesia?

Answer 32

o Changes quickly in birds oLack of reflexes (leg, wing withdrawal), muscle relaxation oLack of response to noxious stimulus o Corneal reflex lost when too deep (birds have the same general reflexes as mammals)

Question 33

heart rate detection methods

Answer 33

stethoscope, doppler

Question 34

monitor heart rate with what consistency?

Answer 34

* Monitor constantly if increased risk o Dyspnea, etc. * Otherwise, monitor trend o Concerning when <100 bpm

Question 35

things that are not really measured for birds under anesthetic

Answer 35

* Blood pressure (can measure indirectly though) * ECG

Question 36

pulse oximetry use for bird anesthetic? limitations?

Answer 36

o Based on human hb saturation curve o Use for trends, not totally accurate o May fail to diagnose hypoxemia o Often does not work (scales, pigmented skin)

Question 37

capnograph limitations in birds

Answer 37

* End-tidal CO2 o Capnographs overestimate PaCO2 in birds - Because respiratory system is so efficient at excreting CO2

Question 38

end tidal CO2 levels we want to see in birds?

Answer 38

o Should maintain between 20-40 mmHg

Question 39

type of capnograph we should use for birds????????

Answer 39

o Microstream capnograph - Neonatal, pediatric - Low sampling volume/rate

Question 40

when will end-tidal CO2 be 0 in birds?

Answer 40

o Low or 0 if breach in air sacs