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Anesthesia > Sedation of Pigs! > Flashcards

Sedation of Pigs! Flashcards

1
Q

In terms of chronologic order of events for pigs undergoing GA, how are they different from ruminants?

A

Pigs are way less cooperative than ruminants, so IM sedation and occasionally induction
may actually precede IV catheter placement to reduce handling and stress.

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2
Q

What are some important anesthetic considerations in pigs based on breed, size, and genetic pool?

A

Wide variety of breed & size
- Meat
- Research
- Companion (miniature OR NOT!!)

Genetic pool (under same umbrella)
- Porcine Stress Syndrome (PSS)
- Pale-Soft-Exudative Pork (PSEP)
- Malignant Hyperthermia (MH)

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3
Q

What breeds are susceptible to MH?

A

MH is malignant hyperthermia
- Pietrain
- Hampshire
- Large White
- Poland China
- Chester White
- Landrace
- Berkshire
- Duroc (Least susceptible)

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4
Q

What breeds are not susceptible to MH?

A

Research breeds: because they are phylogenetically far from the norther European production pigs.
- hanford
- Sinclair
- Yucatan
- Gottingen minipig

Companion breeds
- Vietnamese Pot-Bellied
- Juliana
- American Mini Pig

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5
Q

Pigs are considered what in terms of behavior which makes this a special anesthetic condition?

A
  • Very intelligent: they learn very fast about their environment, people they are interacting with
  • Social behavior (suffer from
    separation from other members)
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6
Q

Whats important about their feeding that you need to consider with anesthesia?

A

Feeding schedule- temp
fluctuations with it
so it is normal for a
production pig to have a rectal temp of 104 F right before feeding time

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7
Q

Do pigs enter the food chain?

A

Yes so we are concerned with Drug residues in meat (FARAD) –> EVEN IF PETS!

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8
Q

Are pigs a personnel saftey concern?

A

uhh yeah
these animals can be very strong
at a relatively small size and charge you, squeeze you against a wall, or bite you.

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9
Q

Pig digestive systems are:

A
  • Omnivorous monogastric so in theory they should behave like a
    dog in this regard.
  • However, they do have a very prominent torus pyloricus to keep
    food in the stomach and improve digestion, but this makes it so that gastric emptying time is prolonged
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10
Q

What are the fasting times of pigs?

A

Feed:
- 12 h adults
- 24 h (for cranial abdominal surgeries)
- 3 h Food (juvenile)
- 1 h Nursing (neonates)
Water: 6-8 h

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11
Q

Is vomitting perioperatively a concern in pigs and how do we treat this?

A

vomiting is pretty rare but can occur, so here at UT we did a couple of projects on maropitant and are now using it pretty routinely at 2 mg/kg SQ.

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12
Q

Physical exam is a challenge. How do you perform this and get as much infor as possible?

A

First History from owner
- Behavior
- Food intake
Then PE:
- Visual (look before touching!):
–> Mentation
–> Ambulation, etc.
- Hands-on

Stress levels ARE going to affect
these parameters

Age: Geriatric populations are
more common nowadays

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13
Q

Commercial pig HR, RR, and temp?

A

70-80 BPM
13-20 brpm
Temp: 101.3-104

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14
Q

Companion pig HR, RR, and temp?

A

70-80 BPM
13-20 brpm
Temp: 101-104

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15
Q

Suckling pig HR & RR?

A

200 bpm
20-50 brpm

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16
Q

Why should we consider oral tranquilization before coming into the hospital? and What is available for this?

A
  • To decrease stess on animals
  • Gabapentin OS
    a. 15 mg/kg (1st dose)
    b. Then, 8.5 mg/kg
  • Trazodone
    –> Difficult to administer orally
  • Clonazepam
    a. 2 mg/kg
    b. Sedation in juvenile commercial
    pigs
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17
Q

When we get pigs in the hospital what should we do to make them less stressed in terms of the environment of stalls etc.?

A

Acclimate them and put things in there so they explore
Provide distractions like:
- food enrichment/distractions
- Bribe them and entertain them with foods such as peanut butter on a spatula like in this video, marsh mellows, apple slices, cookie dough, anything to distract them from what you are doing to them

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18
Q

Why is physical restraint a challenge in pig sedation and anesthesia?

A
  • Poorly tolerated
  • Aggressive physical restrain NOT
    recommended
  • Goal: minimize stress from
    handling → exertion
    hyperthermia –> building up temperature from muscular exertion
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19
Q

What are some techniques you should use to restrain them and low stress?

A

Towel Wraps
Board(s)
Snout twisting with snare
Cart

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20
Q

What are some characteristics of pigs that make them non-anesthesia friendly in terms of anatomy and physiology?

A
  • Thick adipose tissue layer
  • Poor venous and arterial access
  • Laryngeal conformation (epiglottis,
    soft palate, laryngeal vestibule)
  • Tracheal bronchus
  • Small tidal volume and chest
    compliance
  • NO SWEAT GLANDS –> so they cannot dissipate heat by sweating, can only do so by convection or contact with cold surface or panting
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21
Q

Is site of drug administration a challenge with pigs?

A

yes

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22
Q

Where can you administer drugs in pigs?

A
  • OS (better & faster absorption than in
    ruminants)
  • IM
    –> Trapezius muscle, caudal to the ear
    –> Gluteus muscles (non-production)
    –> Semitendinosus/Semimembranosus
  • Intra-nasal –> takes too long sometimes
  • Intra-testicular
  • Intra-osseous (greater tuberculous, trochanteric fossa)
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23
Q

What size needle should you use for injections?

A

1.5” needles recommended
* IM vs Intra-fat injection
Bigger bc you have to overcome layer of adipose fat

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24
Q

Venous access is another challenge. What veins do we use to administer drugs IV? Sample blood? etc.

A

To administer drugs IV (under sedation or heavy restraint)
- External jugular vein
- Cranial vena cava
To sample blood
- Cranial vena cava
- Tarsal vein
Superficial veins (few & small) –> veins located on caudal aspect of ear are used most common
Small catheters (18, 20, 22, 24G)
- Caudal auricular vein –> cranial aspect of ear
- Cephalic vein
- Abdominal?

25
Q

Sedatives and anesthetics used in Swine are similar to those in:

A

ruminants and small animals
- Midazolam
- Xylazine
- butorphanol
- Alfaxalone
- Ketamine
- Tiletamine-zolazepam

Combos:
- butorphanol + midazolam
- Morphine + midazolam + ketamine

26
Q

Whats a combo you can use to make a patient go from unapproachable to immobile?

A
  • Telazol (tiletamine + zolazepam) 3
    mg/kg +
  • Morphine 0.5 mg/kg +
  • Dexmedetomidine 20 µg/kg
  • ALL mixed together
  • Telazol powder diluted with drug volumes to reduce volume of injectate
27
Q

Why would you use mask induction for pigs? What would you set the O2 and vaporizer to?

A
  • To complete loss of consciousness
  • To facilitate intubation
  • Pre-Oxygenation (5-10 min)
  • Deep mask to accomodate deep snout
  • High flow (4 L/min) + high vaporizer setting (5% Isoflurane or 5% Sevoflurane)
28
Q

What are some drugs we use to induce pigs?

A

Nothing special or different from SA
Midazolam
Alfaxalone
Ketamine
Propofil
Telazol

29
Q

Why is intubation such a challenge in pigs?

A
  • Thick & Large epiglottis
  • Redundant tissues in the
    larynx
  • Target small and FAR with
    small opening between
    maxilla and jaw –> mouth doesnt open very much and snout can be very long
  • Obtuse angle to overcome –> orient the tube with curve upward as you go into the rima glottidis and trachea so you dont get stuck in posterior floor of larynx which can act as a diverticulu, and actually rupture if youre too rough with your intubation
30
Q

What supplies do you need for intubation?

A
  • Long Blade Laryngoscope (20-30 cm)
  • Mouth Speculum (optional)
  • Neck extended (Lateral, Sternal, Dorsal Recumbency)
  • Lidocaine splash (1 mg/kg)
  • ETT:
    –> Regular (<90 kg)
    –> Long ETT (>100 kg)
  • Stylet:
    –> Hard Stylet (Metal, NOT recommended)
    –> Soft Stylet (hollow, ETT exchanger,
    x3 ETT length, recommended)
31
Q

How do you actually insert ETT?

A
  • Disengage epiglottis from soft palate and place blade on top of epiglottis so you can visualize the arytenoid cartilage and Rima glottidis
  • Point tube upward and aim for superior part of the rima glottidis so the tube doesnt get stuck in posterior floor of larynx
32
Q

What are some potential complications of intubation?

A
  • Laryngospasm
  • Airway Obstruction
    –> inability to disengage epiglottis from soft palate or all the redundant tissue around larynx
  • Perforation of posterior floor of larynx
    –> made of cartilage so youll see blood, tracheostomy may need to be done
  • Ideal ETT position: Cranial to 2nd
    intercostal space
    –> Tracheal bronchus exclusion
    –> Endobronchial intubation
33
Q

What happens if you have tracheal bronchus exclusion due to improper intubation?

A

When tube goes past tracheal bronchus and now it inflates everything except R. cranial lung lobe
This creates some hypoxemia but not so severe

34
Q

What are the conseqeunces of endobrochial intubation?

A
  • Only the left lung lobe is inflated and the right is excluded
  • This causes V/Q mismatch, hypoxemia, hypoventilation, and hypocardia
35
Q

What are some ways you can maintain anesthesia with injectables?

A

GKX:
- Guaifenesin 5% +
- Ketamine 1 mg/mL +
- Xylazine 1 mg/mL;
- Given @ 1 mL/kg or to effect IV

TKX (sedation + maintenance):
- Telazol 500 mg (powder in 1 vial) +
- Xylazine 250 mg +
- Ketamine 250 mg
- Give 1 mL/35-70 kg IM (decrease 50% for noncommercial swine)

Will produce surgical anesthesia

36
Q

What are some ways to maintain anesthesia via inhalants?

A

Isoflurane
- MAC 1.5-1.9%
Sevoflurane
- MAC 2.4-2.6%
Desflurane
- 8.3-10%

Higher MAC than otehr species

37
Q

What are some ways to have PIVA in pigs?

A

Lidocaine CRI (>50 µg/kg/min)
Ketamine CRI (>20 µg/kg/min)
Fentanyl CRI (>25 µg/kg/hr)

38
Q

Why is positioning important and how should they be positioned?

A

Prevention of neuromyopathy
Padding (heavy swine)
Limbs flexed and relaxed

39
Q

How do you monitor anesthetic depth in pigs?

A
  • Eye reflexes arent really reliable (corneal>palpebral>ocular>pupillary reflex)
  • Jaw tone preferred
40
Q

```

~~~

What are some ways to monitor anesthesia other than depth?

A
  • Pulse-Oximetry
  • ECG: prolonged QT
  • NIBP: cuff 40-60% leg/tail
    circumference
    –> can be unreliable because shape of legs
  • IBP more reliable than NIBP
41
Q

Why is mechanical ventilation recommended in swine? What are some parameters in swine to monitor with ventilation?

A
  • Prone to hypoventilation
  • Small animal machine set
    up
  • Tidal volume: 6-10 mL/kg
  • Target ETCO2 35-45 mm Hg
  • Maximum peak inspiratory
    pressure 20 cm H2O
42
Q

How is blood pressure managed? What drugs are used to manage this?

A
  • Classic approach to treatment
    (treat cause)
  • Dobutamine 5-20 µg/kg/min IV
  • Dopamine 10-20 µg/kg/min IV
  • Dopamine better than
    dobutamine in improving CO
  • Ephedrine, phenylephrine,
    vasopressin, norepinephrine
43
Q

Why is temperature management important and how can we support this?

A

No hair cover
- Hypothermia very common

THEY CAN’T SWEAT!
- Avoid hyperthermia
- The only way they can dissipate heat is by panting!

Temp support crucial during
perioperative period:
- Bair Hugger
- Electric/Water Blankets

44
Q

Malignant hyperthermia is a major challenge in pigs undergoing sedation and anesthesia. What is MH?

A
  • Genetic, hyper metabolic syndrome in humans and swine
  • Associated with PSS & PSEP Syndromes (aka Capture Myopathy in wildlife)
  • Single amino acid mutation on Ryanodine Receptor Type 1 (RYR1)
45
Q

What can trigger MH?

A

Rough handling
High ambient temperature
Vigorous exercise/strain
Transportation
Inhalants (Halothane>Isoflurane>Desflurane)
Succinylcholine

46
Q

Whats the pathophysiology of MH?

A
  • Excess of Ca++ efflux from sarcoplasmatic reticulum
    –> traps Ca in cell and now we have over excitation of myocytes
  • Results in over-activation of excitementcontraction coupling
  • Muscle contracture & release of heat
  • Instauration of anaerobic metabolism
47
Q

What are the major A&B and electrolyte disorders seen with MH?

A
  • Hyperkalemia (>6 mEq/L)
  • Hypercalcemia
  • Hyperphosphatemia
  • Hypermagnesemia
  • Severe lactic acidosis (pH <6.95)

Look at PPT for other clinical signs

48
Q

How do you TX MH?

A
  1. Discontinue inhalant anesthetic
  2. Change breathing circuit and rebreathing bag
  3. Continue 100% O2 administration
  4. Active cooling (ice bath, fans, rectal lavage
    with ice cold water, etc.; terminate when
    100 F)
  5. Dantrolene 0.1-7.5 mg/kg IV ASAP ($$$)
  6. NaHCO3: (BE * BW * 0.3)/2 = mEq to be given
    over 30 min
  7. Treat hypotension (support perfusion)
  8. Treat hyperkalemia
  9. Treat arrhythmias (Ca++ channel blockers are
    contraindicated)
49
Q

Outcome of MH? Even with TX?

A

often fatal

50
Q

How can we prevent MH?

A

Prevention: Dantrolene orally night before anesthetic episode and morning of anesthesia

51
Q

The presence of what may induce suspicion of MH in a pig?

A

Presence and hypertrophy of double gluteal muscle needs to induce suspicion that
there may be a genetic mutation in that individual. If you don’t have genetic testing
done on this subjects and need to anesthetize him, pretreat with Oral dantrolene

52
Q

How is herd screening done in pigs with MH?

A

RYR1 qPCR-HRM assay from EDTA blood
sample (Genalysis Lab)

53
Q

What are some things to do and consider during recovery?

A
  • Keep IV access as long as possible (cover it
    with VetWrap if needed)
  • Prolonged recovery (reversal?)
  • Hypothermia
  • Mutilation by pen-mates
  • Noisy breathing investigated immediately –> may mean upper airway obstruction
54
Q

When should you extubate?

A

Extubation attempted only when signs of FULL before extubation:
- Swallowing/chewing/coughing/shivering

55
Q

What are some reasons we can have post-extubation airway obstruction?

A
  • Laryngospasm
  • Laryngeal Edema
  • Hematoma
  • Soft palate engaged in the larynx
  • Respiratory depression→ Apnea →Resp distress→Airway edema & pulmonary edema
56
Q

Which of the following Is the best location for intramuscular (IM) administration of ketamine and midazolam in pigs?

A

neck muscles

57
Q

Identify which of the following statements is FALSE:
- Pigs are prone to laryngospasm and thus lidocaine is often used during orotracheal intubation
- Pigs typically despise manual restraint and often require pharmacologic restraint
- Pigs are monogastric and thus do not need to be fasted
- Pigs stress easily and thus acclimatization should be employed whenever possible

A
  • Pigs are prone to laryngospasm and thus lidocaine is often used during orotracheal intubation
  • Pigs typically despise manual restraint and often require pharmacologic restraint
  • **Pigs are monogastric and thus do not need to be fasted **
  • Pigs stress easily and thus acclimatization should be employed whenever possible
58
Q

When placing an endotracheal tube in the trachea of a pig, its imperative to ensure the patient end of the tube stays proximal to which structure?

A

tracheal bronchus

59
Q

Which of the following is likely the best option for placement of an intravenous (IV) catheter in a pig?

A

Auricular vein

Anesthesia (7 decks)

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