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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
Sedatives and anesthetics used in Swine are similar to those in:
ruminants and small animals - Midazolam - Xylazine - butorphanol - Alfaxalone - Ketamine - Tiletamine-zolazepam Combos: - butorphanol + midazolam - Morphine + midazolam + ketamine
26
Whats a combo you can use to make a patient go from unapproachable to immobile?
- 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
Why would you use mask induction for pigs? What would you set the O2 and vaporizer to?
- 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
What are some drugs we use to induce pigs?
Nothing special or different from SA Midazolam Alfaxalone Ketamine Propofil Telazol
29
Why is intubation such a challenge in pigs?
- 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
What supplies do you need for intubation?
- 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
How do you actually insert ETT?
- 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
What are some potential complications of intubation?
- 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
What happens if you have tracheal bronchus exclusion due to improper intubation?
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
What are the conseqeunces of endobrochial intubation?
- Only the left lung lobe is inflated and the right is excluded - This causes V/Q mismatch, hypoxemia, hypoventilation, and hypocardia
35
What are some ways you can maintain anesthesia with injectables?
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
What are some ways to maintain anesthesia via inhalants?
Isoflurane - MAC 1.5-1.9% Sevoflurane - MAC 2.4-2.6% Desflurane - 8.3-10% Higher MAC than otehr species
37
What are some ways to have PIVA in pigs?
Lidocaine CRI (>50 µg/kg/min) Ketamine CRI (>20 µg/kg/min) Fentanyl CRI (>25 µg/kg/hr)
38
Why is positioning important and how should they be positioned?
Prevention of neuromyopathy Padding (heavy swine) Limbs flexed and relaxed
39
How do you monitor anesthetic depth in pigs?
- Eye reflexes arent really reliable (corneal>palpebral>ocular>pupillary reflex) - Jaw tone preferred
40
# ``` ``` What are some ways to monitor anesthesia other than depth?
- 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
Why is mechanical ventilation recommended in swine? What are some parameters in swine to monitor with ventilation?
- 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
How is blood pressure managed? What drugs are used to manage this?
- 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
Why is temperature management important and how can we support this?
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
Malignant hyperthermia is a major challenge in pigs undergoing sedation and anesthesia. What is MH?
- 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
What can trigger MH?
Rough handling High ambient temperature Vigorous exercise/strain Transportation Inhalants (Halothane>Isoflurane>Desflurane) Succinylcholine
46
Whats the pathophysiology of MH?
- 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
What are the major A&B and electrolyte disorders seen with MH?
- Hyperkalemia (>6 mEq/L) - Hypercalcemia - Hyperphosphatemia - Hypermagnesemia - Severe lactic acidosis (pH <6.95) ## Footnote Look at PPT for other clinical signs
48
How do you TX MH?
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
Outcome of MH? Even with TX?
often fatal
50
How can we prevent MH?
Prevention: Dantrolene orally night before anesthetic episode and morning of anesthesia
51
The presence of what may induce suspicion of MH in a pig?
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
How is herd screening done in pigs with MH?
RYR1 qPCR-HRM assay from EDTA blood sample (Genalysis Lab)
53
What are some things to do and consider during recovery?
- 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
When should you extubate?
Extubation attempted only when signs of FULL before extubation: - Swallowing/chewing/coughing/shivering
55
What are some reasons we can have post-extubation airway obstruction?
- Laryngospasm - Laryngeal Edema - Hematoma - Soft palate engaged in the larynx - Respiratory depression→ Apnea →Resp distress→Airway edema & pulmonary edema
56
Which of the following Is the best location for intramuscular (IM) administration of ketamine and midazolam in pigs?
neck muscles
57
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
* 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
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?
tracheal bronchus
59
Which of the following is likely the best option for placement of an intravenous (IV) catheter in a pig?
Auricular vein

Anesthesia (7 decks)

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