Swine anesthesia Flashcards
Important points to emphasize regarding swine:
Behavior?
Physical exam?
- Behavior–not amiable for restraint, difficult to grab
- PE difficult to do sometimes
- Observe before handling
- If part of herd: questions about its interactions
- History of porcine stress in herd?
- Pet
- Better history
- Thoracic auscultation–PE can still be difficult
Important oints to emphasize regarding swine
Veins/arteries?
Injection sites?
Intubation?
Alpha2’s?
Stress?
- Veins and arteries not readily accessible
- Limited sites for injections (fat)
- Intubation can be very difficult
- Swine = most resistant species to sedative effects of alpha2’s
- Stress–> trigger to porcine stress syndrome
Restraint
Easy?
Equipment involved?
Which pigs are easiest?
- Not very amiable to restrain–stress easily
- Not much to grab
- Adults can be very strong
- Can use snare (if needed)
- Stanchion = good control
- Baby pigs and small, mini breeds easier
- May squeal when restrained
Injections
Needle?
Sites?
- IM injections necessitates using needles at least 2-3in long to avoid injections into fat
- Sites
- IM injection behind the ear-neck muscle
- Using ‘butterfly’ avoids restraint (good small pigs)
- SQ injection in skin fold of rear leg
- IM injection behind the ear-neck muscle
Venous puncture
6 sites
- Cranial vena cava–site is proximal to manubrium
- Used for large volumes
- Cephalic vein proximal–young/small pigs
- Jugular–deep in jugular groove
- Medial caudal vein–at the first movable tail joint–ventral midline
- Subcutaneous abdomen vein
- Ear vein
IV catheter placement
Difficulty?
Requires what?
Sites?
- Tough skin, veins deep, not readily accessible
- Almost always requires sedation
- Difficult to restrain
- Squealing
- Must avoid stress
- Ear veins
- Auricular vein
- Small ears more difficult
- Lateral saphenous
Preparation for anesthesia
Fasting?
- Adults = 12-24hrs
- Improper fasting–> gas accumulation producing distention; inc. pressure on diaphragm impeding ventilation
- Inc. risk of vomiting/regurg/aspiration
- Piglets = held from suckling 3-4hrs, but prone to hypoglycemia
- Mini pigs = fast up to 12hrs
Sedation
Azaparone
- Butyerophenone (similar to phenothiazines)
- Only tranquilizer approved for swine in US
- Used primarily to decrease fighting and anxiety amongst pigs (lower dosages)
- Sedation at higher dosages
- IM
- Boars– >1mg/kg = penile prolapse
Xylazine
- Most resistant species to xylazine and other alpha2’s
- Does not produce good sedation when used alone
- May cause vomiting
- 2-3mg/kg IV may produce rapid but short sedation that is readily abolished as soon as handler approaches/touches pig
- Add ketamine IM–short-term restraint (20-30min)
Anticholinergics
- Usually not given routinely unless bradycardia warrants
- Ketamine (usually) and telazol (might) produce salivation–> makes visualizing the larynx difficult and may occlude airway or tube
- Low doses atropine may minimize secretions (unless suction is available at intubation)
Benzodiazepines
- May produce some sedation when used alone (small/young pigs)
- Usually combined with other drugs, BUT
- 0.5mg/kg medazolam IM alone can produce moderate sedation
- Can also give medazolam intranasal
- Lab piglets–rapid and reliable sedation
Tiletamine/zolazepam (telazol)
- “Super ketamine/diazepam”
- Reconstitute powder w/ 5ml sterile water
- Very reliable sedation and good muscle relaxation
- Potent–so small volume
- 4mg/kg IM good for IV catheter placement but not enough for intubation and may produce long recoveries (zolazepam)
- Tiletamine = responsible for restraint/anesthesia
- Zolazepam = muscle relaxation and sedation
- Prolonged recoveries using higher doses
TKX (Telazol, ketamine, xylazine)
Reconstitue with?
Ketamine added–>
Xylazine added–>
T&Z?
Route?
- Reconstitute w/ 250mg ketamine + 250mg xylazine = 5ml total
- Ketamine adds more restraint, ‘anesthesia’
- Xylazine provides more sedation, muscle relaxation w/ improved analgesia
- T&Z diluted down to use smaller dosage of mixture
- IM
Opioids
Sedation?
Used as? Example?
Post-op pain?
- Not very good for adding sedation to other sedatives for premedication
- Used as an adjunct to analgesia during anesthesia
- Fentanyl–bolus or infusion
- Post-op pain:
- Fentanyl patches
- Buprenorphine IV (if poss.) or IM
Induction (if not intubatable w/ premedications)
Mask?
Drugs?
- Mask w/ iso or sevo if close, just not quite intubatable
- Propofol (amount depends on how sedated w/ premeds)
- Alfaxalone
- Thiopental
- If using ear vein: dilute in syringe to 1:1–avoid irritating vein
Intubation
When?
Why?
Positioning?
Oxygen?
- Should always intubate unless very short procedures (<30-45 min)
- Protects airway from poss. aspiration
- Long soft palate–may obstruct airway
- Allows for ventilation to avoid hypercapnia and minimize chance of hypoxemia
- Sternal (but some feel dorsal works best)
- Pre-oxygenate before/during induction (mask or flow) at nose
- Lidocaine–sprayed on larynx using long urinary catheter–>depress spasms
- Extend head (do not over-extend)
Why are pigs difficult to intubate?
- Difficult to visualize larynx
- Difficult to open mouth wide
- Narrow glottis and trachea; long soft palate
- Thick tongue, fat cheeks
Name the labeled structures

- dp = pharyngeal diverticulum
- ct = long thyroid cartilage on the floor of the larynx
- pc = pharyngeal recess above larynx
- Places where the tube can get ‘stuck’
- e = epiglottis
Intubation
Steps
- Carefully extend the stylet through the glottis, into the trachea (a small distance)
- ‘Thread’ the T tube over the stylet into the trachea WHILE retracting the stylet
- Must use care to avoid trauma to trachea: hematoma
- Must turn tube upward once past the glottis
- Lidocaine airway again, prior to extubation, when pig starts to swallow/chew tube
How do you verify proper RT placement?
-
ET CO2 wave form
-
Waveform and CO2–only comes from the lungs
- Only reliable sign
-
Waveform and CO2–only comes from the lungs
- Condensation in the tube
- Breathing moves rebreathing bag
- “Normal” chest excursion with IPPV
Endotracheal tube sizes?
- <10kg = 3-4
- 10-15 = 4-6
- 20-40 = 6-8
- 50-100 = 8-10
- >100 = up to 16
Maintenance and monitoring
Rates?
Head signs?
- O2 flow rate ~50-100ml/kg/min initially, then decrease to 10-30ml/kg/min
- Iso 2.5-3% then maintenence usually 1.5-2%
- Head signs not very helpful IMO
- Want loss of palpebral with deviated eyeball
- Monitor autonomic signs
What is monitored during pig ax?
- ECG–rhythm
- BP–indirect (doppler and/or oscillometeric)
- Direct pressure–auricular artery in center of pinna
- Need to cutdown for other arteries
- Pulse oximetry
- Capnography
- Temperature
Maintenance
What is important to remember?
MAP?
Systolic?
- Anesthesia depresses ventilation–and in large/heavy animals hypoventilation is significant
- Hypoventilation = hypercarbia
- Hypercarbia will dec. the PaO2
- Must be ventilated IPPV–to maintain ETCO2 in acceptable range (<50-55mmHg)
- Keep MAP > 60mmHg
- Kee systolic > 85mmHg
Expected vital parameters: mini and market pigs
Normal life span
Rectal temp
Heart rate
Resp rate
Blood pressure
ETCO2

What 4 things should be done during recovery?
- Extubate when pig is swallowing/chewing
- May be prone to spasms once removed
- If laryngeal edema/spasms suspected: lidocaine w/o dilute phenylephrine drip into larynx (before extubation) is helpful
- Keep warm (esp. for surgery)–wrap legs
- Reverse alpha2 agonists if necessary
Potential complications (5)?
- Hypoventilation–provide IPPV
- Hypotension–assess depth
- Reduce inhalent if poss.
- Fluids: dobutamine; dopamine
- Airway obstruction; laryngeal edema
- Porcine stress syndrome
- Striated muscle deterioration
- Malignant hyperthermia
What breeds are associated with porcine stress syndrome/malignant hyperthermia?
- Pietran
- Landrace
- Large white
- Poland China
- Duroc
Porcine stress syndrome/MH: pathophysiology
- Inherited–autosomal recessive mutation in the ryanodine gene (Ca release channel)
- Ca cannot exit sarcoplasmic reticulum
- Leads to muscle rigidity
- Hyper-metabolic state–inc. temp
- Inc. CO2 (prod. exceeds elimination)
- Can be fatal
MH
Triggers?
- Stress (called capture myopathy in wild animals)
- Halothane; succinycholine ‘classic’ triggers assoc. w/ anesthesia
- Has occurred w/ all the inhalents
-
Must have the gene
- Not all pigs will get MH
MH
Signs?
- Rapid onset of tachycardia, tachypnea
- Hyperthermia (>107 F)
- Myoglobinuria
- Inc. K, inc. ionized Ca
- Unstable BP
- Muscle rigidity
-
Rapid rise in ETCO2 (despite increases in RR/volume)
- Hypermetabolic state–overproduction of CO2
- Dysrhythmias lead to cardiac arrest
MH
Antidote?
Problem?
- Dantrolene
- Suppresses Ca release but doesn’t inhibit uptake of Ca by muscle cells
- Aids in Ca removal from SR
- Direct relaxing effect on skeletal muscle
- Suppresses Ca release but doesn’t inhibit uptake of Ca by muscle cells
- Problem–most likely won’t have it
- Call medical center in town to get it fast
MH
Treatment?
- Discontinue inhalent anesthesia; change to fresh machine (w/ new equipment)
- Use propofol or alfaxalone to keep asleep (if necessary) w/ midazolam
- Institute body cooling–ice baths or alcohol
- Cool IV fluids
- Hyperventilate to dec. ETCO2
- Blood gas–for pH, BE, PaCO2, PaO2
- Metabolic acidemia can/will occur
- If PCO2 is still high, Na bicarbonate will only increase CO2
- Still might be necessary (small amounts) if BE > 10-12 mEq/L
Anesthesia for MH susceptible pig?
- Pre-treat w/ dantroline 5mg/kg PO 8-12 hours before surgery
- May need to repeat pre- and post-operatively
- Use injectables (propofol and opioids/medazolam) if necessary to avoid inhalants
Lumbosacral epidural
Use?
Process?
- Facilitate C-section, repair rectal, uterine, vaginal prolapse, other ‘hind-end’ procedures
- Lumbosacral anesthesia
- Retrain–chute, sanction, w/ or w/o sedation
- Palpable depression midline between and just caudal to iliac wings at L6-S1
- Needle length 2-4cm
- Up to 4-10cm > 100kg
- 20mg (1ml) lidocaine/4.5-7kg
What drug is used for castration?
Lidocaine 2% w/ equal volume saline (for more volume) injected into center of each testicle