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Injectable Anesthesia and Analgesia of Birds by J. Paul ... - Ufersa

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In: Recent Advances in Veterinary <strong>Anesthesia</strong> <strong>and</strong> <strong>Analgesia</strong>: Companion Animals, R. D. Gleed <strong>and</strong> J. W.<br />

Ludders (Eds.)<br />

Publisher: International Veterinary Information Service (www.ivis.org), Ithaca, New York, USA.<br />

<strong>Injectable</strong> <strong>Anesthesia</strong> <strong>and</strong> <strong>Analgesia</strong> <strong>of</strong> <strong>Birds</strong> ( 5-Aug-2001 )<br />

J. <strong>Paul</strong>-Murphy <strong>and</strong> J. Fialkowski<br />

School <strong>of</strong> Veterinary Medicine, University <strong>of</strong> Wisconsin, Madison, Wisconsin, USA.<br />

Is<strong>of</strong>lurane is the anesthetic <strong>of</strong> choice for most avian anesthetic procedures. However, inhalation anesthesia is not always<br />

available in field situations involving wild birds, although small portable inhalation anesthesia units are available. Certain<br />

surgical procedures, such as tracheal resection, may warrant the use <strong>of</strong> injectable anesthesia regardless <strong>of</strong> whether or not an<br />

anesthesia machine is available [1]. Anesthetic gases can escape from the bird during surgical procedures that disrupt air sacs,<br />

or the extension <strong>of</strong> air sacs into pneumatic bones, <strong>and</strong> there<strong>by</strong> expose staff to anesthetic gases. Advantages <strong>of</strong> injectable<br />

anesthetic agents include rapid administration, low cost, <strong>and</strong> minimal equipment. Some anesthetic agents can be reversed, an<br />

important advantage when working in field situations. <strong>Injectable</strong> anesthetics are frequently used in large, long legged birds,<br />

such as ratites, when physical restraint is impossible or dangerous. <strong>Injectable</strong> anesthetics used in birds include barbiturates,<br />

chloral hydrate, alpha chloralose, phenothiazines, dissociatives, alpha- 2<br />

adrenergic agonists, alphaxalone/alphadolone <strong>and</strong><br />

prop<strong>of</strong>ol [2]. Some <strong>of</strong> these anesthetics, such as barbiturates, chloral hydrate, alpha chloralose <strong>and</strong> alphaxalone/alphadolone,<br />

are no longer recommended <strong>and</strong> will not be discussed here.<br />

The greatest disadvantage <strong>of</strong> injectable anesthetics is individual <strong>and</strong> species variation relative to drug dose <strong>and</strong> response to a<br />

specific drug. Elimination <strong>of</strong> an injected drug depends on distribution, biotransformation <strong>and</strong> excretion. While we recognize<br />

species differences within domestic animals <strong>and</strong> tailor drug <strong>and</strong> dose accordingly, we nonetheless tend to treat all birds as if<br />

they belonged to one genus or species; as if, for instance, the pigeon is the same as an ostrich when in fact these two birds are<br />

as phylogenetically different from each other as the horse is from the cat. Pharmacokinetic studies <strong>of</strong> antimicrobial drugs in<br />

different species <strong>of</strong> birds have shown that kinetics vary significantly between species <strong>and</strong> even between birds <strong>of</strong> the same<br />

order such as cockatiels <strong>and</strong> Amazon parrots (both Psittaformes). Therefore data collected on an injectable anesthetic using a<br />

pigeon may not be directly transferable to another species <strong>of</strong> bird. Nevertheless, information collected on one avian species is<br />

likely to be better for extrapolation to another avian species than are data from mammalian species.<br />

It is important that the overall clinical condition <strong>of</strong> the bird be considered during selection <strong>of</strong> an anesthetic protocol. Precise<br />

body weight in grams is essential for accurate dosing. When using injectable anesthetics for birds it is difficult to maintain a<br />

surgical plane <strong>of</strong> anesthesia. The risk <strong>of</strong> cardiopulmonary depression is high <strong>and</strong> warrants careful monitoring during an<br />

anesthetic procedure. Orotracheal intubation <strong>of</strong> the anesthetized patient allows for supplemental oxygen <strong>and</strong> positive pressure<br />

ventilation if needed. A ventilation rate <strong>of</strong> 2 breaths per minute assists the spontaneously ventilating bird. When birds are<br />

apneic, the ventilatory rate should be 10 - 15 breaths per minute. In the bird, both inspiration <strong>and</strong> expiration require skeletal<br />

muscle activity <strong>and</strong> most anesthetics depress muscular activity, thus reducing air flow rate <strong>and</strong> oxygen exchange. Assisted or<br />

controlled ventilation ensures air flow <strong>and</strong> improves gas exchange at the level <strong>of</strong> the parabronchus <strong>and</strong> air capillaries.<br />

Intubation provides a patent airway that permits easy control <strong>of</strong> ventilation in emergency situations. Nevertheless, intubation<br />

is not recommended in very small birds because dried mucus may obstruct very narrow endotracheal tubes <strong>and</strong> the<br />

endotracheal tube may increase resistance to airflow because <strong>of</strong> a significant decrease in tracheal diameter.<br />

It is recommended to calculate <strong>and</strong> prepare doses <strong>of</strong> st<strong>and</strong>ard emergency <strong>and</strong> supportive drugs such as epinephrine,<br />

doxapram, lidocaine, <strong>and</strong> atropine before inducing anesthesia. The small size <strong>of</strong> many avian patients requires accurate dosing<br />

<strong>of</strong> very small volumes or dilution <strong>of</strong> st<strong>and</strong>ard concentrations. Having these drugs prepared <strong>and</strong> in labeled syringes saves time<br />

<strong>and</strong> anxiety in critical situations.<br />

Rapid anesthetic recoveries are best for birds. <strong>Birds</strong> appear very disoriented during recovery <strong>and</strong> tend to flap their wings <strong>and</strong><br />

twist their head <strong>and</strong> neck. Holding the patient in a light towel wrap or rolling the bird into a loose newspaper "burrito"<br />

provides mild restraint to prevent chaotic body movements. Keeping the bird in a warm, quiet, dark place also aids a smooth<br />

recovery.<br />

Injection Sites<br />

In most birds, intramuscular injections are best given in the pectoral muscles. In flightless birds, such as ratites, pectoral


muscle mass is minimal, thus the thigh muscles are preferred. Subcutaneous injections are not advocated because uptake <strong>of</strong><br />

anesthetic is slowed, but if selected the recommended site is the inguinal region. Intravenous sites for injection or<br />

catheterization include the right jugular vein, brachial vein, or the medial metatarsal vein. Intraosseous catheters are useful<br />

when venous access is difficult, as occurs with hypotensive birds or very small birds. Intraosseous catheters can be placed in<br />

the proximal ulna or the cranial tibiotarsus. Uptake <strong>of</strong> the drug is comparable to intravenous injection <strong>of</strong> the drug [3].<br />

Local Anesthetics<br />

The toxicity <strong>of</strong> lidocaine is similar for birds as it is for mammals <strong>and</strong> it has been reported to cause seizures <strong>and</strong> cardiac arrest<br />

[4]. Toxicity can be prevented <strong>by</strong> using appropriate concentrations <strong>and</strong> volumes. Lidocaine (1 - 2 mg/kg) can be used as a<br />

local anesthetic or to treat ventricular arrhythmias [4], <strong>and</strong> the maximal dose is 4 mg/kg. For the small avian patient this <strong>of</strong>ten<br />

requires that the stock concentration <strong>of</strong> lidocaine (2%; 20 mg/ml) be diluted. Because <strong>of</strong> reluctance to use local anesthetics in<br />

birds, information regarding long-acting local anesthetics, such as bupivacaine, is sparse. Topical benzocaine has been used<br />

for local analgesia during repair <strong>of</strong> minor wounds in small birds [5]. A 1:1 mixture <strong>of</strong> bupivacaine <strong>and</strong> dimethyl sulfoxide<br />

(DMSO) was applied to amputated chicken beaks immediately after amputation <strong>and</strong> feed intake was improved [6]. Intraarticular<br />

bupivacaine, at a dosage <strong>of</strong> 3 mg in 0.3 ml saline, was reported to be effective for treating arthritic pain in chickens<br />

[7].<br />

Benzodiazepines<br />

Diazepam <strong>and</strong> midazolam can reduce anxiety during anesthetic induction <strong>and</strong> recovery. These sedatives work best if given<br />

10 - 20 min prior to further manipulations. The bird’s behavior does not <strong>of</strong>ten reflect pre-anesthetic sedation, but birds appear<br />

to struggle less during restraint. High doses <strong>of</strong> midazolam produced sufficient sedation in geese to facilitate restraint for<br />

diagnostic procedures [8]. This is highly advantageous with dangerous birds such as large raptors, <strong>and</strong> long-legged birds such<br />

as cranes <strong>and</strong> ratites. The sedative effect <strong>of</strong> these drugs is evident during recovery which is slow <strong>and</strong> smooth. No studies have<br />

been done to determine the duration <strong>of</strong> effect for diazepam or midazolam. The benzodiazepines provide muscle relaxation<br />

when used in conjunction with ketamine <strong>and</strong> reduce the level <strong>of</strong> is<strong>of</strong>lurane needed for anesthesia [9]. Flumazenil<br />

administered IV, helps to reverse benzodiazepine-induced sedation <strong>and</strong> restores alertness as long as enough time has passed<br />

so that additional anesthetic agents are no longer effective.<br />

Dissociatives<br />

Ketamine is rarely used alone because it is associated with poor muscle relaxation, muscle tremors, myotonic contractions,<br />

opisthotonus <strong>and</strong> rough recoveries [1, 10-12]. The dose <strong>of</strong> ketamine depends on body weight, <strong>and</strong> its dosing follows the<br />

principles <strong>of</strong> allometric scaling so that large birds (>1 Kg) respond to 10 - 20 mg/kg whereas small birds (< 50 grams) require<br />

much higher doses, e.g. 70 - 80 mg/kg. Additionally, there is inter-species variability in the response to ketamine. For<br />

example, ketamine causes salivation, excitation <strong>and</strong> convulsions when given to vultures but these signs are rare in other birds<br />

[12]. When effective, anesthesia occurs within 5 - 10 min <strong>of</strong> intramuscular injection <strong>and</strong> may last 5 - 20 min depending on the<br />

dose <strong>and</strong> size <strong>of</strong> the bird. Recovery from ketamine, until the bird can perch or st<strong>and</strong>, can take 40 - 100 min, depending on<br />

dose, body temperature, metabolic health, <strong>and</strong> size <strong>of</strong> the bird. It is recommended that ketamine not be used alone <strong>and</strong> be<br />

combined with benzodiazepines or alpha 2<br />

-adrenergic agonists to improve relaxation <strong>and</strong> depth <strong>of</strong> anesthesia.<br />

Tiletamine <strong>and</strong> Zolazepam<br />

Telazol® combines the effects <strong>of</strong> a dissociative drug (tiletamine) <strong>and</strong> a benzodiazepine (zolazepam). This combination has<br />

similarities to ketamine plus midazolam, but the smaller volume <strong>of</strong> Telazol that is typically used for anesthesia can be an<br />

advantage. At doses <strong>of</strong> 5 or 10 mg/kg it was an effective <strong>and</strong> safe anesthetic for great horned owls <strong>and</strong> screech owls although<br />

decreased heart <strong>and</strong> respiratory rates were noted [13]. Telazol at the same dose was unsatisfactory for anesthesia <strong>of</strong> red tailed<br />

hawks as they responded with salivation, <strong>and</strong> elevated heart <strong>and</strong> respiratory rates [13]. Despite the lack <strong>of</strong> information on<br />

Telazol in a variety <strong>of</strong> avian species, the primary disadvantage seems to be that a high dose provides anesthesia <strong>of</strong> short<br />

duration followed <strong>by</strong> a long (2 - 4 hour) <strong>and</strong> sometimes difficult recovery [11].<br />

Alpha 2<br />

-adrenergic agonists<br />

Xylazine, detomidine <strong>and</strong> medetomidine are usually used in combination with ketamine. The alpha- 2<br />

-adrenergic agonists<br />

provide muscle relaxation, analgesia <strong>and</strong> sedation which smoothes induction <strong>and</strong> recovery. The greatest advantage <strong>of</strong> this<br />

group <strong>of</strong> drugs is the availability <strong>of</strong> specific antagonists to reverse the effects, allowing for smooth <strong>and</strong> rapid recovery.<br />

Atipamezole is recommended to reverse medetomidine <strong>and</strong> detomidine, <strong>and</strong> will also reverse the effects <strong>of</strong> xylazine.<br />

Yohimbine has been used in raptors <strong>and</strong> psittacines to reverse the effects <strong>of</strong> xylazine, both alone or in combination with<br />

ketamine [14-16]. Similar results were noted when tolazoline was used in turkey vultures to shorten xylazine plus ketamine<br />

anesthesia [17]. When reversing an alpha 2<br />

-adrenergic agonist used in combination with ketamine, reversal must be timed so


as to avoid the bird recovering under the effects <strong>of</strong> ketamine alone as this can result in a rough recovery.<br />

Alpha 2<br />

-adrenergic agonist drugs are not recommended as single anesthetic or immobilization agents for birds. In pigeons <strong>and</strong><br />

Amazon parrots, high doses <strong>of</strong> medetomidine had a sedative effect but did not immobilize the birds [18]. Xylazine<br />

administered alone causes respiratory depression, excitation, convulsions <strong>and</strong> prolonged recovery [12]. All alpha 2<br />

-adrenergic<br />

agonists have pr<strong>of</strong>ound cardiopulmonary effects. Xylazine <strong>and</strong> medetomidine cause decreases in HR, RR, blood pH,<br />

hypoxemia, <strong>and</strong> hypercarbia [4,12,14,18]. The arrythmogenic effects <strong>of</strong> the alpha 2<br />

-adrenergic agonists can lead to<br />

cardiovascular instability <strong>and</strong>, when coupled with hypoventilation <strong>and</strong> hypercarbia, can have an irreversible, fatal effect.<br />

Alpha 2<br />

-adrenergic agonist drugs are a poor choice <strong>of</strong> anesthetic, alone or in combination, when a bird is highly stressed.<br />

General excitement can effectively over-ride the sedative effects <strong>of</strong> alpha 2<br />

-adrenergic agonists, although the mechanism for<br />

this effect is not clear. Therefore, when using alpha 2<br />

-adrenergic agonist drugs, approach the bird quietly, inject the drug <strong>and</strong><br />

place the bird back into a familiar, quiet <strong>and</strong> dimly lit enclosure while waiting for the drug to take effect. The induction<br />

period is 5 - 10 min, depending on dose <strong>and</strong> size <strong>of</strong> the bird. Ratites, raptors <strong>and</strong> long-billed birds can have a hood placed<br />

over the head for calming when a dark cage is not available.<br />

Xylazine plus ketamine combinations have been evaluated in several avian species. Blood pressure becomes elevated, heart<br />

rate is decreased, <strong>and</strong> hypoxemia, hypoventilation, <strong>and</strong> hypercapnia occur [19-20].<br />

An anesthetic combination consisting <strong>of</strong> medetomidine, midazolam <strong>and</strong> ketamine was evaluated <strong>and</strong> found to be unsafe for<br />

use in ducks [21] as it caused bradycardia, primarily attributed to the medetomidine [21,22]. Medetomidine also decreases<br />

respiratory rate. Apnea followed <strong>by</strong> a fatal decrease in heart rate <strong>and</strong> blood pressure was documented in four <strong>of</strong> twelve ducks<br />

receiving medetomidine [21]. Atipamezole <strong>and</strong> flumazenil were given intravenously to reverse medetomidine <strong>and</strong><br />

midazolam, respectively, <strong>and</strong> the ducks rapidly regained consciousness <strong>and</strong> voluntary movement [21].<br />

Prop<strong>of</strong>ol<br />

Prop<strong>of</strong>ol is an intravenously administered anesthetic with rapid onset, smooth induction, short duration <strong>of</strong> effect, <strong>and</strong> smooth,<br />

rapid recovery. Intravenous catheters are highly recommended for its administration because the drug must be given slowly<br />

for induction <strong>and</strong> <strong>of</strong>ten given repeatedly to maintain anesthesia. A maximum <strong>of</strong> 2 mg/kg bolus every 30 seconds is<br />

recommended for induction, after which 0.5 - 1.0 mg/kg/min is used to maintain surgical anesthesia [1,23]. In a study using<br />

ducks, prop<strong>of</strong>ol was given as an initial IV bolus <strong>and</strong> was constantly bolused at 1 - 4 mg/kg every 5 min to maintain a light<br />

plane <strong>of</strong> anesthesia [21]. In studies that monitored cardiopulmonary responses to prop<strong>of</strong>ol, mean arterial pressure (MAP)<br />

decreased significantly [1,23]. A short period <strong>of</strong> apnea following induction is a consistent finding [21,22,24] <strong>and</strong> respiratory<br />

depression can occur during induction <strong>and</strong> maintenance with prop<strong>of</strong>ol [23, 24]. Cardiac arrhythmias including ventricular<br />

premature contractions <strong>and</strong> ventricular tachycardia, were common in chickens <strong>and</strong> pr<strong>of</strong>ound bradycardia was noted in ducks<br />

after the initial bolus <strong>of</strong> prop<strong>of</strong>ol [21,23]. Prop<strong>of</strong>ol has a narrow margin <strong>of</strong> safety in birds <strong>and</strong> supplemental oxygen <strong>and</strong><br />

respiratory assistance must be provided to counteract apnea, hypoventilation <strong>and</strong> hypoxemia [21,23-25].<br />

Anticholinergics<br />

The use <strong>of</strong> anticholinergics for birds is controversial. Indeed, atropine <strong>and</strong> glycopyrrolate are effective for the treatment <strong>of</strong><br />

vagally induced bradycardia [26]. Some argue, however, that they cause respiratory secretions to become more viscous <strong>and</strong><br />

thus more likely to plug narrow endotracheal tubes [27]. Others [28] recommend anticholinergics for their ability to reduce<br />

respiratory mucus production <strong>and</strong> prevent formation <strong>of</strong> mucus plugs in small endotracheal tubes [4]. The oculocardiac reflex<br />

has been reported in a cockatiel <strong>and</strong> suggests that treatment with an anticholinergic prior to or during ocular surgery may<br />

prevent this reflex which is thought to be caused <strong>by</strong> ocular manipulation resulting in cardiac dysrhythmias [29].<br />

Ratites (Ostriches, Emus, Cassowaries <strong>and</strong> Rheas)<br />

In these large birds, injectable anesthetics are frequently used for short procedures <strong>and</strong> for induction <strong>of</strong> anesthesia prior to<br />

inhalation anesthesia. Several reports have been written on anesthetic protocols for ratites <strong>and</strong> a recent review compared the<br />

most common protocols [22,30-35]. These bird, when healthy, are too strong <strong>and</strong> unpredictable for simple mask induction<br />

with inhaled anesthetics. Intravenous injections can be given in the jugular vein or brachial vein, although the emu’s brachial<br />

vein is small <strong>and</strong> difficult to access. Placing a catheter in the jugular, brachial, or medial metatarsal vein will facilitate IV<br />

injection <strong>and</strong> induction. <strong>Injectable</strong> anesthetics most commonly used for ratites include combinations <strong>of</strong> Alpha 2<br />

-adrenergic<br />

agonists followed <strong>by</strong> ketamine, or a benzodiazepine followed <strong>by</strong> ketamine, tiletamine-zolazepam, carfentanil or etorphine<br />

[28,34]. Benzodiazepines given prior to induction help produce smooth inductions <strong>and</strong> smooth but slow recoveries. Induction<br />

with tiletamine/zolazepam is excellent <strong>and</strong> rapid, although when given IV, violent recoveries have been reported [30,34].<br />

Benzodiazepines given with tiletamine-zolazepam will smooth recovery [30]. Induction with xylazine-ketamine is adequate,<br />

but recovery can be difficult [34]. Carfentanil is not recommended due to an excitatory response even when used with<br />

xylazine [34]. When etorphine was combined with medetomidine, recumbency occurred rapidly, birds were sedate <strong>and</strong><br />

muscle relaxation was adequate [33]. Other etorphine combinations, when given to free-ranging ostriches, caused initial


excitement [33], although darting procedures, regardless <strong>of</strong> the anesthetic, can create a period <strong>of</strong> excitement. Medetomidine<br />

as a sole anesthetic agent is ineffective in the ostrich [35]. When medetomidine was combined with ketamine <strong>and</strong> followed<br />

<strong>by</strong> intravenous prop<strong>of</strong>ol, it was an effective combination for chemical immobilization <strong>of</strong> captive ostriches, although positive<br />

pressure ventilation was recommended [22]. Apnea is a common occurrence during ostrich anesthesia, regardless <strong>of</strong> the<br />

induction agents selected. Ventilatory support is highly recommended for this group <strong>of</strong> birds.<br />

<strong>Analgesia</strong><br />

Opioids -<br />

The early literature regarding the use <strong>of</strong> opioids in birds is confusing <strong>and</strong> contradictory. For example, one study used two<br />

different strains <strong>of</strong> chickens to evaluate the analgesic effect <strong>of</strong> equal doses <strong>of</strong> morphine. Based on their response to a noxious<br />

thermal stimulus, one strain had a hyperalgesic response while another strain had an analgesic response [36]. With many such<br />

conflicting results in the literature, it was assumed that opioids were not effective analgesics for birds. More recently, the<br />

physiological effects <strong>of</strong> opioids on birds have been documented using is<strong>of</strong>lurane-sparing techniques [37-39]. In these studies,<br />

unpremedicated birds are anesthetized with is<strong>of</strong>lurane. The minimal anesthetic concentration (MAC) is determined in each<br />

bird, after which each bird is injected with an analgesic <strong>and</strong> MAC is again determined. A significant reduction <strong>of</strong> MAC<br />

indicates that the drug being tested has analgesic properties. Using this technique, the analgesic effects <strong>of</strong> butorphanol were<br />

evaluated in cockatoos, African grey parrots, <strong>and</strong> Amazon parrots. Butorphanol at 1 mg/kg was found to be analgesic in<br />

African gray parrots <strong>and</strong> cockatoos, but not Amazon parrots [38,39]. Following injection <strong>of</strong> butorphanol, heart rate, tidal<br />

volume, <strong>and</strong> inspiratory <strong>and</strong> expiratory times were all significantly decreased [38,39]. A similar study compared mu <strong>and</strong><br />

kappa opioids in chickens <strong>and</strong> both drugs had is<strong>of</strong>lurane-sparing effects [37].<br />

Recent studies evaluated the effects <strong>of</strong> butorphanol <strong>and</strong> buprenorphine in conscious parrots [40,41]. In African grey parrots,<br />

butorphanol (1 - 2 mg/kg, IM) had an analgesic effect while large doses <strong>of</strong> buprenorphine had no significant analgesic effect<br />

[41]. In Hispanolian parrots, higher doses <strong>of</strong> butorphanol (3 mg/kg) were needed to produce a similar analgesic effect (J.<br />

<strong>Paul</strong>-Murphy, personal observation). Species variability in response to opioids does occur <strong>and</strong> caution is advised when<br />

extrapolating butorphanol doses from one avian species to another. Fentanyl (0.02 mg/kg, IM), a synthetic mu agonist, was<br />

tested in a similar fashion in cockatoos, <strong>and</strong> was found to have little analgesic effect; a higher dose (0.2 mg/kg, SQ) was<br />

analgesic (S. Hoppes, unpublished data). This may be due to fentanyl binding both mu <strong>and</strong> kappa receptors when given at<br />

high doses. An excitement phase was noted in several <strong>of</strong> the birds shortly after fentanyl was injected (S. Hoppes, unpublished<br />

data). The duration <strong>of</strong> effect <strong>of</strong> all <strong>of</strong> these opioids has only been evaluated empirically <strong>and</strong> their duration <strong>of</strong> effect may be as<br />

short as 2 - 4 hours.<br />

Pharmacodynamic studies have demonstrated that pigeons have more kappa opioid receptors than mu opioid receptors [42].<br />

This one piece <strong>of</strong> information in pigeons is used to explain why birds do not respond as do mammals to mu agonists like<br />

morphine, buprenorphine <strong>and</strong> fentanyl, <strong>and</strong> why kappa opioids, such as butorphanol, may be more efficacious analgesic in<br />

birds. Butorphanol is currently recommended for opioid analgesia in birds, <strong>and</strong> it can be given as a pre-operative <strong>and</strong> postoperative<br />

analgesic. When butorphanol is used as an induction agent <strong>and</strong> pre-operative analgesic the concentration <strong>of</strong><br />

is<strong>of</strong>lurane needed for anesthesia will be reduced.<br />

Non-steroidal anti-inflammatory drugs<br />

There are several categories <strong>of</strong> nonsteroidal anti-inflammatory drugs (NSAIDS), but few have been investigated in birds <strong>and</strong><br />

even fewer have been evaluated for clinical application [26,43]. Much <strong>of</strong> the information about doses <strong>and</strong> effects for birds has<br />

been gained through practical application. Studies using chickens have provided pharmacokinetic information on oral dosing<br />

<strong>of</strong> a few NSAIDS <strong>and</strong> short half-life <strong>and</strong> low bioavailability were common findings, but pharmacokinetic studies are a poor<br />

predictor <strong>of</strong> analgesic efficacy [44-46].<br />

In mammalian species, NSAIDS are synergistic with other classes <strong>of</strong> analgesic agents <strong>and</strong> may be most effective for perioperative<br />

analgesia when used in combination with opioids [47]. In birds, as in other species, pre-emptive use <strong>of</strong> NSAIDS<br />

may decrease tissue sensitization caused <strong>by</strong> surgical trauma <strong>and</strong> may reduce the period <strong>of</strong> post-operative opioid therapy.<br />

The most commonly used NSAIDS in avian medicine today are carpr<strong>of</strong>en <strong>and</strong> ketopr<strong>of</strong>en. The proprionic acid class <strong>of</strong><br />

NSAIDS are analgesic, anti-inflammatory <strong>and</strong> antipyretic in mammals <strong>and</strong> are expected to have similar effects in birds.<br />

Chickens given a 1 mg/kg subcutaneous dose <strong>of</strong> carpr<strong>of</strong>en had peak plasma levels 1 - 2 hours after injection <strong>and</strong> pain<br />

thresholds were raised for at least 90 min [48]. When carpr<strong>of</strong>en-treated feed was <strong>of</strong>fered to chickens, lame chickens selected<br />

more drugged feed than sound birds <strong>and</strong> the amount <strong>of</strong> carpr<strong>of</strong>en consumed increased with the severity <strong>of</strong> lameness [49].<br />

Low plasma concentrations <strong>of</strong> carpr<strong>of</strong>en (0.28 µg/ml) provided some analgesia for birds, but to reach plasma levels <strong>of</strong> 8.3<br />

µg/ml, similar to therapeutic plasma levels in mammals, an equivalent <strong>of</strong> 40 mg/kg body weight per bird was needed in the<br />

feed [48].<br />

A documented side effect <strong>of</strong> NSAIDS in mammals is gastrointestinal ulceration <strong>and</strong> bleeding due to inhibition <strong>of</strong><br />

prostagl<strong>and</strong>in synthesis. A similar toxic effect in birds was reported when high dosages <strong>of</strong> flunixin meglumide (10 mg/kg)


caused regurgitation <strong>and</strong> tenesmus in budgerigars [43]. The most serious complication <strong>of</strong> flunixin meglumide in birds is renal<br />

ischemia. Bobwhite quail experimentally given daily intramuscular injections <strong>of</strong> flunixin meglumide for 7 days had<br />

histological evidence <strong>of</strong> renal damage in all birds, even at doses as low as 0.1 mg/kg. Severity <strong>of</strong> the lesions was directly<br />

correlated to the dose <strong>of</strong> flunixin meglumide with acute necrotizing glomerulitis, tophi in the renal tubules <strong>and</strong> visceral gout<br />

occurring at 32 mg/kg [50]. Renal ischemia <strong>and</strong> necrosis has been documented in Siberian cranes treated with flunixin<br />

meglumide (5 mg/kg) for muscle <strong>and</strong> skeletal trauma [51]. The use <strong>of</strong> flunixin meglumide currently is contraindicated in<br />

cranes <strong>and</strong> used with great caution with other avian species.<br />

Piroxicam is used in mammals to treat chronic inflammatory conditions such as arthritis. It as been used to treat chronic<br />

degenerative joint disease in cranes <strong>and</strong> other species <strong>of</strong> birds <strong>and</strong> appears to provide mild to moderate improvement <strong>and</strong><br />

willingness to bear weight on affected limbs over extended treatment periods.<br />

Drug Dosage (Dose), Route Species / Remarks Reference<br />

Atipamezole<br />

182 - 281 mg/kg (250 mg<br />

dose), IV<br />

Mallard ducks: to reverse medetomidine; rapidly regained<br />

consciousness, struggled & flapped wings; tachycardia <strong>and</strong><br />

tachypnea observed.<br />

Machin<br />

[21]<br />

0.2 mg/kg, IV; <strong>and</strong> 0.2<br />

mg/kg, SC<br />

Ostriches: to reverse medetomidine; half <strong>of</strong> the total 0.4<br />

mg/kg dose was given IV, the other half SC; recovery was<br />

smooth <strong>and</strong> ranged from ~14 - 28 min<br />

Langan<br />

[22]<br />

3.75 - 10 mg/kg<br />

Pigeons (Columbia livia) <strong>and</strong> Amazon Parrots (Amazona<br />

spp.): Used to reverse medetomidine; the dose given was<br />

2.5 or 5 times the medetomidine dose administered. No<br />

differences were seen between the higher <strong>and</strong> lower doses.<br />

Recovery was smooth <strong>and</strong> rapid; st<strong>and</strong>ing times were all<br />

within 4 min<br />

S<strong>and</strong>meier<br />

[18]<br />

0.25 - 1.0 mg/kg<br />

Various avian species: Recommends a dose 5 times that <strong>of</strong><br />

medetomidine to reverse its effects.<br />

Jalanka<br />

[52]<br />

0.5 - 2.5 mg/kg<br />

Various avian species: Recommends a dose 5 times that <strong>of</strong><br />

medetomidine to reverse its effects.<br />

Berthier<br />

[53]<br />

Atipamezole (A) /<br />

Diprenorphine (D)<br />

Atipamezole (A)<br />

Flumazenil (F)<br />

(A) 40 - 161 mg/kg (5 - 20<br />

mg dose)<br />

(D) 12 - 20 mg/kg (15 - 25<br />

mg dose), IV<br />

(A) 182 - 281 mg/kg (250<br />

mg dose)<br />

(F) 18 - 28 mg/kg (25 mg<br />

dose), IV<br />

Red-necked ostriches (Struthio camelus): to reverse<br />

meditomidine/etorphine combination; lead to a fast but<br />

violent recovery.<br />

Mallard ducks: to reverse medetomidine/midazolam,<br />

respectively; rapidly regained consciousness, struggled &<br />

flapped wings; tachycardia <strong>and</strong> tachypnea observed.<br />

Ostrowski<br />

[33]<br />

Machin<br />

[21]<br />

Atropine 0.006 mg/kg, IV Ratite; used to treat bradycardia. Lin [30]<br />

Butorphanol (B)<br />

1 - 2 mg/kg, IM<br />

African grey parrots (Psittacus erithacus): 6/11 birds had<br />

an increased pain threshold to a noxious electrical stimulus<br />

after administration <strong>of</strong> 1 mg/kg B (this may represent the<br />

ED 50<br />

for the drug); higher dosages such as 2 - 3 mg/kg have<br />

been used to treat pain in subsequent studies without<br />

adverse side effects (unpublished findings).<br />

Cockatoos (Cacatua spp.): reduced is<strong>of</strong>lurane requirement<br />

in cockatoos; heart rate was reduced <strong>by</strong> 12%; apnea was<br />

not observed; respiratory rate increased <strong>by</strong> 77%, while tidal<br />

volume decreased <strong>by</strong> 25%, thus having no significant net<br />

effect on minute ventilation.<br />

<strong>Paul</strong>-<br />

Murphy<br />

[41]<br />

1 mg/kg, IM<br />

Curro [38]<br />

1 mg/kg, IM<br />

Psittacines: significantly reduced is<strong>of</strong>lurane ED 50<br />

in<br />

cockatoos (Cacatua spp.) <strong>and</strong> African grey parrots<br />

(Psittacus erithacus), but had no affect on the is<strong>of</strong>lurane<br />

ED 50<br />

in blue-fronted Amazons(Amazona aestiva aestiva).<br />

Curro [39]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Carfentanil<br />

~0.03 mg/kg (3.3 mg<br />

dose), IM<br />

Ostrich (Struthio camelus): darted; marked initial<br />

excitement phase, onset took 2 - 3 min, characterized as<br />

breaking away from the group <strong>and</strong> running in an<br />

uncontrolled manner; walking backwards, circling or<br />

courtship behavior prior to recumbency; smooth reversal<br />

with naltrexone, 3.0 mg/kg.<br />

Raath, et al.<br />

[31]<br />

Carfentanil (C) /<br />

5% Is<strong>of</strong>lurane<br />

(C) 0.3 mg/kg, IM<br />

Ratites: initial excitement phase, 5 min; apnea while under<br />

5% is<strong>of</strong>lurane maintenance anesthesia <strong>and</strong> after is<strong>of</strong>lurane<br />

was discontinued.<br />

Cornick <strong>and</strong><br />

Jensen [34]<br />

Carfentanil (C) /<br />

Xylazine (X)<br />

(C) 0.03 mg/kg (3 mg<br />

dose) /<br />

(X) 1.5 mg/kg (150 mg<br />

dose), IM<br />

Ostrich (Struthio camelus): darted; initial excitement<br />

phase, onset took 2 - 3 min; recumbency in ~ 5 min;<br />

subjective assessment was that xylazine decreased the<br />

initial excitement level; smooth reversal with<br />

naltrexone/yohimbine, 3.0 / 0.125 mg/kg, respectively.<br />

Raath, et al.<br />

[31]<br />

Carpr<strong>of</strong>en<br />

1.0 mg/kg, SC<br />

Chickens: improved ability <strong>of</strong> moderately lame birds to<br />

walk.<br />

McGeown,<br />

et al. [48]<br />

0.4 - 40 mg/kg/day<br />

Broiler Chickens: Self-selection <strong>of</strong> three doses <strong>of</strong><br />

carpr<strong>of</strong>en coated feed (3.4, 34.3, <strong>and</strong> 343 mg/kg <strong>of</strong> feed)<br />

or normal feed; carpr<strong>of</strong>en feeding improved gait in lame<br />

birds; lame birds selected more feed containing carpr<strong>of</strong>en<br />

than did sound birds; consumption <strong>of</strong> carpr<strong>of</strong>en-feed<br />

increased with the severity <strong>of</strong> lameness.<br />

Chickens: D diluted to a 0.2% solution prior to use; D<br />

administered prior to K into opposite thigh muscles;<br />

smoothly induced anesthesia within 4 min <strong>and</strong> lasted ~ 47<br />

min; analgesia evident in 8 min <strong>and</strong> lasted 28 min; muscle<br />

relaxation good; respiratory rate significantly decreased<br />

from baseline; corneal reflex remained present.<br />

Chickens: duration <strong>of</strong> analgesia <strong>and</strong> anesthesia<br />

significantly prolonged with 20 mg/kg vs.10 mg/kg dosage<br />

<strong>of</strong> K, as noted above; smoothly induced anesthesia within<br />

3 min <strong>and</strong> lasted for ~94 min; analgesia was evident in 6<br />

min <strong>and</strong> lasted 63 min<br />

Danbury, et<br />

al. [49]<br />

Detomidine (D) /<br />

Ketamine (K)<br />

(D) 0.3 mg/kg, IM /<br />

(K) 10 mg/kg, IM<br />

Mohammad,<br />

et al. [55]<br />

(D) 0.3 mg/kg, IM /<br />

(K) 20 mg/kg, IM<br />

Mohammad,<br />

et al. [55]<br />

Diazepam<br />

0.13 - 0.41 mg/kg, IV<br />

Ratites: used to smooth recovery from<br />

tiletamine/zolazepam.<br />

Lin [30]<br />

Diprenorphine<br />

~100 - 240 mg/kg (12 - 30<br />

mg dose), IV<br />

Red-necked ostriches (Struthio camelus): to reverse<br />

etorphine; lead to a fast but violent recovery.<br />

Ostrowski<br />

[33]<br />

Doxapram<br />

5 mg/kg, IV or intralingual<br />

Ostriches (Struthio camelus): experiencing respiratory<br />

distress; ventilated mechanically.<br />

Ostrowski<br />

[33]<br />

Equithesin<br />

2.5 ml/kg, IM<br />

Chickens: drowsiness observed 3 - 5 min after<br />

administration; pain reflexes remained <strong>and</strong> birds were<br />

easily aroused.<br />

Christensen,<br />

et al. [10]<br />

Equithesin (E) /<br />

Diazepam (D)<br />

(E) 2.5 ml/kg, IM /<br />

(D) 2.5 mg/kg, IV<br />

Chickens: D administered 15 min after E resulted in<br />

immediate surgical anesthesia which lasted 60 - 90 min,<br />

for long-duration surgical procedures; depth <strong>of</strong> anesthesia<br />

increased with increased diazepam doses.<br />

Christensen,<br />

et al. [10]<br />

Etorphine (E) /<br />

Ketamine (K)<br />

(E) 40 - 72 mg/kg (5 - 9<br />

mg dose) /<br />

(K) 1.0 - 1.5 mg/kg (120 -<br />

180 mg dose), IM<br />

Ostriches (Struthio camelus): darted; initial excitation<br />

phase; mean time to recumbency 12 min; deep sedation<br />

but short duration, 9 - 15 min; risk <strong>of</strong> over-exertion<br />

myopathy, apnea, <strong>and</strong> bradycardia; reversal with<br />

diprenorphine resulted in quick but violent recoveries.<br />

Ostrowski<br />

[33]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Etorphine (E) /<br />

Medetomidine (M)<br />

(E) 64 - 72 mg/kg (8 - 9<br />

mg dose) /<br />

(M) 32 - 64 mg/kg (4 - 8<br />

mg dose), IM<br />

Ostriches (Struthio camelus): darted; initial excitation<br />

phase; mean time to recumbency 8 min; deep sedation but<br />

short duration, 8 - 16 min; risk <strong>of</strong> over-exertion myopathy,<br />

apnea, <strong>and</strong> bradycardia; reversal with<br />

diprenorphine/atipamezole resulted in quick but violent<br />

recoveries.<br />

Ostrowski<br />

[33]<br />

Flunixin<br />

meglumine (FM),<br />

(NSAID)<br />

4 mg/kg IM<br />

African grey (Psittacus erithacus) <strong>and</strong> blue-fronted<br />

Amazon parrots (Amazona aestiva aestiva): Does not have<br />

an is<strong>of</strong>lurane-sparing effect.<br />

Curro [39]<br />

0.1 - 32.0 mg/kg, IM<br />

Northern bobwhite (Colinus virginianus): Six dosage<br />

groups were administered FM, SID, for 7 days; all six<br />

groups had significantly more mineralized deposits in renal<br />

glomeruli than seen in controls <strong>and</strong> the severity increased<br />

with dosage; no changes in renal function indicators; at<br />

highest dosage, 32 mg/kg, necrosis was observed at the<br />

injection site.<br />

Klein, et<br />

al. [50]<br />

5 mg/kg, IM<br />

Mallard ducks (Anas platyrhynchos): Thromboxane (TBX)<br />

levels significantly suppressed for at least 4 hr; pain<br />

responses were not assessed, so there was no correlation<br />

made between degree <strong>of</strong> TBX inhibition <strong>and</strong> degree <strong>of</strong><br />

analgesia; muscle necrosis <strong>of</strong> ~1 - 2 cc at the injection site;<br />

may not be suitable for use in ducks.<br />

Machin et<br />

al., [56]<br />

5.26 mg/liter <strong>of</strong> drinking<br />

water<br />

Broiler Chickens: survival times improved when treated<br />

water was supplied for three days prior to heat stress;<br />

peripheral prostagl<strong>and</strong>in F was unaffected <strong>by</strong> treatment;<br />

mechanism <strong>of</strong> action unclear.<br />

Oliver <strong>and</strong><br />

Birrenkott<br />

[54]<br />

Flumazenil<br />

0.1 mg/kg, IM<br />

Quail (Colinus virginianus): reversal <strong>of</strong> midazolam (6<br />

mg/kg); time to complete recovery from heavy sedation<br />

averaged 1.6 min; birds progressed from dorsal<br />

recumbency to flight without relapse into sedation.<br />

Day <strong>and</strong><br />

Roge [57]<br />

Glycopyrrolate 0.011 mg/kg, IV Ostriches (Struthio camelus): to treat bradycardia<br />

Ibupr<strong>of</strong>en<br />

Indomethacin<br />

25 mg/kg, IV<br />

50 mg/kg, IM, PO<br />

50 mg/kg, IV<br />

2 mg/kg, IV, PO<br />

Chickens: pharmacokinetic study with no assessment <strong>of</strong><br />

analgesic effects; shorter half-life than in dogs; low<br />

bioavailability (F= 46.7% IM <strong>and</strong> 24.2% PO) compared to<br />

mammals. high pH in the crop may have precipitated the<br />

drug in the g.i. tract; unpredictable crop emptying <strong>and</strong><br />

decreased motility <strong>of</strong> the crop due to h<strong>and</strong>ling the birds<br />

could have affected absorption.<br />

Broiler Chickens: Acute toxicity! Exhibited<br />

hyperexcitability, respiratory distress <strong>and</strong> death within 3<br />

min; these central nervous system signs have not been<br />

reported in other species; postulated that this may be a<br />

nonpharmacological effect such as the displacement <strong>of</strong><br />

other albumin bound ions (Ca or Mg) that leads to acute<br />

toxicity.<br />

Chickens: pharmacokinetic study with no assessment <strong>of</strong><br />

analgesic effects; a large volume <strong>of</strong> distribution (suggesting<br />

tissue retention <strong>by</strong> peripheral tissues <strong>and</strong>/or high binding to<br />

plasma proteins with a slow return <strong>of</strong> the drug to the<br />

blood); slow but sustained oral absorption, attributed to<br />

high pH <strong>and</strong> unpredictable emptying <strong>of</strong> the crop, lead to<br />

mean residence times that were five times larger with the<br />

PO route than <strong>by</strong> IV administration; from the oral Cmax<br />

range <strong>of</strong> 0.5 - 1.1 mg/ml observed, they inferred that this<br />

was an effective anti-inflammatory dose based studies in<br />

mammals.<br />

Ostrowski<br />

[33]<br />

Roder, et<br />

al. [44]<br />

Roder, et<br />

al. [44]<br />

Crist<strong>of</strong>ol,<br />

et al. [45]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Ketamine<br />

30 mg/kg, intraosseous<br />

Chickens: tendency towards decreased heart rate <strong>and</strong><br />

systolic blood pressure after administration; failure rate for<br />

cannulation <strong>and</strong> induction <strong>of</strong> anesthesia was 21% (3/14);<br />

some thrashing during induction; time to induction ~ 20<br />

seconds; time to recovery ~ 19 - 34 min<br />

Valverde, et<br />

al. [3]<br />

Ketamine, D (+), L<br />

(-), or D/L (+/-)<br />

racemic mixture<br />

10 mg/kg (+), IV; or<br />

20 mg/kg (+/-), IV; or<br />

30 mg/kg (-), IV<br />

Great horned owls (Bubo virginianus): The (+) isomer<br />

provided an equal duration <strong>of</strong> immobility <strong>and</strong> significantly<br />

greater muscle relaxation compared to a three-fold greater<br />

dose <strong>of</strong> the (-) isomer. Apnea <strong>and</strong> cardiac irregularities<br />

occurred only with the (-) isomer <strong>and</strong> the racemate.<br />

Redig, et al.<br />

[58]<br />

Ketamine (K) /<br />

Diazepam (D)<br />

(K) 75 mg/kg, IM /<br />

(D) 2.5 mg/kg, IV<br />

Chickens: K administration brought on a tranquilized state,<br />

arousal from which elicited excitation; pain reflexes<br />

remained <strong>and</strong> h<strong>and</strong>ling brought on muscle contractions or<br />

tremor; D administration after 10 min deepened the<br />

tranquilized state but did not reach a surgical plane <strong>of</strong><br />

anesthesia; heart rate was significantly decreased during<br />

the anesthetized period.<br />

Christensen,<br />

et al. [10]<br />

10 - 50 mg/kg, IM / 0.5 -<br />

2.0, IM or IV<br />

Pet <strong>Birds</strong>: (K) doses can be halved for IV use; less cardiac<br />

depressant effect than a ketamine/xylazine combination;<br />

good choice for very sick birds, but only if is<strong>of</strong>lurane<br />

anesthesia is not available.<br />

Wheler [59]<br />

Ketamine (K) /<br />

Diazepam (D) /<br />

Atropine (A)<br />

Ketamine (K) /<br />

Medetomidine (M)<br />

(K) 30 - 40 mg/kg /<br />

(D) 1.0 - 1.5 mg/kg /<br />

(A) 0.05 mg/kg, IV<br />

(K) 2 mg/kg, IM /<br />

(M) 80 mg/kg, IV<br />

(K) 3 - 5 mg/kg / (M) 50 -<br />

100 mg/kg, IM; or<br />

(K) 2 - 4 mg/kg / (M) 25 -<br />

75 mg/kg, IV<br />

(K) 3 - 7 mg/kg / (M) 75 -<br />

150 mg/kg, IM<br />

(K) 2 - 5 mg/kg / (M) 50 -<br />

100 mg/kg, IV<br />

(K) 5 - 10 mg/kg / (M)<br />

100 - 200 mg/kg, IM or IV<br />

Raptors: diazepam decreased the ketamine dosage; owls<br />

may require < half <strong>of</strong> this dosage; overweight individuals<br />

need divided doses; if the total dose <strong>of</strong> ketamine exceeds<br />

50 mg it should be given in divided doses <strong>of</strong> < 50 mg at 2 -<br />

3 min intervals<br />

Ostriches (Struthio camelus): preanesthesia: pr<strong>of</strong>ound<br />

sedation & sternal recumbency in 6/8 birds, two birds were<br />

moderately sedated but remained st<strong>and</strong>ing; provided<br />

immobilization; reversed with atipamezole (after prop<strong>of</strong>ol<br />

anesthesia was discontinued)<br />

Raptors: induction 2 - 7 min, IM, <strong>and</strong> 10 - 30 sec., after IV<br />

administration; induction period was calm; injection<br />

volumes were small; respiration deep <strong>and</strong> regular;<br />

myorelaxation was good; owls were especially susceptible<br />

to the anesthetic effects; spontaneous recoveries were calm<br />

<strong>and</strong> began ~10 - 20 min after injection; Reversal with<br />

atipamezole was rapid.<br />

Psittacines: induction 2 - 7 min, IM, <strong>and</strong> 10 - 30 sec., after<br />

IV administration; induction period was calm; injection<br />

volumes were small; respiration deep <strong>and</strong> regular;<br />

myorelaxation was good; spontaneous recoveries were<br />

calm <strong>and</strong> began ~10 - 20 min after injection; Reversal with<br />

atipamezole was rapid.<br />

Geese: induction 2 - 7 min, IM, <strong>and</strong> 10 - 30 sec., after IV<br />

administration; induction period was calm; injection<br />

volumes were small; respirations deep <strong>and</strong> regular;<br />

myorelaxation was good; spontaneous recoveries were<br />

calm <strong>and</strong> began ~10 - 20 min after injection; Reversal with<br />

atipamezole was rapid.<br />

Redig &<br />

Duke [60]<br />

Langan [22]<br />

Jalanka [52]<br />

Jalanka [52]<br />

Jalanka [52]<br />

(K) 4.6 - 28.0 mg/kg / (M)<br />

93 - 500 mg/kg, IV<br />

16 avian species with 1 - 11 birds/species (60 birds total);<br />

the median dosage <strong>of</strong> ketamine was 8.2 mg/kg <strong>and</strong> the ~<br />

median dosage <strong>of</strong> medetomidine 250 - 300 mg/kg;<br />

Reversal with atipamezole<br />

Berthier<br />

[53]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Ketamine (K) /<br />

Medetomidine<br />

(Me) /<br />

Midazolam (Mi)<br />

(K) 7.3 - 11.2 mg/kg (10<br />

mg dose) / (Me) 36.5 - 56.2<br />

mg/kg (50mg dose) / (Mi)<br />

1.46 - 2.25 mg/kg (2 mg<br />

dose), IV<br />

Mallard ducks: 20 min duration; transient hypertension,<br />

bradycardia, <strong>and</strong> apnea; decreased respiratory rate after<br />

induction; resuscitation <strong>of</strong>ten required; survival risk;<br />

reversal with atipamezole, 0.25 mg, <strong>and</strong> flumazenil, 0.025<br />

mg, IV<br />

Machin<br />

[21]<br />

Ketamine (K) /<br />

Midazolam (M)<br />

(K) 10 - 25 mg/kg / (M)<br />

0.5 - 1.0 mg/kg, IM<br />

Pet <strong>Birds</strong>: (M) is short-acting & contraindicated when<br />

severe hepatic disease is present.<br />

Wheler<br />

[59]<br />

Ketamine (K) /<br />

Prop<strong>of</strong>ol (P)<br />

(K) 20 mg/kg, IM / (P)<br />

4.1 - 8.6 mg/kg (to effect),<br />

IV<br />

Pigeons (Columbia livia): ketamine followed <strong>by</strong> repeated<br />

doses <strong>of</strong> prop<strong>of</strong>ol provided ~ 3.5 min loss <strong>of</strong> muscle tone<br />

<strong>and</strong> pedal reflexes for each dose <strong>of</strong> prop<strong>of</strong>ol. Increased<br />

heart rate <strong>and</strong> decreased respiration within first minute<br />

after prop<strong>of</strong>ol administration. Apnea occurred after 62% <strong>of</strong><br />

the prop<strong>of</strong>ol incremental doses. Assisted ventilation was<br />

necessary to revive the bird if the apnea was prolonged.<br />

Budgerigars (Melopsittacus undulatus): no response to toe<br />

pinch within 5 min; anesthesia was effective for 45 + min<br />

2/14 birds died; one at 44 min <strong>and</strong> the other at 220 min<br />

after ketamine/xylazine administration. Reversal with<br />

yohimbine.<br />

Fitzgerald<br />

& Cooper<br />

[25]<br />

Ketamine (K) /<br />

Xylazine (X)<br />

(K) 40 mg/kg / (X) 10<br />

mg/kg, IM<br />

Heaton<br />

<strong>and</strong><br />

Brauth<br />

[16]<br />

(K) 50 mg/kg / (X) 4<br />

mg/kg, IM<br />

Goshawks (Accipiter gentilis): lethal dose!<br />

Lumeij<br />

[20]<br />

(K) 15 mg/kg / (X) 0.15<br />

mg/kg, IM<br />

Great Horned Owl (Bubo virginianus): immobilization<br />

noted within five min; transient apnea during initial 5 min;<br />

normal ventilation returned after 10 min Advise caution in<br />

using repeated doses due to an observed deterioration in<br />

cardiopulmonary stability. Supplemental oxygen improved<br />

cardiopulmonary performance.<br />

Raffe, et<br />

al. [19]<br />

(K) 50 mg/kg / (X) 4<br />

mg/kg, IM<br />

Pigeons: no satisfactory induction <strong>of</strong> anesthesia was<br />

observed at this dosage.<br />

Lumeij<br />

[20]<br />

(K) 4.4 mg/kg / (X) 2.2<br />

mg/kg, IV<br />

Red-tailed hawks (Buteo jamaicensis): adequate anesthesia<br />

for ~ 15 min <strong>of</strong> diagnostic or surgical procedures;<br />

significant respiratory <strong>and</strong> cardiovascular depression;<br />

reversal with yohimbine, 0.10 mg/kg, IV<br />

Degernes<br />

[14]<br />

(K) 5.0 mg/kg / (X) 1.0<br />

mg/kg, IV<br />

Ostrich (Struthio camelus) chicks (9 - 10 weeks): rapid<br />

induction; corneal reflexes remained present while pedal<br />

reflexes were lost in 3 <strong>of</strong> 4 birds for 2 - 7 min; anesthesia<br />

maintained with the use <strong>of</strong> alphaxalone/alphadolone<br />

G<strong>and</strong>ini,<br />

et al. [32]<br />

(K) 10 mg/kg / (X) 1<br />

mg/kg, IM<br />

Turkey vultures (Cathartes aura): Induction was observed<br />

in ~5 min <strong>and</strong> anesthesia (dorsal recumbency) lasted ~110<br />

min; good muscle relaxation was observed; reversal with<br />

tolazoline was rapid.<br />

Allen <strong>and</strong><br />

Oosterhuis<br />

[17]<br />

Ketopr<strong>of</strong>en<br />

5 mg/kg, IM<br />

Mallard ducks (Anas platyrhynchos): Thromboxane (TBX)<br />

levels significantly suppressed for at least 4 hr; pain<br />

responses were not assessed, so there was no correlation<br />

made between degree <strong>of</strong> TBX inhibition <strong>and</strong> degree <strong>of</strong><br />

analgesia.<br />

Machin et<br />

al., [56]<br />

2 mg/kg, PO<br />

Quail: pharmacokinetic study (poor predictor <strong>of</strong> NSAIDS<br />

efficacy); "extremely short" half life <strong>and</strong> low<br />

bioavailability (F= 23%) when administered orally.<br />

Graham<br />

[46]<br />

Lidocaine<br />

2 mg/kg, IV<br />

<strong>Birds</strong> > 2 kg: local anesthetic; st<strong>and</strong>ard formulary must be<br />

diluted prior to use to accurately measure usable volumes.<br />

Ludders<br />

[4]<br />

0.5 mg/kg, IV<br />

Chickens (Gallus gallus domesticus): Used to treat<br />

ventricular tachycardia causing an arrhythmia in one bird.<br />

Lukasik<br />

[23]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Medetomidine<br />

Metomidate<br />

Metomidate (M) /<br />

Diazepam (D)<br />

Midazolam<br />

2.0 mg/kg, IM<br />

2.0 mg/kg, IM<br />

~18 mg/kg (2 g dose), IM<br />

(M) 20 mg//kg, IM / (D)<br />

2.5 mg/kg, IV<br />

2.0 mg/kg, IM<br />

6 mg/kg, IM<br />

Amazon Parrots (Amazona spp.): Sedation characterized<br />

<strong>by</strong> laying on sternum <strong>and</strong> just able to support their head;<br />

birds could be placed in dorsal recumbency were they<br />

remained if undisturbed. If disturbed they would st<strong>and</strong> up,<br />

open their eyes, <strong>and</strong> lift their heads. A 1.5 mg/kg dose did<br />

not allow placing the birds in dorsal recumbency. An<br />

anesthetic state was not acheived. The sedation level may<br />

facilitate radiography, venipuncture, or beak <strong>and</strong> nail<br />

trims. Reversal acheived with atipamezole.<br />

Pigeons (Columba livia): Sedation was characterized <strong>by</strong><br />

laying on their sternums <strong>and</strong> just able to support their<br />

head; birds could be placed in dorsal recumbency were<br />

they remained if undisturbed. If disturbed they would<br />

st<strong>and</strong> up, open their eyes, <strong>and</strong> lift their heads. A 1.5 mg/kg<br />

dose allowed placing only 3 out <strong>of</strong> 4 birds in dorsal<br />

recumbency; the other pigeon remained st<strong>and</strong>ing. Reversal<br />

acheived with atipamezole.<br />

Red-necked ostriches (Struthio camelus) (two sub-adults):<br />

Darted; showed no signs <strong>of</strong> sedation or behavioral<br />

abnormalities<br />

Chickens: rapid tranquilization & loss <strong>of</strong> consciousness <strong>by</strong><br />

~ 1 min; pain reflexes remained but were diminished;<br />

duration <strong>of</strong> action was short, ~ 5 - 10 min; adverse<br />

reactions to M in 2/8 birds, one bird recovered after 1 min<br />

<strong>of</strong> apnea, the other died; respiration & blood pressure<br />

increased, while heart rate decreased after M admin;<br />

diazepam administered 10 min after M resulted in surgical<br />

plane <strong>of</strong> anesthesia for ~15 min in the majority <strong>of</strong> the<br />

birds; 3 birds’ pain reflexes were abolished; 2 birds never<br />

reached a surgical plane <strong>of</strong> anesthesia.<br />

Canada geese (Branta canadensis): moderate sedation at<br />

15 - 20 min; 1.0 mg/kg was inadequate for sedation;<br />

significantly increased respiratory rate at 10 - 30 min post<br />

injection; did not significantly affect blood pressure, heart<br />

rate, or temperature<br />

Quail (Colinus virginianus): induced heavy sedation<br />

(defined as being in dorsal recumbency with both wings<br />

easily extended) in 9/10 birds, <strong>and</strong> mild sedation in one<br />

bird; peak time to heavy sedation was at 10 min but ranged<br />

from 5 - 30 min; no arousal due to noise was observed.<br />

Dosages <strong>of</strong> 2 & 4 mg/kg were tested but the level <strong>of</strong><br />

sedation varied <strong>and</strong> inadvertent noise aroused the birds.<br />

Naloxone 0.02 mg/kg, IV Ratites to reverse Carfentanil, fair recovery<br />

S<strong>and</strong>meier<br />

[18]<br />

S<strong>and</strong>meier<br />

[18]<br />

Ostrowski<br />

[33]<br />

Christensen,<br />

et al. [10]<br />

Valverde<br />

[8]<br />

Day <strong>and</strong><br />

Roge [57]<br />

Cornick<br />

[34]<br />

Naloxone (N) /<br />

Diprenorphine (D)<br />

(N) 0.02 mg/kg, IV / (D)<br />

0.04 mg/kg, IM<br />

Ratites to reverse Carfentanil, good recovery<br />

Cornick<br />

[34]<br />

Naltrexone (N) /<br />

Yohimbine (Y)<br />

(N) 3.0 mg/kg / (Y) 0.125<br />

mg/kg, IV<br />

Ostrich (Struthio camelus): reversal <strong>of</strong><br />

Carfentanil/xylazine mixture<br />

Raath, et al.<br />

[31]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

Prop<strong>of</strong>ol<br />

4 - 12 mg, IV, for<br />

induction / 0.5 mg/kg/min,<br />

IV, maintenance<br />

Barn Owl (Tyto alba): induced anesthesia with 4 mg given<br />

in 1 mg boluses at 30-sec intervals; an additional 8 mg was<br />

given over the next 10 min due to bird’s response to feather<br />

plucking; a constant infusion <strong>of</strong> prop<strong>of</strong>ol was used to<br />

maintain a stable plane <strong>of</strong> anesthesia; transient decrease in<br />

SAP, DAP, <strong>and</strong> MAP observed immediately after<br />

induction; after infusion was stopped wing movement<br />

occurred within 5 min <strong>and</strong> ability to lift head up <strong>and</strong><br />

maintain sternal posture within 30 min; appropriate for<br />

short surgical procedures (in this case a tracheal resection)<br />

(case report).<br />

Mama, et<br />

al. [1]<br />

4.5 - 9.7 mg/kg, IV<br />

Chickens (Gallus gallus domesticus); maintained <strong>by</strong><br />

constant infusion <strong>of</strong> prop<strong>of</strong>ol, 0.5 - 1.2 mg/kg/min;<br />

arrhythmias common; significant respiratory <strong>and</strong><br />

cardiovascular depression; hypoxemia also common;<br />

narrow margin <strong>of</strong> safety, 3 times the induction dose was<br />

fatal.<br />

Mallard ducks; 1 to 4 mg IV bolus maintenance doses<br />

(0.7 - 4.5 mg/kg) at ~ 5 min intervals; apnea after induction<br />

bolus, but increased in respiratory rate with time; risk <strong>of</strong><br />

severe bradycardia; light plane <strong>of</strong> anesthesia; intraoperative<br />

analgesia required<br />

Ostriches (Struthio camelus); ketamine/medetomidine<br />

(preanesthetic) allowed sufficient sedation to place IV<br />

catheter; prop<strong>of</strong>ol induction & maintenance (0.2<br />

mg/kg/min constant rate infusion); apnea & bradycardia<br />

observed; anesthesia rated good<br />

Pigeon (Columbia livia): bolus dose produced a smooth,<br />

rapid induction, with good muscle relaxation, <strong>and</strong> loss <strong>of</strong><br />

voluntary reflexes lasting 2 - 7 min. Lethal Dose<br />

determined to be ~ 20 - 26 mg/kg if ventilation was not<br />

assisted.<br />

Wild Turkeys; maintained surgical plane <strong>of</strong> anesthesia with<br />

0.5 mg/kg/min <strong>of</strong> prop<strong>of</strong>ol, IV; apnea immediately after<br />

induction lasted 10 - 30 sec; risk <strong>of</strong> hypoxemia; smooth<br />

recovery<br />

Lukasik<br />

[23]<br />

7.3 - 11.2 mg/kg (10 mg<br />

dose), IV<br />

Machin<br />

[21]<br />

3 mg/kg (induction), IV<br />

Langan<br />

[22]<br />

14 mg/kg, IV<br />

Fitzgerald<br />

& Cooper<br />

[25]<br />

5 mg/kg (in 20sec), IV<br />

Schmacher<br />

[24]<br />

Thiopental<br />

20 mg/kg, intraosseous<br />

Chickens: time to induction was ~12 - 21 seconds; allowed<br />

intubation; increased respiratory rate; time to recovery ~<br />

13 - 20 min; failure rate for cannulation <strong>and</strong> induction <strong>of</strong><br />

anesthesia was 21% (3/14).<br />

Valverde,<br />

et al. [3]<br />

Tiletamine (T) /<br />

Zolazepam (Z)<br />

5 mg/kg, IM<br />

Great Horned Owls (Bubo virginianus): Induction times<br />

ranged from ~5.5 - 12 min; times to st<strong>and</strong>ing ranged from<br />

~60 - 77 min. Rapid decrease seen in heart rate within 2<br />

min after induction then remained constant. Respiration<br />

rates decreased for the initial 20 min <strong>of</strong> anesthesia.<br />

Inductions <strong>and</strong> recoveries were smooth.<br />

Kreeger, et<br />

al. [13]<br />

10 mg/kg, IM<br />

Great Horned Owls (Bubo virginianus): Induction times<br />

ranged from ~3.2 - 4.0 min; times to st<strong>and</strong>ing ranged from<br />

~81 - 95 min. Heart rates within first 2 min after induction<br />

remained higher than after a 5 mg/kg dosage but decreased<br />

over time. Respiration rates decreased for the initial 20 min<br />

<strong>of</strong> anesthesia. Inductions <strong>and</strong> recoveries were smooth.<br />

Total recover times ranged from ~210 - 283 min.<br />

Kreeger, et<br />

al. [13]<br />

2.3 - 5.8 mg/kg, IV<br />

Ratites: used to induce sternal recumbency; rapid <strong>and</strong><br />

smooth; 3.4 - 4.9 mg/kg for emus; 3.0 - 5.8 mg/kg for<br />

rheas; 2.3 - 4.0 mg/kg for ostriches<br />

Lin [30]


Drug Dosage (Dose), Route Species / Remarks Reference<br />

2.3 - 4.9 mg/kg, IV<br />

Ratites: induced with tiletamine/zolazepam; maintained<br />

with is<strong>of</strong>lurane, 1 - 4%; bradycardia & apnea observed;<br />

diazepam (0.21 - 0.41 mg/kg, IV) administered post-op to<br />

smooth recovery<br />

Lin [30]<br />

10, 15, 20, or 40 mg/kg,<br />

IM<br />

Red Tailed Hawks: None <strong>of</strong> these doses induced a loss <strong>of</strong><br />

consciousness.<br />

Kreeger,<br />

et al. [13]<br />

10 mg/kg, IM<br />

Screech Owls(2): Induction times ranged from 1.5 - 2.7<br />

min; time to first raise their heads ranged from ~60 - 63<br />

min. Total recover times were > 5 hours.<br />

Kreeger,<br />

et al. [13]<br />

Tolazoline<br />

15 mg/kg, IV<br />

Turkey vultures (Cathartes aura): to reverse the effects <strong>of</strong><br />

xylazine (see ketamine/xylazine combination above);<br />

regained consciousness in ~ 2 - 6 min; normal st<strong>and</strong>ing<br />

postures were observed in under 20 min but appeared to<br />

have a dull mentation <strong>and</strong> moderately sedated for 30 - 60<br />

min after administration.<br />

Allen <strong>and</strong><br />

Oosterhuis<br />

[17]<br />

Xylazine<br />

~1.1 - 1.3 mg/kg (150 mg<br />

dose), IM<br />

Ostrich (Struthio camelus) (n=1): darted; marked excitation<br />

but no immobilization <strong>and</strong> the bird was unapproachable<br />

Ostrowski<br />

[33]<br />

Xylazine (X) /<br />

Butorphanol (B)<br />

(X) 1.06 - 2.03 mg/kg / (B)<br />

0.10 - 0.14 mg/kg, IM<br />

Ostriches & emus: produced a calming effect; drowsy <strong>and</strong><br />

ataxic 10 - 15 min after injection<br />

Rheas: higher dosages <strong>of</strong> xylazine/butorphanol needed to<br />

produce a similar tranquilizing effect as seen in ostriches<br />

<strong>and</strong> emus; maintained on is<strong>of</strong>lurane, 1 - 5%; midazolam<br />

(0.15 mg/kg, IV) or diazepam (0.33 mg/kg, IV)<br />

administered post-op to smooth recovery<br />

Lin [30]<br />

(X) 2.26 - 2.75 mg/kg / (B)<br />

0.12 - 0.20 mg/kg, IM<br />

Lin [30]<br />

Xylazine (X) /<br />

Butorphanol (B) /<br />

Tiletaminezolazepam<br />

(Tz)<br />

(X) 1.06 - 2.21 mg/kg / (B)<br />

0.10 - 0.55 mg/kg, IM /<br />

(Tz) 3.5 mg/kg, IV<br />

Ratites: tranquilized with X/B; induced with Tz;<br />

maintained with 1 - 3.5% is<strong>of</strong>lurane; bradycardia & apnea<br />

observed; diazepam (0.13 - 0.40 mg/kg, IV) administered<br />

post-op to smooth recovery<br />

Lin [30]<br />

Xylazine (X) /<br />

Carfentanil (C)<br />

(X) 0.5 mg/kg, IM / (C)<br />

0.15 mg/kg, IV<br />

Ratites: Xylazine given prior to carfentanil. good induction<br />

allowing intubation; apnea, hypercapnia, IPPV needed;<br />

Cornick<br />

<strong>and</strong><br />

Jensen<br />

[34]<br />

Yohimbine<br />

0.11 mg/kg, IM<br />

Ostrich; used to reverse xylazine during a prolonged<br />

recovery period<br />

Lin [30]<br />

0.10 mg/kg, IV<br />

Red-tailed hawks (Buteo jamaicensis): optimal dosage to<br />

significantly reduce st<strong>and</strong>ing times after 20 min anesthesia<br />

with a 4.4 mg/kg ketamine <strong>and</strong> 2.2 mg/kg xylazine without<br />

causing pr<strong>of</strong>ound cardiovascular or respiratory responses<br />

Degernes<br />

[14]<br />

Yohimbine<br />

0.275 mg/kg, IM<br />

Budgerigars (Melopsittacus undulatus): reversal <strong>of</strong><br />

ketamine/xylazine combination. Significantly reduced<br />

recovery times indicated <strong>by</strong> a head lift, st<strong>and</strong>ing unaided<br />

without ataxia, <strong>and</strong> perching.<br />

Heaton<br />

<strong>and</strong><br />

Brauth<br />

[16]<br />

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