EXOTICS Camelid undergoing field

anaesthesia for a skin biopsy

Field anaesthesia in camelids LEAH BRADBURY

SOUTH American camelids, such as llamas and alpacas, can be challenging to manage in the field.
Not only are these animals unusual, they can also be very valuable. Although different anatomically,
camelids can be considered simply as small ruminants, such as goats and sheep, as they experience
similar problems under general anaesthesia (eg, regurgitation, profuse salivation and hypoventilation).
This article provides some basic guidelines for field anaesthesia of camelids for routine procedures,
such as castration, skin biopsies or abdominal ultrasound.

CONSIDERATIONS FOR ANAESTHESIA

Leah Bradbury
AND SEDATION IN THE CAMELID There are currently no licensed drugs for use in
graduated from
the University of
camelids. Medicines licensed for other species (eg,
Sydney, Australia,
Camelids are generally docile animals and tolerate small ruminants) should therefore be administered
in 1999. She worked
restraint well. Most animals are halter trained and do not under the prescribing cascade.
in mixed practice in
Australia and the overtly display signs of stress or pain, but will sit down
UK for three years
before undertaking if provoked or frustrated. However, animals that are not
a residency in used to being handled may kick, spit and vocalise.
anaesthesia and
critical care at Regurgitation under general anaesthesia in camelids
Liverpool. In 2006, is common and can be described as either passive or
she moved back
to Australia where
active. Active regurgitation occurs during a light plane
she is currently a of anaesthesia and is characterised by antiperistalsis of
senior registrar the oesophagus, which produces intermittent projectile
in veterinary
anaesthesia at regurgitation. Passive regurgitation occurs under a deep
the University plane of anaesthesia and is characterised by a continuous
of Melbourne.
flow of fluid from the mouth.
Fasting patients for between 12 to 18 hours will help
to prevent regurgitation, although fasting should be
avoided in very young patients. Some authors also advo-
cate that water is withheld for eight to 12 hours before
anaesthesia to reduce the amount of water in the rumen.
The choice of anaesthetic agent should also be taken into
consideration; for example, ketamine is thought to cause
less regurgitation than thiopental.
Excess salivation and foaming of saliva makes
endotracheal intubation difficult and may lead to
aspiration pneumonia if the airway is unprotected.
Anticholinergic drugs, such as atropine, are not recom-
mended as they may cause the saliva to become ‘ropey’
and may result in a number of adverse side effects,
including ileus. If an endotracheal tube has been placed
and the animal refluxes during anaesthesia, pulling the The animal’s head should be held up during field
anaesthesia to minimise the risk of regurgitation.
In Practice (2008)
partly inflated tube will help to clear debris from the Pulse oximetry can be used to monitor the oxygen
30, 460-463 pharynx and larynx. Camelids are also thought to be saturation

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obligate nasal breathers, so it is important to ensure a
patent nasal airway in recovery by placing a nasopha-
ryngeal tube as in horses.
As with ruminants, camelids placed in lateral or
dorsal recumbency are prone to bloat. Therefore, they
should be maintained in sternal recumbency for as long
as possible, which allows them to eructate. Abdominal
distension under anaesthesia results in increased pres-
sure on the chest and a decreased cardiac output.
Pulmonary ventilation under anaesthesia may be com-
promised, in which case oxygen supplementation is
recommended. A pulse oximetry probe will provide an
estimation of the patient’s oxygenation in the field and
can be placed either on the tongue, nasal septum, ear or
vulva. The saturation level of oxygen in the haemoglobin
should be at least 90 per cent. Placement of an
intravenous catheter

PHYSICAL EXAMINATION downward position. These valves can sometimes prevent

the catheter from advancing. In such cases, retract the
A routine preanaesthetic examination should be per- catheter slightly and inject saline while advancing the
formed by auscultating the heart and lungs, and evaluat- catheter again.
ing the pulse rate and quality, mucous membranes and
body temperature. Further examination or tests may be
carried out depending on the physical state of the animal ENDOTRACHEAL INTUBATION
or as a result of the preliminary examination.
It is easy to overestimate the bodyweight of camelids, Endotracheal intubation in anaesthetised patients is
especially those in full fleece, so, if possible, obtain an the best way to protect the airway from regurgitation
accurate bodyweight. As a rule of thumb, a large male and excess salivation. It is also the only way to supply
llama will weigh no more than 150 kg, while a large positive pressure ventilation in an emergency situation.
male alpaca would be no more than 90 kg. It is best attempted using a long-blade laryngoscope,
measuring 250 to 350 mm, with the animal in sternal
recumbency to prevent regurgitation.
VENOUS CATHETERISATION
Technique
Ideally, a catheter should be placed before the start ■ Ensure that the animal is adequately anaesthetised.
of any general anaesthesia procedure to facilitate the ■ Use bandage ties to open the mouth.
administration of intravenous fluids, medication, top-up ■ Spray local anaesthetic (eg, 1 to 2 ml of 2 per cent
agents or, more importantly, reversal agents and emer- lidocaine) on to the larynx and place the endotracheal
gency drugs. The jugular vein is usually used, although tube.
the medial saphenous vein can also be catheterised. ■ Confirm correct tube placement by checking for
Jugular catheter placement in camelids is difficult, as the expelled air at the end of the tube as the patient breathes.
vein cannot always be visualised easily and the skin is Stylets or guides can aid placement in more difficult
extremely tough. It is best to use the right side of the jug- cases.
ular vein to avoid inadvertent trauma to the oesophagus, Animals vary in size, so different lengths of endotra-
which, in the author’s experience, can lead to oesopha- cheal tube should be on hand (from 7 mm for a juvenile
geal trauma and potential stricture. The catheter should to 12 mm for an adult).
be placed in the cranial 5 to 10 cm of the neck where the
vein is most superficial and easier to visualise.

Technique
■ Clip the area with wide margins.
■ Locate the vein by drawing one line vertically from
the base of the ear and another one parallel to the hori-
zontal mandible. The jugular groove is approximately
situated where these lines intersect.
■ Surgically prepare the site and place a bleb of local
anaesthetic.
■ Make a small nick in the skin with a blade, ensuring
that both the dermis and epidermis are incised.
■ Place the catheter up or down the neck in the same
way as that employed for equine patients. If the vein is
difficult to locate, attach a heparinised extension set
with slight back pressure to help identify it.
Intubation in an alpaca
Camelids, like giraffes, have valves in their veins using a long-blade
to stop blood pooling in the head when the head is in a laryngoscope

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AGENTS FOR SEDATION
Monitoring
Drug Intravenous Intramuscular Comments

Xylazine 0·1-0·2 mg/kg 0·3-0·9 mg/kg Provides sedation and analgesia. Animals A patient’s respiratory rate should be monitored
may continue to stand with lower doses. during anaesthesia and is normally between 10 and
Lasts for 30 to 40 minutes. Care required
20 breaths per minute. If respiratory arrest is noted,
with ill or pregnant animals. Reverse
with 0·125 mg/kg atipamezole administration of all anaesthetic agents should
Butorphanol 0·05-0·2 mg/kg 0·05-0·2 mg/kg Provides sedation and analgesia. Animals be stopped. In addition, if not already intubated,
may continue to stand with lower doses the patient should be intubated and intermit-
Diazepam, 0·2-1·0 mg/kg – Mild sedation, recumbency. Lasts for 15 tent positive pressure ventilation instituted. All
midazolam to 20 minutes. Particularly useful in ill or
anaesthetic agents should be reversed, where
pregnant animals. No analgesia
possible.
Medetomidine – 0·01-0·03 mg/kg Provides sedation and analgesia. Animals
may continue to stand with lower doses. Heart rate can be monitored by auscultation of
Lasts for up to two hours. Care required the heart with a stethoscope or palpation of the
with ill and pregnant animals. Reverse
with 0·125 mg/kg atipamezole
pulse. Readily accessible pulses can be found on the
outside of the ear (auricular artery), ventral surface
Xylazine + 0·1-0·25 mg/kg 0·4 mg/kg 0·2 mg/kg of each agent given
butorphanol 0·05-0·2 mg/kg 0·1-0·2 mg/kg intravenously will produce good of the carpus (radial artery) and the medial surface
sedation for one hour of the hindlimb just above the stifle (saphenous
Butorphanol + 0·05-0·1 mg/kg – Results in recumbency in sick or pregnant artery). Heart rate varies from 40 to 100 beats per
diazepam 0·2 mg/kg animals. Lasts for 30 minutes

Atipamezole 0·125 mg/kg 0·25 mg/kg Used to reverse the effects of α2- agonists
(slow) Camelids often become recumbent when sedated,
which places them at greater risk of regurgitation. To
minimise this risk, keep the animal’s head raised and the
SEDATION body in a sternal position.
A reliable sedation protocol that can be used in
Sedation may be all that is warranted for a range of proce- healthy animals involves the intramuscular administra-
dures such as clipping of the coat for fibre, transabdomi- tion of 1 ml of xylazine (20 mg/ml) and 0·3 ml of butor-
nal ultrasound for pregnancy diagnosis or ear tagging. phanol (10 mg/ml) per 50 kg.
South American camelids will usually tolerate physical
restraint well in sternal recumbency. However, occasion-
ally, some form of intramuscular sedation may be war- GENERAL ANAESTHESIA
ranted. Preanaesthetic sedation may also minimise stress,
especially for catheter placement. For more uncooperative animals or those requiring
more invasive procedures, general anaesthesia may be
AGENTS FOR GENERAL ANAESTHESIA needed. Venous access can often be difficult to attain in
Drug Intravenous Intramuscular Comments
these species, so it is important that it is secured before
general anaesthesia is instituted. The author also recom-
Thiopental 5-15 mg/kg – Lasts for five to 10 minutes. Not suitable for
prolonged maintenance. Intubation essential
mends endotracheal intubation, as camelids are prone
to regurgitation and are at high risk of aspiration under
Ketamine 2·2-10 mg/kg 2·2-10 mg/kg Usually not used alone. Better at preserving
the larynx. Less likely to cause regurgitation. anaesthesia.
Analgesic A range of agents have been used to anaesthetise
Propofol 2-6 mg/kg – Provides good induction for a short time. Can be camelids successfully. A reliable combination for field
maintained at 0·4 mg/kg/minute for 60 minutes
with intubation. No analgesia
anaesthesia in a healthy patient is 4 ml of 20 mg/ml
xylazine, 1 ml of 10 mg/ml butorphanol and 10 ml of
Ketamine + 2·2 mg/kg – Administer diazepam one to two minutes before
diazepam 0·1-0·2 mg/kg ketamine or both together. Regurgitation possible 100 mg/ml ketamine, mixed together and administered
intramuscularly at 1 ml per 20 kg.

Gastric ulceration ANALGESIA

Camelids are prone to gastric ulceration, which is thought to be stress-related. The use of non-steroidal anti-inflammatory drugs car-
Minimising the time in hospital and the stress associated with treatment/man- ries the risk of ulcer formation in the third gastric
agement procedures, together with appropriate sedation, is recommended. compartment and owners should be warned to look for
Anti-inflammatory and analgesic agents should be given if the pain associated
with a condition is likely to cause stress. If prolonged hospitalisation or medica-
tion and handling are required, it is best to pre-empt this and treat animals with AGENTS FOR ANALGESIA

an antiulcer medication. Drug Dosage and route

Flunixin 0·5-1·1 mg/kg iv sid or bid

AGENTS FOR GASTRIC ULCERATION
Phenylbutazone 2·2 mg/kg po every 48 hours
Drug Dose and route Comments
Morphine 0·05-0·1 mg/kg im
Omeprazole 1·4 mg/kg po, 0·4-0·8 mg/kg iv Give po tid, or iv up to every two hours
Pethidine 1-5 mg/kg im only
Sucralfate 20-40 mg/kg po Give every six hours
Butorphanol 0·01-0·2 mg/kg iv or im
Misoprostol 10 µg/kg slow iv Side effects include disorientation and
collapse. Expensive Buprenorphine 0·01 mg/kg im

po Orally, iv Intravenously, tid Three times daily po Orally, iv Intravenously, im Intramuscularly, sid Once daily,
bid Twice daily

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castration. It is important not to exceed the toxic dose,
especially in young and low bodyweight animals.
minute, depending on the species, age and size of
■ LIDOCAINE. Total dose should not exceed 4 mg/kg.
the animal.
Onset is quick and anaesthesia lasts for 60 to 90 minutes;
Movement is the most reliable method of detect-
■ BUPIVICAINE. Total dose should not exceed 1 mg/kg.
ing the depth of anaesthesia in camelids. A light
Onset of action is slow (15 to 20 minutes), but anaesthe-
plane of anaesthesia is indicated by movement of
sia lasts for four to six hours.
the limbs or ears in response to stimulation, chew-
ing, spontaneous eye movement and active regurgi-
tation. Adequate depth is indicated by no limb, jaw
SUMMARY
or lower eyelid movement (a palpebral reflex of the
upper lid remains and there is a corneal reflex) and
Although chemical restraint of South American camelids
no active or passive regurgitation.
in the field poses a challenge, with an understanding of
Most equipment, apart from a veterinary sur-
their physiological and pharmacological differences
geon’s own senses, is not available for field anaes-
compared to other domestic species, it can be instituted
thesia. However, a battery-operated pulse oximeter
safely and can be rewarding.
may provide some information about a patient’s
Further reading
pulse rate and oxygenation status. CHRISTENNSEN, J. M., LIMSAKUN, T., SMITH, B. B., HOLLINSGHEAD, N. &
HUBER, M. (2001) Pharmacokinetics and pharmacodynamics of antiulcer
agents in llama. Journal of Veterinary Pharmacology and Therapeutics
24, 23-33
clinical signs such as acute recumbency, dullness or ano- DREW, M. L., RAMSAY, E., FOWLER, M. E. & KASS, P. H. (1992) Effect
rexia after administration. Opioids may cause ileus, but of flunixin meglumine and cimetidine hydrochloride on the pH in the
should nevertheless be used for more painful conditions. third compartment of the stomach of llamas. Journal of the American
Veterinary Medical Association 201, 1559-1563
FOWLER, M. E. (Ed) (1989) Anaesthesia. In Medicine and Surgery of South
American Camelids. Ames, Iowa State University Press
GARCIA PEREIRA, F. L., GREENE, S. A., McEWEN, M. M. & KEEGAN, R.
LOCAL ANAESTHETICS (2006) Analgesia and anesthesia in camelids. Small Ruminant Research
61, 227-233
REIBOLD, T. W. (2007) Ruminants. In Lumb and Jones’s Veterinary
Local anaesthetics may be used as anaesthetic-sparing Anaesthesia, 4th edn. Eds W. J. Tranquilli, J. C. Thurmon and K. A. Grimm.
agents, for example, to desensitise the testicles during Ames, Blackwell Publishing Professional. pp 731-746

In Practice ● SEPTEMBER 2008 463