So it's kind of a niche market, but there's some interesting facets which I hope to take you through. So, just a bit of background as to why. You know, I'm giving this talk.
I do. I work at the University of Tennessee, and one of our clients is is a large cat sanctuary which is located pretty close by. They have a decent number of large fieldids, most of which are tigers, anywhere up to about 300 cats.
And that's about a 30-minute drive from us at the university. So we work with them routinely, you know, once or twice a week at least. And probably anaesthetize, you know, 100 to 150 animals per year for exams or procedures, whatever they need.
So over over the 6 or 7 years I've been at UT, I've built up a decent amount of experience with them. And so I thought I'd share that with you. So they're about 2 days a week, you know, most of those cats are not trained for blood work or, you know, tail or leg presentation.
And they're mostly tigers, although, you know, they're interspersed with lions, servis, cougars, cheetahs. There's some other stuff there as well. But most of our work is, is with tigers.
So an outline for this webinar I'm going to go with some pre-consideration before you decide to sedate your large cat. And, you know, what you might want to take into account before you decide to go for it. And then I think after that, it's drug choices.
So you can use a decent number of variety of drugs. A lot of them will be safe and a lot of them will be effective. But I think probably it's worth having a really good think about what you're going to gain from the procedure before you decide to do it.
And certainly drug choices comes later on that list. And I, and I would like to talk about how we manage the patients in terms of monitoring support and different roles that people may have, and then obviously how to recover them safely, for you and people around them. So in terms of large non-domestic feeders, there's 8 species in 4 different genera, so cougars are in elis and there's clouded leopards are in Neopelli, lion, tiger, leopard, jags, snow leopards roll in Panthera.
I bolded tiger because that's the majority of this talk. We could do a separate one for different species, but you know, tigers are going to take precedent here, and then cheetahs are in their own, which is asinonics. It can be challenging to do, you know, as with, you know, what you might expect, we can't really examine these animals prior to sedation.
We can't also intervene unless they're fully sedated. And one of the worst things you can see is an animal that's having difficulty during either induction or recovery, whether that's vomiting, whether it's having a seizure, whether it's got its head or its legs stuck somewhere, and you can't go in there and help them unless they're fully sedated because it's dangerous for the personnel. So all those things have to be taken into account, as I said before you decide to sedate any of these animals.
The limited ability to examine them prior to means you may miss. You know, you just don't know about cardiac disease. You don't know about, you know, hemodynamics or anything that's going on with them.
So all those things need to be considered before. And risk versus benefit is something that we constantly talk about. What's the risk to that animal and what benefits are we going to get from that exam?
Make it a checklist is paramount importance. You know, the number of times I've had animals wake up or go home and then we forgot to do something. It's very frustrating, especially if it's an animal, you you you're struggling to get hands on.
Look at the age. So is it a very young or small animal, or is it very old? Is it geriatric?
You know, that might change your, your thinking and what to do. Estimate the weight. We have vet students that come through and it is incredible what they will guesstimate weights at.
I've had people guess 500 kg, . More for a tiger. The average tiger is probably a little less than 150 kg, and that's that's our general jump off point.
Obviously they vary within that, but the average adult tiger probably about 150. Think about the disease state. So is this a very acute disease process, or is it a chronic debilitating disease that, you know, might need multiple, sessions to work on?
And again, it goes back to risk and benefit. Is this something you can fix in one go? Is this something you're never gonna be able to fix?
You know, think about those things before you decide to go ahead with whatever procedure you've got going on. And think about what information you could get without sedation. So if this is a particularly friendly animal, like the cheetah, you know, they're pretty much the Labradors of the big cat world.
A lot of zoos have those as ambassador animals or hand-raised creatures, and you can, you can get a lot of information with those just, just by going in and hands on. You know, if you're comfortable, if it's safe, you can, you can, you know, help yourself to some info. Is it small enough you can scruff and do an exam on like this little tiger cub here?
You know, that's, that can obviously give you a good amount of information without sedation needed. Or can you just watch it? If you watch the big cats for long enough, they will invariably turn around, they'll invariably yawn and give you a good look at the teeth.
So you can do all those things and give you lots of information without actually getting hands on the animal without using medications. Videos are helpful as well. This is a cat, a male lion that was a rescue, and he was presented with some perceived neurological abnormalities, but you can see, you know, just doing a visual exam there, we can see wounds on him, and I'll just play that to you again.
If you watch him at the start of the video, he does kind of fall on his back legs, shows some ataxia when he turns around, just watch him there. So he's certainly got some weakness in the back end as well, something to consider, as to, you know, that may be the cause as to why he's got these lesions. And you can see also, he's got a lesion on his tail, and he's actually fairly skinny in his back end.
He's lost a lot of muscle mass on his back legs. You can see his, his, his hips are fairly prominent. So you use videos, use pictures to really get some information.
If you wait long enough, you can get a, a pee sample, and certainly poo samples are easy to get as well. So, all this is helpful, and all this might give you some clues into their disease process without ever getting hands on the creatures. If it's a trained animal, they may be trained for blood collection.
It's more common in zoos. You see, this animal is targeted to put its head down there and then take its tail out and we can get blood from a tail fairly easily, fairly safely. It's not a great vessel for large volumes, but you can get enough for a haematologist.
Biochemistry from that, from that site and you can see here the person is safe. They're outside the fence. The only bit this out is the tail, and they're away from the bitey end, and all those are pluses and so they will help in our diagnosis of this creature before we even move ahead with procedures.
And think about what facilities you've got. So here you've got, here's a tiger procedure within a den, a concrete den within a zoo. This is a, this is in a room with a radiology unit.
This is obviously a, you know, space to be outside, which, you know, some may consider a problem. And this facilities the concrete room is pretty small. There's a lot of people.
There's not many escape routes in that room. The picture at the bottom is from a clinic doing a root canal on a tiger. There's probably 8 or 9 people inside a tiny little room.
So think about that. Should the animal decide to wake up fairly quickly, always think about your escape routes, always think about what equipment you've got available and whether you can manage those animals effectively. And the picture on the right is a tiger UT going through a CT scanner.
Obviously this is the ivory towers, you know, with all the diagnostic tools we could use. So that's a, that's a great facility for us to be able to use. I know these facilities are great, but how you're going to transport them to and from places so you can put them on stretchers, you can carry them that way.
You can put them on trailers and drive them through safari parks or whatever you need to do. Be aware that's early in the anaesthesia, potentially they, they're potentially rousable. So be careful.
This is a lion that we actually FedExed. This is not a normal transport. I just thought I'd throw these pictures in.
So this is a lion getting FedExed to another zoo, driving up to the up to the airport and then getting FedEx to another place. So some more preconsideration you might want to do, you know, let's say you've decided to do the procedure. Fasten them for 24 hours is recommended.
The drugs we usually use include alpha 2 agonists, which generally produce nausea and vomiting, and that can be a problem if they've got food in the stomach. Think about the weather. If it's a non-emergency procedure and it's gonna be baking hot or freezing cold, maybe try and put it off to a better day if there's one coming up, you know, rather than just create those problems.
Think about how you're going to get the meds into the animal. So you know, could you pre-sedate it with some oral meds? Does it have to be a dart or remote injection?
Is it trained for a hand injection or would you use a pulse syringe and get it from a distance away? All those are options to get medications into them and all can have their uses depending on each situation. This picture here is the setup that we have with Tiger Haven at UT.
Obviously we do them routinely, so you know, we're fairly well set up. So this is a picture taken from inside. They come in these trucks and these what are called rolling cages, which most of these cats will load into, and then we can wheel them off and in and do whatever we need to do with access from kind of all all all points on that animal.
This is an animal for a hand injection. So you can see here I'm giving a hand injection of medications. The tiger's being distracted over here while we do that as long as you're, you know, fairly quick and don't put your arm all the way in.
That's great. Be prepared to jump if they turn around. Just don't jump backwards into this cat here that's waiting to grab me if I fall onto the fence, so be aware of that.
In terms of darts, there's two main muscle masses you can go for. There's either the shoulders or the back end. Tend to prefer the back end, you know, the kind of head end is always a little bit spooky.
You know, if you miss a bit to the left, you hit the head. If you miss to the right, you get the chest. You know, neither of those are great positions for darts to go into.
Whereas at the back end, if you miss one way, you just miss the animal, which is OK. Into, if you missed the cranially, you get the album, which of course is not great, but, . At least it reduces your chance of problems.
Also, the muscle mass tends to be bigger on the back end as well. And then after that we've decided to go ahead. It's it's the drug choices and obviously as with any anaesthetic protocol, it's a mixture of drugs in order to produce a balanced anaesthetic event.
So some sedatives, so alpha 2s we mentioned already, benzodiazepines are opioid derivatives, and then when I turn the knockdown drugs or the anaesthesia drugs, generally that's cyclohexamines. So I know you guys are all probably have some experience with these drugs, so yeah, I'll probably go fairly quickly over these rather than go to the pharmacology. But the alpha 2 agonists that we, that we think about or consider will be meatomidine, dexmeatomidine, and xylozine.
Now meatomidine and dexmeatomidine are effectively the same active drug. Dexamedatomidine just contains the Dex isomer, whereas meatomidine is a mixture of Dex and levo meatomidine. .
So it's the Dex meatomidine part of of meatomidine that's actually useful. Xylazine is obviously a different alpha 2. It's older and we don't like it as much in cats.
They tend to go down fairly well, but recovery can be rough, and we see a lot more nausea with with Xylazine than either metoidine or dex metoidine. And the availability of these drugs may vary country to country or facility to facility. And in the small animal medicine side, we obviously have Dexxamedomidine at 0.5 mg per mL.
The meatomidine we purchase from Zooarm and we get that at 10 mg per mL which allows us to use lower volumes, which is certainly faster for hand injections, which we do most of our cats with. We can antagonise those with alpha 2 antagonists. So atipiazole would be melatoidine or dexametlatoidine, and you can use yourhibe if you happen to use lazine.
So those, those two antagonists will take those drugs away. The benzodiazepines, midazolam or diazepam are the ones we normally reach for. Generally it's midazolam.
Zoazepam is is the active benzodiazepine within telazol or Zolatile depending on which country you're in, and you can take those away with flumazanil. So those are the benzodiazepines. The opioid derivatives might provide some pain relief, .
Certainly have other side effects as well, and butophennol or buprenorphine will be the the drugs that spring to mind for that. And you can you can antagonise those with naltrexone or naloxone. In terms of cyclohexamines, really, it's ketamine, that's our, that's our go to.
Telazol is available as well. We mentioned it in the last slide because it's the lazepam as well as teletamine, so it's a mixture of two drugs, ready to use. And there is a certain dogma that persists about using tlazol in tigers.
So I thought this was an interesting little case study just to talk about. So I don't know if anybody's heard about using tlazol in tigers or specifically, you cannot use tellazol in tigers. And so if you have, great, and if you haven't, and this is just a story, but way back in the, in the 80s, in the proceedings, there was, there was this comment from Dr.
Klein. That suggested that a tiger was ataxic a couple of days after, after sedation with Tlazol, which is, you know, just a kind of throwaway line. In a newsletter then that came out 10 years later, there's a couple of other reports of cats or tigers specifically that were immobilised with Tlazol and that showed ataxia or central nervous system disease and one cat that actually died during Tlazol immobilisation.
So now there's a couple of little reports, you know, kind of. You know, a tentative link between issues in Tigers and Tlazol. But in '99, it made it into a peer-reviewed journal that Telazur's contraindicated in Tigers, which was a big jump from the previous reports.
And then that advanced into a couple of textbooks, so the Fowler wild wild animal book and the zoo An anaesthesia book should not be given and contraindicated respectively, which obviously creates more problems. And then in the news he got more problems. So out in India there were collar and wild tigers and two died and they're due to steal us all and Then a couple of pet tigers out in Nevada near Vegas and two cats died and they used Thilazol as well.
And I think they got into trouble because in the literature it says Thilazol was contraindicated despite the fact it's not really based on anything, it was based on those previous newsletters we talked about. So then there was a large scale study, you know, looking at, how tigers and Thilazo became contraindicated, and it basically found that just over 1% mortality rate with Tlazol, which when comparison to other anaesthesia regimes was very similar. So the take home is for Tlazole, that reactions may occur, but it shouldn't really be contraindicated.
And it just persists through the dogma of literature today that it is. So it's, it's moving away. And I think if people have the choice, they tend not to use it.
I think it's forever being tainted. But in terms of peer-reviewed stuff, it probably should not be contraindicated. So we could talk a lot about different combinations.
I'm going to try and stick to the ones that we use primarily, and we generally use meatomidine, midazolam, plus minus ketamine, and I've got plus minus in there because there's some situations when I don't use ketamine, and they are basically if I just need a leg or a tail for a blood sample or I need the back end for a urine sample. I think the metatomini midazolam will produce a heavy sedation, and it's heavy, but it's rousable, so I tend not to go anywhere near the head and don't climbing with the animal with just those drugs on board. If I have to move the animal out, get it in the open, if I have to go near the head, I will definitely add ketamine on board.
For the smaller cats, snow leopards, cougars, cheetahs, and this is, this is a nice combination butophoro, meatomidine, midazolam. This really produces a very heavy sedation rather than a full anaesthesia, I think, but it's deep enough that they can be intubated. You can certainly use gas.
You can certainly move them around. And you know, people have tried this combination in big cats, bigger cats like lions and tigers and have problems. So I would, I would tend to steer away from it being used in the larger species.
So this is over at ET. This is a cat that's in on the table. You can see it's anaesthetized.
We've already got to wait for it after it came off. We've placed an intravenous catheter here. You can see someone's made a mess, and then we start to add monitoring tools and intubate it.
So just to talk through the process here, so you know we've used our melatoninium benazolam ketamine, determine the animal's safe to we pull up the rolling cage, which you can see behind and pulled the animal out. Start to place some monitoring equipment. So here obviously this is pre-COVID.
There's no masks around in life before COVID. You can see we've got a blood pressure cuff on the leg. We've got an ECG going over here, stethoscope, and this animal looks pretty comfortable.
There's some students and ECGs placed on this animal up here. Got a catnograph going here, probably not ready on this animal yet, but the top picture you can see a catnograph. Indirect blood pressure is an interesting thing.
I think it's fairly useful and as a guide and following trends. It's not always reliable when you compare it to arterial blood pressure. And actually, we've got some, some work coming out soon, looking at oscillometric blood pressure versus direct blood pressure in tigers, provided a fairly good agreement, when animals were normal or hypertensive.
So that'll come out at some point in the next few months, I think. Dairy blood pressure is obviously the gold standard for monitoring blood pressure in these animals, but it's not always really applicable. And I just wanted to talk a little bit about some research that we did, trying to get some pressures.
So if you go back to physics and med school, you know that mean arterial pressure is determined by both cardiac output and systemic vascular resistance. Both of these can be affected by the drugs reuse, which generally causes hypotension, and certainly in the field, we struggle to either know that and or manage it. So that's the equation again.
And what do people do if they find it's hypotensive, they generally give it a fluid bolus, which is reasonable and it works for a lot of things, but actually it's kind of interesting, and this is where this talk gets a little nerdy. So if you give it a flu bolus, you've got to think about this, which is the Frank Starling curve. I'm sorry if anybody's zoning out here, doesn't remember it, but we'll just go through it really quickly.
So we'll take the situation on the left. So on the left of this graph where we can see the response to the fluid bolus is fairly large. If this animal was here on the on the Frank Stirling curve, so load out on this orange line, the fluid bolus increases preload by x amount, depending on how many fluids go in, and that will push.
Push the stroke volume up and therefore increase mean arterial pressure because the purple line or the orange line is much more vertical. If your animal is further to the right on either the orange or the purple line, and you give it the exact same flu bolus, it has the same effects on preload because it's the same volume, but actually it it increases stroke volume by much less than if they were further left on this curve. So you don't know where your animal is on the Frank Starling curve.
So for that reason, flu bolus may or may not work to resolve a hypertensive animal. So just put that in the back of your mind and we'll just move on and we're going to come back to it in a second. But this is PVI, which is a new kind of monitoring tool we've been using over at UT, and it, and it can be found on a variety of new pulse oximeters, and it gives you this reading, which is plasmographic variability index, and it just goes on, you can see there's some numbers coming through here and there's a pulse rate, SPO 2 monitor, and you can see 5 on this machine.
That's a PVI. In PVI, people use it in humans to Basically predict where people are on the Frank Starling curve. And so they can use that PVI level to say they are going to be responsive to fluid therapy or the fluid bolus like we saw a couple of slides ago, or whether they're not.
In dogs, it's about 12% and in in humans it's about 14% and 12% being the PDI value, sorry. So we wanted to jump off from that and look for a correlation between PVI and blood pressure to see whether we could use PVI in the field to predict what kind of blood pressure these animals were under. So this is that you could ignore the column on the right, which is PI just concentrate on PVI.
What we found that when these animals were hypotensive, that mean PVI was 16, it fell away as their blood pressures increased. So we can, you can see 16 here. If you plot that on a graph, you've got mean arterial pressure on the y axis and PVI on the x-axis, and you can see as PVI increases, pressure decreases.
So can we jump off from that to give us a give us a blood pressure estimate based on PVI? You can see these are the three groups, so a hypertensive of the squares, no tensive of the triangles, and hypertensive of the circles, and those are the animals. What we could say was, we can take this little group here and say, hey, look, a PVI 18 is highly suggestive that that animal is With oops, It is within that blood pressure range of being hypotensive.
So what we ended up with was with the PVI of 18 suggests hypotensive. It didn't work as well for the lower pressures. So if you cast your eyes to the PVI column, the PVI axis, sorry, at 10.
And run your eyes up there. If you had a PVI of 10, it could be a circle, a triangle, or a square, which means it could be any of those blood pressure states. It's really hard to differentiate, but once you get over in this right in this lower right quadrant, it's really suggestive of being hypotensive.
So that paper is there if you're interested in going into more of it, and it should be noticed these were animals that were mechanically ventilated. So these are not free breathing animals. I think it's probably less useful when animals are free breathing, and that's certainly something that we're we're looking at next.
So back to less physics, intubation is relatively simple. The way I've, the way I've found it easier to do is to take the top jaw and really crank it backwards so the head is 90 degrees to the spine. If you pull it back that way, someone on the top jaw, someone someone pulling the tongue out, it really opens up that larynx and lets you, lets you integrate with a, a fairly, you know, decent degree of success.
Try not to stick your arms in. They they can be fairly reactive when you touch that larynx. It's a fairly It can be problematic, so try not to stick your arm and use a stylelet and intubate like that, probably a tiger.
18 size ET tube, 20 maybe if it's a big 1, 16 if it's a small female, something like that. And then do you do more monitoring. So here we are.
We have an arterial pressure line going in the dorsal pedal artery here in this picture on the right, and we have this animal on a ventilator. I think you've got to weigh up your procedure of how much monitoring you need, and that is often driven by how long the procedure is. So if you're going to do something very quick, if you're going to spend 20 minutes placing an arterial catheter, could you have just finished the procedure and woken the animal up?
If this animal is going in for a spay, it's gonna be asleep for 4 hours, then sure, place an arterial line. I think that's worthwhile. So look at your length of procedure and determine how comfortable you are with the monitoring tools you've got and what you want to place.
Obviously, the normal ones, we can do heart rate, respiratory rate, that we should go without saying. We can measure blood pressures which you've talked about. But then one other thing we should mention is blood gases.
So have a think about blood gases, specifically potassium levels. So we see in these big animals, we see hyperkalemia, climbing in large feids which are under sedation or anaesthesia. We haven't yet found a real predictive factor, despite the fact we've looked at a lot of anaesthesia charts and tried to find something that would predict this animal is going to happen.
I found an animal that has been OK for a procedure for 2 hours, you know, for another 2 hour procedure a month later it goes hyperkalemic despite it's the same animal and the same drug dosages. There's a couple of theories floating around. One of them here is that melatonin actually depresses insulin release, which causes a hyperglycemia, and because potassium and glucose can go through co-transporters, that leads to a hyperkalemic.
Situation. So that's a, that's an issue with the meatomidine. And we've kind of managed that by giving them little bumps of attipimazole or the antagonist to take that metatoidine away and manage it that way.
I think secondarily to that meatomidine and the effects on the vascular system. Leads to myopathies because perfusion is is reduced to muscles, especially in animal line on its back for two hours. And I think you get hyperkalemic from myopathies that way.
And that's something that I think we'd like to look at the change in muscle enzymes kind of as, as, as time goes by. So we monitor potassium through certainly long procedures, you know, that's that's a potential fatal complication. You might see tall peak T waves, T waves, sorry.
We've only seen these a couple of times. We've had animals with horrible potassiums and normal ECGs, which is kind of spooky, so don't just rely on ECG. That is the point on that one.
So what we do here is we take an initial blood sample and the animals goes down and we get a baseline potassium on that and then probably from there we take it at 1 hour and then about every 30 minutes to 1 hour after that, depending on how fast or how much it's changed. So if it starts at 3.5 and at 1 hour it's 3.6, I'll probably check it an hour later and see what it's doing.
If I start at 3.5 and at 1 hour it's already up to like 4.3 or something, then I then I institute more regular checks.
And we probably start antagonism, so that seems to be able to prevent it, whether that's through allowing the insulin release because you're taking meatomidine away or it's increasing perfusion because of all the vascular effects of meatomidine, I think it's probably a combination of the two. What I would say is if you fully antagonise the animal on the table, ketamine lasts about 45 minutes, and so you know, let's say you're doing this at 1 hour, the ketamine's gone. You take the melatoninin away.
You must have them on gas anaesthetic, and I keep them at or above at least 2 isofluorine and probably 2.5% because you've only got midazolam and isofluorine on board there. In terms of treatment, you can fully antagonise it, which we kind of mentioned.
We've definitely had some animals where we've given them dextrose and insulin to kind of drive down that glucose, as well as give them cal calcium gluconate because of the potassium effects on the cardiac structures. I've seen this twice. Animals that were severely hypoglycemic, and we've given fast acting insulin to at a fairly low dose, and for a couple of days after that, these animals have been in these hypoglycemic comma, which I can't explain other than their glucose is low and their insulin levels are normal because I checked those as well.
And One recovered and one did not. So now it's made me very wary about using insulin and, you know, kind of really careful about the potassium levels. And that's something I don't have a full explanation for the pathophysiology as to why the hypoglycemia, you know, 24 hours after a procedure when the insulin level is normal.
So there's a few papers out there on that as well, mostly from UT but from other places as well. This one looked at the biochemical and electrical electrolyte alterations in tigers and lions. So plasma, potassium, glucose, and phosphorus all increase with time, and I think time is a big factor in these things.
This one was a couple of jaguars out in Belize, and again, we're at 1.5 and 2 hours post starting and it's so you see changes in one animal. And again, this one looked at procedure duration attipa's administration and a significant interaction between time and attipamazole administration, and it showed that if we administer atipamazole, we can mitigate the rise in potassium.
And that paper actually had this graph in it, which is the most complicated graph I've ever seen, and I helped make it and I still don't really, you know, I still need a long time to understand it. I think there's a lot going on. So what I would recommend if you're really interested in this, take some time and look at this chart, but it involves the shading of the chart, the pluses and minuses, the time, and the etipa milligrammes and then this, these wavy lines of the potassium.
Values. So what I think the take home point is, you see high potassiums at 5, 5.5 and 6, they're all after 200 minutes.
And again, it really goes back to time being the big predictor of this, as to, as to how they become hyperkalemic. So here's a cheat sheet for that. For the graph And basically, the, the conclusion is amazole administration on rising potassium is dependent on both the dose of the amazole and time of administration.
So, bear those in mind and think about it, have a plan ready for whatever you might come across if you're sedating a cat for a longer amount of time. Some other complications you might see. So you might see vomiting or nausea and induction.
That's totally reasonable. It's an alpha 2 effect. Now you can make domestic cats sick with xylazine, so it makes sense.
You can make big cats sick with alpha 2s as well. I, I think fasting helps. We tried a little project with Cerenia where we would give the cats, or give the tiger yena the day before, a planned procedure.
And really didn't see any change in, in how much they vomited. So it's still, it's probably about 50% of them that we see that actually, you know, throw up whether it's just bile. Most of them show nausea to some degree, about 5 to 10 minutes after the injection.
We can see hyper or hypotension, see bradycardia or tachycardia, hypoventilation. We can see seizures. I've seen that once or twice during anaesthesia or during induction.
It's not very pretty. But those can all happen. So be prepared.
Obviously these anaesthetic complications are not specific to tigers, but they become more complex when it's a large cat that you're not able to go in with unless it's fully asleep. So during recovery, make sure you go through the checklist that I mentioned earlier. As I said, there's nothing worse than waking them up and then finding you haven't got everything done.
If you haven't already antagonised the alpha 2 agonist, you make sure that's complete. We don't normally antagonise the midazolam. Normally find there's no need.
I, I think you get a smoother recovery if that's still on board, but certainly if the animal is slow to wake up. . Low temperature will be the first choice.
Midazolam hanging around a bit too long would be another choice. So certainly use of flomazinil is, is recommended if you felt that was necessary. We maintain the airway as needed.
And you can see here these cats are asleep. These doors actually drop in and there's a little gap. It's called a tail protector.
So if they're normally awake, the tail can come out, it doesn't get trapped. We use it as an ET tube protector, so when the doors down, there's a gap and the ET tube can come out. And so we can put the pulse ox on the tongue and have that outside the cage.
My big tip here is you can see the ties are off from around these cats' ears, and the ties are there. Make sure they're not around the canines. I've had it a couple of times where people have tried to extubate, you know, the animals start to swallow or move its head, and they've tried to pull the tube and that tie is wrapped around the canines and it becomes a little bit of a problem just then.
So make sure those ties are loose. Make sure they're just against the tube, and then when you pull them, it's going to pull the whole thing. So normally I keep them here for a little bit, put them on room air as long as they're breathing OK, monitor the heart rate through a pulse ox, and you see that start to climb very slowly.
And then when you feel like it's ready, when they're, you know, breathing well, when they're starting to react to the tube, you can pull it. So if anyone's got any questions, I'm happy to take those. It's about 40 minutes.
And obviously it could go into lots more depth on other species that was primarily tigers, but hopefully that gives you a good indication of, you know, how you would go about anaesthetizing the tiger, and, and what complications you might see. So, thank you for listening. Reach out if you have any questions.
Thanks. Bye.