Clinical Care Programs - The Merck Veterinary Manual

Clinical Care Programs

Behavioral Training

Physical Restraint

Diagnostic Techniques

The mainstay of the zoo medical program is a qualified and dedicated keeper staff. The keepers know the individuals under their care and observe them daily. They are the first to recognize abnormalities such as anorexia, inactivity, abnormal feces, or changes in behavior that may reflect early medical problems. Overzealous reporting of observations is preferable to indifference. Because many zoo animals, especially prey species, instinctively conceal overt signs of illness until the disease process is well advanced, it is necessary to make keepers aware of the significance of what may seem to be trivial changes. Past associations with the veterinarian may arouse some animals’ responses to the veterinarian’s presence, which will mask subtle changes noticeable to keepers.

Once a diagnosis is made, the treatment of zoo animals is similar to that of domestic species except in the method of drug administration and restraint. A comparative medical approach is generally most successful and productive and utilizes application of medical or surgical information about diseases affecting free-ranging animals, related domestic animals, or humans. Frequently, human medical, veterinary, or dental specialists are consulted for advice or assistance with complicated medical or surgical cases. Knowledge of comparative anatomy, physiology, behavior, nutrition, pathology, and taxonomy is useful. Attention must be paid to both individual and population health.

Behavioral Training:

An active behavioral training program enables improved health care. Through positive reinforcement, amphibians, reptiles, birds, and mammals in zoo settings have been trained to perform behaviors on command that facilitate accomplishment of various management or medical procedures. Management behaviors include shifting on and off exhibit, onto scales, and into restraint devices or shipping containers. Medical procedures include urine collection, venipuncture, IM injection, tuberculin testing, and rectal or vaginal examination. Often these behaviors are incorporated into behavioral and environmental enrichment programs. Enrichment programs are designed to encourage animals to display more of their normal behavioral repertoire, eg, increasing opportunities for foraging or social interaction, which allows animals to spend their time more as they would in nature.

Physical Restraint:

Most zoo animals resent being handled and resist manual restraint. Struggling with an animal to administer treatment may do more harm than can be offset by treatment. Physical restraint is indicated in some species for minor manipulation or close observation. Restraint devices (squeeze cages) or chute systems are frequently used for difficult to handle, larger, or dangerous species. Many procedures can be performed on unanesthetized animals so confined, including limited physical examinations, tuberculin testing, administration of injections or anesthetics, collection of blood samples, trimming malformed claws or overgrown hooves, and application of topical medications.

While the dimensions and construction of these devices vary, some operate by movement of one wall to restrain the animal against the other. Openings are provided to allow safe access to the animal. Many restraint devices for hoofstock are designed with a “V” shape; once the animal enters, the floor is lowered and the animal’s body is restrained by the “V” with its feet suspended off the ground. Whenever possible, animals should be trained to enter or be enticed, rather than forced, into the restraint device. Ideally, these facilities should be designed as part of the animal’s regular quarters and located in an area where the animal is normally shifted as part of the daily routine. Exhibits should contain nest boxes or restraint pens equipped with doors that operate remotely to confine the animal. From these areas, the animal can be transferred to a restraint device, anesthetic chamber, or shipping container. Weighing facilities are essential.

Small mammals and birds may be caught and restrained in long-handled hoop nets. These nets must be deep enough that the animal can be confined in the blind end, with the upper part of the net twisted to prevent escape.

Personnel participating in capture or restraint procedures must understand their role and be aware of the behavioral characteristics and physical abilities of animals. This is essential to ensure safety of both animals and personnel. Heavy gloves protect handlers from teeth and claws when animals are manually held after capture. Care must be used to avoid excessive pressure on animals, because gloves hinder dexterity and the perception of the pressure being exerted. Gloves are also difficult to clean and can be a fomite for transmitting infectious agents.

Diagnostic Techniques:

The fundamental diagnostic technique is a good history and thorough visual and physical examination (often requiring anesthesia). Ease of sample collection for laboratory testing (CBC, biochemical profile, serology, cytology); fecal examination for parasites; urine for urinalysis; and aerobic, anaerobic, fungal, and viral culture is dependent on species anatomic differences compared with other more commonly treated species. Radiography and ultrasonography are commonly employed. Endoscopy, laparoscopy, and minimally invasive surgery are utilized when indicated. Computed tomography and MRI are less commonly utilized but also have a role in specific cases. Virtually any technique used for other species can be modified for use in zoo species.

Drug Administration:

Few drugs are approved for use in zoo species, but extra-label drug use laws allow drugs to be legally used in species for which they are not licensed. Providing quality medical care to zoo animals requires that medications be used without documented therapeutic benefit, dosage, treatment schedule, contraindication, and toxicity data in zoo animals. Therefore, extrapolation from what is known about these parameters in other species is necessary. When prescribing, these factors must be kept in mind if therapy is to be beneficial, especially with drugs that have the potential for organ toxicity. The different metabolic rates of various animals, eg, snakes vs birds, must be considered when extrapolating drug dosages. Antibiotic, antifungal, and analgesic treatments, as well as anesthetic dosages, are becoming less empirical due to increasing species-specific knowledge resulting from pharmacokinetics studies in zoo species. When using a drug on a group of animals for the first time, it is often wise to initially administer it to just one or two individuals. If no adverse effects are seen, the rest of the group can then be treated.

In general, zoo animals can be placed in metabolic groups. Dosages should be extrapolated within such groups when data are available. Dosages are generally higher in small animals and lower in large animals in the same metabolic group; an animal 15 times the size (body wt) of a smaller animal may require only half the dosage rate of the smaller animal when both belong to the same energy or metabolic group. If available, pharmacokinetic data for the species being treated should be consulted first.

Drug administration can be challenging. Oral medication has the advantage of minimal disturbance to the animal, but ensuring adequate individual intake may be a problem, especially when animals are housed in a group. Mixing the medication with favorite foods or treats is helpful. Oral antibiotics in hoofstock and other species can disrupt normal bacterial flora and lead to GI problems. Oral sedative or anesthetic administration can result in variable onset, duration, and depth of effect due to inadequate consumption or delayed absorption. IM injections with a hand syringe can be difficult unless a restraint device or other means of physical restraint is used. Remote IM injections may be made by firing a projectile syringe from a dart gun. However, these injections may be painful and may add the trauma of dart impact and injection, especially when delivering large volumes (eg, 10 mL) over long distances (50 m). Problems can be minimized through careful selection of the most appropriate drug and drug concentration, as well as the type of dart gun for the intended use. In addition, practice with projectile darts is mandatory before their use. Marksmanship, as well as familiarity with the weapon, is essential—such weapons in the hands of a novice can be fatal. Other less traumatic methods of IM injection, over shorter distance, include syringe poles or blow guns. Through behavioral training, it is also possible to administer IM injections through voluntary participation of the animal. IV therapy is generally restricted to anesthetized animals or those maintained in restraint devices or small enclosures for the duration of treatment.

Anesthesia:

Safe anesthesia of zoo animals is of special concern. Many procedures routinely accomplished on domestic animals with minimal restraint require anesthesia of zoologic species for the welfare and safety of both zoo animals and personnel. Prior to initiation of anesthesia in a zoo animal, the operator should be familiar with the species and choice of anesthetic agent. Anesthesia records for the individual, other specimens of the same species in the collection, or published references for the species should be reviewed. Consultation with someone knowledgeable in the field is advised, as there are great differences in effective drugs and dosages in the diversity of species in a zoologic practice.

Many factors influence an animal’s response to anesthetic drugs, including age, sex, stage of reproductive cycle, general nutritional status, and most especially mental state before drug administration. Variations may be marked between species as well as individuals and between different collections of the same species. An excited animal usually requires more drug and, once anesthetized, has a greater tendency to develop capture myopathy secondary to hyperthermia, respiratory depression, and acidosis. Capture myopathy can also occur in manually restrained animals and is more common in ungulates or long-legged birds (see Capture Myopathy of Wild Animals). Monitoring of anesthetized animals may include heart and respiratory rates, temperature, ECG, and blood oxygen saturation through pulse oximetry. Attention must be paid at all times to appropriate positioning and padding of anesthetized animals and extremes of environmental conditions to prevent secondary comlications.

The nature of an enclosure in which animals are to be anesthetized should be carefully considered before initiation of an anesthetic episode to minimize complications. For example, prey species that are darted may startle and hit fences or other barriers. In herd situations, the herd members may attack and injure or kill the darted animal as anesthetic induction begins (eg, ataxia).

Xylazine (an α₂-adrenoreceptor agonist) used alone produces adequate sedation in some ungulates, mainly bovids, to allow manipulative procedures. The sedative effects can be antagonized by administration of yohimbine, tolazoline, or atipamezole. Xylazine should not be used as the sole anesthetic agent in dangerous carnivores because they may appear sedated but can respond aggressively when stimulated.

The cyclohexamine ketamine (either alone or in combination with tranquilizers or sedatives such as xylazine or medetomidine) is a common anesthetic for small to medium-sized mammals, especially carnivores, primates, and some ungulates. A concentrated ketamine preparation (200 mg/mL) can be obtained from compounding pharmacies with a resultant decrease in the required injection volume. Combining ketamine with a sedative or tranquilizer speeds induction, minimizes excitement, increases muscle relaxation, and provides a smoother anesthetic induction and recovery than using ketamine alone. The ability to reverse the sedative effects of xylazine or medetomidine with the antagonists yohimbine, tolazaline, or atipamezole enables the use of a lower ketamine dosage and a more complete and rapid reversal upon completion of the procedure.

Tiletamine-zolazepam, a dissociative anesthetic-tranquilizer combination, is relatively safe in most species, has a rapid induction, and can be concentrated to 200 mg/mL to allow a small delivery volume. A disadvantage of this drug is that no complete antagonist exists; therefore, recoveries can be longer than with other drug combinations that can be completely reversed. It is commonly used for anesthesia of carnivores and primates.

The rapid onset and short duration of anesthesia induced by the sedative-hypnotic propofol renders it particularly attractive for use in zoo species. However, due to the necessity for IV administration, its use is limited to species such as reptiles, birds, and small mammals that can safely be manually restrained for drug administration. It is also useful as an adjunct anesthetic agent in large mammals first immobilized with another drug combination.

The potent opioids etorphine and carfentanil, alone or in combination with other agents (eg, acepromazine, xylazine, detomidine), have been used extensively for anesthesia of ungulates, elephants, and rhinoceros. The antagonist of choice for etorphine or carfentanil is naltrexone, a pure narcotic antagonist, which induces complete reversal when given at 100 mg of naltrexone per mg of carfentanil or etorphine. The reversal dosage of naltrexone can be given IV or IM, and in species prone to renarcotization after reversal, additional naltrexone may be administered SC. It can also be given IM 6-8 hr later by remote delivery to prevent renarcotization when the animal is not being observed. Accidental exposure of people to etorphine and carfentanil is quite dangerous. Therefore, they should only be used by trained, experienced personnel, and only after development of accidental-exposure protocols.

Various drug combinations (utilizing ketamine, telazol, medetomidine, detomidine, butorphanol, midazolam, diazepam, or xylazine) have been developed for specific species and purposes. Administration to novel species should be undertaken with care.

Isoflurane has become the inhalation anesthetic of choice for small mammals, birds, and reptiles. It is also used as a supplement to an injectable anesthetic or as an anesthetic maintenance agent to prolong anesthesia in virtually all species. Isoflurane is safe and potent and has minimal side effects, short induction, and quick recovery periods. Sevoflurane, if available, has the advantage of even shorter induction and recovery periods and may be preferred over isoflurane in some species. Small animals can be induced with a face mask or placed in an anesthetic chamber. Injectable anesthesia can be maintained or supplemented using a face mask, nasal cannulae, or intratracheal intubation depending on the species and anesthetic plane.

Regulatory Issues:

Collection, transport, and exhibition of wild animals requires compliance with local, state, and federal laws. Permits may be necessary to maintain these species. Institutions in the USA must comply with appropriate rules and regulations such as those of the USDA, United States Fish and Wildlife Service, National Oceanographic and Atmospheric Administration, and National Marine Fisheries Service. Some specific health requirements in the USA include compliance with the USDA’s Animal Welfare Act and Permanent Post-entry Quarantine regulations and the Centers for Disease Control and Prevention’s regulations governing importation of primates and maintenance of colonies of captive bats.

Zoonoses:

Free-ranging and captive wild animals may harbor zoonotic diseases that pose a potential health risk for those who work with these animals. Reptiles are commonly asymptomatic carriers of Salmonella spp . Avian species may be infected with Chlamydophila spp . Tuberculosis infections in mammals, especially primates and ungulates, can be transmitted from people or harbored and shed by animals to infect zoo staff. Many enteric bacterial or parasitic pathogens of primates can be transmitted to humans. Bats may be a source of Histoplasma spp or rabies. Carnivorous species of reptiles, birds, and mammals that consume uncooked meat-based commercial diets or whole prey may develop an asymptomatic Salmonella carrier state. Numerous zoo species, as well as feral domestic or native species on zoo grounds, may harbor Leptospira spp . Recognition of these zoonotic diseases and institution of procedures to minimize the disease risk to zoo staff and the visiting public are important components of a zoologic practice. Personal protective equipment (eg, disposable gowns, gloves, face shields) should be used as required by zoo personnel. Frequent hand washing is also recommended. (See also zoonoses, Zoonoses .)