Resident Class of 1985
Thursday began just like any other Thursday of any other week, that is, until the mid-afternoon telephone call arrived. It was always an afternoon phone call but this time the tone of the caller betrayed urgency. A 19 year old 135 kg 238 day gestational primigravida was discovered to have vaginal bleeding. She was also a low land gorilla; in labor and in an ugly mood. In the next half-hour of discussion plans for emergent obstetrical and anesthetic coverage were laid out. Specific problems of monitoring, induction, maintenance, emergence, and post operative pain control were addressed. We would not lose this patient. Was I available for an afternoon cup of coffee?
I became involved with the Toledo Zoo in 1986 because of a life-long interest in wild animal medicine. Who hasn’t, even if for a fleeting moment, wanted to doctor lions and tigers and bears? Part of this work involves delivering anesthetics in suboptimal conditions. Part of this job means that you get dirtier and smellier than you could ever imagine. Once, I remarked to the Curator of Mammals, (after working on several primates,) “I smell worse than a baby elephant.” She laughed and shook her head from side to side “no - you don’t smell that bad yet!”
The best part of this job is that you meet people from the community who gather to aid sick or injured animals. Some of these people are in the health professions while others meet just to make sure the place runs. It’s a very interesting position indeed.
We take care of many animal species at the zoo and some of them have special management requirements. Luckily, most higher mammals are more similar than dissimilar to humans, and the old lessons learned in our basic biology and medical sciences studies apply themselves well to these circumstances. Anesthetic requirements for many higher animals are similar to human anesthetics as with the gorillas and mandrills. Many anesthetics consist of nothing more than intramuscular ketamine and a secure airway. I get involved when operative conditions dictate prolonged anesthesia on difficult or rare animals. Then we generally conduct inductions with narcotics and major tranquilizers which are administered intramuscularly followed by transport to the hospital facility.
No time is wasted sorting IV’s at this point, patients are either intubated orally under direct vision or manually using your left hand palpating the epiglottis and guiding the endotracheal tube while your right hand pushes it forward into the trachea. I would caution everyone not to attempt this type of maneuver on any animal until you can evaluate the sometimes slight differences between the well anesthetized wild animal and the marginal. A bite block in an animal’s mouth saved my hand once when I was in error. That’s when I learned, anesthetic depth is checked by tapping the animal with a broomstick between his eyes. If the broomstick is retrieved in one piece, he’s ready to intubate. Induction of anesthesia is many times the most challenging part of the exercise. After induction and intubation, the anesthetic maintenance is carried out with oxygen, narcotics and halogenated agents. Intravenous lines are started after intubation for further administration of agents as circumstances dictate. Muscle relaxants are generally not employed and the surgeons do not seem to miss them. They do not daIly about as they realize that the animals do better postoperatively when their anesthetic exposure is minimized.
The emergence phase can be a very exciting occasion, especially if the patient awakes prematurely, as they are usually dysphoric and ill tempered. When the operation is done, the anesthetic is deepened with halogenated agents and pure oxygen with the animal spontaneously ventilating through its endotracheal tube. A well orchestrated team effort across the zoo comes into play. The patient is placed on a large nylon tarp and removed to a waiting van, which is equipped with basic life support equipment. A brisk ride to the animal’s private living quarters is made with the way held clear by security personal and animal keepers.
Now the fun part comes. With suction on hand, the animal is placed in a “lateral tonsil portion” and we wait to extubate the patient in his quarters when he awakens. After extubation, we briskly exit his quarters, lock the door, and then wait the next 30 to 90 minutes to ensure successful emergence to preoperative status.
And that pregnant gorilla? Well, being how obstetrical anesthesia is at best unpredictable, she spontaneously delivered vaginally under the threat of benign intervention and that cup of coffee. You should have seen what we had planned for her.
Originally published December, 1988