SURGICAL PROCEDURES IN PINNIPED AND CETACEAN SPECIES

Apneustic anesthesia ventilation improves pulmonary function in anesthetized bottlenose dolphins (Tursiops truncatus)

Introduction

Use of mechanical ventilation during general anesthesia is a necessary practice in the anesthetization of small cetaceans as spontaneous ventilation fails to provide adequate gas exchange. Currently available methods of ventilation do not account for the intermittent breathing strategy of representative species within this infraorder of fully aquatic mammals and may have a significant effect on cardiac and respiratory physiology.

Methods

To understand the impact of mechanical ventilation on cardiopulmonary function in one small species of cetacean, the bottlenose dolphin (Tursiops truncatus), we compared controlled mechanical ventilation (CMV) to a novel ventilation method known as apneustic anesthesia ventilation (AAV). AAV simulates the normal inspiratory breath-hold pattern of dolphins. Ten anesthetic procedures (dental procedure, n = 9; bronchoscopy, n = 2) were performed on nine dolphins (age range: 10-42 years; mean = 32 years; median = 37 years; female = 3, 40%; male = 6, 60%). In a cross-over study design, dolphins were instrumented and randomly assigned to AAV or CMV as the initial mode of ventilation, then switched to the alternate mode. Baseline cardiopulmonary data were collected and again after 30 min on each mode of ventilation. Cardiac index, stroke volume index, systemic vascular resistance, alveolar dead space, alveolar-arterial oxygen tension gradient, arterial oxygen content, oxygen delivery index, and dynamic respiratory system compliance index were calculated at each of the four time points.

Results

During AAV, dolphins had higher arterial oxygen tension, higher mean airway pressure, reduced alveolar dead space ventilation and lower alveolar-arterial oxygen difference. Cardiovascular performance was not statistically different between the two modes.

Discussion

Our study suggests AAV, which more closely resembles the conscious intermittent respiratory pattern phenotype of dolphins, improves ventilation and pulmonary function in the anesthetized dolphin. Future studies should evaluate the cardiopulmonary effects of neutral buoyancy and cardiopulmonary sparing drug protocols to reduce the need for hemodynamic support of current protocols.

The Respiratory System of the Arctocephalus australis in Comparison to the Dog as a Land-Carnivore: Are There Adaptations to Marine Life?

Marine mammals are divided into three groups, with similar adaptations resulting from their aquatic lifestyle: sirenians, pinnipeds, and cetaceans. The present work focused on the South American fur seal, or Arctocephalus australis, a carnivore included in the pinnipeds group. We assessed whether the anatomical features of the Arctocephalus australis' respiratory system are comparable to those of other land-carnivores or whether these individuals show anatomical adaptations related to their ability to dive or their breath-holding capacities. We studied 11 cadavers of Arctocephalus australis, which included adult (n = 2) and juvenile (n = 9) individuals, by anatomically dissecting their isolated entire respiratory system. Although it is generally similar to that in land-carnivores, we demonstrated that the Arctocephalus australis's respiratory apparatus shows several specific characteristics. Therefore, our results are of great importance for clinical diagnostic and wildlife conservation purposes.

TOTAL EAR CANAL ABLATION AND LATERAL BULLA OSTEOTOMY (TECA-LBO) IN ATLANTIC HARBOR SEALS (PHOCA VITULINA CONCOLOR) FOR SUCCESSFUL SURGICAL MANAGEMENT OF OTITIS MEDIA

Chronic, severe otitis media was diagnosed in four Atlantic harbor seals (Phoca vitulina concolor), three of which were stranded animals undergoing rehabilitation. All seals presented with unilateral purulent aural discharge that would intermittently recur despite prolonged topical and systemic antimicrobial therapy. Aerobic culture from aural discharge isolated multidrug-resistant organisms in all seals, including Pseudomonas aeruginosa, Staphylococcus pseudintermedius, Klebsiella pneumoniae, and/or Enterococcus faecalis. Computed tomography was used in three cases to confirm otitis media and positive contrast ear canalography was used in one case to confirm tympanic membrane rupture. Given the persistent nature of otitis, surgical intervention in the form of a total ear canal ablation and lateral bulla osteotomy (TECA-LBO) was indicated. Surgery was successful in achieving complete clinical resolution of otitis in all seals. Postoperative complications included temporary unilateral paralysis of the left nare (2/4) and a transient left ptosis (1/4). Partial to complete surgical site dehiscence occurred in all cases; however, complete healing was achieved by second intention in 60 d or less. One rehabilitated seal was fitted with a satellite tag that confirmed normal swimming and diving patterns post release. In harbor seals, TECA-LBO can be performed safely to treat persistent cases of otitis media and should be considered in cases of chronic otitis that are not responsive to medical management.

In vitro evaluation and in vivo use of a novel surgical stent to minimize suture pressure necrosis

OBJECTIVE

To evaluate the efficacy of stents to distribute pressure when incorporated into tension-relieving sutures.

STUDY DESIGN

An in vitro study and case report.

ANIMAL

One common bottlenose dolphin (Tursiops truncates).

METHODS

Three novel silicone stents, a traditional stent, and a control were tested in vitro by using a suture simulator. Stent surface area was measured by using a pressure mapping sensor. Pressure was derived from the measured surface area and the downward force of the suture simulator. Novel silicone stents were also used in the closure of an incision in a bottlenose dolphin.

RESULTS

No difference was found in surface area or pressure among the three silicone stents (adjusted P > .05). Silicone stents yielded an average, 2.69 cm² more surface area and 842.37 kPa less pressure compared with the control as well as 1.67 cm² more surface area and 110.67 kPa less pressure compared with the traditional stent. The traditional stent yielded 1.02 cm² more surface area and 731.7 kPa less pressure compared with the control. Incision site and silicone stent assessment performed postoperatively revealed no obvious pressure necrosis.

CONCLUSION

Stents improved distribution of suture pressure, and novel silicone stents were more effective compared with traditional stents. Novel silicone stents appear to have preliminary clinical success in vivo.

CLINICAL SIGNIFICANCE

Our study provides evidence that stents effectively help distribute suture pressure, and their incorporation might minimize the risk of suture pressure necrosis. Novel silicone stents should be integrated into tension-relieving suture patterns when closing wounds and incisions, particularly in aquatic animals.

Treatment of Canine Tooth Fractures in the Northern Elephant Seal ( Mirounga angustirostris): Three Cases

The Marine Mammal Center (TMMC) in Sausalito, California, rescues, rehabilitates, and releases hundreds of stranded northern elephant seals ( Mirounga angustirostris) each year. Common causes for stranding include maternal separation, malnutrition, and trauma. Causes of trauma include shark bites, conspecific interactions, and anthropogenic factors. Several cases of fractured teeth, secondary to presumed trauma, are presented to the center each year. This case series describes surgical approach and treatment of 3 young northern elephant seals that were admitted to TMMC for rehabilitation with tooth fractures with pulp exposure of maxillary or mandibular canine teeth. All 3 seals were successfully released into their natural environment.

Bilateral Phacoemulsification in an African Elephant (Loxodonta africana)

A 37-year-old bull African elephant (Loxodonta africana) at the North Carolina Zoo (NCZ) was diagnosed with bilateral cataracts leading to behavioral changes and significant weight loss secondary to functional blindness. On initial examination, a weight loss of 234 kg, a mature cataract in the right eye, and a focal cataract in the left eye were diagnosed. Ultrasound and electroretinography (ERG) indicated normal retinal attachment and both eyes were viable candidates for surgery. After careful planning and behavioral training, the left cataract was surgically removed via phacoemulsification and irrigation/aspiration. The right eye subsequently developed a ventral lens subluxation, and phacoemulsification and irrigation/aspiration were performed six months after the first procedure. Four years after surgery, menace response, palpebral reflex, dazzle reflex, and pupillary light reflexes were present in both eyes. Body weight was 5,515 kg, 88kg more than at the time of the second surgery. This is the first published report of an African bull elephant undergoing bilateral cataract removal using phacoemulsification and irrigation/aspiration. The lack of significant postoperative inflammation and uneventful recovery of the elephant suggests that this surgical procedure along with proper preoperative planning and postoperative medical management can be a safe and effective treatment option for elephants with cataracts.

Surgical Management of a Chronic Neck Abscess in a U.S. Navy Bottlenose Dolphin

Surgical intervention on cetaceans is rarely performed due to challenges including general anesthesia and post-operative wound healing. This report describes the evaluation and treatment of an adult female bottlenose dolphin (Tursiops truncatus) with the US Navy Marine Mammal Program, with a chronic ventral cervical abscess caused by Candida glabrata. Despite aspiration and lavage along with multiple antifungal drugs, the patient developed inspiratory stridor with decreased performance level and surgical treatment was pursued. Under general anesthesia with the dolphin in dorsal recumbency position a 12-cm longitudinal ventral midline neck incision was used for exploration. Intraoperative ultrasound aided the identification of surgical landmarks and the abscess cavity. After adequate drainage and curettage, a closed-suction drain was placed in the surgical site. Retention sutures were used to close the incision and the external drain bulb was secured to a pectoral fin strap. One-year post-op, the dolphin was clinically normal and follow-up imaging showed no significant recurrence of the abscess. This case demonstrates a novel surgical approach of managing abscesses in dolphins, including placement and management of a negative suction drain in a submerged patient. The successful collaboration between veterinary anesthesiology, veterinary medicine, radiology, and general surgery allowed the patient to continue her normal activities as a full-duty service member.

Cognitive control of heart rate in diving harbor porpoises

Marine mammals have adapted to forage while holding their breath in a suite of aquatic habitats from shallow rivers to deep oceans. The key to tolerate such extensive apnea is the dive response, which comprises bradycardia and peripheral vasoconstriction. Although initially considered an all-or-nothing reflex [1], numerous studies on freely diving marine mammals have revealed substantial dynamics of the dive response to meet the impending dive demands of depth, duration and exercise [2]. Such adjustments are not only autonomic responses, but are under acute cognitive control in pinnipeds [3] living amphibiously on land and in water. The fully aquatic cetaceans would similarly benefit from cognitive cardiovascular control; however, even though they have exercise-modulated diving bradycardia [2] and full voluntary control of their respiratory system to such extent that even mild anesthesia often leads to asphyxiation [4], cognitive cardiovascular control has never been demonstrated for this large group of marine mammals. To address this, we tested the hypothesis that porpoises modulate bradycardia according to anticipated dive duration. Two harbor porpoises, instrumented with ECG recording tags, were trained to perform 20- and 80-second stationary dives, during which they adjusted bradycardia to the anticipated duration, demonstrating cognitive control of their dive response.

Optimal marine mammal welfare under human care: Current efforts and future directions

Marine mammals include cetaceans, pinnipeds, sirenians, sea otters and polar bears, many of which are charismatic and popular species commonly kept under human care in zoos and aquaria. However, in comparison with their fully terrestrial counterparts their welfare has been less intensively studied, and their partial or full reliance on the aquatic environment leads to unique welfare challenges. In this paper we attempt to collate and review the research undertaken thus far on marine mammal welfare, and identify the most important gaps in knowledge. We use 'best practice case studies' to highlight examples of research promoting optimal welfare, include suggestions for future directions of research efforts, and make recommendations to strive for optimal welfare, where it is currently lacking, above and beyond minimum legislation and guidelines. Our review of the current literature shows that recently there have been positive forward strides in marine mammal welfare assessment, but fundamental research is still required to validate positive and negative indicators of welfare in marine mammals. Across all marine mammals, more research is required on the dimensions and complexity of pools and land areas necessary for optimal welfare, and the impact of staff absence for most of the 24-h day, as standard working hours are usually between 0900 and 1700.

Intraperitoneal implantation of life-long telemetry transmitters in three rehabilitated harbor seal pups

BACKGROUND

Pinnipeds, including many phocid species of concern, are inaccessible and difficult to monitor for extended periods using conventional, externally attached telemetry devices that are shed during the annual molt. Archival satellite transmitters were implanted intraperitoneally into three stranded Pacific harbor seal pups (Phoca vitulina richardii) that completed rehabilitation, to evaluate the viability of this surgical technique for the deployment of life long telemetry devices in phocids. The life history transmitters record information throughout the life of the host and transmit data to orbiting satellites after extrusion following death.

RESULTS

Surgeries were performed under general anesthesia and a single transmitter was inserted into the ventrocaudal abdominal cavity via a 7-8 cm incision along the ventral midline between the umbilicus and pubic symphysis or preputial opening in each animal. Surgeries lasted from 45 to 51 min, and anesthesic times ranged from 55 to 79 min. All animals recovered well, were released into dry holding pens overnight, and were given access to water the following day. All three animals exhibited an expected inflammatory response, with acute phase responses lasting approximately three to four weeks. All three animals were tracked via externally attached satellite transmitters after release at 58 to 78 days following surgery, and minimum post-release survival was confirmed through continued movement data received over 278 to 289 days.

CONCLUSION

The initial findings of low morbidity and zero mortality encountered during captive observation and post-release tracking periods support the viability of this surgical technique for the implantation of long-term telemetry devices in phocids.

ANESTHETIC MANAGEMENT OF AN INDO-PACIFIC BOTTLENOSE DOLPHIN (TURSIOPS ADUNCUS) REQUIRING SURGICAL DEBRIDEMENT OF A TAIL ABSCESS

This report describes the anesthetic management of a 14-yr-old, 160-kg, female Indo-Pacific bottlenose dolphin ( Tursiops aduncus ) that underwent surgical debridement for a refractory subcutaneous abscess twice within a 6-mo interval. The animal was otherwise in good physical condition at each anesthetic procedure. Following premedication with intramuscular midazolam and butorphanol, anesthesia was induced with propofol and maintained with sevoflurane by intubation. During surgery ventilation was controlled. Blood pressure was indirectly estimated using either oscillometric or pulse oximetry. Presumed hypotension was managed by adjusting the sevoflurane concentration and infusion of dopamine. During recovery, the dolphin regained adequate spontaneous respiration following intravenous administration of flumazenil and doxapram. The dolphin was extubated at 85 min and 53 min after the first and second surgeries, respectively. Successful weaning from the ventilator and initiation of spontaneous respiration was the most important complication encountered. Establishment of a reliable blood pressure measurement technique is critical to success for anesthesia in this species.

Exotic Mammal Laparoscopy

Laparoscopy is an evolving field in veterinary medicine, and there is an increased interest in using laparoscopic techniques in nondomestic mammals, including zoo animals, wildlife, and exotic pets. The aim of this article is to summarize the approach to laparoscopic procedures, including instrumentation, patient selection and preparation, and surgical approaches, and to review the current literature on laparoscopy in exotic mammals.

APHAKIC PHACOEMULSIFICATION AND AUTOMATED ANTERIOR VITRECTOMY, AND POSTRETURN MONITORING OF A REHABILITATED HARBOR SEAL (PHOCA VITULINA RICHARDSI) PUP

A female harbor seal pup rescued along the coast of San Diego on 13 June 2012 was diagnosed with bilateral mature cataracts, apparently congenital, in association with vitreal herniation in the anterior chamber of each eye. The cataracts were surgically removed on 1 August 2012 with single-port aphakic phacoemulsification and automated anterior vitrectomy. Postoperative monitoring during the next several weeks indicated that vision had been functionally repaired and that she could visually orient to and capture live fish in three different environments and in the presence of other animals. Consequently, we equipped the seal with a satellite-linked radio transmitter and returned her to the Pacific Ocean on 21 November 2012, and then monitored her movements until radio contact ended on 2 March 2013. She remained along the San Diego coast from 21 November until 5 December 2012 when she relocated to the Coronado Islands and remained there until 26 December. She then traveled directly to San Clemente Island and remained foraging in the near-shore kelp beds there through 2 March 2013, when radio contact ended. To our knowledge, this is the first published report of cataract treatment in a marine mammal using high-frequency ultrasound to emulsify the lenses followed by suction removal of the emulsified microfragments (i.e., phacoemulsification). Moreover, the rapid postoperative recovery of the seal and its quick acclimation, orientation, navigation, and foraging in marine habitats after return to the Pacific Ocean indicates that these surgical procedures can be safe and effective treatments for cataracts in seals, with substantially reduced postsurgical complications relative to other types of lens fragmentation and removal procedures.