Anesthesia of Pet Birds
Thomas G. Curro, DVM, MS
It is common for veterinarians who specialize in small
animals and species to be presented with pet bird
patients for procedures that require general anesthesia,
including complete physical examination, venipunc-
ture, diagnostic workup, or medical and surgical treat-
ments. The basic principles of anesthetic management
that govern mammalian anesthesia also apply to birds,
although specific anatomic and physiological differ-
ences must be considered. The goal of this article is to
present a, clinically applicable approach to pet bird
anesthesia, including preanesthetic considerations,
physical restraint, induction agents, anesthetic mainte-
nance, supportive measures, anesthetic recovery, and
management of anesthetic complications.
Copyright9 1998by W. B. Saunders Company.
Key words: Avian, anesthesia, Psittaciforme, Passeri-
forme, restraint.
eterinarians who specialize in small animals
V and avian species are commonly presented
with pet bird patients for procedures that re-
quire general anesthesia. T h e most c o m m o n pet
birds belong to two major orders. Passeriformes
include perching birds, such as canaries and
finches. Psittaciformes include a wide variety of
hooked-bill or parrot species, such as budgeri-
gars (mistakenly called parakeets), cockatiels,
conures, Amazons, cockatoos, African Greys, ma-
caws, and others. Less frequently, doves, pigeons,
quail, toucans, and poultry may be presented as
pet birds. Although this article will concentrate
on the Passeriforme and Psittaciforme species,
the basics of avian anesthesia apply to most bird
species.
Overview of Anesthesia in Birds
Anesthesia of birds may be required to per-
f o r m a complete physical examination, venipunc-
ture, diagnostic workup, and medical or surgical
therapy. In fact, many procedures may be less
From the Westside Family Pet Clinic, Dane County Humane
Society, Madison, WI.
Address reprint requests to Thomas G. C'u*~'o,D~CWI,MS, 4326
DeVolis Pky, Madison, WI53711.
Copyright 9 1998 by W. B. Saunders Company.
1055-937X/98/0701-0002508. 00/0
10 Seminars in Avian and Exotic Pet Medicine, Vol 7, No I (January), 1998:pp 10-21
stressful if p e r f o r m e d u n d e r general anesthesia,
rather than with physical restraint alone. As
anesthetic agents have evolved, so have avian
anesthetic techniques. Before the introduction
of safe inhalant anesthetics, injectable anesthetic
techniques were used for immobilization. Once
methoxyflurane and halothane were shown to be
safe and effective inhalant agents, their use in
veterinary medicine evolved to include birds.
Isoflurane has replaced injectable techniques, as
well as methoxyflurane and halothane, as the
most commonly used and safest general anes-
thetic agent for birds. T h e basic principles of
anesthetic m a n a g e m e n t are the same for birds
and mammals. Similarities and differences, de-
p e n d e n t on anatomy and physiology, will be-
come apparent as they are presented.
Preanesthetic Preparation
Before any anesthetic p r o c e d u r e in birds, a
complete history should include signalment,
environment, diet, immediate health problem,
past health problems, and past reactions to
handling and anesthesia. A complete physical
examination is desirable, but this may be the
reason that the bird is being anesthetized.
Fasting
Fasting recommendations for birds, even small
passerines, have varied from no preanesthetic
fasting to an overnight fast. 1-~ Because of the
high metabolic rate of birds, an extended fast
may be detrimental, as hepatic glycogen stores
can be quickly depleted. Birds larger than 300 g
are less p r o n e to hypoglycemia that could de-
velop during a p r o l o n g e d fast. A blood glucose
of <200 m g / d L is considered hypoglycemic in
most bird species.
Fasting is r e c o m m e n d e d to decrease the likeli-
h o o d of regurgitation and aspiration of food.
Ideally, a fast should be long e n o u g h to empty
the crop of its contents. 4 It is especially impor-
tant to empty the crop o f fluid contents, which
are easily refluxed during general anesthesia or
recovery. Frugivorous birds, such as iorikeets,
 Anesthesia of Pet Birds
which normally have a diet high in fluid content,
are especially susceptible to regurgitation and
potential aspiration. 5 I f an e m e r g e n c y situation
precludes waiting for the crop to empty, a small
feeding tube may be passed into the esophagus
a n d / o r crop to wick fluid by capillary action or
to directly aspirate fluid contents. I f passing a
tube would be an unacceptable stress before
anesthesia, a feeding tube m a y be passed after a
bird is induced and intubated to remove fluid
before diagnostic or surgical manipulation. If
crop surgery is to be p e r f o r m e d , fasting should
be long e n o u g h (4 to 6 hours) to e m p t y the crop.
It is a generally accepted practice to fast
healthy l~irds 1 to 3 hours before anesthesia. 5-s
Generally, the smaller the bird, the shorter the
fasting period. 4,9,1~ Small passerines, such as
finches or canaries, or i m m a t u r e birds of larger
species, should not n e e d m o r e than a 1 h o u r fast.
Larger birds (>300 g) will tolerate an overnight
fast (8 to 10 hours), but anesthesia should be
p l a n n e d for early in the day. An overnight fast is
reasonable, because most birds do not eat during
this time. I n d e p e n d e n t of the food fast, water
should be available until approximately 1 h o u r
before anesthesia in most species.
Physical Restraint
Before the administration o f preanesthetic or
anesthetic agents, the bird will n e e d physical
restraint. In the case of Psittaciformes, restraint
of the h e a d is i m p o r t a n t to prevent biting injury
to the handler. T h e most c o m m o n restraint
technique is to capture the bird with a hand-
covered towel, sized appropriately for the spe-
cies. L e a t h e r gloves should be avoided because
m a n y pet birds are hand-tame, and capturing
with a gloved h a n d may cause a bird to b e c o m e
hand-shy. Gloves also decrease tactile senses
n e e d e d to assess the extent of the restraint.
For restraint, one h a n d restrains the h e a d
while the other h a n d controls the b o d y (Fig 1).
Restraint of the h e a d begins by creating a ring
a r o u n d the bird's neck with one hand. Gentle,
but firm, pressure is used against the base of the
skull and lower mandible to extend the h e a d
away f r o m the body (Fig 2). This technique will
work with the largest macaw, when the size of the
h e a d may preclude small hands f r o m restraining
the h e a d directly. Passeriformes are c o m m o n l y
restrained with the bird cradled in the p a l m of
11
Figure 1. Preferred towel restraint technique for Psit-
taciformes.
the hand, a n d the head restrained between the
index and middle fingers.
It is not i m p o r t a n t to capture the bird in the
ideal position, but rather to capture the bird
quickly to avoid the stress of chasing the bird
a r o u n d the cage. D i m m i n g the lights in the
r o o m may facilitate capture. O n c e the bird is
captured, it can be m a n i p u l a t e d to a p r e f e r r e d
position. Birds breathe via m o v e m e n t of the
thoracic Cage, and restriction of the thorax by
the handler must be avoided.
Preanesthetic Medications
Preanesthetic medications are used to provide
c a r d i o p u l m o n a r y and central nervous system
(CNS) stabilization, physical restraint, sedation,
muscle relaxation, and analgesia, a n d / o r to
decrease the doses of concurrently used anes-
thetic agents. O f the n u m e r o u s medications that
can be used during the preanesthetic period,
fluids are the most important. Crystalloid and
colloid fluids aid in cardiovascular stabilization.
Preoxygenation may e n h a n c e homeostasis in the
respiratory-compromised patient. Steroids may
be used in the event of shock or CNS injury. It is
beyond the scope of this article to address all the
n o n a n e s t h e t i c p r e m e d i c a t i o n s in detail, al-
t h o u g h fluids will be discussed in a later section.
Preanesthetic medications are used infre-
quently in p e t birds. Although the use of anticho-
linergics as p r e m e d i c a n t s is rare, atropine and
glycopyrrolate are effective for the t r e a t m e n t of
vagally induced bradycardia. 11,12 Diazepam and
12 Thomas G. Carro
Figure 2. Preferred restraint technique for Psittacifor-
rues, demonstrating hand positioning without towel.
midazolam may produce sedation,5,7,1!-lB muscle
relaxation during ketamine anesthesia, ~2,~4 and
an anesthetic-sparing effect 15 in birds. Phenothi-
azine tranquilizers have been noted to be ineffec-
tive in birds, 11,16 although acepromazine has
b e e n used in combination with ketamine. 2,5,17
Opioid agents, such as butorphanol, have demon-
strated potential benefit in pet birds as sedatives
and analgesics, la,19 and their use will be discussed
u n d e r supportive therapy.
Induction
Intramuscular/IntravenousAgents
Historically, many injectable anesthetics have
b e e n used for immobilization and anesthesia in
birds, including barbiturates, chloral hydrate,
alpha chloralose, phenothiazines, dissociatives,
az-agonists, alphaxalone/alphadolone acetate 2~
and, more recently, propofol. 22,23Stable, uncom-
plicated levels of anesthesia are difficult to pro-
duce with these agents. T h e advantages of using
injectable anesthetics include ease of use in the
field, minimal need for technical equipment,
availability, ease of administration, rapid induc-
tion, and relatively low cost. Disadvantages in-
elude elimination that is d e p e n d e n t on bio-
transformation and excretion, dose-dependent
cardiopulmonary depression, potentially difficult
reversal of drug effects in an emergency situa-
tion, potentially p r o l o n g e d and violent recover-
ies, and lack of adequate muscle relaxation with
some drugs. Propofol use for induction and
maintenance in chickens is associated with signifi-
cant adverse cardiopulmonary effects, and can-
not be r e c o m m e n d e d for use in pet birds. 23
Injectable agents may be administered intramus-
cularly (IM) (pectorals), intravenously (IV) (jugu-
lar, cutaneous ulnar, medial metatarsal), or in-
traosseously. 24 Catheterization is r e c o m m e n d e d
for IV or intraosseous administration, and accu-
rate body weight is essential for calculation of an
injectable anesthetic dose.
Combinations of ketamine with diazepam,
midazolam, or xylazine p r o d u c e restraint to light
surgical plane anesthesia, d e p e n d i n g on dosage.
Ketamine alone usually produces inadequate
anesthesia, and recoveries are often violent. Com-
bining ketamine with diazepam or midazolam
provides muscle relaxation and sedation, and
reduces the degree of struggling on recovery, a,l~
Benzodiazepines are r e c o m m e n d e d because they
produce minimal adverse cardiopulmonary ef-
fects. A tiletamine (dissociative) and zolazepam
(benzodiazepine) combination (Telazol; Fort
Dodge Laboratories, Fort Dodge, IA), provides
effects similar to ketamine and diazepam, with a
longer duration of effect.
Ketamine combined with xylazine is a com-
monly reported injectable regimen for birds. 6,12,
17,25-29Xylazine also improves anesthetic recovery
and provides sedation and analgesia when used
in combination with ketamine. Unfortunately,
xylazine has p o t e n t cardiopulmonary-depressive
effects, which are not compensated by the effects
ofketamine. Sun Conures have been n o t e d to be
less tolerant of an xylazine-ketamine combina-
tion compared with other pet birds. 2vA benzodi-
azepine-ketamine combination is the best choice
when an injectable anesthetic technique must be
 Anesthesia of Pet Birds
used in a cardiopulmonary-compromised pa-
tient.
T h e potential for severe cardiopulmonary
depression may be minimized by administering
injectable agents in multiple small boluses (or as
an infusion), titrated to effect, rather than as a
single large bolus, especially when the IV or
intraosseous route is used. 7 Current r e c o m m e n -
dations are that injectable anesthetics be used in
pet birds only when an inhalant anesthetic,
particularly isoflurane, is unavailable. Ideally,
isoflurane anesthesia should be used in all situa-
tions o f debilitation, or when a prolonged dura-
tion of anesthesia is required.
If injectable anesthesia is unavoidable, appro-
priate agents include ketamine combined with
e i t h e r xylazine, diazepam, midazolam, or
acepromazine (Table 1). Medetomidine (Domi-
tor; Pfizer Animal Health, Exton, PA) with ket-
amine has also been reported, but is less com-
monly used than the other combinations at this
time. Tiletamine/zolazepam is an effective inject-
able anesthetic combination (7.7 to 26.0 m g / k g
IM). When referring to Table 1 dosages, the
high-end dosage is used for smaller birds (<250
g), or when a surgical plane of anesthesia is
desired in larger birds. The low-end dosage is
used in larger birds (>250 g) or when only
sedation is desired in smaller birds. Induction
occurs in 5~to 10 minutes and complete recovery
may take 2 to 4 hours or longer.
Antagonists
Antagonism of anesthetic agents is beneficial,
especially when anesthetic emergencies develop
or when duration of anesthesia is prolonged.
Yohimbine and tolazoline have been used to
reverse the effects of xylazine. 12,26 T h e sedative
and respiratory-depressant effects of xylazine
can be successfully reversed with yohimbine (1
m g / k g IM). Opioids, of which butorphanol has
Table 1. Common Ketamine Combinations and
Dosages Used for Pet Bird Injectable Anesthesia
Drug Combined
Ketamine With Ketamine
Drug Combination (mg/kg) (mg/kg)
Ketamine/xylazine 10-50 1.0-10.0
Ketamine/diazepam 10-50 0.5-2.0
Ketamine/midazolam 1040 0.5-1.5
Ketamine/acepromazine 10-25 0.5-1.0
13
demonstrated potential analgesic and sedative
effects in pet birds, can be reversed with the pure
opioid antagonist, naloxone (0.3 mg/kg). Gener-
ally, reversal of opioids should only be d o n e as an
emergency treatment of severely depressed birds,
because reversal will also reverse analgesia. Diaz-
epam and midazolam are antagonized with fluma-
zenil, a pure benzodiazepine antagonist.
Inhalation Agents
Historically, ether, 3~ methoxyflurane, 3234
halothane, 9,3~ and isoflurane have been used for
inhalant anesthesia in birds. Nitrous oxide has
also been used in combination with other inhal-
ants. Ideally, an inhalant should provide rapid
anesthetic induction and recovery without pro-
ducing p r o f o u n d cardiopulmonary depression
or organ toxicity.
Isoflurane is currently the p r e f e r r e d agent for
general anesthesia in pet birds. This inhalant is a
clinically proven safe, and effective anesthetic
agent. Its potency has b e e n evaluated based on
minimum anesthetic concentration (EDs0) stud-
ies in waterfowel, cranes, pigeons, and Psittacifor-
rues. 15,19,~6,37 Because o f isoflurane's low blood
solubility and minimal metabolism (<0.2%) and
the efficiency of avian respiratory gas exchange,
induction, changes in anesthetic depth, and
recovery are easily and quickly controlled. At
sedative and light surgical planes of anesthesia
with isoflurane, adverse cardiopulmonary effects
are minimal, although certain species seem par-
ticularly sensitive to the respiratory-depressant
effects.
Isoflurane concentrations of 4 to 5 vol% are
used for mask induction and must be reduced
when signs of sedation and anesthesia b e c o m e
apparent. Minimum anesthetic concentrations
for maintenance in the intubated bird will aver-
age 1.45%. If maintained with a mask, concentra-
tions may be 25% to 30% higher, unless the mask
fits snugly. Surgical plane anesthesia will gener-
ally require isoflurane concentrations of 1.80%
to 2.20% and potentially higher. Because of the
dose-dependent respiratory depression of isoflu-
rane, ventilation should be assisted or con-
trolled, especially during p r o l o n g e d procedures.
Inhalation Agent Delivery
Nonrebreathing, semiopen anesthesia circuits
are r e c o m m e n d e d for inhalant delivery. The
14
advantages of these systems are low resistance to
breathing and immediate changes in the deliv-
ered anesthetic concentration when the vapor-
izer setting is changed. Disadvantages are that
the required high oxygen flow rate wastes oxy-
gen and anesthetic, produces excessive environ-
mental pollution, and also causes significant
patient cooling due to inspiration of cool dry
gas.
Various configurations of n o n r e b r e a t h i n g sys-
tems have been used. T h e Bain anesthesia circuit
is commonly used because o f its low cost and
weight. Small rebreathing bags (89L) are commer-
cially available, or may be fashioned from bal-
l o o n s Y An effective anesthetic gas scavenger
should always be used with inhalant anesthetic
systems to minimize h u m a n exposure to waste
gas pollution:
Anesthesia is induced with the head physically
restrained and placed in an anesthetic mask
attached to the nonrebreathing circuit. Masks
may be purchased commercially, or constructed
from various sized plastic tubing or syringe
casings and a latex diaphragm (exam glove).
Equilibrating the circuit with inhalant before
patient exposure (priming) has b e e n advo-
cated, 27 but is unnecessary because the high
oxygen flow rate (>1.0 L / m i n ) quickly delivers
the desired induction concentration. Priming
also contributes to waste gas pollution. Once the
bird is restrained in the mask, the desired concen-
tration of anesthetic is delivered by one of two
protocols. The first m e t h o d begins at low inhal-
ant concentrations and proceeds to higher con-
centrations as anesthetic effects deve!op, allow-
ing rapid reversal of anesthesia if complications
arise. This protocol has b e e n suggested for
debilitated birds because of less likelihood of
overdosing. Unfortunately, the low-to-high proto-
col requires longer physical restraint and stress
time, which can be especially detrimental to a
debilitated bird. The benefit must be c o m p a r e d
with this risk, with the goal being to avoid both
overdose a n d / t h e stress associated with slow-
onset anesthesia. The p r e f e r r e d protocol begins
with a high (4% to 5% isoflurane) concentration
of inhalant, which is decreased as clinical signs of
anesthesia b e c o m e apparent. The key to this
m e t h o d is close monitoring of clinical signs and
an appropriate and timely decrease in inhalant
concentration delivered. Sedation usually occurs
within seconds, and a light surgical plane of
Thomas G. Curro
anesthesia within minutes. This protocol has
been shown to work safely on healthy, as well as
debilitated, birds.
Once a light surgical plane of anesthesia has
b e e n induced, the mask should be removed, the
bird intubated, and the endotracheal tube quickly
connected to the delivery circuit. Continuous
delivery of inhalant anesthetic is necessary to
prevent wakening, especially during the induc-
tion phase. The vaporizer setting should then be
adjusted to an appropriate concentration to
maintain a stable plane o f anesthesia.
Maintenance
Intubation
Endotracheal intubation provides airway ac-
cess for the delivery of oxygen and anesthetic
gases and an effective route for delivery of
manual or mechanical ventilation. The endotra-
cheal tube also protects the airway from aspira-
tion of secretions and refluxed gastrointestinal
contents.
For an endotracheal tube to p e r f o r m these
functions properly, a sealed airway is required,
which cannot be achieved with either an un-
cuffed or an uninflated cuffed tube. Endotra-
cheal intubation with cuffed tubes is recom-
m e n d e d for use in birds despite the presence of
complete cartilaginous tracheal rings in all spe-
cies. The cuff must be carefully inflated just
e n o u g h to prevent leakage when 10 to 15 cm
H 2 0 pressure is applied to the airway.
The size of the bird will dictate the size of
endotracheal tube used. T h e smallest available
cuffed tubes have an internal diameter (ID) of
3.0 mm. Psittaciformes as small as 350 g have
b e e n intubated with a 3.0 ID tube. Birds smaller
than this will require the use of uncuffed tubes or
large gauge IV catheters. Birds as small as 100 g
may be intubated with these smaller tubes. Care
should be taken when catheter-sized tubes are
used, because they will not provide a sealed
airway and may easily b e c o m e plugged with
secretions, mucus, or blood. Also, the resistance
to gas flow through small catheters is high, which
may significantly impede both spontaneous and
manual ventilation. Use of Murphy tubes, which
have a side opening as well as an end opening,
decrease the chance of mucus occlusion. Airway
patency should be checked regularly during
general anesthesia. Birds smaller than 100 g are
 Anesthesia of Pet Birds
best m a i n t a i n e d with a mask. I f a mask is used to
maintain anesthesia, m o u t h gags fashioned f r o m
p a p e r clip wire have b e e n used to keep the fleshy
tongues of certain avian species from obstructing
the glottis.
Most birds are easy to intubate. T h e y lack an
epiglottis and the glottis is located o n the mid-
line at the base of the tongue (Fig 3). To visualize
the glottis, the tongue is gently grasped a n d
pulled forward with a forceps, or the tongue is
pressed against the mandible with a cotton-
tipped applicator. An endotracheal tube, spar-
ingly lubricated, is then gently inserted directly
into the trachea, and secured to the maxilla with
tape. Endotracheal tube length should only ex-
tend caudally beyond the thoracic inlet a n d
rostrally past the e n d of the b e a k no m o r e than
the length of the endotracheal tube adapter. T h e
latter will minimize the dead space attributable
to the endotracheal tube.
In the event of airway obstruction, or to
p e r f o r m procedures of the h e a d or oral cavity,
inhalant anesthetics may be administered into
the air sacs. Percutaneous catheters for inhalant
administration may be placed in the clavicular,
caudal thoracic, or a b d o m i n a l air sacs, and the
p r o c e d u r e for catheter p l a c e m e n t has b e e n de-
s c r i b e d 9 ,4~ Briefly, a skin incision is m a d e over
Figure 3. Demonstration of
the bird glottal opening be-
fore endotracheal intuba-
tion.
15
the desired p l a c e m e n t site, the air sac m e m b r a n e
is exposed, a sterile catheter is passed into the air
sac, and the skin incision is closed to secure the
catheter in place. Effective ventilation and deliv-
ery of gases can be administered through air sac
catheters. Caudal thoracic or a b d o m i n a l air sac
catheters are p r e f e r r e d because gas delivery at
these sites better mimic the general flow of gases
t h r o u g h the avian respiratory system. Oxygen
and anesthetic gases flow f r o m the cannulated
air sac and exit t h r o u g h the trachea. Unfortu-
nately, scavenging of waste gases is not practical
when this technique is used.
Supportive Therapy
Positioning/ThermalSupport
Positioning of the avian patient during anes-
thesia depends on the p r o c e d u r e being per-
formed. Birds are usually positioned in either
lateral or dorsal recumbency. W h e n positioning
an anesthetized bird, it is critical that unre-
stricted m o v e m e n t of the thoracic cage be main-
tained. Because birds lack a diaphragm, ventila-
tion is achieved by the expansion and contraction
of the thoracic cage. If this m o v e m e n t is im-
peded, hypoventilation will be significant. A1-
16 Thomas G. Curro
though one r e p o r t indicated that birds in dorsal
r e c u m b e n c y hypoventilate, 41 it evaluated heavy-
bodied poultry that, because of their body con-
figuration and thoracic musculature, could not
ventilate adequately. Anesthetized, spontane-
ously breathing cockatoos have been studied in
dorsal recumbency for up to 7 hours without
development of significant hypoventilation.~9
Special padding is not n e e d e d for pet birds; in
most cases, a soft towel is adequate. If more rigid,
sustained positioning is needed, a c o n f o r m i n g
body pad may be used.
Maintenance of normal body temperature
during anesthesia is extremely important in pet
birds. Hypothermia reduces anesthetic require-
ments, increases the potential for cardiac instabil-
ity, and prolongs recoveryY The n o r m a l body
temperature for birds ranges from 40 to 44~
Because of their small size and high body surface-
to-volume ratio and the use of high oxygen flow
rates, birds can become hypothermic very quickly
during anesthesia.
To minimize heat loss, all anesthetized birds
should be provided with thermal support. Meth-
ods to prevent heat loss include insulating the
patient with clear plastic surgical drapes or
wrapping nonsurgical field regions in plastic.
Plucking of feathers and surgical preparation
with alcohol should be minimized. T h e use of a
chlorhexidine solution and warm water is a
better choice for aseptic skin preparation. Supple-
mental heat can be provided by increasing the
ambient temperature, using a circulating warm
water blanket (40.5~ administering warmed
fluids, positioning a warming lamp over the bird,
and placing heated water containers near the
patient. Latex gloves or empty fluid bags can be
filled with water, sealed, and warmed in a micro-
wave oven. Heated water containers should never
be placed directly next to the bird. They may
initially be too hot and, as they cool, may actually
convect heat away from the patient. Body tem-
perature should be m o n i t o r e d with a cloacal
t h e r m o m e t e r or temperature probe to evaluate
the effectiveness of heat retention measures.
Fluid Administration
As with other animals, the goal of fluid admin-
istration is to provide daily fluid requirements,
and to correct preexisting dehydration, electro-
lyte imbalances, and losses o f intravascular vol-
u m e due to hemorrhage. Daily fluid require-
m e n t in resting birds is estimated to be 40 to 60
m L / k g / d a y . The estimated fluid replacement to
correct dehydration is calculated as:
Deficit (mL) = body weight (g) x % dehydration
Debilitated birds should be assumed to be 5%
to 7% dehydrated. A packed cell volume (PCV)
>55% to 60% is an indication o f dehydration. A
serum uric acid of > 3 0 m g / d L may indicate
either dehydration or renal disease. Dehydration
should be corrected with 88 to 89 of the calculated
fluid deficit in the first 4 to 6 hours, with the
remaining volume administered over the follow-
i n g 2 4 hours. 42 If a bird must be anesthetized on
an emergency basis before volume stabilization,
the volume deficit should be incorporated into
the anesthetic maintenance fluids.
Healthy, anesthetized birds should receive
replacement fluids at a rate of 10 m L / k g / h r for
the first 2 hours, and then 5 to 8 m L / k g / h r to
prevent overhydration. Fluid replacement should
be considered on an individual animal basis. If
h e m o r r h a g e occurs, the administered volume of
a crystalloid replacement fluid should be three
times the blood loss volume. If blood volume loss
is >30% of the estimated normal blood volume,
a blood transfusion is indicated.
Oral, subcutaneous (SC), IV, or intraosseous
(intramedullary) routes are appropriate for fluid
administration. Alert birds without gastrointesti-
nal disease benefit from oral fluid administra-
tion. Debilitated birds and birds with altered
mentation should receive parenteral fluids. In
noncritical situations, SC fluids may be adminis-
tered. Preferred sites for SC fluid delivery in-
clude the propatagium (wing web), intrascapu-
lar region, and inguinal region. Care should be
taken to avoid inadvertent administration of SC
fluids into an air sac.
Birds requiring emergency therapy should
receive IV or intraosseous fluids. These two
routes offer the fastest and most effective meth-
ods for large fluid volume administration. Jugu-
lar, cutaneous ulnar, and medial metatarsal veins
are c o m m o n sites of IV access, d e p e n d i n g on the
size of the bird. Avian veins are fragile and have
little SC supportive tissue. Therefore, care must
be taken to prevent vein laceration and perivaseu-
lar hemorrhage. Although butterfly catheters
can be used for venipuncture, they should only
be used in immobilized birds. Over-the-needle
type catheters are r e c o m m e n d e d and well toler-
 Anesthesia of Pet Birds
ated by debilitated, conscious birds, if mobility is
restricted. Catheters should be sutured or glued
with cyanoacrylate tissue glue to the underlying
skin. Restrictive collars (Elizabethan, tube) may
be used to prevent dislodgment of the catheter.
W h e n venous access is unavailable because of
the size of the bird or hydration status, fluids may
be administered via an intraosseous catheter.
The distal ulna and the proximal tibiotarsus
provide access sites for intraosseous catheteriza-
tion. Procedures for catheter placement have
b e e n described. 43 Aseptic preparation of the site
is essential. Spinal needles (22 or 20 G) approxi-
mately one-third the length of the bone are
r e c o m m e n d e d in larger birds, whereas hypoder-
mic needles (27 to 25 G) have b e e n used in
smaller birds. 43 Catheters are sutured or taped in
place. If ulnar access is used, the wing should be
immobilized for the duration of catheter place-
ment. Intraosseous catheters should not be placed
in pneumatic bones (humerus or femur).
During anesthesia, balanced electrolyte solu-
tions may be given by SC boluses, IV boluses, or
continuous infusion. Lactated Ringer's solution
(LRS) is the most commonly used crystalloid. As
a replacement fluid, LRS is useful for rehydra-
tion, intravascular volume support, and fluid
maintenance. Dextrose solutions may be used
for the prevention or treatment of hypoglyce-
mia. Parenteral administration of dextrose solu-
tions should be conservative because they may
induce compartmental shifts in water and electro-
lytes, leading to hypovolemia. 42 Dextrose solu-
tions >2.5% concentration are contraindicated
for SC use. Half-strength dextrose with half-
strength LRS is useful during p r o l o n g e d anesthe-
sia.
T h e r e are few reports describing the use of
synthetic colloids (Dextran, starch, oxypolygela-
tin) in birds. 44 These solutions are useful when
osmotic support is n e e d e d for intravascular vol-
u m e expansion, Synthetic colloids should be
considered during hypovolemic, hypotensive, or
hypoproteinemic crises when blood products are
unavailable. If a hemorrhagic event produces a
> 3 0 % total body blood volume loss, crystalloid
therapy needs to be supplemented with a syn-
thetic or natural colloid product.
Blood transfusions are indicated in birds with
a total plasma protein of <2.5 g/dL, a PCV of
<15% to 25%, or an acute blood loss > 3 0 % of
the total blood volume. Total blood volume
17
(mL) may be estimated as 10% of the body
weight (g). D o n o r blood should be from a bird
of close parental relation or of a similar phyloge-
netic lineage. Because the availability of similar
lineage blood donors may be limited, chicken or
pigeon s blood may be transfused successfully to
Psittaciformes. Single transfusions do not usually
p r o d u c e immunologic complications. Major
a n d / o r minor crossmatching should be d o n e for
multiple transfusions. No commercial cross-
matching test kits are available for birds. Disease-
free donors, screened for appropriate hematoge-
nously spread avian diseases, are essential.
All fluids should be warmed before administra-
tion to minimize their contribution to anesthetic-
induced hypothermia. Crystalloid and synthetic
colloid solutions may be easily warmed to a
temperature of 38 ~ to 39~ in a microwave oven
without affecting their composition. Natural
blood products should be warmed in a warm
water bath.
Monitoring
Sensitivity to anesthesia differs between indi-
viduals and species. Therefore, monitoring the
effects and d e p t h of anesthesia is essential, be-
cause birds are p r o n e to develop anesthetic
complications relatively acutely. Ideally, anes-
thetic depth should be just adequate to p e r f o r m
the necessary procedure, and respiratory, cardio-
vascular, and CNS status should be continuously
monitored.
Respiration is usually rapid and irregular with
a shallow tidal volume during initial stages of
induction, but becomes slow, regular, and deep
as a medium surgical plane is achieved. Respira-
tory rate and tidal volume continue to decrease
as anesthetic depth increases. Visual monitoring
of the bird and the r e b r e a t h i n g bag will allow
assessment of respiratory rate and provide crude
evaluation of tidal volume. Clear, plastic surgical
drapes should be used to assist visual monitor-
ing. Electronic respiratory devices, which pro-
duce an auditory tidal flow signal, are effective
for assessment of respiratory rate. Unfortunately,
some do not function well with the small tidal
volumes of pet birds or with high oxygen flow
rates used in birds.
H e a r t rate and rhythm should be monitored.
Direct auscultation with a stethoscope is useful,
but may be difficult in small birds u n d e r surgical
drapes. An electrocardiograph (ECG) provides
 18 Thomas G. Curro
monitoring of the heart rate, rhythm, and electri-
cal conduction activity. The avian ECG has b e e n
described, 45 and normal ECG values have b e e n
established for African Grey and Amazon Par-
rots. 46 The mammalian hexagonal ECG lead
system is applied to birds. Normally, the avian RS
complex deflects downward in lead II. Attach-
m e n t of most ECG leads involves an alligator clip
that is potentially traumatic to the thin skin of
birds. To prevent injury, alligator clips can be
attached to stainless steel wire suture that is
l o o p e d through the skin, or leads with stick-on
attachments may be used. Likewise, small (27 to
25 G) hypodermic needles may be placed cutane-
ously, to which clips may be attached. Another
useful technique involves cutting small pieces of
gauze to pad the skin u n d e r the clips. Moistening
the gauze pads with alcohol provides adequate
ECG lead contact. Leads are commonly attached
to the propatagium and to loose skin in the stifle
region. Although an ECG will reflect myocardial
electrical activity, it does not indicate adequate
cardiac output and tissue perfusion.
H e a r t rate, rhythm, and tissue perfusion can
be m o n i t o r e d with a Doppler flow p r o b e device,
which is discussed in detail in Bailey's article. In
larger birds, an inflatable cuff and sphygmoma-
n o m e t e r may be used in combination with the
Doppler to monitor systolic blood pressure.
Pulse oximeters are becoming a popular moni-
toring tool in veterinary medicine. These devices
provide an indirect measure of h e m o g l o b i n
saturation with oxygen. Pulse oximeters are use-
ful evaluators of changes in pulse rate and
percentage of oxygen saturation. Reflectance
p r o b e s have been successfully used orally and
cloacally.
CNS monitoring involves the evaluation of
muscle tone and variOus reflexes. Anesthetic
depth follows a relatively predictable progression
in pet birds. During the initial stages o f anesthe-
sia, birds will be lethargic and have drooping
eyelids, a lowered head, and ruffled feathers, but
will be easily arousable. As the bird progresses to
a light surgical plane, palpebral, corneal, cere,
and pedal reflexes remain present and poten-
tially brisk, 'but there is no voluntary m o v e m e n t
at this stage. At a m e d i u m surgical plane, corneal
and pedal reflexes are slow to intermittent with
loss of the palpebral reflex. During deep surgical
anesthesia, respirations are slow and shallow, and
reflexes are no longer present. 1~
In larger birds, ventilation, oxygenation, and
acid-base status may be assessed with the measure-
m e n t of arterial blood gases. However, arterial
blood samples are technically difficult to obtain
in most pet birds, and evaluation requires the
immediate availability of a blood gas analyzer.
Ventilation
Ventilation in birds results from active muscu-
lar movement of the thoracic cage during inspira-
tion and expiration. Any restriction of thoracic
movement (excessive restraint, heavy surgical
drapes) will exacerbate anesthetic-induced hypo-
ventilation. Ventilation should be manually as-
sisted or mechanically controlled in all anesthe-
tized birds because hypoventilation can result in
cardiac depression and arrest. Emergency param-
eters for ventilation are discussed u n d e r Compli-
cations.
Inhalant anesthetics p r o d u c e dose-dependent
depression of ventilation, and certain avian spe-
cies are more susceptible to this effect. In a study
comparing three species of parrots, cockatoos
and Blue-fronted Amazons ventilated normally,
but African Grey Parrots hypoventilated at mini-
m u m anesthetic concentrations of isoflurane. 19
Additional reports support the finding that Afri-
can Grey Parrots do hypoventilate during isoflu-
rane anesthesia. 4s,49Xylazine is a p r o f o u n d respi-
ratory depressant and ventilation should be
monitored closely during injectable regimens
that include this sedative.
Analgesics
Analgesics, particularly opioids, are gaining
popularity as a therapeutic adjunct in pet birds.
Their use is largely based on clinical impressions.
The published dose for butorphanol (3 to 4
m g / k g ) resulted from a clinical trial involving
budgerigars.~S Controlled research on the analge-
sic effects of b u t o r p h a n o l in cockatoos and
African Grey Parrots has demonstrated potential
analgesic properties.19,36 Butorphanol does cause
a decrease in both heart rate and minute ventila-
tion, but neither effect results in significant
physiologic alterations.
Nonsteroidal anti-inflammatory agents have
also been used clinically in birds. Flunixin meglu-
mine (1 to 10 m g / k g IM) and ace@salicylic acid
(aspirin) (one 5 grain tablet/250 mL drinking
 Anesthesia of Pet Birds
water) have been r e c o m m e n d e d , although nei-
ther has been critically evaluated in birds.
Recovery
Recovery should include delivery of 100%
oxygen after the inhalant has been discontinued.
After swabbing the oral cavity of any accumu-
lated secretions, detaching the endotracheal tube
from the beak, and deflating the cuff, the tube is
removed when the bird is light enough to object
to its presence.
Regardless of the anesthetic protocol used,
most birds will experience e m e r g e n c e delirium,
which usually occurs at the time o f or shortly
after extubation. Vigorous wing flapping and
disorientation are c o m m o n and usually m o r e
p r o n o u n c e d during recovery from injectable
anesthetics. A potential complication of anes-
thetic recovery is self-inflicted trauma, and re-
straint is essential to prevent postanesthedc in-
jury. Birds should be lightly wrapped in a towel
and manually restrained by available personnel
until able to stand. Recovery from isoflurane
anesthesia occurs within 5 to 15 minutes after
anesthetic delivery is discontinued. If recovery
personnel are not available, or if a p r o l o n g e d
recovery is anticipated, birds can be wrapped in a
towel or paper and placed in a small, empty,
p a d d e d enclosure. Restraint should be minimal
so that once a bird recovers sufficiently, it can
easily free itself from the restraint. As with
induction, restraint must not interfere with the
normal breathing movement.
T h e recovery area should be warm (25 to
30~ quiet, and dimly lighted or dark to mini-
mize external stimulation during recovery. Food
and water should be offered as soon as the bird is
alert and able to perch.
Complications
Preoperative
Like all other species, birds should be stabi-
lized before general anesthesia, whenever pos-
sible. Contraindicafions for general anesthesia
include shock, respiratory distress, ascites, dehy-
dration, anemia (PCV < 1 5 % to 17%), hypopro-
teinemia (total protein <2.5 to 3.0 g / d L ) , hypo-
glycemia (<200 m g / d L ) , metabolic acidosis,
and: a fluid-filled crop. Unless corrected, these
19
pathophysiological changes will greatly increase
the patient's anesthetic risk status.
Intraoperative
Intraoperative h e m o r r h a g e must be immedi-
ately controlled. Estimated blood volume of
birds, in milliliters, is 10% of the body weight in
grams. The average volume of a drop of blood is
0.05 mL. Because the blood volume o f a 30-g
bird is 3 mL, the loss of 20 drops (or 1 mL, which
is barely a spot on a gauze sponge) will result in a
30% blood loss in this bird. Although this is a
dramatic example, it does demonstrate the criti-
cal importance of intraoperative hemostasis in
birds. Delicate surgical technique and the appli-
cation of electrocautery will aid in minimizing
blood loss.
Hypoventilation (decreased tidal volume or
rate) or apnea for longer than 20 seconds re-
quires application of ventilatory support and
assessment of airway patency and anesthetic
depth. Decreasing the anesthetic depth is usually
indicated, and should precede application of
assisted or controlled positive-pressure ventila-
tion. Assisted ventilation is delivered with a peak
inspiratory pressure o f 10 to 15 cm H20, 2 to 3
times per minute, in addition to the bird's rate.
Controlled ventilation should deliver 10 to 12
b r e a t h s / m i n u t e with a peak inspiratory pressure
of 8 to 12 cm H2O pressure. If an endotracheal
tube is not placed, and the tracheal airway is
unobstructed, effective ventilation may be deliv-
ered by moving the sternum ventrally and dor-
sally, which produces inflation and deflation of
the air sacs, respectively. This action should
produce adequate m o v e m e n t of gas through the
lungs because of the avxan unidirectional gas
flow pattern. Cessation o f breathing in birds may
be rapidly followed by cardiac arrest. Therefore,
immediate recognition and intervention is re-
quired.
It is best to prevent cardiac arrest by maintain-
ing normovolemia, adequate oxygenation and
ventilation, appropriate anesthetic depth, mini-
mal use of cardiodepressive drugs, and adequate
monitoring. If cardiac arrest occurs, circulation
may be assisted by manipulating the sternum as
described for ventilatory assistance, which uses
the thoracic-pump mechanism o f cardiopulmo-
nary resuscitation. Direct cardiac massage is
difficult in birds because of the structure of t h e
thoracic cage. 1V or intracardiac epinephrine
20 Thomas G. Curro
may be used in an attempt to stimulate the
return o f cardiac function. 1~ Unfortunately, car-
diac resuscitation is frequently and frustratingly
unsuccessful in birds and prevention is of critical
importance.
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