Anyone ever intubated a gorilla?
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deleted643396
Bad airway...consider an awake fiberoptic.
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Yea, they'll be spontaneous, diazepam, ketamine, and iso. I'll have a fiberoptic available if I need it. I was going to try and DL first, it seems like that's what they do in the vet literature I've been able to find, but they don't go into any more detail than that.
If only you could have been there for Harambe . . . sorry, too soon?
If they ask you to do the ketamine dart, consider passing on this opportunity.
Asleep glidescope and have a fiber ready to go. If their is a hole in to the lungs I can get through it with a fiber and a glidescope. 9.0 and 8.5 tube maybe something to shave the face to tape your tube. Here is a scenario where I'm concerned more about how to extubate then intubate.
Dr. Lundy Campbell from UCSF used to tell us stories about his gorilla intubations. [email protected]
you're awesome, thanks, I'll shoot him an email
You can't stick Ur entire hand in there and just shove the tube in?
What size tube do you use?
What size tube do you use?
Precedex. Precedex. Precedex.
I have pic of gorilla intubation from a couple of years ago. Will need to find it. It was a pretty easy intubation. Like a class 0 airway. The oral maxillary residents showed me cause they had to operate on the gorilla.
Will have to fish out the old pic if u can find it on my computer.
Will have to fish out the old pic if u can find it on my computer.
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It's probably not that hard.
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Il Destriero
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Il Destriero
If that person doesn't get back to you, Giesecke gives a presentation on this very topic.
Department of Anesthesiology | Noel M. Giesecke, MD - McGovern Medical School
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BTW are they going to preoxygenate the gorilla in a oxygen box? I imagine the extubation will be asleep. Could you imagine a Gorilla with emergence delirium.
It goes without saying, but we're going to need an after action report on this one!
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Il Destriero
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Il Destriero
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deleted162650
Grab the lower "canine" teeth to provide jaw thrust. I'm not sure what the best blade to intubate would be, but you bet your ass I'd be extubating that thing DEEEEP.
IV access is tricky in the great apes. While they have huge veins, they are very thick walled with a relatively small lumen. I know they also routinely place the pulse-ox on the foreskin because the skin on their fingers is too dark and thick for the probe to pick up well.
IV access is tricky in the great apes. While they have huge veins, they are very thick walled with a relatively small lumen. I know they also routinely place the pulse-ox on the foreskin because the skin on their fingers is too dark and thick for the probe to pick up well.
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deleted643396
It's probably not that hard.
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Il Destriero
Thyromental distance looks pretty short. I stand by my awake fiberoptic.
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deleted547339
Plan for emergence = untape tube, turn off gas, leave room quickly?
Do anesthesiologists get called to do this sort of thing frequently?
shove a central line in that vein, the central line needle is so damn sharp.
what procedure is it that they need general with a tube???
Sorry guys. I know I got the 2013/2014 pic somewhere on my computer. It's on the portable drive but gonna to take time to find it. The omfs residents intubated the gorilla at the zoo and gave me the pic. It was super easy they said.
Just use common sense how wide a gorilla can open its mouth. Just look at pic I found on the internet how wide a gorilla mouth can open.
If I can find it. I will definitely post it. Just have 500gb of pics and so many of the kids. So hard to find it now in between all the family pics.
Just use common sense how wide a gorilla can open its mouth. Just look at pic I found on the internet how wide a gorilla mouth can open.
If I can find it. I will definitely post it. Just have 500gb of pics and so many of the kids. So hard to find it now in between all the family pics.
Attachments
Man this is an instant classic thread! Can you use a glidescope and record it? Bring a fastrack intubating lma? Are you planning on mask ventilating? Who is placing the pulse ox on the foreskin? LTA for the cords? Definitely give a full report and have fun!!!!
Retrograde wire.
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Andy Casabianca, from UToledo intubated one last year at the Toledo Zoo. Probably find his email on the Univ Toledo anesthesiology webpage.
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deleted547339
Second the "use VL and record" for our enjoyment.
Dude, what about HIPAA?
if you find the pic will you post it up for us to see?
edit: just read the rest of the thread and saw you were looking.
Someone told me once that at the zoo, gorillas have the easiest airways and koalas are the hardest to intubate.
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deleted162650
I know warthogs are known difficult airways due to the fact that their larynx is actually intrathoracic.
I intubate "gorillas" every day at my job.
I did some animal stuff when I was in the Navy with dolphins. They had a research facility in San Diego. No intubations though. Just mouth to blow hole I would think...
Wait a second, that doesn't sound right...
Lol!
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Il Destriero
Wait a second, that doesn't sound right...
Lol!
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Il Destriero
That's a big ****ing ETT!
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Il Destriero
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Il Destriero
It's a nice zoo in a mid sized city, so I don't think they have any vets on staff that are comfortable intubating the gorillas. The way we got involved was that a vet from a larger city bailed on them at the last minute last year. They called my chairman and he intubated one of the male silverbacks last year, so now they just come to us to tube their massive kill beasts.
See the article below. Mark Greenberg at UCSD has a lot of experience at the San Diego Zoo.
Animal Instinct: Saving Lives at the Zoo
[email protected]
Animal Instinct: Saving Lives at the Zoo
[email protected]
Alright, so this is how it went down.
Arrive at the zoo around 7:30. The head zookeeper gives us a long safety talk, basically saying stay away from anywhere where the gorilla could grab you and rip your arms off. All the while there's a guy, we'll call him Jeff, standing quietly in the corner with a big ass shot gun at the low ready position. Now Jeff's job, as I'm sure you can deduce, is to "eliminate the threat" in case anything goes fubar.
Of course at this point, I'm questioning why I decided to do this, and how much trouble I'm going to get into with my wife if I happen to get my face eaten off. So, we go down through an OR suite and another procedure room to where all the cages are. The thing it kept reminding me of was the Velociraptor pen in Jurassic Park, and what do the Velociraptors in Jurassic Park always do? They get out and eat people.... Again, this instilled a lot of confidence in what was about to go down.
We got to the staging area, the first gorilla was chilling in her cage, rolling around, seeming like she was having a pretty good morning. This was until we busted out the blow dart gun (literally it's a blow dart gun, they said it's less traumatic than shooting it out of an actual gun, makes sense). At this point she, no pun intended, starts going ape ****. I mean, the females are probably around 40% smaller than the males, but I can totally see how if one of these wanted to stomp out your existence, there's not a whole lot that you could do about it.
So for blow dart induction it was:
0.1 mg/Kg midaz
0.5 mg/Kg Medetomidine
5mg/Kg Ketamine
When we blow dart her, she lets out this loud, deep, guttural yelp, staggers around for about two minutes until she decides to lay down for nap time. We wait another 10 minutes before approaching her, shes unresponsive, but breathing spontaneously. We move her to another cage where we're going to do the procedures. There's a cute little anesthesia machine about the size of a suitcase that i use to gas her down with iso (honestly it was nicer than the machines we use for mission work down in the Dominican). Now I'm sure we could have used a normal mask if they made a size 9 mask, but I don't think that exists, so we used a milk jug with the bottom cut out. Once I was confident that she was sufficiently deep, we opened her mouth with bungee cords. Now the key thing for intubating gorillas is to grab some 4x4 and pull the hell out of their tongue, which I got from the vid @vector2 posted, thanks man! Once you do this, you can literally almost see epiglottis, so I just pooped a mac 5 in there and put an 8.5 in like normal business.
Once the tube was secured, I went to go pop in an IV. Great ape veins are definitely not like human veins, they actually have a pretty thick muscular walls, they feels more like arteries. We drew some blood and ran in LR, if for any reason she got light, we would have given propofol through the IV. They did their procedures, skin biopsies, echo, abd ultrasound etc, then it was time for wake up.
Now how do you wake up a gorilla you say? I would have thought deep, but no, no, no. So we turn off the gas and move her into the second cage that you can see in the second image, this is the gorilla PACU. Jeff is standing there just in case anything goes ****ey. The ETT is secured with plastic cord ties in a bow tie. Once she started to gag on the tube, I put my hand through the cage and quickly removed the ETT and bite block (the bite block being a door stopper wrapped in duct tape).
The second gorilla was way more relaxed, she actually let the vet tech inject her through the bars with the induction meds. This time I decided to use an LMA, a size 5 actually seated quite nicely, I'm sure for a larger male you'd need something bigger. At the end I exchanged the LMA for an ETT as the staff wasn't comfortable emerging with an LMA.
After emerging the second great ape, I went home, and my wife an I got ice cream and she told me how glad she was that my face didn't get eaten off.
Arrive at the zoo around 7:30. The head zookeeper gives us a long safety talk, basically saying stay away from anywhere where the gorilla could grab you and rip your arms off. All the while there's a guy, we'll call him Jeff, standing quietly in the corner with a big ass shot gun at the low ready position. Now Jeff's job, as I'm sure you can deduce, is to "eliminate the threat" in case anything goes fubar.
Of course at this point, I'm questioning why I decided to do this, and how much trouble I'm going to get into with my wife if I happen to get my face eaten off. So, we go down through an OR suite and another procedure room to where all the cages are. The thing it kept reminding me of was the Velociraptor pen in Jurassic Park, and what do the Velociraptors in Jurassic Park always do? They get out and eat people.... Again, this instilled a lot of confidence in what was about to go down.
We got to the staging area, the first gorilla was chilling in her cage, rolling around, seeming like she was having a pretty good morning. This was until we busted out the blow dart gun (literally it's a blow dart gun, they said it's less traumatic than shooting it out of an actual gun, makes sense). At this point she, no pun intended, starts going ape ****. I mean, the females are probably around 40% smaller than the males, but I can totally see how if one of these wanted to stomp out your existence, there's not a whole lot that you could do about it.
So for blow dart induction it was:
0.1 mg/Kg midaz
0.5 mg/Kg Medetomidine
5mg/Kg Ketamine
When we blow dart her, she lets out this loud, deep, guttural yelp, staggers around for about two minutes until she decides to lay down for nap time. We wait another 10 minutes before approaching her, shes unresponsive, but breathing spontaneously. We move her to another cage where we're going to do the procedures. There's a cute little anesthesia machine about the size of a suitcase that i use to gas her down with iso (honestly it was nicer than the machines we use for mission work down in the Dominican). Now I'm sure we could have used a normal mask if they made a size 9 mask, but I don't think that exists, so we used a milk jug with the bottom cut out. Once I was confident that she was sufficiently deep, we opened her mouth with bungee cords. Now the key thing for intubating gorillas is to grab some 4x4 and pull the hell out of their tongue, which I got from the vid @vector2 posted, thanks man! Once you do this, you can literally almost see epiglottis, so I just pooped a mac 5 in there and put an 8.5 in like normal business.
Once the tube was secured, I went to go pop in an IV. Great ape veins are definitely not like human veins, they actually have a pretty thick muscular walls, they feels more like arteries. We drew some blood and ran in LR, if for any reason she got light, we would have given propofol through the IV. They did their procedures, skin biopsies, echo, abd ultrasound etc, then it was time for wake up.
Now how do you wake up a gorilla you say? I would have thought deep, but no, no, no. So we turn off the gas and move her into the second cage that you can see in the second image, this is the gorilla PACU. Jeff is standing there just in case anything goes ****ey. The ETT is secured with plastic cord ties in a bow tie. Once she started to gag on the tube, I put my hand through the cage and quickly removed the ETT and bite block (the bite block being a door stopper wrapped in duct tape).
The second gorilla was way more relaxed, she actually let the vet tech inject her through the bars with the induction meds. This time I decided to use an LMA, a size 5 actually seated quite nicely, I'm sure for a larger male you'd need something bigger. At the end I exchanged the LMA for an ETT as the staff wasn't comfortable emerging with an LMA.
After emerging the second great ape, I went home, and my wife an I got ice cream and she told me how glad she was that my face didn't get eaten off.
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Awesome! Thanks for the update!
PS If you go back, ask why all the zoo people everywhere wear khaki pants and a green top?
Do they think the animals won't notice them in their natural camouflage? [emoji23]
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Il Destriero
PS If you go back, ask why all the zoo people everywhere wear khaki pants and a green top?
Do they think the animals won't notice them in their natural camouflage? [emoji23]
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Il Destriero
That's awesome. Glad it went well. One question, was the towel over her eyes cause she didn't sign the HIPAA release? Oh I crack myself up (and that's why my wife just rolls her eyes at me)
Freaking awesome. Great case report.
Outstanding. Sounds like your usual peds day.
A guy with a shotgun should be part of the routine staff in my hospital's ORs.
