Case Report

A simple method to provide positive end expiratory pressure to treat hypoxaemia in an anaesthetised Asian Elephant (Elephas maximus)

Jessica Leung, Thierry Beths, Michael Lynch, Sarah Frith, Sebastien H. Bauquier
Journal of the South African Veterinary Association | Vol 92 | a2118 | DOI: https://doi.org/10.4102/jsava.v92i0.2118 | © 2021 Sebastien H Bauquier, Jessica Leung, Thierry Beths, Sarah Frith, Michael Lynch | This work is licensed under CC Attribution 4.0
Submitted: 23 September 2020 | Published: 19 May 2021

About the author(s)

Jessica Leung, UVet Animal Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Australia
Thierry Beths, UVet Animal Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Australia
Michael Lynch, Faculty of Veterinary and Agricultural Sciences, Zoos Victoria, Parkville, Australia
Sarah Frith, Faculty of Veterinary and Agricultural Sciences, Zoos Victoria, Parkville, Australia
Sebastien H. Bauquier, UVet Animal Hospital, Faculty of Veterinary and Agricultural Sciences, The University of Melbourne, Werribee, Australia


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Abstract

Hypoxaemia is a common complication in anaesthetised or immobilised elephants. It is presumably because of hypoventilation and ventilation-perfusion mismatch. To prevent hypoxaemia, orotracheal intubation and positive pressure ventilation are recommended. This case report describes a hypoxaemic period despite positive pressure ventilation in a 46-year-old female Asian elephant (Elephas maximus) anaesthetised with azaperone-etorphine, medetomidine and an etorphine constant rate infusion in lateral recumbency for a dental procedure. The hypoxaemia was corrected utilising positive end-expiratory pressure (PEEP) of 5 cm – 10 cm H2O, a technique that has not previously been reported in the management of anaesthetised elephants. PEEP decreases atelectasis, shunt fraction, and increases lung compliance. Positive end-expiratory pressure was achieved by partial occlusion of the tailpiece of a manually triggered demand valve ventilator during expiration. This is a simple effective method of generating PEEP and correcting hypoxaemia without the need for any additional specialised equipment. However, PEEP decreased arterial blood pressure and should be implemented with caution if arterial blood pressure is not monitored.

Keywords

anaesthesia; Asian elephant; Elephas maximus; hypoxaemia; Positive end-expiratory pressure; ventilation

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