TOPICS IN MEDICINE AND SURGERY

ANESTHESIA AND ANALGESIA IN BIRDS

Michael Lierz, Prof Dr. med. vet., DZooMed, Dip. ECZM (Wildlife Population Health), Dip.
ECPVS, and Rüdiger Korbel, Prof Dr. med. vet., Dip. ECZM (Avian)

Abstract
Surgical intervention and painful conditions often apply to avian patients that are presented to veterinary
hospitals. Therefore, anesthesia and analgesia are an important part of the daily routine associated with
avian veterinary practice. These procedures differ from mammal medicine primarily because of different
physiologic composition and different anatomical structures, which are described when relevant to anesthetic
management. This article describes the most common anesthetic and analgesic procedures for birds and
provides recommendations for veterinarians who treat these species. Moreover, there are detailed descriptions
of preanesthetic and postanesthetic patient care and how to monitor anesthetized birds. Advantages and
disadvantages of the different anesthetic techniques and analgesic protocols are also reviewed. If one treats
birds in a veterinary hospital, it is important to have inhalation anesthesia equipment readily available so that
it can be used when needed. Copyright 2012 Elsevier Inc. All rights reserved.
Key words: avian; pain management; preoperative care; postoperative care; monitoring

H
istorically, birds were thought to have little to no ability to feel pain because they are
unable to communicate those feelings. Therefore, avian anesthetic and analgesic proce-
dures were not performed. The majority of scientific studies investigating analgesic
therapeutic protocols and anesthetic procedures have occurred during the last 20 years.
However, in principle, nociception in birds is similar to that in mammals, as has been
demonstrated by anatomical, functional, and biochemical studies using computer tomography and
electroencephalography. Those studies demonstrated the so-called nidopallium as the corresponding
anatomic structure to the mammalian brain pain center.1-4

In addition to pain relief for surgical interven-
tion, anesthesia is an important tool for stress
reduction in birds. Stressful procedures per-
formed on avian patients include radiologic,
ophthalmologic, and detailed physical examina-
tions. Additionally, anesthesia is used for immo-
bilization purposes, which is required for several
different types of procedures in birds (e.g.,
feather imping). Analgesic agents used in birds
are required before and/or after surgery, and are
also an important tool for the treatment of any
painful condition. Thus, analgesia is indispens-
able in avian medicine for ethical reasons and
also for psychologically improving the animal’s
ability to withstand the stresses associated with
surgical recovery and disease conditions.5
BASIC ANATOMY AND PHYSIOLOGY
Avian anatomy and physiology varies significantly
from that described in mammalian species. There-
fore, the differences between these 2 groups of ani-
mals relevant to anesthesia protocols are discussed.6
For more specific details regarding anatomy and
physiology of avian species, the reader is advised to
explore other published material, especially because
there are many species-related differences.7
The avian trachea consists of closed rings
and does not have an epiglottis. Therefore, en-
dotracheal tubes should not be cuffed because
an inflated cuff may result in pressure necrosis
of the tracheal mucosa, fractured tracheal rings,
postsurgical bleeding, or stricture formation
within the tracheal lumen. The lack of an epi-

From the Clinic for Birds, Reptiles, Amphibians and Fishes, Justus-Liebig-University Giessen, Giessen, Germany; and the Clinic for Birds,
Reptiles, Amphibians and Ornamental Fish, Ludwig-Maximillian-University Munich, Oberschleissheim, Germany.
Address correspondence to: Michael Lierz, Prof Dr. med. vet., DZooMed, Dip. ECZM, Clinic for Birds, Reptiles, Amphibians and Fishes,
Justus-Liebig-University Giessen, Frankfurter Str. 91-93, 35392 Giessen, Germany. E-mail: Michael.Lierz@vetmed.uni-giessen.de.
© 2012 Elsevier Inc. All rights reserved.
1557-5063/12/2101-$30.00
doi:10.1053/j.jepm.2011.11.008

4 4 Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

glottis increases the susceptibility of birds to
aspiration of efflux before or immediately after
the anesthetic procedure. Thus, the use of en-
dotracheal tubes is recommended for most if
not all avian procedures in which general anes-
thesia is used. The mucosal membranes of the
avian trachea produce viscous mucus, which
may lead to the obstruction of the endotra-
cheal tube or trachea while the patient is under
anesthesia. The patient should be closely moni-
tored and mucus regularly removed, if present.
The avian lung is connected to the thoracic
walls and is therefore unable to increase its size
to any significant degree. Instead, the air sacs
function as bellows pushing air through the
lungs; they do not participate in gas exchange.
The cycle of inspiration and expiration is an ac-
tive procedure closely bound to muscular activ-
ity. The respiratory cycle is primarily achieved by
lifting and releasing the sternum through the use
of intercostal and pectoral muscles. Lifting of the
sternum, during inspiration, requires strong mus-
cle activity, whereas release, during expiration, is
possible without much effort. This exertional re-
quirement should be considered when perform-
ing a surgical procedure on an avian patient be-
cause the bird is often positioned in dorsal re-
cumbency. The bird should be placed in ventral
or lateral recumbency as soon as possible after
the surgical procedure has been completed.
Air sacs form diverticula into certain bones
that comprise the avian skeleton (e.g., humerus,
femur, cervical vertebrae, sternum, ribs, pelvis,
pectoral girdle). Fractures of these pneumatized
bones with subsequent damage of the respiratory
epithelium may result in loss of anesthetic gases
or infection of the air sac due to invading patho-
gens. Because oxygen is a carrier for inhalation
anesthetic agents, caution is required when laser
or radiosurgical devices are used for a surgical
procedure to avoid a flammable event.8
PREANESTHETIC PREPARATIONS
AND EXAMINATION
Before any anesthetic procedure, the bird should
be examined and properly prepared to lower the
risk of anesthetic incident. As many physiologic
parameters of the patient (e.g., complete blood
count, plasma chemistry panel) should be as-
sessed as possible; however, this is usually re-
stricted to an owner’s willingness to pay for the
diagnostic testing. Required parameters do vary
with the clinical history, species, age, and risk
group of the avian patient. The minimum proto-
Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58
col used to assess a patient for a procedure in
which general anesthesia is used should be a
general physical examination, and it should in-
clude assessments of the bird’s nutritional status,
body weight (for correct dosage calculation), and
hydration status. The general physical examina-
tion should also include an evaluation of the
central nervous system, pupillary opening (e.g.,
anisocoria is a sign of head trauma; note that
possible reverse pupillary actions [mydriasis after
light stimulation] may occur because of primarily
striated rather than smooth internal ocular mus-
culature), and ear (e.g., hemorrhage). Collected
anamnestic data should include any abnormali-
ties that might affect the anesthetic risk including
seizures, polyuria, polydypsia, and discoloration
of feces. As a minimal database,
the white blood cell count will pro- The minimum
vide information regarding inflam-
matory response to disease, and the protocol used to
packed cell volume and hemoglo- assess a patient
bin may highlight abnormal hydra-
tion status and blood loss or may for a procedure
indicate an impaired oxygen-carry- in which general
ing capacity of the blood. Addi-
tional liver and kidney values are anesthesia is
also useful in determining the over- used should be a
all health status of a patient. Any
handling should be reduced to an general physical
absolute minimum and restricted examination,
to those procedures that are neces-
sary. Detailed descriptions of differ- and it should
ent handling techniques for avian include
patients are described in other vet-
erinary medical publications.9 assessments of
Any bird that is dehydrated, de- the bird’s
bilitated, or emaciated should be
stabilized before anesthetic induc- nutritional
tion. Approximately 15 minutes status, body
before induction, birds should re-
ceive prewarmed lactated Ringer’s weight (for
solution or 5% glucose solution correct dosage
(up to 40 mL/kg subcutaneously).
For critical cases, a blood transfu- calculation), and
sion (0.5 mL citrate to 4.5 mL do- hydration status.
nor blood of the same species;
transfuse up to 10 mL/kg) may have to be con-
sidered. Birds with respiratory distress and/or
blood loss should be provided with additional
oxygen.
It is of the utmost importance that every anes-
thesia procedure is properly planned and all re-
quired equipment organized before patient han-
dling and anesthetic induction. All emergency
drugs must be prepared within syringes before
4 5
 the procedure to avoid time-consuming dose de- ● Lowering the bird’s body with the head up
termination during an anesthetic emergency. If ● Keeping the bird in this position until fully
severe blood loss is expected during surgery, a conscious
blood transfusion should be readied for possible ● Applying digital pressure on the upper neck in
administration at a moment’s notice. A written the esophageal region during mask induction
anesthesia protocol is compulsory for each pa- reduces regurgitation in vultures.
tient and procedure.
Premedication for Anesthesia
Food Deprivation
Preanesthetic drugs are not commonly used in
Before the anesthetic procedure, birds should be
birds. The advantage of using a preanesthetic
fasted. Fasting avoids regurgitation and aspiration
drug protocol may be nullified by the disadvan-
of food during induction, the procedure, and/or
tages of handling stress induced when the bird is
recovery. Additionally, an empty stomach and
restrained for administration of the preanesthetic
gut reduces the weight load that would restrict
agents. Orally applied sedatives may be appropri-
the respiratory system, especially when the bird
ate for anxious birds or birds removed from large
is in dorsal recumbency. The duration of fasting
cages. When injectable anesthetic agents are
required for an avian patient is dependent on the
used, premedication may reduce the necessary
size of the bird and species. Large species that
dosage of the anesthetic drug itself, resulting in
have a well-developed crop (e.g., birds of prey,
fewer side effects. However, because injectable
not including owls; parrots; and pigeons) require
anesthetics should be restricted to a very lim-
a longer fasting period when compared with
ited number of cases, this advantage is minor.
small insect-eating Passeriformes, in which no
The use of parasympatholytics (e.g., atropine)
fasting is required. Table 1 provides a general
in birds is a controversial subject.11,12 Although
overview of recommended fasting periods in
atropine reduces salivary excretion and mucus
birds with respect to species, size, and body con-
production in the trachea, which results in a
dition.6 In rare cases (e.g., emergency situations,
lower risk of airway or endotracheal tube
crop stasis) fasting is not indicated before anes-
blockage, it has also been reported to increase
thesia. Emptying the crop by lavage might lead
the viscosity of tracheal mucus, which would
to further stress of the patient and therefore is
result in a higher risk of airway blockage.11,12
usually not recommended. In cases in which the
To prevent bradyarrhythmia, especially as a
crop cannot be emptied before anesthetic induc-
result from the ocularcardiac reflex during oph-
tion, the following procedure is recommended10:
thalmic surgery, atropine may be indicated.6
● Intubation of the patient However, if atropine is used to prevent brady-
● Blockage of the pharynx with a gauze sponge arrhythmia, it should be applied during anes-

TABLE 1. Appropriate preanesthetic fasting periods and comments6

Factor Fasting Duration of Fast Comments
Species prone to regurgitation or Yes As long as possible based on Raptors, seed-eating birds,
with extensive crops body condition score and psittaciformes
weight
Surgery of neck, cervical Yes Until crop is empty Tracheal laceration, crop fistula,
esophagus, or crop area laceration repair
Body condition score 1/5 No None Stabilize before procedure
Body condition score 2/5 Yes Short Stable, eating well, gaining weight
Body condition score 3/5 or Yes As indicated based on body Stable, eating well, gaining weight
greater condition score, species, and
weight
Body weight ⬎ 1 kg Yes 12 to 48 hours Raptors, large psittacines, ratites,
galliformes, anseriformes
Body weight 600 to 1000g Yes 6 to 12 hours
Body weight 400 to 600g Yes 4 to 6 hours
Body weight 200 to 400 g Yes 2 to 4 hours
Body weight ⬍ 200 g, stable Yes 1 to 2 hours
Body weight ⬍ 200 g, unstable No None

4 6 Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

thesia and not as a premedication agent be-
cause it may not be active long enough during
the entire surgical procedure.13 An alternative
to atropine use is glycopyrrolate, which is a
more selective antisecretory drug. Atropine,
however, does have a faster onset of action,
making it the preferred drug in cardiac emer-
gencies.14
ANESTHETIC MONITORING
Attentive monitoring of vital signs is indispens-
able to the avian patient when under a surgical
plane of anesthesia. Monitoring a patient’s vital
signs allows for the adjustment of anesthetic
depth and early intervention in the event of criti-
cal incidents. Generally, anesthetic monitoring
may be performed with a combination of man-
ual or equipment-based procedures.
The patient’s reflexes are an important visual
parameter to monitor anesthetic depth.4 For this
purpose a reflex scheme was developed that gen-
erated points for each single reflex to be moni-
tored.15 Table 2 provides different stages of avian
anesthesia based on monitoring of physiological
parameters and reflexes.6 Although the reflexes
and heart sound provide an empirical assessment
of the bird, sophisticated avian anesthesia re-
quires the use of equipment-based monitoring,
which includes the capnograph, pulse oximeter,
temperature probes, electrocardiograph, Doppler
ultrasound, and manometer. When using sophis-
ticated monitoring equipment, one must con-
sider the time required for setup in relation to
the estimated anesthetic time required to perform
the procedure, bird size, and practicability.
Because reflexes and manually assessed pulse
are basic requirements for patient assessment
while patients are under anesthesia, the measure-
ment of body temperature and heart rate is es-
sential. Because of their large air sac system,
birds are extremely susceptible to hypothermia.
Therefore, the patient’s body temperature, using
either a cloacal or esophageal probe, should be
monitored throughout the procedure and range
between 40°C (104°F) and 43°C (109.4°F), be-
ing routinely higher in smaller birds.
When using air sac perfusion anesthesia (see
below), some bird species do not breathe. Conse-
quently, pulse oximetry is an essential parameter
to monitor.16 The use of an 8-MHz Doppler
transducer, best placed over the tibiotarsal or ra-
dial artery, allows auditory recognition of the
rate and quality of the pulse.6 Traditionally, mea-
surement of blood pressure has been limited to

TABLE 2. Different stages of avian anesthesia6

Anesthetic Expected Physiological
Plane Reflexes Present Reflexes Absent Parameters Comments
I. Induction All: palpebral, pedal, None Sedate, lethargic, eyelids
cere; voluntary droop. Breathing deep
movement of or shallow, rapid and
third eyelid irregular based on
patient excitement.
II. All None, eyes closed Feathers ruffled, head Excitatory phase
hangs down, arousable may occur here;
but does not resist more likely in
handling. Increased large birds.
third eyelid movement.
III. Light Palpebral, pedal and Lack of voluntary Rapid, regular, deep Preferred plane for
cere present but movement, no respirations, no minor
slow. Corneal, response to postural response to sound. nonpainful
withdrawal, pain changes. Some jaw tone present. procedures.
on feather pluck.
IV. Medium Corneal present but Palpebral, pedal, cere Good muscular Preferred plane for
Surgical sluggish. withdrawal, pain of relaxation, slow, deep, surgery.
feather pluck. regular respiration.
Little jaw tone.
V. Deep None, lack of All Respiration is slow and Death ensues,
corneal. shallow to emergency
intermittent. Pupillary pending.
dilation.

Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58 4 7

 scientific work, but there have been attempts in
recent years to increase its use in monitoring
anesthetized avian patients through indirect mea-
surement. Unfortunately, indirect blood pres-
sure measurement in smaller avian species
(⬍ 2 kg) does not correlate to a bird’s direct
pressure measurements. Direct measurement of
blood pressure is not practical for the clinical
veterinary practice. Indirect measurement can
be performed by audio-controlled manual as-
sessment similar to the procedure used in hu-
mans or mammals, but again results may not
be as reliable as direct measurement.17-19 Gen-
erally, avian systolic blood pressure should be
maintained above 90 mm Hg.6
Capnography provides important data regard-
ing the respiratory function of the patient. The
use of capnography is of limited value in smaller
birds. Expired CO2 concentration is the most im-
portant parameter measured with capnography,
but inhaled oxygen and anesthetic gases can also
be monitored depending on the machine used.
Determination of the expired CO2 allows one to
estimate the appropriate ventilation of the birds.
End-tidal CO2 should be maintained within the
range of 20 to 40 mm Hg when using intermit-
tent positive-pressure ventilation.6
PERIANESTHETIC SUPPORT MANAGEMENT
For the avian patient in a surgical plane of anes-
thesia, fluid therapy and thermal support are very
important. During prolonged anesthetic events
(⬎ 30 minutes), a venous catheter should be
used for constant rate infusion of fluids (e.g.,
lactated Ringer’s solution, approximately 10 mL/
kg/h). As an alternative route, intraosseous path-
ways may be used.20 To avoid loss of body heat,
the fluid product that will be used to infuse the
avian patient should be warmed to the bird’s
body temperature before application. Smaller
birds (⬍ 100 g body weight) should receive bi-
carbonate (e.g., sodium bicarbonate: 1-4 mL/kg
of isotonic solution) mixed within the fluid
product because these species are prone to respi-
ratory acidosis.
Except for very short anesthetic procedures in
large birds, thermal support is indispensable. The
surgical theater should be kept warm and addi-
tional heat should be directly applied to the pa-
tient by heating blankets (e.g., electrical, water,
air-circulating units) or radiant heat lamps.6,21
Additionally, surgical preparation (e.g., feather
plucking) and the use of disinfectants (e.g., alco-
hol) increases body heat loss, so care should be
4 8 Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58
taken to minimize the effects of these proce-
dures. Care should also be taken not to increase
the heat support, because this might lead to hy-
perthermia. Ultimately, all of these factors
strongly reinforce that monitoring of body tem-
perature is vital.22 The use of a anesthetic gas hu-
midifier and heater is also recommended.4
POSTANESTHETIC MANAGEMENT
Birds should be closely monitored until all re-
flexes return and they are able to perch as nor-
mal. For recovery, a quiet, warm (approximately
25°C; 77°F), and light-reduced environment
should be selected; which allows for visual con-
trol of the patient. Patients should be immedi-
ately placed in ventral recumbency and loosely
wrapped in a towel to avoid wing flapping. Wing
flapping typically occurs when using injectable
anesthetic agents (e.g., ketamine). The towel
needs to be removed as soon as the bird is lifting
its head and opens its eyes with a concurrent re-
curring pedal reflex. Water should only be of-
fered when the bird has regained full conscious-
ness. The endotracheal tube should be removed
when the bird demonstrates spontaneous breath-
ing, general muscle tone, and the ability to move
its head.
EMERGENCY PROTOCOLS
There are several conditions that may lead to an
anesthetic emergency including apnea, endotra-
cheal tube blockage, hypothermia, regurgitation,
hypovolemia, and cardiac arrest.4,6 The occur-
rence of an emergency event may be avoided or
at least reduced by proper anesthetic manage-
ment (see above) and the use of inhalation anes-
thesia. However, the occurrence of anesthetic
emergencies can never be completely avoided.
Whenever an emergency situation occurs, flow of
the anesthetic agent should immediately be
stopped. Doxapram or caffeine-sodium-salicylate
may be administered if apnea is present. In the
event of cardiac arrest, a direct heart massage
(Fig 1) may be helpful in saving the patient. Ad-
ditionally, strophanthin or adrenaline should be
provided to the patient experiencing a cardiac
arrest. The intravenous application of emergency
drugs is possible through an intravenous catheter
(Fig 2). Generally, the same emergency proce-
dures used for mammals should be applied to
avian patients. Table 3 lists common avian
emergency presentations and their appropriate
responses.6,23,24
 of allometric scaling need to be applied.25 The
use of allometric scaling allows for smaller birds,
in many cases, to receive an increased dose rela-
tive to larger species. The authors recommend
that readers review pharmacologic texts on the
specifics of allometric scaling and its application
in avian patients.

Ketamine
Ketamine was used as a monoanesthetic drug for
a long period of time in avian patients. However,
ketamine causes a dissociative anesthesia and its
analgesic potency is insufficient for surgical pro-
cedures. Additionally, it does not result in muscle
FIGURE 1. Heart massage technique in a common buz-
zard (Buteo buteo). relaxation and the bird can become very excitable
during recovery. Therefore, ketamine should not
INJECTABLE ANESTHESIA be used as a single anesthetic agent, but may be
used in combination with an alpha-2-agonist or
The main disadvantage of injectable anesthesia is a benzodiazepine drug.
the inability to modify the effects of the drug
after it has been administered. Species and indi- Alpha-2-agonist
vidual variations toward anesthetic drug sensitiv-
ity are common, making individual adjustment The most commonly used alpha-2-agonists are
to dosages extremely challenging. Additionally, xylazine and medetomidine. In combination
the correct weight of the patient is needed for with ketamine, these 2 drugs are regularly used
dosage calculation. Adverse effects to certain in- outside of the veterinary hospital. Alpha-2-ago-
jectable anesthetic agents have been described nists provide sufficient muscle relaxation and
when birds are stressed, and the application of contribute to a smooth recovery. One major ad-
an additional dose when a bird is not main- vantage when using alpha-2-agonists is that spe-
tained in a surgical plane of anesthesia may be cific antagonists (e.g., atipamezole, yohimbine)
problematic. Because of body condition, and the are available to shorten the recovery period.26-28
fat solubility of certain anesthetic drugs, a second An important drawback of alpha-2-agonists is
dose may be metabolized quickly, making an their cardiopulmonary depressive action; it is im-
overdose possible. Injectable anesthetic agents portant that this is monitored, especially during
are typically metabolized in the liver and elimi- anesthetic introduction. Alpha-2-agonists should
nated through the kidneys. Patients that are diag- not be used as a monoanesthetic agent.29,30
nosed with hepatic and/or renal disease may
have reduced drug elimination, a long anesthetic
recovery period, and concurrent cardiopulmonary
depression. A surgical plane of anesthesia using
injectable anesthetic agents is typically possible
for up to 30 minutes, which can be used primar-
ily for short surgical procedures, sedation for di-
agnostic purposes, and sampling during field
studies. Local anesthesia is not commonly used
in avian patients because small doses of local
anesthetic drugs may have toxic effects and, most
importantly, the patient remains conscious dur-
ing a very stressful procedure. Most anesthetic
drug dosages are empirical, and pharmacokinetic
studies in birds are limited to certain drugs and
species. Table 4 provides dosages of selected an-
esthetic drugs commonly used in avian medicine.
In general, any dose of injectable anesthetic drug FIGURE 2. Venous catheter placement in the medial metatarsal vein
is not only weight dependent, but the principles of a falcon.

Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58 4 9

 TABLE 3. Clinical measures and prognosis of common avian emergencies6,20,23,24
Emergency
Situation Clinical Signs Treatment Prognosis
Apnea Lack of respiration based Confirm apnea, intubate. Confirm Good if appropriate action
on keel movement. level of anesthesia by checking is taken in a timely
muscle tone and reflexes. Turn manner.
off anesthetic gas or reverse
injectable anesthetics. Give IPPV.
Confirm pulse and heartbeat.
Administer doxapram; repeat in
2 min if no appropriate response
occurs. Consider administration
of adrenaline and atropine after
2 min.
Endotracheal tube Difficult, slow, or Remove endotracheal tube and Fair to good if appropriate
blockage nonexistent expiration. replace if necessary. Provide actions are taken in a
Slow recovery. Duration 100% oxygen and reduce timely manner.
of expiration prolonged. anesthetic gas amount if recovery
Upon mechanical is feasible. Use of pre-emptive
insufflation or anticholinergics is controversial.
inspiration, air sacs fill
normally, but during
expiration air sacs empty
slowly or not at all.
Hypovolemia Loss of blood and fluid, Volume replacement with warmed Fair to good, depending on
poor perfusion as isotonic fluids, colloids, or blood volume lost. Birds may
evidenced by thready or as indicated, preferably lose up to 30% of their
weak pulses, prolonged intravenous or intraosseous. blood volume before
capillary refill time. experiencing shock.
Vomiting, Liquid from mouth, in Hold head down to drain liquid, Fair to guarded. Bird
regurgitation anesthetic mask or, clean oral cavity with gauze should be monitored for
worse, in endotracheal sponges or cotton-tipped signs of aspiration
tube. applicators. Ensure choana is pneumonia. Antibiotic
completely cleared of debris. treatment may be
Suction endotracheal tube and considered.
consider replacement of tube
after oral cavity is cleaned.
Hypothermia Body temperature below Increase thermal support, Good to guarded
38°C monitoring.
Cardiac arrest Electrocardiogram flat Intubate and give 100% oxygen Guarded to poor
line, lack of pulse, and IPPV, discontinue or reverse
extremity pallor anesthetics. Alternate keel
compression and caudal
coelomic compression to
simulate normal respiratory rate.
Administer atropine, adrenaline,
doxapram, and dexamethasone
intravenously or intratracheally.
Abbreviation: IPPV, Intermittent positive-pressure ventilation.

Benzodiazepine combination with ketamine, advantages of ben-

Diazepam, midazolam, and zolazepam are the
most commonly used benzodiazepines in birds.
Benzodiazepines are used as preanesthetic agents
and for sedation in birds, but should not be con-
sidered monoanesthetic agents. When used in
zodiazepines include sufficient muscle relaxation,
sedative effects, and anticonvulsant properties.
Additionally, benzodiazepines have minimal car-
diovascular effects. Considerations when contem-
plating the use of benzodiazepines include mild

5 0 Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

TABLE 4. Common drugs used for avian anesthesia, analgesia, premedication, and emergencies4
Drug Dosage (mg/kg/body weight) Application Indication Comment
Inhalation anesthetic drugs
Isoflurane Induction: 4 to 5 vol.-%; maintenance: Head mask, General anesthesia; air sac Endotracheal tubes without cuff.
according to anesthetic depth 0.8 to endotracheal tube, perfusion: Beware of anesthetic waste gas.
2.5 vol.-% in oxygen; air sac air sac catheter ophthalmoscopic, tracheal Perfusions larger than 0.3l/kg/
perfusion: 0.3l/kg/min surgery min may induce a hypocapnic
alkalosis.
Sevoflurane Induction: 5 to 8 vol.-%; maintenance: See isoflurane See isoflurane Shorter induction and recovery
3 to 4 vol.-% times compared with
isoflurane, might be
advantageous in high-risk
patients.
Oxygen 50 to 100 vol.-% See isoflurane Carrier gas
Injectable anesthetic drugs
Ketamine 20 to 40 IM Not a monoanesthetic drug; Insufficient analgesia, excitations
may be used as a during recovery, increased
dissociative for nonpainful intraocular pressure, not for
procedures. ophthalmic procedures,
hypothermia.
Ketamine ⫹ diazepam 25 ⫹ 7.5 IM Short-term anesthesia Not mixable in 1 syringe;
salivation, cardiac arrhythmia,
decreased blood pressure.
Ketamine ⫹ xylazine K40(50) ⫹ X10(4)/K7 ⫹ X0.2 IM/IV Short-term anesthesia Surgical anesthesia for approx. 20
to 30 min, bradycardia. IV
lower dosages required, well
assessed in raptors.
Ketamine ⫹ xylazine ⫹ 15 ⫹ 2.5 ⫹ 0.3 IM Short-term anesthesia Tested in Guinea fowl.46
midazolam
Ketamine ⫹ K3 to 5⫹ M0.05 to 0.1; K2 to 5⫹ IM Short-term anesthesia Raptors, psittaciformes, ostriches;
medetomidine M0.75 to 0.1; K5 to 10⫹ M0.1 to 0.2 relaxation and analgesia,
cardiopulmonary depression,
may be antagonized.
Thiafentanil ⫹ 0.175 ⫹ 0.092 IM Short-term anesthesia Remote injection in emus.47
medetomidine
Xylazine 1 to 2 IM, IV Sedation Do not use in debilitated birds
because of cardiac depression,
be cautious when using as a
monoanesthetic agent.
5 1
5 2

TABLE 4. Continued
Drug Dosage (mg/kg/body weight) Application Indication Comment
Ketamine ⫹ climazolam 25 ⫹ 12.5 IM Short-term anesthesia See ketamine/medetomidine.
Diazepam 0.2 to 1 IM, IV Sedation, control of fitting Every 12 to 24 h.
Tiletamine zolazepam 20 to 30 IM Short-term anesthesia Hypothermia, salivation, vomitus
Propofol 3 to 14 (0.5) IV Short-term anesthesia; length Good relaxation, no analgesia,
adjustable by continuous apnea if administered fast,
infusion (dosage in usually IPPV necessary.
parentheses)
Saffan 9 6.75/2.25 mL/kg IV Short-term anesthesia Evaluated in falcons.
(Alfaxalone/Alfadolone)
Antagonistic drugs
Tolazolin 10 IM Partial alpha-2-antagonist
Atipamezole 5⫻ dose of medetomidine 0.25 to 5 IM, IV 〈lpha-2-antagonist Mainly used as antagonist for
Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

medetomidine.
Yohimbine 0.2 to 2 IM, IV 〈lpha-2-antagonist Reversal of xylazine.
Analgesic drugs
Butorphanol 1.0 (to 3.0) IM Moderate to severe pain If opioids required, drug of
control, especially soft choice. Do not use during
tissue pain anesthesia- hypothermia; birds
may become somnolent; may
be used as preemptive
analgesia: apply up to 30 min
before painful procedures;
seems to be toxic in Gyrfalcons;
do not use in owls; isoflurane-
saving effect up to 25% in
cockatoos, 11% in African grey
parrots, none in amazons. Half-
time approx. 2 to 4 h.
Buprenorphine 0.01 to 0.05 IM Moderate to severe pain Overdosage may cause
control, especially soft somnolence, duration of action
tissue pain varies between species: up to
7 h; 0.1 to 0.5 mg/kg
ineffective in African grey
parrots.
Tramadol 5 IV, oral BID Pain relief not studied Pharmacokinetic study in bald
eagles, no side effects.41
Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

TABLE 4. Continued
Drug Dosage (mg/kg/body weight) Application Indication Comment
Meloxicam 0.3 to 0.5 IM, IV, PO twice per Moderate pain, Drug of choice in birds,
day antiinflammatory, maximum drug level: 30 to 90
orthopedics min post application;
cardiopulmonary depression
discussed if applied during
anesthesia but not confirmed;
postoperative application: 3 to
10 days post operationem (post
surgery). Half-time depends on
species and varies up to 3
times.
Celecoxib 10.0 PO SID See meloxicam. In avian medicine used as
antiinflammatory drug for
proventricular dilatation disease
treatment.
Flunixin-meglumine — — — Renal toxic effects
Acetylsalicylic acid 5.0 to 10 PO — Maximum 3 days, little
experience available.
Carprofen 2.0 to 4.0 IM, SC, PO twice per See meloxicam. Apply every 12 h; highest drug
day level 1 to 2 h postapplication.
Ibuprofen 5.0 to 1.0 IM Renal toxic effect
Flurbiprofen 0.03% Local Uveitis, conjunctivitis No study available, renal toxic
effects are discussed.
Ketoprofen 1.0 to 5.0 IM, SC Limited experience available,
every 8 to 12 h
Fentanyl 0.01 to 0.02 IV Short half-time: African grey
parrot: 1.3 h
Metamizol 100 to 150 IM Postoperative pain Short half-time
Preanesthetic and
emergency drugs
Adrenaline (1:1000) 0.5 to 1 IM, IV, intraosseous, Emergency Cardiac arrest
intratracheal
Atropine 0.5 IM, IV, intraosseous, Preanesthetic, emergency May reduce salivation before
intratracheal endotracheal tube placement,
bradycardia.
Glycopyrrolate 0.01 to 0.03 IM Antisecretory, bradycardia
Dexamethasone 2 to 6 IM, IV Emergency Shock; note that corticosteroids
are immunosuppressive in
birds
5 3
 analgesic effects and ataxia in free-ranging or ex-

Abbreviations: IM, Intramuscular; IV, Intravenous; IPPV, Intermittent positive-pressure ventilation; BID, twice daily; PO, by mouth; SID, once daily; SC, Subcutaneously; CPR, Cardiopul-
cited birds.13,14

Respiratory arrest, apnea, CPR,

Telazol, a combination of tiletamine (dissocia-
tive anesthetic agent; see ketamine) and zolaz-

respiratory depression
Cardiopulmonary arrest
epam, was used in the capture of raptors from a

Respiratory depression
Comment
large flight cage, but negative side effects (e.g.,
salivation, cardiopulmonary) were described in
red-tailed hawks (Buteo jamaicensis).31,32

Propofol

CPR
In recent years, propofol, a short-acting nonbar-
biturate isopropyl phenol, has gained popularity
for its use in birds. Propofol must be adminis-
tered intravenously. Induction is very fast and
this drug provides adequate muscle relaxation.
Indication

However, anesthetic duration is short with this

drug; therefore, the placement of an intravenous
catheter is usually required for continued admin-
Emergency

Emergency

Emergency
Emergency

istration to achieve prolonged anesthesia. If

propofol is administered quickly, apnea may re-
sult.33 Propofol is usually used for anesthetic in-
duction or in fieldwork in which inhalation anes-
thesia is not possible.
IM, IV, intraosseous,

Orally, intranasal
Application

Sublingual, IM

Saffan
intratracheal

Saffan is a synonym for the drug combination

alfaxalone/alfadolone, which was commonly
IM, IV

used in cats. There has been successful use of this

drug combination in falcons. Consequently, saf-
fan may be considered for short-term procedures
when deciding on an injectable anesthetic proto-
col.34
Dosage (mg/kg/body weight)

INHALATION ANESTHESIA
Per drop, according to action

10 to 30 every 15 min prn

When anesthetizing avian patients, inhalation

anesthesia is the veterinarian’s method of choice.
Inhalation anesthesia should be used whenever
possible. Modern inhalation anesthetic agents
have a low blood-gas solubility, which results in
a rapid induction as well as a rapid recovery.
Per drop
5 to 20

Therefore, the concentration of administered an-

esthetic gas can be adjusted easily.
monary resucitation; prn, as needed.

Basic considerations are similar to small mam-

mal medicine and anesthetic circuits include
nonrebreathing systems, pediatric circles, and
Prednisolone sodium

adult circle systems.6 If necessary, the bird can be

TABLE 4. Continued

Caffeine-sodium

ventilated using volume- or pressure-controlled

Drug

application systems, the latter having major ad-

Strophantin
Doxapram

vantages because they are patient-size indepen-

succinate
salicylate

dent.6
The main risk of inhalation anesthesia, espe-
cially in smaller birds, is hypothermia because of
the large surface area of the air sac system. Thus,

5 4 Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58

prewarming of anesthetic gases, use of a gas hu-
midifier, and application of external heat
source(s) may reduce the occurrence of signifi-
cant body temperature loss. Usually the anes-
thetic gas is carried by oxygen or an oxygen-air
mixture, which is usually introduced to the pa-
tient by head mask, endotracheal tube, or air sac
perfusion tubes. The head mask is typically used
for anesthetic induction or for short procedures.
The head of the bird is introduced into the head
mask and the anesthetic gas mixture is adminis-
tered. After induction, an endotracheal tube can
be placed past the opening of the glottis into the
trachea. One major disadvantage of the head
mask is the high amount of waste gas created.
Another is that this form of anesthetic adminis-
tration cannot be used during surgical procedures
involving structures on the head. The use of en-
dotracheal tubes is therefore advantageous for
prolonged surgical procedures and those involv-
ing the head (Fig 3). If spontaneous breathing of
the bird is unwanted and intermittent positive
pressure ventilation is applied, an endotracheal
tube is necessary.
In certain surgical cases (e.g., eye, trachea) the
use of air sac perfusion anesthesia (APA) is rec-
ommended.16 For APA, the air sac is punctured
behind the last rib, cranial to the iliotibialis mus-
cle through which an air sac perfusion catheter is
placed (Fig 4).4 The procedure to introduce the
air sac perfusion catheter is similar to that used
for a laparoscopic entrance.35 A constant flow of
anesthetic gas mixture of approximately 0.3 l/kg/min
is applied to maintain the patient on a surgical
plane of anesthesia. Because of a CO2-washout
effect, the anesthetized bird may spontaneously
stop breathing, making an anesthetic monitoring
system (pulse oximetry) indispensable. Further-
more, at the end of an APA event the respiratory
tract should be flushed with pure oxygen to re-
FIGURE 3. Placement of an endotracheal tube in a com-
mon buzzard.
Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58
FIGURE 4. Air sac perfusion anesthesia in an African gray parrot
(Psittacus erithacus).
move any remaining isoflurane. Spontaneous
respiratory movements will reoccur within ap-
proximately 4 minutes of the oxygen-flushing
procedure.
Inhalation anesthetics such as isoflurane and
sevoflurane are not readily metabolized. Conse-
quently, there is minor concern when using these
anesthetic compounds in patients with liver dam-
age or renal damage because most of the drug is
eliminated via expiration. Furthermore, the risk
of liver damage to personnel through waste gases
is minor when compared with gas anesthetic
agents used in the past (e.g., halothane, me-
thoxyflurane). However, one must recognize that
the modern anesthetic gas agents pose a poten-
tial risk of genetic damage; as a result, adequate
measures for the reduction of waste gases should
be applied.36 Reduction of waste gases includes
the use of tight-fitting head masks, endotracheal
tubes, and vacuum systems. Additionally, abor-
tion may be a possible adverse effect for preg-
nant personnel in the operating theater, which
further underlines the danger of being in contact
with anesthesia waste gases.36
Sevoflurane may be recommended in emer-
gency patients because of the advantages of very
short induction and recovery periods.15,37,38
LOCAL ANESTHESIA
The use of local anesthesia in birds is seldom
described and it does not reduce the stress of the
bird when the procedure is performed. Addition-
ally, local anesthetic agents (e.g., lidocaine) ap-
pear to require high doses in most avian species.
5 5
 These high doses may be toxic and result in ad-
verse neurologic effects.39 Additionally, there ap-
pears to be significant species differences and
individual variation in local anesthetic agents.6
At this time, with the exception of various oph-
thalmologic indications, local anesthetic use in
birds is not recommended.
ANALGESIA
There is no question that birds are able to feel
pain; therefore, the indications for analgesic use
in avian species is similar to that of mammals.
Birds do not often demonstrate obvious pain,
and it is important that clinicians
recognize the following signs asso-
As with almost ciated with pain in birds:
all ● Acute pain: Getaway or defense
pharmacokinetic behavior; screaming; increase of
blood pressure, heart, and breath-
data involving ing rate; numbness.
birds, species ● Chronic pain: Loss of appetite;
numbness; lethargy; aggression;
differences were untypical body posture; lameness;
found with reduced grooming behavior.
meloxicam, with Whenever the use of analgesic
medication is required, the body
half-life levels condition of the patient should be
of the drug in stable (i.e., sufficient nutrition and
fluid support) because birds feeling
chickens and pain often stop eating. Addition-
pigeons being ally, the source of pain must be
addressed and eliminated. Depend-
3 times as long ing on the source of pain, the anal-
as that in gesic synergistic effect of different
drugs may be used. In particular,
ostriches, ducks, the combination of centrally acting
and turkeys. drugs with peripheral-acting drugs
might reduce the required dose lev-
els, thereby reducing possible adverse side effects.
More detailed information can be found in previ-
ously published articles.1,4,6,40
Opioids
Opioids act through their ability to primarily
bind to central or occasionally to peripheral opi-
oid receptors. The use of opioid agents is indi-
cated in moderate to severe pain and has anes-
thetic-sparing effects. Depending on the opioid
medication administered, it may only be effective
for a few hours and cardiopulmonary depression
is a common side effect. Therefore, opioid agents
should not be used before or during anesthesia.
5 6 Lierz and Korbel/Journal of Exotic Pet Medicine 21 (2012), pp 44 –58
Based on studies in psittaciformes, butorphanol
is commonly used in birds, whereas other avail-
able opioid medications (e.g., morphine, bu-
prenorphine, fentanyl, nalbuphine) are not.2 Use
of butorphanol, however, may have adverse ef-
fects in various raptor species such as gyrfalcons
(Falco rusticolus) and owls; adverse signs may in-
clude respiratory depression and reduction in
gastrointestinal tract motility.2 A recently avail-
able opioid drug, tramadol, has been adminis-
tered to bald eagles (Haliaeetus leucocephalus)
without side effects, but pain relief was not
studied.41
Nonsteroidal Antiinflammatory Drugs
Nonsteroidal antiinflammatory drugs (NSAIDs)
are commonly used in avian medicine, especially
for postsurgical pain relief or in orthopedic cases,
except for pain in relation to fractures. In addi-
tion to their analgesic effects, NSAIDs reduce in-
flammation via the inhibition of cyclooxygenase
activity. Various NSAIDs have been used to treat
birds for pain, including acetylsalicylic acid,
carprofen, celecoxib, dimethylsulfoxide, flunixin
meglumine, ibuprofen, ketoprofen, meloxicam,
piroxicam, phenylbutazone, and tepoxalin.1,6
Carprofen and meloxicam are the NSAIDs of
choice in avian practice. As with all other drugs
within this class, these 2 NSAIDs may produce
significant adverse side effects (e.g., renal fail-
ure).42 In general, the adverse side effects appear
to vary between avian families; therefore NSAIDs
should be used with care if a dose is extrapolated
from one avian species to another. In particular,
diclofenac used in cattle was recently described
as a major cause of death in free-ranging vultures
in Asia.43 Celecoxib is regularly used in psittaci-
formes with proventricular dilation disease be-
cause it appears to reduce the inflammatory ef-
fects at the nerve ganglia and slow down the dis-
ease process. Compared with opioid agents, pain
relief elicited through the use of NSAIDs may be
less, but the duration of action is usually longer
(up to 12 hours).44 Of the NSAIDs commonly
used in avian medicine, carprofen appears to
have the widest margin of safety.6 There have
been a number of research investigations in
which the effectiveness and pharmacokinetic data
were evaluated for meloxicam use in specific
avian species. For the species tested, meloxicam
appears to have a wide safety margin and was
found to be effective. As with almost all pharma-
cokinetic data involving birds, species differences
were found with meloxicam, with half-life levels
of the drug in chickens and pigeons being 3
times as long as that in ostriches, ducks, and
turkeys.45
CONCLUSION
Anesthetic and analgesic procedures in avian
medicine have advanced tremendously over the
last 10 years. Veterinary practices accepting avian
cases should be equipped to use inhalation anes-
thesia and have an appropriate anesthetic moni-
toring system.
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