Received: 27 March 2023 Revised: 10 August 2023 Accepted: 25 September 2023

DOI: 10.1002/vrc2.743

CASE REPORT
Zoo animals

Anaesthesia of a little blue penguin (Eudyptula minor) for magnetic

resonance imaging
Erica Daly William McFadzean Phillipa Kate Tucker

Cave Veterinary Specialists, part of Linnaeus Abstract

Veterinary Limited., Wellington, UK
A 2-year-old, male, entire Eudyptula minor, kept in a colony of little penguins, started
Correspondence
displaying neurological signs, including stumbling, shaking and ear scratching. Several
Erica Daly, Cave Veterinary Specialists, George’s treatment trials proved unsuccessful, and previous computed tomography failed to yield
Farm Nr Wellington, West Buckland, Wellington, images of diagnostic quality. Due to the ongoing progression of the disease, the penguin
UK.
Email: [email protected]
was presented for general anaesthesia for magnetic resonance imaging. On presenta-
tion, a full neurological examination was conducted, the abnormalities were localised
to vestibular apparatus or cerebellum, with a top differential diagnosis of bilateral otitis
interna. The patient was scheduled for general anaesthesia to facilitate magnetic res-
onance imaging of the brain. There are limited reported data on anaesthesia of little
penguins. When anaesthetising this species, there are multiple pre-anaesthetic consid-
erations: fasting period, availability of suitable monitoring, the presence of a tracheal
septum, positioning of the patient, challenging intravenous access and complications
such as alterations in normal body temperature and environmental temperature.

K E YWOR D S
anaesthesia, exotics, magnetic resonance imaging (MRI), penguin

BACKGROUND as part of a breeding programme. This flock was housed in a

purpose-built enclosure. This penguin was one of the first off-
Little blue penguins or Fairy penguins (Eudyptula minor) are spring to be hand-reared by keepers, and so was used to very
the smallest species of penguin in the world. They are south- regular handling. This penguin was not currently undergoing
ern hemisphere penguins native to southern Australia and moult or preparing for moult.
New Zealand and some sub-Antarctic regions. Clinical signs were first noted when the penguin was 1-
Anaesthesia of little blue penguins is rarely reported in year-old; these were stumbling, shaking, leaning forward,
the literature, and additionally there is no previous report using its chest and wings to balance and scratching at its
of anaesthesia of a little blue penguin for magnetic reso- ears. A number of treatment trials were initiated, includ-
nance imaging (MRI). Advanced imaging of exotic species ing enrofloxacin (Baytril, Elanco UK; 10 mg/kg once a day
is becoming more frequent with wider availability.1 This is [SID]), terbinafine (Terbinafine actavis, Aurobindo Pharma—
increasing the requirement for suitable anaesthetic protocols Milpharm; 10 mg/kg twice a day [BID]), meloxicam (Melox-
to facilitate image acquisition. Of the reported anaesthetic idyl, Ceva Santé Animale; 0.2 mg/kg SID) and increased
protocols for penguins, there is a large variation in methods temperature within the indoor part of the enclosure. The water
and drugs used.2–8 and food quality were also investigated. The clinical signs con-
General anaesthesia (GA) for MRI acquisition necessitates tinued over a period of 2 years, with the patient never showing
separation between the anaesthetist and the patient during complete resolution of clinical signs within this time; however,
scanning, increasing the anaesthetist’s reliance on monitor- there was partial response of clinical signs observed during
ing equipment rather than direct patient assessment, as well the treatment trials. Meanwhile, seven out of the nine other
as having an association with a long duration of procedure. penguins in the flock that had originally been hand-reared
This case describes one anaesthetic protocol, highlights were showing some similar clinical signs. There was a con-
potential complications that may be encountered and suggests cern that this was a flock health issue, because of the number
improvements that should be considered with future cases. of individuals affected.
A computed tomography (CT) examination was under-
taken a year into the course of clinical signs. The patient
CASE PRESENTATION was anaesthetised for this procedure by the referring veteri-
nary surgeons, using isoflurane in oxygen delivered by mask.
The patient was a 3-year-old, male, entire E. minor bred in The images were of poor diagnostic quality, so did not fur-
the United Kingdom from penguins imported from Australia ther the diagnostic investigation. Following the continuation
This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided
the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.
© 2023 The Authors. Veterinary Record Case Reports published by John Wiley & Sons Ltd on behalf of British Veterinary Association.

Vet Rec Case Rep. 2024;12:e743. wileyonlinelibrary.com/journal/vrc2  of 

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VETERINARY RECORD CASE REPORTS  of 

there are some reports, normal reference intervals are not well
established for this species.9,10 The procedure was undertaken
in November, and it was confirmed that the penguins had
already undergone moulting that year.
The patient was transported to the hospital in a large pet
carrier filled with damp towels. During his travel, in an air-
conditioned van, and it was a journey of only one and a
half-hour duration. In order to minimise stress, the patient
was examined as soon as it arrived at the hospital, and the
procedure was commenced as soon as possible thereafter. The
penguin was very interested and inquisitive in the new envi-
ronment and had experienced transportation previously for
its CT scan and other veterinary visits.
Upon presentation, a physical examination was conducted
with respiratory rate noted to be 12 breaths per minute, heart
rate 112 beats per minute, mucous membranes pink and moist,
and the patient was noted to be in overall good body condi-
tion, with a body mass of 1.07 kg. Temperature measurement
was not performed during the clinical examination so as not
to stress the patient, but was immediately measured following
F I G U R E  The cervico-thoracic radiograph that was acquired to
induction of GA. A complete neurological examination was
identify the level of the tracheal septum. The white line represents the points undertaken, and the patient was deemed to be neurologically
we measured between. normal based on examination. Based on the history reported
and neurolocalisation to the vestibular apparatus and/or cere-
bellum, the most likely differential diagnosis was considered
to be bilateral inner ear disease. Neurolocalisation was made
based on the reported clinical signs observed in the patient’s
home environment.

INVESTIGATIONS

The patient had food withheld for 24 hours in advance of the

procedure, while still having free access to water. The pres-
ence of a tracheal septum in penguins is reported; its presence
means there is the potential for damage to it during intubation
or accidental one lung ventilation. Due to the unique char-
acteristics of penguin tracheas, a Cole pattern endotracheal
tube (ETT) was chosen with the hope that the tube’s shoul-
ders would provide a sufficient seal at the larynx. A cuffed
ETT was avoided due to the potential for damage to the com-
plete tracheal rings exhibited in avian species. Before GA, an
approximate measurement for depth of insertion of the Cole
ETT, distal to its shoulders, was taken based on the previous
CT images, which enabled identification of the level of the tra-
cheal septum. On the day of the procedure, it was elected to
do a conscious cervico-thoracic radiograph (Figure 1) to con-
firm the anatomical level of the tracheal septum, due to the
previous CT images being of questionable diagnostic qual-
ity. To obtain the cervico-thoracic radiograph, the patient was
enclosed in a clear plastic induction chamber in a standing
F I G U R E  This image shows the penguin standing in a clear plastic
position (Figure 2). This revealed the septum to be 2.5 cm dis-
induction chamber before radiograph acquisition. tal from the glottis and the tracheal diameter was 0.46 cm,
unfortunately we did not use a measurement marker for this,
which may have impacted the accuracy of the measurements
of clinical signs, the penguin was referred for a neurological undertaken. This was taken into consideration when selecting
examination and MRI. an appropriate ETT before tracheal intubation.
In advance of the intended general anaesthetic, pre- Following radiography, the patient was premedicated with
anaesthetic haematology and biochemistry were performed butorphanol (0.5 mg/kg; Torbugesic, Zoetis UK) and mida-
on a venous blood sample taken from the metatarsal vein zolam (1 mg/kg; Dormazolam, Dechra UK) injected intra-
while the penguin was physically restrained, and the results muscularly (IM) into the pectoral muscles using a 23-gauge
were considered within normal limits for this species. While 5/8 inch needle, while the penguin was physically restrained.
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 of  VETERINARY RECORD CASE REPORTS

This initially seemed to have a moderate sedative effect, but

did not provide sufficient sedation to facilitate placement of
an intravenous (IV) cannula. Subsequent sedation was pro-
vided with initially midazolam (0.5 mg/kg) and subsequently
alfaxalone (0.5 mg/kg IM; Alfaxan, Jurox UK) at 15-minute
intervals. For subsequent IM injections, the pectoral muscles
were contralaterally alternated. Following the initial premed-
ication and subsequent top-ups, a moderate level of sedation
was achieved. The patient maintained a standing position, but
with its head drooping slightly and becoming significantly
less interactive with its environment. It remained reactive
to attempts at IV cannulation of its metatarsal veins, while
undergoing physical restraint. F I G U R E  This image shows the penguin with its trachea intubated, as
Due to inability to achieve IV access, anaesthetic induction the tube was being secured.
using an induction chamber, which was 61 × 40 × 35 cm in size
and which was connected to the anaesthetic machine using an measurement of the new 3.5 mm internal diameter Cole ETT,
Ayre’s modified T-piece (Mapleson D) breathing system, was because the distal part, with an external diameter of 6 mm,
performed with sevoflurane (Sevotek; Animalcare), delivered was of greater length than the distance between the glottis
in oxygen. This was done over a period of 10 minutes, slowly and the tracheal septum. The distal portion of the ETT was
increasing the dialled concentration of sevoflurane starting at marked to indicate a safe insertable length, which was 2 cm
0.5% and reaching 6%, with a fresh gas flow of 3–4 L/min of depth, unfortunately this meant that the seal that is normally
O2 . When the patient had reached an adequate depth of anaes- achieved as a result of the shoulders of the Cole ETT sitting
thesia, evidenced by its immobility and lack of response to on the larynx was not necessarily achieved; however, the
gentle auditory and tactile stimulation, it was removed from external diameter of the ETT was of an appropriate size for
the induction chamber and its trachea was intubated using the patient’s trachea, minimising environmental contamina-
a 2.5 mm internal diameter Cole ETT with external diame- tion. Following this successful reintubation of the trachea, the
ter 4 mm of the distal portion, which had been premeasured patient was positioned, and the MRI scanning commenced.
to ensure that its insertion depth would not exceed 2 cm, Throughout general anaesthesia, the patient received NaCl
which would have had the potential to damage the tracheal 0.9% (1 mL/kg/h IV; Aqupharm 1, Animalcare) to help
septum. Intubation was performed solely using visual exam- maintain IV cannula patency. During MRI, the patient was
ination due to the ease of visualisation of the larynx in avian maintained in sternal recumbency to prevent compression of
species, despite the narrow gape of the patient. Correct place- the air sacs. The patient’s lungs and air sacs were ventilated
ment of the ETT in the patient’s trachea was confirmed by the using a SAV04 small animal ventilator (Vetronic Services) to
presence of a capnography trace (a low dead space connecter a peak inspiratory pressure of 8 cmH2 O at a respiratory fre-
was used), and movement of the patient’s chest when manual quency of 10 breaths per minute, which was selected based
intermittent positive-pressure ventilation (IPPV) was applied. on its resting respiratory frequency on pre-anaesthesia exam-
The tube was secured using tape to the patient’s beak. ination, delivering sevoflurane (4.5%–7%) in 100% oxygen,
While the patient’s trachea was intubated, a 26-gauge IV at a flow of 2–3 L/min via a modified T-piece (Mapleson
cannula was placed in its right metatarsal vein, and flow-by D) breathing system. The SAV04 small animal ventilator
oxygen was provided. While the IV cannula was placed, mon- (Vetronic Services) was selected because it was pressure lim-
itoring was simultaneously performed, and oxygen saturation iting, which allowed better tolerance of potential leaks, and
of the haemoglobin of peripheral pulsatile blood (SpO2 ), allowed greater control for such a small patient.
heart rate, respiratory rate, temperature and end tidal car- Monitoring of the following was continued throughout
bon dioxide and end tidal anaesthetic agent tensions were the procedure: SpO2 (with a transmittance probe on the
measured. These parameters when measured immediately patient’s foot), heart rate (derived by the pulse oximeter)
following induction were considered within normal limits. and respiratory rate (deduced by visual examination). This
Following this, the patient was deemed to be at a light plane information was available in the MRI control room from a
of anaesthesia, as it was displaying swimming motions, and relay monitor and through visual examination. Temperature
was given propofol (3 mg/kg IV; PropoFlo Plus; Zoeitis) before was monitored at the beginning and end of the proce-
transfer from the induction pod to the MRI unit on the MRI dure using a digital thermometer placed in the patient’s
table, a distance of approximately 2 m. Due to the risk of cloaca. Gadoteric acid–gadoterate meglumine contrast agent
hyperthermia, no blankets were placed on the patient. (0.1 mmol/kg IV; Dotarem, Guerbet) was administered during
During transfer into the MRI unit, the ETT was dislodged, image acquisition.
and the trachea was reintubated with the same ETT. Sub- Once the necessary images had been acquired, the delivery
sequently, the security of the ETT was increased by taping of sevoflurane was terminated but oxygen continued to be
the tube to both the patient’s beak and a wooden tongue supplied. Controlled mechanical ventilation was discon-
depressor, with the tongue depressor aligned with the beak tinued, but intermittent manual ventilation was supplied
and neck of the penguin on the right side of the penguin as deemed required by the attending anaesthetist. The
(Figure 3). During positioning for MRI, the ETT again duration of general anaesthesia was 1 hour 35 minutes. Fol-
became dislodged, and subsequently a bigger ETT (3.5 mm lowing removal from the MRI unit, the patient’s cloacal
internal diameter Cole ETT) was used for the final reintuba- temperature was found to be below the readable value of
tion of the patient’s trachea. More care had to be taken in the the thermometer, which is 33◦ C. This had dropped from a
 20526121, 2024, 1, Downloaded from https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/vrc2.743 by Cochrane Colombia, Wiley Online Library on [06/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
VETERINARY RECORD CASE REPORTS  of 

starting temperature of 37.4◦ C. Active warming was initiated, For this case, anticipated problems included hyperthermia,
using a forced warm air unit (BAIR hugger 505 warming hypoventilation, one-lung ventilation, challenging IV access,
unit) set to 43◦ C initially and then dropped to 38◦ C. The occlusion of the ETT, regurgitation with potential for aspira-
patient was maintained in a head-elevated sternal position tion, physiological dive reflex and excitation in the recovery
to minimise the risk of regurgitation. During the recovery period.11
period, heart rate, respiratory rate and SpO2 continued to be A long fasting period is advocated for penguins due to the
monitored. high risk of regurgitation.8 In this case, the patient was fasted
Tracheal extubation was performed 20 minutes after the for 24 hours in advance of general anaesthesia, but had free
discontinuation of sevoflurane (Sevotek, Animalcare) deliv- access to water.8,12 An exotics expert consulted also supported
ery, when the patient showed signs of swallowing and lifting a long fasting period. To avoid the potential for regurgi-
its head. In the recovery period, active warming and posi- tation during premedication and recovery, the patient was
tional support was continued, a peripheral blood sample was maintained in either a standing position or a head-elevated
used to measure blood glucose and found to be 7.9 mmol/L. sternal position. The patient’s trachea was extubated when it
The patient regurgitated about 20 minutes after tracheal was swallowing and moving its head. Despite this long fast-
extubation. Following complete recovery and achievement ing period, the patient regurgitated in the recovery period
of normothermic temperature of 37.6◦ C at 45 minutes after approximately 20 minutes after tracheal extubation when it
cessation of sevoflurane (Sevotek, Animalcare) delivery, the was standing and walking around and could safely control its
patient was offered a meal, but did not eat. It did display nor- own airway.
mal preening behaviour and levels of interaction, and was Penguins are widely acknowledged to have a tracheal
discharged into the care of the regular keeper, with instruc- septum.2,11,13 The septum bifurcates the trachea, but its length
tions to feed it as soon as possible and to keep it separate from and positioning is variable among species. For some genera,
the rest of the flock until the following day. this level is described: the septum is of irregular length in the
Spheniscus, short in Eudyptes and long in the Aptenodytes, but
there is little literature available to support the anatomic level
DIFFERENTIAL DIAGNOSIS in the little blue penguin.2 In preparation for the anaesthetic,
the previous CT images were reviewed to identify the level of
Differential diagnosis considered included developmental, the tracheal septum in this patient; however, as the images
metabolic, nutritional, inflammatory, infectious or toxins in were not of diagnostic quality, it was not possible to accu-
the environment. rately ascertain its location, and so a radiograph to confirm
Before presentation, investigations had been conducted to was deemed necessary. On the radiograph, we measured from
exclude metabolic, nutritional, infectious or toxic aetiologies. the glottis to the most proximal extent of septum (Figure 1).
Investigations undertaken included tracking of the tempera- To obtain the radiograph, the penguin was enclosed standing
ture of the enclosure and the pool, testing of the water in the in a clear plastic induction chamber (Figure 2). This method
pool, analysis of the diet to ensure that the fish was of suffi- was similar to a technique described for conscious CT in little
ciently high quality, feather sampling and culturing and a CT blue penguins, which meant that the patient was not physically
scan. restrained and so minimised the stress caused to it.14
Cole pattern ETTs are preferred for avian patients as their
design, of a wider proximal portion and narrower distal tip,
OUTCOME AND FOLLOW-UP proposes that a seal is formed at the glottis, by the shoulders
of the tube.15 An uncuffed tube is recommended in avian
Recovery from general anaesthesia was slightly delayed due patients due to their complete tracheal rings. Cuffed ETTs
to the hypothermia experienced by the penguin. Reintro- may present a risk of pressure necrosis, caused by the inflated
duction to the colony took place the following day without cuff, or even potential for tracheal rupture, due to the inability
incident. There was also an incident of regurgitation follow- of the trachea to increase its diameter because of the complete
ing the immediate recovery period. The patient ate later that tracheal rings. Before general anaesthesia, the distal portion
evening upon return to it home, and it appeared completely of the ETT was measured to ensure that if inserted fully into
recovered the following day. The MRI images were unre- the trachea, its distal point would not reach and damage
markable and did not support a definitive diagnosis but did the tracheal septum. On the first intubation of the patient’s
help to exclude some important differential diagnoses, such trachea, the tube was secured using tape to attach it to the
as congenital, structural or inflammatory neurological causes. patient’s beak. Unexpectedly during movement from the
induction pod to the MRI unit, the ETT became dislodged.
The patient’s trachea was successfully reintubated, and the
DISCUSSION ETT was secured to the patient’s beak with the aid of a rigid
tongue depressor and tape. When the ETT became dislodged
There are no previous published descriptions of general anaes- a second time, the decision was made to use a larger diameter
thesia in little blue penguins for MRI. General anaesthesia of ETT; however, this meant it could not be inserted to its full
exotic species where there is limited reported drug data can depth, limiting the benefits of the use of Cole ETT as it now
present challenges. Preparation and planning in advance are failed to form a seal at the glottis. However, the external
of the utmost significance. It is important to ensure that there diameter of the ETT in use was of an appropriate size for the
is suitable equipment available, as the size, anatomy and physi- diameter of the patient’s trachea, minimising the potential
ology may differ significantly from domesticated patient types. atmospheric pollution, although there was the potential for a
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 of  VETERINARY RECORD CASE REPORTS

leak, as it was an uncuffed tube. This presented challenges with surement may have been taken before movement into the
a reduced ability to administer positive-pressure ventilation, MRI unit; however, due to the small size of the patient and
and may have impacted the ability to maintain a steady plane unfamiliar anatomy, it may have been challenging, and the
of general anaesthesia. It may also have influenced the end duration of the anaesthetic was considered to be the most sig-
tidal carbon dioxide and end tidal anaesthetic agent tensions, nificant risk to the patient. So following risk assessment, it
making them lower than the actual values, due to possible was decided to proceed to MRI without a measurement, espe-
dilution by room air. On reflection, the authors acknowledge cially given it would not be possible to continue to measure
that the ETT used could have been cut and shortened to allow it throughout the general anaesthetic. In hindsight, Doppler
the shoulders of the ETT to sit on the glottis and form the blood pressure measurement could have been conducted in
desired seal. A supraglottic airway device (SGAD) may also the recovery period, and this would be a refinement for future
have been considered as an option; however, it was considered cases. Unfortunately, there are no established reference ranges
that the smallest available size would have been too large for for blood pressure values in penguins, so any values would
the gape of this penguin’s beak, and additionally due to the have to be extrapolated from other commonly encountered
high risk of regurgitation, an SGAD was not considered species. The available MRI-safe electrocardiogram pads were
desirable. also non-compatible with the small size of the patient, and
It is described that avian patients should not be positioned thus it was necessary to pluck a large area of feathers from
in dorsal recumbency, as it compresses the abdominal air sacs, the penguin for them to adhere to the skin. Monitoring of
and it may increase the work of breathing to lift the keel anaesthesia for MRI presents a challenge, as hands-on mon-
against gravity.16 In a paper comparing air sac volume, lung itoring is restricted due to the distant location. During this
volume and lung densities in Humboldt penguins (Spheniscus case, the patient was visible through a window in the bore of
humboldti), the air sac volume was largest in penguins in ven- the MRI. Invasive blood pressure monitoring could have been
tral (sternal) recumbency and smallest in penguins positioned a good addition to the monitoring of this case, but the dis-
in dorsal recumbency.16 This patient was ultimately posi- tance and length of the line required would have dampened
tioned in ventral recumbency, and mechanically ventilated the signal and increased the risk of inaccurate readings. This
successfully for the duration of the MRI. highlights the vital importance that possible complications are
IV access may be difficult in patients of small size, and par- envisioned and that there are available solutions to them in
ticularly in avian species. Before the procedure, the brachial advance.
vein was considered the vein of choice for cannulation, as it The anaesthetic plan was selected based on a variety of ref-
was a larger vein. However, upon examination, the feather erences. Carpenter’s exotic formulary reported that a dose of
cover was very dense, and it was decided that it would require 0.5–4 mg/kg of butorphanol can be administered IV or IM
excessive feather plucking to enable visualisation and cannu- and doses of 0.1–2 mg midazolam can be administered by
lation of the vein, and so an alternative vessel was selected. IV or IM routes in most species of birds.3 The use of propo-
Penguins in general exhibit a denser feather cover, in com- fol for induction and maintenance of anaesthesia has been
parison with other avian species, with feathers that are short reported in King penguins.4 During treatment of pododer-
and stiff and which provide insulation when swimming.2 matitis of little penguins after oil spill, a reported sedation
The metatarsal veins were initially rejected as an option due protocol for debridement included butorphanol (4 mg/kg IM)
to the risk of faecal contamination of the IV cannulation combined with tiletamine and zolazepam (0.05–0.15 mg/kg)
sites, and these veins were extremely small and difficult to or midazolam (0.1–0.5 mg/kg IM).5 West et al. suggested
visualise.2 However, they were ultimately the veins where per- 1.5 mg/kg midazolam administered IM for the sedation of lit-
cutaneous IV cannulation was most likely to be successful. tle penguins for radiology.2 Many sources also advocate the
The right metatarsal vein was cannulated with a 26Ga IV use of mask induction of anaesthesia with a volatile agent
cannula. mixed in oxygen.2,11 Sevoflurane use for induction and main-
The monitoring available during this procedure included tenance of anaesthesia has been described in many penguin
measurement of end tidal carbon dioxide and end tidal anaes- species.2,3,7,8 Based on this variety of reported drug dosages,
thetic agent tensions via sidestream gas sampling, and SpO2 it was opted to start with lower doses, so that they could be
with a transmittance probe on a foot. SpO2 readings may titrated upwards if required. In theory, allometric scaling may
be expected to be of a lower percentage than would be have been employed to start with higher doses, but due to
deemed acceptable in mammalian patients: pulse oximeters the authors’ lack of familiarity with the species, a cautious
in common use are designed to measure oxyhaemoglobin approach was deemed more sensible. Lower doses were also
and deoxyhaemoglobin in mammalian haemoglobin and not considered appropriate due to the amenable nature of the
avian haemoglobin.11 The high absorption ratio of red to patient. Butorphanol was selected based on its good sedative
infrared light of avian haemoglobin means that a lower sat- properties and reported success in sedation of little penguins.5
uration value is given by pulse oximeters calibrated according Midazolam was selected based on the report of its effective-
to mammalian haemoglobin.2,17 During the anaesthetic, SpO2 ness in sedation of little penguins for radiology.2 When the
values between 88% and 90% were recorded. These values selected premedication protocol had proven inadequate for IV
were deemed to be acceptable, but in order to establish appro- cannulation, alfaxalone IM was selected as a desirable addi-
priate readings, an avian-specific scale would be required. tional agent based on its favourable safety profile in domestic
Oscillometric blood pressure was not attainable due to the and exotic species and reported use as a sedative agent when
size and shape of the patient’s extremities, and Doppler mea- administered intramuscularly, and ultimately familiarity to
surements were not possible due to the MRI-incompatible the users.18–22 Propofol was originally intended as the IV
nature of the Doppler unit. A Doppler blood pressure mea- induction agent, so it was subsequently used to deepen the
 20526121, 2024, 1, Downloaded from https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/vrc2.743 by Cochrane Colombia, Wiley Online Library on [06/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
VETERINARY RECORD CASE REPORTS  of 

plane of anaesthesia despite the addition of alfaxalone IM to Monitoring the depth of anaesthesia in little penguins pre-
the premedication. sented a challenge, as there are no established methods of
The initial anaesthetic plan had been to induce general doing so. As always, returning to first principles is useful. To
anaesthesia by administering an IV induction agent titrated establish depth of anaesthesia, the authors monitored respira-
slowly to effect. Despite displaying a good level of sedation tory rate and effort before commencement of IPPV, palpebral
after premedication however, the patient was not amenable reflex and beak tone.
to IV cannula placement. Subsequent premedication top-ups It is common practice in captive zoological collections to
did not increase the tolerance of the patient to IV cannula employ positive reinforcement techniques to facilitate the
placement. The decision was reached to use an induction undertaking of commonly required veterinary procedures in
chamber to perform anaesthetic induction with an inhala- as stress-free a manner as possible. This penguin was hand-
tion agent, although this had originally been planned to be reared and very amenable to handling, which was fortunate, as
avoided due to the risk of environmental contamination. it meant there was minimal stress caused to the penguin due
The patient was placed in an induction chamber initially to the handling required for this procedure. As this penguin
with a low fractional inspired sevoflurane. This was titrated was only 1 kg in body mass, restraint when required was easy
upwards until the desired effect, of immobility, muscle relax- to achieve. In larger penguins, specific alternative techniques
ation and unresponsiveness, was achieved. A low initial may be required to facilitate manual restraint.
fractional inspired sevoflurane concentration, with titration Penguins undergo periods of significant metabolic stress
upwards, was selected to minimise any aversive response during periods associated with mating and moulting. Signif-
exhibited by the patient, which may have initiated a dive icant reduction in body mass may be associated with these
response and limited the effectiveness of the induction of periods due to the associated starvation times. The toler-
GA using inhalant anaesthetic agent due to the patient hold- ance of penguins to this period of long starvation meant the
ing its breath. The risk of initiating a dive response may authors were not concerned about the fasting period advised
have been greater had mask induction been the selected in advance of anaesthesia. It is not advisable to anaesthetise
method, as this would have caused a greater stress to the penguins during these periods of increased metabolic stress.2
patient. If anaesthetising a little penguin again, there are several
Hyperthermia is reported to be a common complication changes that the authors would make in the protocol used.
experienced by penguins under general anaesthesia. This is The patient in this case presented a challenge as it seemed
thought to be due to their thick layer of subcutaneous fat and to exhibit a very good level of sedation, but was reactive to
thick feathering.2 Penguins are documented as having well- attempts at IV cannulation. In future following administration
developed arteriovenous shunt mechanisms for heat control at of premedication, the authors would recommend returning
three anatomical locations: neck, wings and legs. These assist the patient to its carrier to aid with achieving peak sedative
in internal temperature regulation during extreme external effect. The authors would advocate trialling an alternative fast-
temperature fluctuations.23 Little blue penguins are reported ing period. On reflection, however, it is difficult to assess if the
to have poor tolerance of heat stress and are unable to reg- selected fasting period of 24 hours in this case, was too long
ulate their body temperature in low water temperatures.2,24 or insufficient. Water was not withheld in this case, which may
As such, precautions were taken to prevent hyperthermia. No also be altered in future. More research of fasting times is war-
blankets were placed over the patient, and the temperature of ranted in this species. The authors would also advocate for
the MRI suite was set to a lower-than-normal ambient tem- advance preparation by cutting the ETT to a suitable length
perature. Regrettably, there was no availability of MRI-safe in advance of intubation attempts. It may also be advisable
thermometers compatible with our monitoring equipment. It to secure the ETT rigorously to prevent dislodgement. The
had initially been planned to remove the patient to repeat authors would recommend the use of an additional item such
temperature measurement mid-way through the procedure; as a tongue depressor to aid in the rigidity and security of
however, given the complication with maintenance of the ETT, the ETT. The authors would recommend the use of a radio-
it was decided that dislodgement of the ETT posed the greater graph for determination of the site of the tracheal septum.
risk to the patient. It must be noted that a risk of removing Finally, following the significant hypothermia experienced by
the patient from MRI for this purpose could be interference this patient, the authors would recommend more frequent
with the image interpretation. In this case, however, the MRI temperature monitoring and quicker intervention in order to
table in use docks onto the scanner, so moving the table out of maintain normothermia.
the MRI would not have necessitated change in positioning
of the patient. Ice had also been prepared for the eventual- AU T H O R C O N T R I B U T I O N S
ity of the patient becoming hyperthermic. Unexpectedly, at All authors were involved in the case preparation and manage-
the end of the procedure, the patient was found to be severely ment. Erica Daly prepared the manuscript. The manuscript
hypothermic. Following discontinuation of volatile anaesthe- was reviewed by William McFadzean and Phillipa Kate
sia, active warming was initiated using a BAIR hugger. During Tucker.
the recovery period, the patient’s temperature was measured
every 5 minutes. A steady improvement was noted until return C O N F L I C T O F I N T E R E S T S TAT E M E N T
to normothermia at 45 minutes after cessation of sevoflu- The authors declare they have no conflicts of interest.
rane delivery. Little blue penguins may experience a greater
risk of hypothermia due to their smaller size and relatively F U N D I N G I N F O R M AT I O N
greater body surface area in comparison to other penguin Linnaeus Veterinary Limited supported the costs of the Open
species. Access Publication Charges.
 20526121, 2024, 1, Downloaded from https://bvajournals.onlinelibrary.wiley.com/doi/10.1002/vrc2.743 by Cochrane Colombia, Wiley Online Library on [06/04/2024]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
 of  VETERINARY RECORD CASE REPORTS

E T H I C S S TAT E M E N T mined by use of computed tomography in conscious and anesthetized

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