The avian respiratory system: implications for anaesthesia

Anaesthesia is not a natural state for any animal, including birds. The unique anatomic and physiological attributes of the class Aves that have made it possible for birds to inhabit every continent on this planet and to live in a variety of environments, some considered challenging if not inhospitable to mammals, pose challenges to their anaesthetic management. Indeed, it is more challenging than the anaesthetic management of mammals, a reality substantiated by the fact that the risk of anaesthesia-related death of birds is up to 20 times higher than for dogs and cats. This article highlights those anatomic (respiratory system, renal-portal system), physiological (gas exchange, respiratory control mechanisms in respiratory brainstem and peripheral chemoreceptor areas, including intrapulmonary chemoreceptors) and pharmacological attributes (pharmacokinetics and pharmacodynamics) that make anaesthetic management, both inhalant and injectable anaesthesia, of birds challenging, and how those challenges are managed.This article is part of the theme issue 'The biology of the avian respiratory system'.

USE OF THE ZOOLOGICAL INFORMATION MANAGEMENT SYSTEM (ZIMS) DATABASE (2003-2023) FOR EVALUATION OF PRACTITIONER-SELECTED MELOXICAM DOSES AND THE RELATIONSHIP TO AVIAN TAXONOMY

Meloxicam, a commonly used NSAID, has wide variation in pharmacokinetics between different avian species. The present study hypothesized that meloxicam dosage regimens were similar within, but differ between, groups of avian species with similar feeding habits, habitats, or migratory behaviors. Utilizing the international Zoological Information Management System (ZIMS), drug usage extracts were compiled for meloxicam across eleven major orders of birds. The orders were selected based on their prevalence in zoological collections, wildlife rehabilitation centers, the pet trade, and production environments. Each species with a record available in drug usage extracts was classified into broad categories of main habitat, diet, and migratory status. Significant patterns associated with habitat, diet, or migratory status were not identified statistically. An inverse relationship was identified statistically between the practitioner mg/kg dose and body weight in kg in birds that weigh approximately 20 kg or greater. This study includes practitioner-reported summary data of current doses used in the veterinary field to treat many different avian species. Adverse effects of meloxicam were recorded in <5% of individuals evaluated at the species level in this study.

Pharmacokinetics and bioavailability of meloxicam in Pekin ducks following intravenous, intramuscular and oral administration

OBJECTIVE

To determine the pharmacokinetics and bioavailability of meloxicam following intravenous (IV), intramuscular (IM), and oral administrations at a dose of 1.0 mg kg-1 in Pekin ducks.

STUDY DESIGN

Randomized experimental trial.

ANIMALS

A total of 18 clinically healthy male Pekin ducks.

METHODS

Pekin ducks were randomly assigned to three groups of six ducks: IV, IM and oral. Meloxicam (1.0 mg kg-1) was administered to each Pekin duck. A non-compartmental analysis was used to evaluate pharmacokinetic parameters.

RESULTS

No local or systemic adverse effects were observed in any bird. Meloxicam was detected in the plasma up to 120 hours following IV, IM or oral administration. The elimination half-life of the IV route was slightly shorter than that of the IM and oral routes (p < 0.05). Following IV administration, volume of distribution at steady state and total clearance were 133.17 mL kg-1 and 6.68 mL kg-1 hour-1, respectively. The mean absorption time was 2.29 hours for IM and 1.13 hours for oral route. There were significant differences between IM and oral administration for the peak plasma concentration (Cmax), time to reach Cmax and bioavailability (p < 0.05).

CONCLUSIONS AND CLINICAL RELEVANCE

Meloxicam showed long elimination half-life and high bioavailability following IM and oral administration. Meloxicam in Pekin ducks provided the effective therapeutic concentration indicated in other species for up to 48 hours. However, there is a need to determine the clinical efficacy of meloxicam in Pekin ducks.

Pharmacokinetics of meloxicam in pigeons after single intravenous, oral, and intramuscular administration

This study aimed to determine the pharmacokinetics of meloxicam in pigeons. Twenty-four 7-wk-old meat pigeons (Columba livia) were randomly divided into 3 groups (PO, IM, and IV) and given a single dose of 1 mg/kg body weight of meloxicam. Plasma samples were taken at predetermined times, which were then analyzed using a validated high-performance liquid chromatography (HPLC) method and subjected to noncompartmental analysis using Phoenix software. Results indicated that meloxicam was absorbed effectively and quickly after PO and IM dosing. Peak concentrations (0.83 ± 0.21 and 1.59 ± 0.49 μg/mL) were achieved at 2 and 0.26 h, respectively, with mean absorption times of 2.56 ± 1.50 and 1.47 ± 0.89 h. Bioavailability was high at 86.31 ± 43.45% and 81.57 ± 52.58%, respectively, and the area under the concentration-time curve (AUC0-∞) was 5.33 ± 2.68 and 5.03 ± 3.26 h·µg/mL. After IV administration, the elimination was faster with a total body clearance (CL) of 188.75 ± 83.23 mL/h/kg, an elimination half-life (t1/2λz) of 1.76 ± 0.56 h, and a volume of distribution at steady-state (VSS) of 427.50 ± 188.43 mL/kg. Considering the lack of a precise analgesic threshold of meloxicam in pigeons and the notable differences in its analgesic threshold among various animal species, formulating a dosing regimen in pigeons presented a significant challenge. Based on the previous analgesic threshold (3.5 μg/mL) in parrots, a higher dose (e.g., 2 mg/kg) or shorter dosing interval (e.g., every 6 h) is recommended for treating pain in pigeons. Nonetheless, further pharmacodynamic research is required to verify these recommendations.

PHARMACOKINETICS OF MELOXICAM AFTER SINGLE ORAL AND INTRAMUSCULAR ADMINISTRATION IN CHINA ROCKFISH (SEBASTES NEBULOSUS)

Fish species are important for various purposes including aquaculture stock and display animals, but there are significant gaps in the medical knowledge regarding pharmacological parameters and effective pain management. Meloxicam is a nonsteroidal anti-inflammatory drug (NSAID) that has been studied in few teleost species and with several administration routes. However, these species were typically freshwater or euryhaline fish, and evaluation in marine species is lacking. The pharmacokinetic properties of meloxicam were determined in nine adult China rockfish (Sebastes nebulosus), presumed healthy based on physical examination and benign medical histories. Based on a pilot study, China rockfish were given 1 mg/kg meloxicam via IM injection in the epaxial musculature, and, after a 48-h washout period, 1 mg/kg meloxicam was given by PO gavage. Blood samples were collected from the caudal vein at baseline and at nine time intervals over a 48-h time period following administration of meloxicam. Plasma meloxicam concentrations were determined by reverse phase high-performance liquid chromatography, and noncompartmental analysis was performed. The mean peak plasma concentration after IM injection was 4.9 µg/ml, and the mean terminal half-life was 5.0 h. The mean peak plasma concentration after PO administration was 0.07 µg/ml. Based on these findings, IM injected meloxicam reaches plasma levels consistent with therapeutic concentrations in select mammals, and peak levels were maintained for ≤12 h. Single-dose PO administration failed to achieve similar concentrations, and clinical practicality is unknown. Further studies evaluating NSAID multidose regimes and their pharmacodynamic effects may provide additional dosing information.

Treatment of Pain in Birds

This article provides an overview of the current understanding of evidence-based clinical analgesic use in birds. The field of avian analgesia has dramatically expanded during the last 20 years, affording more options for alleviating both acute and chronic pain. These options include opioids, nonsteroidal anti-inflammatory drugs, local anesthetics, and/or other drugs like gabapentin, amantadine, and cannabinoids, acting at different points in the nociceptive system thereby helping to provide greater pain relief while reducing the risk of adverse effects when combined.

A Critical Review of the Pharmacokinetics, Pharmacodynamics, and Safety Data of Antibiotics in Avian Species

In avian medicine, the use of antibiotic dosing regimens based on species-specific pharmacological studies is ideal. However, due to a lack of such studies, dose extrapolation, which may cause inefficacy and toxicity, is common practice. Multiple searches were performed using the PubMed and Web of Science databases to extract relevant pharmacological studies performed in exotic avian species. The pharmacokinetics (PK), pharmacodynamics (PD), and safety data of the selected antibiotics (enrofloxacin, marbofloxacin, gentamicin, amikacin, ceftiofur, doxycycline, and amoxicillin/clavulanate) from these studies were reviewed. This review aimed to identify trends amenable for safe inter-species dose extrapolation and provide updated findings on dosing regimens that are safe and efficacious for various exotic avian species. We observed that the half-life of antibiotics appears to be shorter in the common ostrich and that amikacin may be amenable to inter-species dose extrapolation as it is safe and shows little inter-species PK and PD variation. Species-specific enrofloxacin dosing regimens that were not listed in the Exotic Animal Formulary (5th ed.) were found for Caribbean flamingos, African penguins, southern crested caracaras, common ostriches, and greater rheas. Specific dosing regimens recommended for psittacine birds (doxycycline 130 mg/kg medicated water) and ratites (PO doxycycline 2–3.5 mg/kg q12 h, PO enrofloxacin 1.5–2.5 mg/kg q12 h and IM enrofloxacin 5 mg/kg q12 h) in the formulary may not be effective in budgerigars and common ostriches, respectively. Apart from the lack of species-specific pharmacological studies, a lack of multiple dose studies was also noted.

RETROSPECTIVE STUDY OF MORBIDITY AND MORTALITY OF AFRICAN PENGUINS (SPHENISCUS DEMERSUS) UNDER MANAGED CARE IN NORTH AMERICA: 2007-2018

Currently, more than 20% (51/240) of zoos and aquariums accredited by the Association of Zoos and Aquariums house African penguins (Spheniscus demersus) in their collections. The African penguin Species Survival Plan (SSP) veterinary advisors regularly collect information from those facilities to characterize morbidity and mortality for this species and to collate preventative medicine and treatment regimens. These efforts resulted in more than 10 yr of collection of management data across the SSP, representing the care and management of more than a thousand birds. The most common morbidities reported included those of dermatologic (27%, 125/452 institutions) and musculoskeletal or neurologic (18%, 82/452 institutions) disease, while the most common causes of mortality were respiratory diseases (20%, 65/323 deaths) and systemic or multifactorial conditions (19%, 62/323 deaths). Aspergillosis cases accounted for 69% (45/65 deaths) of respiratory-related mortality and avian malaria cases comprised 31% (19/62 deaths) of mortality related to systemic diseases. Mortality was most commonly reported in geriatric birds, or those older than 15 yr of age (34%, 111/323 deaths). Reproductive related mortality was only defined in female birds, while other causes of death were more evenly distributed between sexes. Utilizing the SSP data to determine morbidity and mortality trends within this population provides important information to veterinary and animal care teams, allowing them to provide enhanced levels of care to the penguins housed at their institutions. By recognizing the most important diseases and causes of death in this species, management and healthcare resources can target conditions with the highest impact on the population.

Use of a canine melanoma vaccine in the management of malignant melanoma in an African penguin (Spheniscus demersus)

CASE DESCRIPTION

A 25-year-old 4.4-kg male aquarium-hatched African penguin (Spheniscus demersus) was evaluated because of a raised 1.5 × 0.5-cm pigmented mass extending from within the right naris noted 2 days earlier.

CLINICAL FINDINGS

The penguin had a raised pigmented mass extending out from the right naris and onto the upper beak. Histologic examination of excisional biopsy specimens confirmed a diagnosis of malignant melanoma. A treatment plan including administration of meloxicam, radiation therapy, and immunotherapy was initiated.

TREATMENT AND OUTCOME

Treatment with meloxicam (0.2 mg/kg, PO, q 24 h) was initiated and continued for a total of 45 weeks; however, the medication was discontinued for a period of 6 weeks because of the risk of toxic effects in the chick that the penguin was feeding at that time. The penguin underwent local hypofractionated radiation therapy and received 4 once weekly 8-Gy fractions of radiation (total radiation dose, 32 Gy). The penguin was administered a canine melanoma vaccine transdermally every other week for 4 doses, with a booster injection given 7 months after the first dose. Treatment with the vaccine appeared to have no adverse effects. The penguin's pre- and postvaccination tyrosinase-specific antibody titers were measured with an anti-human tyrosinase-specific ELISA, and a 3-fold titer increase indicated a positive humoral immune response to the canine melanoma vaccination. The penguin died of unrelated causes 54 weeks after initial diagnosis, and there was no evidence of metastasis on necropsy.

CLINICAL RELEVANCE

These case findings suggested that vaccination with a canine melanoma vaccine may be a safe and useful adjunct treatment for management of malignant melanoma in penguins.

Pharmacokinetics of a Single Dose of Oral Meloxicam in Rehabilitated Wild Brown Pelicans (Pelecanus occidentalis)

Because of concerns regarding potential adverse effects of meloxicam in pelicans reported by several zoos and wildlife rehabilitation facilities, this study was undertaken to determine the pharmacokinetics of a single oral dose of meloxicam in brown pelicans (Pelecanus occidentalis). A pilot study was performed with 6 apparently healthy wild adult brown pelicans of unknown sex during rehabilitation, administered a single oral dose of meloxicam at 0.2 mg/kg. Plasma drug concentrations were monitored for 24 hours but failed to capture the elimination phase of the drug. Consequently, a principal study monitored plasma concentrations for 120 hours. Six additional adult wild brown pelicans, 3 males and 3 females, approaching releasable condition in rehabilitation were split into 3 groups and each orally administered 0.2 mg/kg meloxicam. Blood samples were collected at baseline and at 4 additional time points that differed between groups. Plasma concentrations were measured with liquid chromatography-mass spectrometry. The mean maximum plasma concentration was 1.22 µg/mL and was achieved at 24 hours after drug administration. The elimination half-life was 36.3 hours, the longest reported to date for any avian species. Further studies are needed to determine the pharmacokinetics of multiple doses of meloxicam and other routes of administration, as well as the pharmacodynamics and safety profile of meloxicam in brown pelicans. On the basis of the results of these investigations, caution is advised when dosing brown pelicans with meloxicam until more studies are completed. By extrapolation, close taxonomic relatives in the order Pelecaniformes may also warrant additional studies.

PHARMACOKINETIC BEHAVIOR OF MELOXICAM IN LOGGERHEAD (CARETTA CARETTA), KEMP'S RIDLEY (LEPIDOCHELYS KEMPII), AND GREEN (CHELONIA MYDAS) SEA TURTLES AFTER SUBCUTANEOUS ADMINISTRATION

The objective of this study was to determine the pharmacokinetics of a single dose of meloxicam administered subcutaneously (SQ) to three species of sea turtles: loggerheads (Caretta caretta), Kemp's ridley (Lepidochelys kempii), and greens (Chelonia mydas). A dose of 1 mg/kg was given to the Kemp's ridleys and greens, whereas the loggerheads received 2 mg/kg. After SQ administration, the half-life (t1/2) of meloxicam administered at 1 mg/kg in the Kemp's ridleys was 5.51 hr but could not be determined in the greens. The half-life of meloxicam administered at 2 mg/kg in the loggerheads was 2.99 hr. The maximum concentration (Cmax) for meloxicam after SQ administration at 1 mg/kg in the Kemp's ridleys was 6.76 µg/ml and in the greens was 9.35 µg/ml. The Cmax in loggerheads for meloxicam after SQ administration at 2 mg/kg was 3.63 µg/mL. Meloxicam administered SQ at a dose of 1 mg/kg to the Kemp's ridley and greens provided measurable plasma concentrations of meloxicam for 48 and 120 hr, respectively, with no adverse side effects. In loggerheads, meloxicam administered SQ at a dose of 2 mg/kg provided measurable plasma levels of meloxicam for only 24 hr. Plasma levels of meloxicam of greater than 0.5 µg/ml are considered to be therapeutic in humans. Results suggested that administration of meloxicam SQ at 1 mg/kg in Kemp's ridleys and greens would result in plasma concentrations greater than 0.5 µg/ml for 12 and 120 hr, respectively. The administration of 2 mg/kg meloxicam to loggerhead turtles resulted in plasma concentrations greater than 0.5 µg/ml for only 4 hr.

Pharmacokinetics of meloxicam, carprofen, and tolfenamic acid after intramuscular and oral administration in Japanese quails (Coturnix coturnix japonica)

The aim of this study was to determine the pharmacokinetics of meloxicam (MLX), carprofen (CRP), and tolfenamic acid (TA) in Japanese quails (Coturnix coturnix japonica) following intramuscular (IM) and oral administration at doses of 1, 10, and 2 mg/kg, respectively. A total of 72 quails were randomly divided into 3 equal groups as MLX, CRP, and TA. Each group was separated into two sub-groups that received IM and oral administration of each drug. Plasma concentrations of MLX, CRP, and TA were determined using HPLC-UV and analyzed by non-compartmental method. The t_1/2ʎz and MRT of MLX, CRP, and TA after oral administration were similar to those after IM administration. The V_darea /F of MLX, CRP, and TA after IM administration was 0.28, 2.05, and 0.20 L/kg. The Cl/F of MLX, CRP, and TA after IM administration was 0.12, 0.19, and 0.09 L/h/kg. MLX, CRP, and TA after oral administration showed significantly lower C_max and longer T_max compared with IM administration. The relative bioavailability of MLX, CRP, and TA following oral administration in quails was 76.13%, 61.46%, and 57.32%, respectively. The IM and oral route of MLX, CRP, and TA can be used for the treatment of various conditions in quails. However, further research is necessary to determine the pharmacodynamics and safety of MLX, CRP, and TA before use in quails.

Pharmacokinetics and Safety of Intramuscular Meloxicam in Zebra Finches (Taeniopygia guttata)

Meloxicam is the most frequently used NSAID in birds; however, its elimination t_1/2 is highly variable among species. Because zebra finches that require analgesia could benefit from receiving meloxicam, we performed a pharmacokinetic study involving a single intramuscular dose of 1 or 2 mg/kg. Data analysis showed that C_max, t_1/2, and elimination rate constants were not significantly different between the 2 doses. In contrast, C_max for 1- and 2-mg/kg doses of meloxicam approached a significant difference, and those for AUC_0-∞ were significantly different. Importantly, a plasma concentration of 3500 ng/mL, considered a target level for meloxicam in other avian species, was maintained for approximately 9.5 h in finches that received 2 mg/kg, which was 4 h longer than in birds given 1 mg/kg. Both doses reached low plasma concentrations by 12 h after administration. Subsequently, 8 total doses of 1 or 2 mg/kg were administered to birds at 12-h intervals; these regimens caused no significant changes in select biochemical analytes or the Hct of meloxicam-treated birds. In addition, histopathologic changes for injection sites, kidney, liver, proventriculus, and ventriculus were minimal and similar between control and experimental groups after the multiple doses. These results suggest a 12-h or more frequent dosing interval is likely needed in zebra finches and that meloxicam at 1 or 2 mg/kg IM twice daily for 4 d is safe. The higher dose might provide longer analgesia compared with the lower dose, but a pharmacodynamics evaluation of meloxicam in zebra finches is needed to confirm analgesic efficacy.