How to Anaesthetize a Giraffe*

Important Principles
1. The large size of giraffe limits the ability of theatre
personnel to physically control them during the delicate
phases of induction and recovery.
2. The giraffe’s long neck acts as a lever arm and can be a
source of danger to theatre staff as well as the patient
itself. During the recovery period muscle spasms in the
patient’s neck can be fatal.
3. Giraffe tend to vomit and regurgitate. This is most
likely to occur upon induction from the increased intra-
abdominal pressure resulting from the patient
impacting the ground since the skin and muscles over
the abdomen are very tense. Opioids make this even
more likely and a rumen bolus may be seen progressing
up the neck as a precursor to a potentially fatal
aspiration.
4. The posterior position of the larynx and their limited
mouth opening makes intubating the giraffe technically
difficult. Consequently this is rarely done.
5. Prolonged induction and anaesthesia can lead to
hyperthermia, myopathy and secondary trauma.
6. Physiological adaptations of significance to the
anaesthetist include hypertension, small respiratory
tidal volume, large physiological dead space and low
cardiac output during anaesthesia.

You Will Need

1. An operating area with stable footing, smooth walls and
very tall ceilings. A modified cattle crush with catwalk
would be ideal.
2. At least four strong men in addition to the anaesthetist
and surgical staff.
3. Several lengths of thick rope, a blindfold and earplugs.
4. A long spine board- a wide plank or Malibu surfboard
will suffice as alternatives.
5. Anaesthetic agents (see below), dart gun, iv cannulae
and infusion equipment.

Preoperative Assessment and Preparation

1. Measure patient’s height and weight. If the latter is not
feasible note the patient’s shoulder height in cm.
2. Ensure all theatre staff are fully briefed and prepared
for the induction. Only experienced and physically fit
staff should be involved.
3. Fast patient from food for 72hrs and from water for
48hrs.
4. Warn the patient’s carers of the high risk of
perioperative morbidity and mortality- up to 10%.
5. Only book one case for the theatre session.

Perioperative Management and Monitoring

1. Induction takes between 30minutes and an hour.
Initial sedation is usually achieved with a sedative
administered via dart gun. To induce recumbency
further anaesthetic agents are given. It may be
necessary to physically bring the giraffe down by
casting it with a rope.
2. Especial care must be taken with regard to the patient’s
neck. It must be supported by a long board so that the
head is above the stomach. The neck should be
extended to keep the airway patent and the nose
pointed down to facilitate drainage of secretions. The
angle of the neck is altered q10-15mins to prevent
muscle spasms.
3. Blindfold the patient and apply earplugs.
4. Secure iv access- the jugular vein is the preferred site.
5. Apply standard monitoring: shave ear and apply pulse
oximeter, place standard ETT in patient’s nostril and
attach CO2 sensor to it, insert rectal temperature probe
and apply BP cuff above the carpus. The pulse can be
palpated in the auricular or mandibular artery.
6. Depth of anaesthesia monitoring can be facilitated by
noting the patient’s response to hoof trimming.

7. Record the patient’s pulse, blood pressure, respirations

and oxygen saturation. Note that ET CO2 may not
accurately reflect true arterial tensions.
8. Coordinate staff in preparation for emergence.
Administer antagonist agents.
9. As the patient wakens, remove the blindfold and
earplugs. Place a rope around the patient’s shoulders.
Before attempting the final phase of the recovery
ensure the patient has adequate muscle strength - this
correlates with the patient’s ability to resist head
restraint by lifting one man off the ground. Support the
patient’s head and elevate the head as three assistants
apply traction on the shoulder rope to assist the patient
into the sternal position.
Anaesthetic Agents

1. Several combinations have been

used successfully. The first
reported cases were with
succinylcholine but there were
significant problems associated
with the use of this as a sole
agent.
2. Most experience is with a
combination of xylazine, an α 2-
agonist and etorphine, an opioid.
Atropine (7-8mg/ adult) is often
given to prevent xylazine
induced bradycardia. Giraffe are
very sensitive to opioids and
caution is mandatory with the
use of these agents as they
cause profound cardiorespiratory
depression and can provoke
vomiting and regurgitation.
3. 5% glycerol glycolate has been
used to deepen the anaesthetic
and facilitate muscle relaxation.
4. Anatgonists used to reverse xylazine include
atipamezole, yohimbine and doxapram. Naltrexone is
most commonly used to antagonize the opioids.
5. More recently success has been reported with a
combination of medetomidine (150mcg) and ketamine
(3mg/ cm of shoulder height). Hyaluronidase was
mixed in to facilitate absorption of the intramuscular
injection. Opioids were required to supplement
anaesthesia for major procedures, eg. Carfentanil.
Again atipamezole was used to reverse the effects of
the medetomidine.

*Why Giraffe? Because I like them, that’s why.