A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery.  A second surgery was required after 3 months. To colic general information Case report Colic and abdominal surgery in 14-month-old African elephant Date: 2018 Place: South Africa Data provided by: History A 14-month-old African elephant presented with colic caused by colon obstipation. Due to the severity of the symptoms, it was decided to perform abdominal surgery. A second surgery was required after 3 months. Treatment The animal was anesthetized with etorphin, intubated in the trachea, maintained on isoflurane and positioned in dorsal recumbancy. A midline incision was elected to approach the intestines. An obstruction of the colon was found and surgically removed. The peritoneum and muscle layers in the ventral midline were closed in one layer with Number 1 Maxon loop sutures, used in horse colic surgery to close the abdomen. Each suture knot was thrown 5 times, instead of the normal 3 times. The subcutis was closed with 2/0 Vicryl (continuous sutures) and the skin with Number 1 Nylon (single sutures). Reaction of the wound occured both times and she developed an incisional infection . This infection was treated by keeping the wound clean and both times the wound finally healed well. Treatment results The elephant recovered completely without further complications. Paramedian incision Instead of a midline incision, aparamedian incision can be used, just several centimeters left or right of the ventral midline. The advantage of this approach is the possibility to suture more muscle tissue compared to the connective tissue of the linea alba. There may, however, be more bleeding during surgery and access may be more limited than when a midline incision is used. Diagram of the closure of a paramedian incision. A) Skin B) Abdominal tunic C) Aponeurosis of the external abdominal oblique muscles D Rectus abdominal muscle E) Aponeurosis of the transverse abdominal muscle F) Peritoneum To page top

Colic is a condition that is often seen in elephants. This page describes the symptoms of colic and connects to several case reports To non-infectious diseases Colic Compiled by: Willem Schaftenaar Definition of colic Colic can be defined as a symptom of pain in the abdomen. Elephants that suffer of colic can show a variety of symptoms, ncluding: Frequent looking at the abdomen. Touching the abdomen with the trunk. Hitting the abdomen with the trunk. Throwing sand or water towards the abdomen. Throwing sand or water over the backside. Restlessness. Vocalization. Standing with open mouth. Frequently going down and standing up. Lifting a hind leg, supporting it on an object. Kicking a hindleg in the direction of the abdoemn. Bilateral bending the hind legs. Straining. Additional symptoms that may occur simultaneously: increased respiratory rate, increased heart beat, bloating. To colic case reports Causes of colic Gastro-intestinal tract: One of the most frequent causes of colics in elephans is sand impaction. Enteritis, gut spasms, constipation and tympany can also cause colics. Peritonitis. Torsio mesentericum. Abdominal organs: Although not reported in elephants, all abnormal conditions in abdominal organs can cause colics (inflammation, abscess, tumor). The elephant has no gall bladder, but gall stones stuck in the biliary ducts might result in colic. Reproductive tract: Normal parturition. Abnormal parturition. Herniation of the uterus. Large leiomyoma. Urinary tract: Calculi in the urethra. Herniation of the urinary bladder. Bladder stones. Treatment Text to be provided Diagnostic results Text to be provided To page top

Nail issues in elephants are common and usually need treatment. Pedicure should be part of the management procedures. Untreated nail cracks can result in osteoarthritis of the phalangeal joints. Radiography procedures are described in this chapter. Back to index orthopedic problems Nail lesions The most common nail lesion is the crack , perpendicular to the ground. These cracks are often the result of overpressure on the nail tip, when the nail is longer than the sole. In that situation, each step the elephant makes results in heavy forces on the nail tip during the phase when the elephant unwinds its foot. As demonstrated clearly in the slow-motion video below, the tip of the elephant's nails hardly touches the ground. When the nail becomes too long like in the Asian elephant nail in this photo, the excessive pressure on the nail edge can cause a small crack that enlarges over time if not properly treated. Cracks in the nails of an African elephant When left untreated, these cracks will become larger and can affect deeper structures, resulting in an abscess , pododermatitis or even osteomyelitis of the phalangeal bones. If only the horn-producing tissue is involved, we usually call this a pododermatitis. When the infection is trapped in the underlying tissue, an abscess can easily develop. Onychia is an infection or trauma to the horn lamellae of the nail, which may result in complete loss of the nail. Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole. Nail abscess with osteolysis in an Asian elephant. Nail abscess with complete loss of the 2 distal phalanges osteolysis in an Asian elephant. If phalanges are affected as the result of a deep nail abscess and pododermatitis, the recommended treatment of such an osteitis is the surgical removal of the affected bones. Click here to read more about this treatment. More examples of nail abscesses (photos: Susan Mikota). Treatment may take a long time, requiring multiple pedicure sessions, daily cleaning and foot soaks (click here for foot soak information) Traumatic onychia in an Asian elephant. Complete nail loss due to traumatic onychia in an Asian elephant. Diagnostic procedures nail lesions Use your eyes: check if there is any visible lameness. Describe the visible lesions. Use your hand: does the affected area feels warm? Is it painful when pressure is applied? Use your nose: if there is a wound, try to identify the smell of necrosis. Take a swab for bacterial culture. Additional diagnostic steps: If there is a deep lesion: radiographs should be taken to look at the integrety of the underlying bony structures (phalanges and phalangeal joints). Thermography may help to identify if the affected area has a higher temperature than the surrounding tissues. Radiography of the elephant's foot Radiography foot A powerful portable X-ray machine (100 kV or more) is required to visualize the bony structures in the elephant foot. Digital plates largely increase the quality of the image. It is important to work under safe conditions. Under free contact management , the fore foot can be positioned on a stand for the oblique palmar-dorsal shooting direction. The angle required for visualization of the phalangeal joints is indicated in the images below. Oblique palmar-dorsal image of the hind foot under free contact management condition (Mumby et al 2015) Positioning for the oblique dorsal-plantar image of the hind foot, this foot can be can be positioned on a stand (Mumby et al 2015). A different approach is required when working under protected contact management . The elephant needs to be trained to position its legs on a horizontal bar of the training wall. It should also be accustomed to the proximity of the X-ray-machine, the plate and the protective clothing of the operators. Lateral shooting position of the right front foot of an Asian elephant under protected contact. The angle of the beam depends on which phalanges need to be visualized. To avoid superposition and depending on the selected phalanges, the beam should have a more or less oblique direction. (Courtesy Rotterdam Zoo). Oblique dorsal-plantar shooting position of the left rear foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Oblique palmar-dorsal shooting postion of the right front foot of an Asian elephant under protected contact. Note that the X-ray machine is positioned upside down (use a support block to protect the electric wires)! (Courtesy Rotterdam Zoo and Emmen Zoo). Click here to view the radiograph. Lateral shooting postion of the left hind foot of an Asian elephant under protected contact (Courtesy Rotterdam Zoo). Click here to view the radiograph. Some examples of radiographs of the distal part of the right front leg of a 24 yr-old female Asian elephant at Rotterdam Zoo (the Netherlands) are shown below. The elephant is under standing sedation for an unrelated reason. Lateral shooting position of the right front leg (distal part of the radius and ulna, Courtesy Rotterdam Zoo). Click here to view the radiograph. Anterior-posterior shooting position of the right radio-carpal and ulnar carpal joint AP front leg (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right radial-carpal and ulnar-carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral position of the right carpal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right foot (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Lateral shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Click here to view the radiograph. Posterior-anterior shooting position of the right tarsal joint (Courtesy Rotterdam Zoo). Stereo radiography A technique, which is called stereo radiography can help interpreting the X-rays. Two radiographs of the same areas are made each of them taken 10 cm more lateral from the other. Digital images were converted to bitmap (BMP) format to preserve image quality. The 3D stereoradiograph images can be constructed using special software (Bentley 2021). The images can be viewed with red-cyan 3D glasses. Illustration of how 3D stereoradiograph images are produced. (a) Original radiograph that provides the ‘‘left’’ image for the 3D Anaglyph software. (b) Paired radiograph used for ‘‘right’’ image. (c) Completed stereoradiograph that has been inverted with red-cyan settings applied. (Bentley 2021) Thermography of nail lesions Thermographic imaging can be used to measure the absolute temperature and the difference in temperature between the lesion and its surrounding tissues. Below a severe case of a nail abscess-related osteomyelitis and osteolysis of Ph4 in an old Asian elephant bulls is shown. The thermografic image shows a low temperature of the skin that covers the affected are. This is suggestive for a large necro-purulent process. The thermographic image shown here demonstrates the low temperature of the skin covering the abscess, associated with deep lesions of D4 of the left front leg of an Asian elephant bull, involving a lot of necrosis and complete loss of the distal phalanx of the toe. On radiology this bone is completely missing and the distal part of the toe shows an irregular surface: Osteomyelitis and purulent arthritis of the Ph3-4 joint of D4. Treatment nail lesions Treatment of nail lesions Pedicure is usually the treatment of choice in cases of nail lesions. There are a few principles to be respected in pedicure: Use proper equipment Always remove all abnormal horn tissue (undermined, infected) and loose nail flaps. Make the transition from healthy horn to the deepest point of the lesion as smooth as possible. Directly adjacent to the lesion, the horn must be flexible and as thin as a piece of paper. Permanently check this flexibility by gently pressing the area where just cut away the horn. The most important pieces of equipment needed for pedicure are 2 hoof knives (left and right handed), a scalpel and a sharpening stone for hoof knives, preferably with round edges (see photos above). Just with hoof knives alone, most of the clinical pedicure treatment can be done. A scalpel can be useful when very small pieces of horn are to be removed adjacent to a lesion. A horse hoof rasp is a useful tool to shorten the nail and remove excessive horn from the sole. Care should be taken NOT to make the nail edges round, what is often practiced (see below). A strong nail brush is needed for cleaning the nail prior to pedicure and a smaller brush can be used to remove dirt from areas that cannot be reached by a large brush. Small wood carving knives can be used when thin layers of nail horn are to be removed (similar to the use of a scalpel). Pedicure equipment Very often the tip of the nails are made round by rasping the corners. There is no justification for doing so rather than a cosmetic one. However, one should avoid to remove tissue from the nail wall/nale sole junction (comparible to the "white line " in the horse hoof) as this junction is a very important barrier against infiltration of dirt and pathogens. So the advice is: do not file the nail corners to leave the entire white line in tact. Situation before a pedicure session of a deep nail crack Situation after a pedicure session of a deep nail crack Pedicure around a (deep) crack serves 2 main purposes: Draining of infected area Removing pressure on the wound, which enables the regeneration of destroyed horn lamellae. In order to achieve both goals, the deepest point of the crack has to be freed from covering horn. One should start making the horn wall thinner at a distance of several centimeters from the lesion and continue the pedicure towards the deepest point in a gradual way. Each nail crack should be considered as being a wound, because the crack has usually damaged the horn lamellae. When the pedicure has reached the wound area, it is of utmost importance that the edges bordering the wound are made as thin and flexible as possible. Check this by pressing your finger on the horn adjacent to the wound. Large cracks usually need to be treated in several sessions. Bleeding may occur when the lamellae are cut, which is no direct reason to worry! Pain reactions of the elephant will tell the operator when the session should be stopped and continued a few days later Cuticle lesions The cuticles form a natural barrier against dirt and pathogens. When they overgrow the nails, this protective barrier is weakened and infiltration of microoganisms may result in lesions in the horn lamellae underneath the nail (onychia). Sweat glands are embedded in the cuticles. Overgrown cuticles may become hard and crack or form interdigital callus. When abnormal horn tissue blocks the sweat glands, fluid pockets may be formed. This can be a painful process and needs to be treated. Minor cuticle lesion in a African elephant, which may be connected to a deeper lesion underneath the nail. Explorative pedicure is probably needed to find the cause (Courtesy: Barcelona Zoo) Extensive overgrown cuticles with feathering and interdigital callus formation (Fowler & Mikota 2006) Interdigital callus formation in an Asian elephant (Courtesy: Susan Mikota) Sweat glands are present in large numbers in the cuticles. When the cuticles are overgrown, they may form pockets in which the sweat-fluid may accumulate ("blisters"or "blebs"). When cutting in such a fluid-filled pocket, the contents may squirt out (see video; courtesy: Susan Mikota). Careful (!) trimming of the cuticles is only indicated when they have overgrown the nail (Courtesy: Susan Mikota) Applying oil on the cuticles will make them softer and may resolve the problem of cuticle overgrowth in most situations. Example of a pedicure procedure of a pododermatitis in conjunction with a cuticle lesion in an African elephant (courtesy Barcelona Zoo) Pododermatitis in the nail of an African elephant. Note the excessive wear of the sole and the large defect of the cuticle. Second step: follow-up the necrotic tissue and find the connection with the cuticle defect. Note that a large part of the nail was undermined, causing the cuticle defect. First step in pedicure: making the horn on each side of the lesion thinner and removing necrotic tissues. By frequently removing all necrotic tissues and keeping the edges of the wound thin, the horn lamellae can produce healthy horn again. SUCCESSFUL TREATMENT OF DIGITAL OSTEITIS BY INTRAVENOUS REGIONAL PERFUSION OF CEFTIOFUR IN AN AFRICAN ELEPHANT (Loxodonta africana ) (Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017) A 41-yr-old African elephant (Loxodonta africana) presented with a swollen third digit of the left forelimb and a 2-cm hole in the pad. Corrective trimming, topical treatments, and an oral antibiotic resulted in apparent resolution; however, it reoccurred after 4 mo. Radiographs suggested bone lysis in the third phalanx, with the primary differential diagnosis being septic osteitis. Flushing with metronidazole solution and intravenous regional perfusion (IVRP) of the foot were commenced. A tourniquet was applied just above the carpus, an interdigital vein was identified by ultrasound, and into this vein 2 g (20 ml) of ceftiofur sodium solution, followed by 60 ml of heparinized saline, was administered. The foot was kept raised for 25 min and then the tourniquet was removed. IVRP was repeated every other day for 70 treatments over 6 mo. Healing occurred, which was confirmed radiographically. IVRP offers an excellent treatment modality in a well-trained elephant. SURGICAL REMOVAL OF INFECTED PHALANGES FROM AN ASIAN ELEPHANT (Elephas maximus ) Gage, L. Blasko D, Fowler M.E. and Pascoe J. Joint Conference AAZ/WDA/AAWV After unsuccessful antimicrobial treatment of an osteitis in a 40 yr-old Asian elephant, surgical removal of the affected phalanges resulted in the complete healing of the foot. Click here to read the report. Digital osteitis treatment Literature Bentley C.E., Cracknell J.N., Kitchener A.C., Pereira Y.M., Pizzi R. 2021. Improved diagnosis of foot osteoarthritis in elephants (Elephas maximus , Loxodonta africana ) using stereoradiography. Journal of Zoo and Wildlife Medicine 52(1): 67–74, 2021. Dutton C.J., Delnatte P.G., Hollamby S.R., and Crawshaw G.J. 2017. Successfull treatment of digital osteitis by intravenous regional prefusion of ceftiofur in an african elephant (Loxodonta africana) . Journal of Zoo and Wildlife Medicine 48(2): 554–558, 2017). Gage, L. Blasko D, Fowler M.E. and Pascoe J. 1995. Surgical removal of infected phalanges from an asian elephant (Elephas maximus ). Joint conference AAZV / WDA/ AAWV . Mumby, C., Bouts, T., Sambrook, L., Danika, S., Rees, E., Parry, A., Rendle, M., Masters, N. and Weller, R. (2013), Validation of a new radiographic protocol for Asian elephant feet and description of their radiographic anatomy. Veterinary Record, 173: 318-318. https://doi.org/10.1136/vr.101696 . Fowler M.E. and Mikota S.K. 2006. Biology, Medicine, and Surgery of Elephants. 271-290. To page top

This page directs you to the following case reports about botulism, Dieffenbachia and paraquat intoxication in elephants. To non-infectious diseases Intoxication Botulism Dieffenbachia intoxication Paraquat intoxication Kodo millet intoxication Reference values toxicology

A series of videos guides you through the aspects of a full elephant necropsy. These recordings were made for a workshop given in Myanmar in 2019 and are kindly provided by the MIchigan State University. To necropsy report index Necropsy Procedure EAZA Necropsy protocol Videos elephant necropsy These videos were prepared for workshops given to elephant veterinarians in Myanmar by Elephant Care International. http://elephantcare.org Necropsy procedure Preparation Ante/postmortem changes Sample collection Circulatory system Respiratory system Reproductive system Brain + neural system Integument Multi-systemic Musculo-skeletal Foot Tusks and molars Renal and urinary To page top

Description of a surgical repair of a perineal hernia in an Asian elephant in Myanmar. Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 To perineal hernia Case report Perineal hernia, surgical repair Date: 2016 Place: Myanmar Data provided by: Gajah History A 47 years old captive female Asian elephant, working in the logging industry, displayed a large bulging mass below the tail since 10 years, which increased in diameter from 4 inches to 22 inches. At ultrasonographic examination it was diagnosed as a cervico-vaginal prolaps. Better described as perineal hernia with cervico-vaginal involvement (WS). The elephant did not suffer of any limitations in relationship to this condition. Previous cases in other female elephants of the company had died of this condition. As the mass was increasing in size, it was decided to perform a correcting surgery. At the time of surgery the animal was in healthy condition. Read the article in Gajah Treatment A standing sedation procedure with xylazine and ketamine was used. A incision of the skin and the vaginal vestibule was made 7 inches lateral to the perineal midline, allowing manual passage to explore the subcutaneous area. A catheter (1/4 inch diameter) was advanced into the uterus (or was it into the urthra?) and the uterus (bladder?) could be drained. The catheter was replaced by a larger catherter (½ inch) and more fluid, which contained several stones was drained. The the cervix uteri and the vagina (bladder?) were pushed back into the p elvic cavity through the herniated pelvic diafragm using the arm that was advanced into the vagina . The vaginal vestibule was closed using a continuous catgut suture. The skin was closed using 3 continuous nylon matrass sutures. At each knot a protecting plastic plate was placed underneath the knot to protect the skin from perforation by the nylon suture. Finally, a wooden block with a foamy protection layer was tightly tied to the (formerly) bulging area using ropes around the elephants body. Treatment results The ropes and the supporting block remained in place and the hernia did not recur between surgery and publication of this paper. However, it is not know for how long this animal stayed without recurrence. Complete report: Oo Z.M., et al. 2016 Surgical treatment of a cervico-vaginal prolapse in an Asian elephant in Myanmar. Gajah 44, 36-39 To page top

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Prevalence, symptoms, treatment and vaccination against anthrax (Bacillus anthracis) in elephants are described. To infectious diseases Anthrax This figure gives a nice overview of the epidemiological cycles of Bacillus anthracis (https://anipedia.org/resources/anthrax/1203 ). Anthrax infection in humans Human anthrax infections are often contracted during work activities in oneofthe following fields: Tanneries Wool sorters Bone processors Slaughterhouses Laboratory workers When humans become infected, the disease is usually presented as skin wounds that heal very slowly. The bacteria can penetrate the skin if they come in contact with a fresh skin wound. These photos demonstrate the type of wound that results from such an infection. The person with the wound on the left image worked on a cattle carcass that died from anthrax. While handling this carcass, he injured himself by a sharp bone fragment that was infected with the anthrax bacteria ( https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ). The person on the right image is probably a tannery worker, who infected himself by rubbing his knuckles on the skin of an animal that died of anthrax ( http://www.fao.org/ag/againfo/programmes/en/empres/news_070212.html ) If untreated or if the infected wound is big, the bacteria can spread in a large area around the wound, as is shown here. This severe wound needs immediate treatment with the right antibiotic. Anthrax spores can also be inhaled. In the lungs the anthrax bacteria can cause a very severe inflammation. On the left image you can see an X-ray of healthy lungs, with a clear heart shadow. On the right X-ray you can distinguish a big mass in the thorax that does not allow the x-rays to get through. If this disease is left untreated until obvious symptoms occur, it is usually fatal. This patient had a business where he made drums using cattle and goat skins imported from Africa. He died 1 day after this X-ray was made. (https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm ) Anthrax infection in animals Typically, the incubation period is 3–7 days (range 1−14 days). The clinical course ranges from peracute to chronic. The peracute form (common in cattle and sheep) is characterized by sudden onset and a rapidly fatal course. Staggering, dyspnea, trembling, collapse, a few convulsive movements, and death may occur in cattle, sheep, or goats with only a brief evidence of illness. Often, the course of disease is so rapid that illness is not observed and animals are found dead. A very characteristic feature of acute anthrax is free non-coagulating blood running from body openings, due to the disturbed coagulation. The disease in horses may be acute. Signs may include fever, chills, severe colic, anorexia, depression, weakness, bloody diarrhea, and swellings of the neck, sternum, lower abdomen, and external genitalia. Death usually occurs within 2–3 days of onset. Anthrax bacteria disturb the natural blood coagulation. This results in bleedings in the skin and all internal organs. Non-coagulated blood is collected in the lymph nodes, while free-running blood appears from all openings. These symptoms usually lead to a sudden death. Anthrax can affect multiple species, like cattle and wild ruminants (greater kudu), zebras as well as predators (lion). Note the running blood from nostrils or eyes in all these animals and the small bleedings in the skin of the kudu. (https://anipedia.org/resources/1203) Multiple outbreaks of anthrax in wild hippopothamus has been reported in several southern African countries ( https://www.sciencealert.com/anthrax-outbreak-suspected-to-have-killed-more-than-100-hippos-in-namibia ) Animal to animal transmission There are several ways of transmission of B. anthracis between animals. Animals grazing in areas where anthrax victims have been buried, can be infected when the carcass remnants are digged up either by the feeding animal or through human activities (road or building constructions). Flies that have fed on an anthrax-carcass can easily spread the bacteria through their droppings that remain on leaves. Predators (big cats) that feed on infected carcasses can become infected and die of anthrax. Flies that feed on an infected carcass may spread B.anthacis through their droppings as illustrated on these images (https://anipedia.org ). Anthrax in elephants Anthrax in elephants is usually a gastro-intestinal infection. The animal ingests the spores while feeding food or water contaminated with spores. After an incubation period of a few days, the animal dies of septicemia. Multiple cases have been reported from several range countries in Asia (Kumaraguru A. et al. 2015). In some areas Asian elephants play a role in the transmission of anthrax between wildlife and farm animals (Walsh M.G. et al. 2019). Like in other mammals, symptoms consist of rapid detoriation after infection. Usually the elephant is found dead before symptoms were observed. Running blood from the trunk, mouth, eyes, rectum or vagina should alarm the finder of the carcass for this being an anthrax case. Anti-PA antibodies were detected in elephants, which suggests that they can mount adaptive immune responses against anthrax. In addition, these results suggest that elephants can be infected with anthrax and survive infection under some circumstances (Cizauskas et al. 2014). A fatal case of anthrax in a 15-yrs-old African elephant was reported from a wildlife park in Nigeria (Okewole, 1993). Frequent urination, restlessness and weakeness of the hind quarters were observed prior to death. A co-infection with Cowdria ruminatium was diagnosed at post mortem examination (coccoid intracytoplasmatic bodies in the endothelia of the brain). A wild Asian elephant that died of anthrax in the forest of Myanmar. Note the amount of free running blood around the head. Photo courtesy: Myanmar Forest Police A wild Asian elephant that died of anthrax in the forest in India (Kumaraguru A. 2015) Treatment Early detection of the disease is essential, though difficult. Multiple classes of antibiotics can be used if treatment is started in time: oxytetracycline, penicillins, aminoglycosides, fluoroquinolones, macrolides, and sulfonamides. Dosages can be obtained from the website of Elephant Care International: https://www.elephantcare.org/formulary Diagnosis (post-mortem) Post mortem findings in elephants are: Bleedings In and under the skin Around muscles In organs Free blood in the intestines Free blood in the lungs Free blood in the abdomen Edematous swelling of the skin Swollen spleen with bleedings Liver and lymph nodes are swollen and contain a lot of blood Disposal of an anthrax carcass If a dead elephant is suspected of anthrax, a full necropsy is not recommended. A blood smear from a small incision made in an ear should first be made and examined microscopically for the presence of Gram-positive stained rods, lying in chains, sometimes accompanied by spores. The carcass should be disposed off as soon as possible in a proper way. The disposal must be done following the next steps: To minimize the spread of blood, you should try to plug the openings (trunk, ears, mouth, anus, vulva) with non-absorbent material. You can also wrap the head of the elephant in plastic and tape it with duct tape or tie it with a rope to the skin of the neck. Don’t move the animal around Incinerate the carcass if possible If incineration is not possible, burry the carcass as deep as possible. Use heavy excavating equipment (backhoe loader) to dig a deep, large hole, at least 2 meters deep Disinfect all materials that have been in contact: 10% formalin or 5% lime solution (sodium hydroxide) Necropsies of any animal should always be performed with great care. If there are signs of anthrax, a peripheral blood smear should always be examined first. If accidently the diagnose was missed, any signs of internal bleedings should alarm the prosector. B. anthacis can be cultured quite easily. Every necropsy should be performed with adequate body protection: proper eye protection, a respiration mask, long gloves, rubber boots and protective clothing. Vaccination Elephants can be vaccinated against anthrax with commercially available vaccines. This is highly recommended in areas where anthrax is seen in farm animals or if there is a history of anthrax in elephants in that area. References/further reading Berry HH. 1993. Surveillance and control of anthrax and rabies in wild herbivores and carnivores in Namibia. Rev Sci Tech 12(1):137–146.Cizauskas CA, Bellan SE, Turner WC, Vance RE, Getz WM. 2014. Frequent and seasonally variable sublethal anthrax infections are accompanied by short-lived immunity in an endemic system. J Anim Ecol 83(5):1078–1090 Hanna P., 1998. Anthrax pathogenesis and host response. Curr Top Microbiol Immunol 225:13–35 Turnbull PC, Bell RH, Saigawa K, Munyenyembe FE, Mulenga CK, Makala LH. 1991. Anthrax in wildlife in the Luangwa Valley, Zambia. Vet Rec 128(17):399–403. Kumaraguru A., Kumaraguru Arumugam , N.S. Manoharan , Ramakrishnan Balasundaram . 2015. Prevalence and disease management with reference to anthrax in the Asian elephant (Elephas maximus) in the Sathyamangalam Wildlife Santuary, Tamil Nadu, India & Indash; A case study. Scientific Transactions in Environment and Technovation, 5(1): 48-51. Okewole P.A., Oyetunde I.L., Irikanulo E.A., Chima J.C., Nwankpa N., Laleye Y., Bot C. 1993. Anthrax and cowdriosis in an African elephant (Loxodonta africana). Walsh, M.G., Mor, S.M., Hossain, S., 2019. The elephant–livestock interface modulates anthrax suitability in India. Proceedings of the Royal Society B: Biological Sciences 286 EAZWV Transmissible Disease Fact Sheet ANTHRAX American Association of Zoo Veterinarians Infectious Disease Manual ANTHRAX Recommended websites: Merck Veterinary Manual. 2021. https://www.merckvetmanual.com/generalized-conditions/anthrax/overview-of-anthrax OIE (Organization for Animal Health: https://anipedia.org/resources/anthrax/1203 FAO: http://www.fao.org/home/search/en/?q=anthrax Microbiology and Immunology On-line: https://www.microbiologybook.org/ghaffar/anthrax-pennsylvania.htm To page top General information Merck Veterinary Manual (2021) : Anthrax is a zoonotic disease caused by the sporeforming bacterium Bacillus anthracis . Anthrax is most common in wild and domestic herbivores (eg, cattle, sheep, goats, camels, antelopes) but can also be seen in people exposed to tissue from infected animals, to contaminated animal products, or directly to B anthracis spores under certain conditions. Depending on the route of infection, host factors, and potentially strain-specific factors, anthrax can have several different clinical presentations. In herbivores, anthrax commonly presents as an acute septicemia with a high fatality rate, often accompanied by hemorrhagic lymphadenitis. In dogs, people, horses, and pigs, it is usually less acute although still potentially fatal. Toxins are the source of most of the disease symptoms associated with anthrax. Edema toxin complex (EdTx) causes the fluid and edema seen in cutaneous anthrax infections, and lethal toxin complex (LeTx) causes shock and death from systemic anthrax (Hanna, 1998). B anthracis spores can remain viable in soil for many years. During this time, they are a potential source of infection for grazing livestock but generally do not represent a direct risk of infection for people. Grazing animals may become infected when they ingest sufficient quantities of these spores from the soil. In addition to direct transmission, biting flies may mechanically transmit B anthracis spores from one animal to another. The latter follows when there have been rains encouraging a high fly hatch and reporting has been delayed on the index ranch, such that there are 4–6 moribund or dead cattle for the flies to feed on. Feed contaminated with bone or other meal from infected animals can serve as a source of infection for livestock, as can hay muddy with contaminated soil. Raw or poorly cooked contaminated meat is a source of infection for zoo carnivores and omnivores; anthrax resulting from contaminated meat consumption has been reported in pigs, dogs, cats, mink, wild carnivores, and people. Human cases may follow contact with contaminated carcasses or animal products (raw meat, skins of animals that died of anthrax). Flies that have fed on a carcass from an anthrax victim can spread the disease over longer distances. Diagnosis Anthrax can be diagnosed in fresh blood smears taken from the ear. Microscopically, B. anthracis can be recognized as long chains of Gram-positive bacteria. If the smear has been exposed to air, the bacteria may have formed spores that can be easily detected. B. anthracis differs in shape from other Bacillus species, that may contaminate the sample in case the animal has been dead for a longer period. Whereas the bacteria chains of B. anthracis seem to be sharply cut off with a knife, the chains of B. cereus have round edges.

Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids (Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. To infectious diseases Rabies General information Rabies is a viral disease that is usually fatal. It is caused by a neurotropic Lyssa virus. Several species of Lyssaviruses have been identified, of which the rabies virus (worldwide), the Mokola virus (Africa), the Duvenhage virus (South Africa) and the European and Australian bat lyssaviruses are responsible for fatal encephalomyelitis. Rabies is transmitted by a percutaneous bite from a rabies-infected animal or by wound contamination with saliva from a rabid animal (MSD, 2021). Air born infection through aerosols can occur when visiting bat caves. Reservoir hosts vary geographically. In the U.S. hosts include skunks, bats, raccoons, foxes, and coyotes. Civets, mongooses and hyenas are the main hosts in Africa; domestic dogs are hosts in Asia, South America, and Africa. Certain bat species in southern Africa are host for a Lyssa virus After infection of the bite wound, the virus migrates from the wound to the brain via the nerves that run from the wound area, resulting in neurological signs. Virus replication takes place in the brain, from where the virus migrates to the salivary glands. The incubation period varies from 3 weeks to many months. In most species affected by rabies, the animal shows an increase of aggressive behaviour and will try to bite other animals. Hydrophobia can be one of the accompanying symptoms. In a few species (e.g. domestic cat), the animal becomes more quite or even soporous. Once the virus has reached the brain, there is no cure. Treatment is only possible in the short period between infection and start of the migration. In this short time window, the animal should be treated daily with a rabies vaccine (described below). If available, locally anti-rabies serum should be injected around the wound area. Diagnose of rabies is based on PCR or histopathology of brain tissue by demonstrating the presence of typical Negri bodies using a special stain especially in pyramidal cells within the Ammon's horn of the hippocampus. Wound tissue, saliva and cerebrospinal fluid can be used when the animal is still alive (CDC, 2021). Rabies in elephants Rabies has been diagnosed in a few elephants and was fatal in all reported cases. The source of the infection was attributed to canids ( Wimalaratne et al. 1999, Nanayakkara et al. 2003, Sharma et al. 2005, Aravind et al. 2006). The incubation time for rabies in elephants is unknown. Depending on the distance between the bite wound and the elephant's brain, a long incubation period can be expected. Rabies should be included in the differential diagnosis whenever there are neurological signs. The initial signs of rabies in elephants may be vague but most often the elephant (FAO 2005): Is listless. Prefers to stay in dark places. Eats very little. As the disease progresses the elephant likely: Writhes in pain. Does not recognize the mahout. Chases and attacks humans and animals. Has eyes that roll and wander. Does not eat. Walks unsteadily and the legs lose strength. Goes to the ground in paralysis. Has locked jaws and the tail hangs still. Has saliva flowing continuously. Death may shortly follow the appearance of these more severe signs. The differential diagnose in case of rabies comprises any disease that can cause central nervous system symptoms, like: Tetanus Trauma Snakebite Toxicity (e.g. heavy metal; pesticide) Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: 1. Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. 2. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. 3. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. 4. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Treatment of rabies in elephants Immediately after a suspected dog bite, wash the wound intensively with soap and water. Then apply tincture of iodine or Povidone-iodine 1% in and around the wound (FAO 2005). There is no effective treatment once the symptoms have appeared. Even though the disease is not contagious to other elephants, separate the elephant, taking it to a shady, clean and quiet place. Make sure the elephant is chained tightly and securely (FAO 2005). Although there is no report on post-exposure vaccination, emergency vaccination of the elephant can be considered, if a rabies vaccine is available. One study describes the successful post-exposure treatment in pigs that where heavily exposed to rabies. The affected pigs were repeatedly vaccinated with an inactivated rabies vaccine 0, 3, 7, 14 and 30 days after the bite incident, while equine rabies immune globulins were injected in and around the bite wound (Mitmoonpitak et al. 2002). When an elephant is exposed to rabies, consider to inject the animal intramuscularly with a 2 ml dose of an (inactivated = killed) rabies vaccine as soon as possible after it was bitten by a rabid animal. These vaccinations should to be given daily for at least 5 days. During this period the elephant should be kept under close observation. Anytime an elephant is bitten, particularly if the bite has drawn blood, the mahout and owner should take four actions: Write the day on a calendar; then you will be able to predict when the elephant may show clinical signs if it was infected. Talk to people who know the dog and ask about its behaviour in the days prior to the attack; if the dog has been acting strangely (staring fixedly, foaming at the mouth, etc.) there is a good chance the dog is rabid. Inform everybody in the community of the health hazard, because the disease also attacks humans, and ask them to help track down the dog. Very carefully capture the dog, confine it securely, and observe its condition; if after ten days it is normal then the elephant does not have rabies. If the elephant dies, consult Disposal of carcasses, page 55 of the FAO manual . Prevention Regular rabies vaccination is recommended for all elephants kept under human care in areas where rabies is endemic. Because rabies is incurable the best prevention is to annually vaccinate all the dogs and cats in the community. For many years, following the recommendation for rabies vaccination in horses has been considered prudent: (inactivated!) vaccine (2 ml IM) given from the age of 6 months, to be repeated after 3-4 weeks and annually boostered. When using this vaccination schedule in elephants, antibodies against rabies could be demonstrated after 24 months (Isaza et al. 2006, Miller et al. 2009). However, this rabies vaccination strategy was evaluated in a herd of 9 African elephants, including two calves, four subadults, and three adults which lead to new conclusions about rabies vaccination strategy. Prior to 2017, elephants were vaccinated opportunistically IM. Starting in 2018, calves at least 4 months of age were administered 2 ml of a commercially available inactivated vaccine and received boosters at 1 y of age. Adults and subadults underwent annual vaccination at the same dose. After 1 year, neutralization titers in five of nine elephants were below levels considered protective in domestic animals (< 0.5 IU/ml). Therefore the dose of rabies vaccine was increased to 4 ml, which resulted in titers more consistently greater than or equal to 0.5 IU/ml for at least 6 months. Institutions with elephants under human care may consider performing rabies vaccination neutralizing titers when possible to help guide vaccination. See also: vaccination. References Aravind B., Anilkumar M., Raju S., and Saseendranath M.R. 2006. A case of rabies in an Indian elephant (Elephas maximus) . Zoo's print journal 21 (2) 2170. Browning G.R., Peters R., and Howard L.L. 2021. Rabies vaccination and antibody response in African elephants ( Loxodonta africana ) as part of a comprehensive program of veterinary care. Joint AAZV EAZWV Conference Proceedings 2021. CDC 2021: https://www.cdc.gov/rabies/diagnosis/animals-humans.html FAO 2005: Elephant care manual for mahouts and camp managers. 2005. Isaza R., Davis R.D., Moore S.M., and Briggs D.J. 2006. Results of vaccinat i on of Asian elephants (Elephas maximus) with monovalent inactivated rabies vaccine. AJVR, Vol 67 (11), 1934-1936, 2006 Miller M.A. and Olea-Popelka F. 2009. Serum antibody titers following routine rabies vaccination in African elephants. JAVMA, Vol 235 (8),978-981 2009 Mitmoonpitak C., Limusanno S., Khawplod P., Tepsumethanon V, and Wilde H. 2002. Post-exposure rabies treatment in pigs. Vaccine 20 (2002) 2019–2021. MSD, 2021: https://www.msdmanuals.com/home/brain,-spinal-cord,-and-nerve-disorders/brain-infections/rabies Nanayakkara S, Jean S. Smith, and Charles E. Rupprecht. 2003. Rabies in Sri Lanka: Splendid Isolation. Emerging Infectious Diseases • Vol. 9, No. 3, March 2003. Sharma A.K., Choudhury B, and Singh K.P. 2005. Rabies in a captive elephant . Indian Journal of Veterinary Pathology 29(2): 125-126 Wimalaratne O, and Kodikara D.S. 1999. First reported case of elephant rabies in Sri Lanka. Vet. Rec. 144 (4): 98. To page top

Esophageal spasms are rarely seen in elephants. This case reports describes this condition in an Asian elephant. Water regurgitation indicated the blockage of water, while the animal was unable to swallow any food. A home-made endoscope greatly facilitated the visualization of the esophagus and stomach wall. A standing sedation using detomidine and butorphanol was used during the treatment procedure. No mouth gag was needed to open the mouth. Continue To non-infectious diseases Case report Esophagus spasm Place: Selwo Zoo, Spain Date: 2019 Data provided by: Cecilia Sierra Arqueros, DVM History Species: Asian elephant Accommodation: Zoo Age, gender: 54 years, female For several years this female Asian elephant had episodes of rhythmic contractions in the ventral area of the neck at the entrence to the thorax (video 1). These contractions were only observed during in the cold seasons of the year. At the age of 54 years, she suddenly became unable to swallow her food and water (video 2). Video 1. Rhythmic contractions in the ventral neck area of an Asian elephant Day 1: The elephant tried to drink water. After 10-20 seconds the water came out her mouth again (regurgitation). The regurgitated water was clear and had no abnormal smell (no stomach smell). Appetite: in the morning she ate horse pellets and some roughage, but then she refused bread and apple slices (her favorites!). She tried to eat fresh gras, but after chewing on it, it came out; no smell of stomach contents. Refused to eat anymore. Regular defecation, though the fecal balls became smaller during the following day. The digestion of the fibers had not changed. Water regurgitation Day 2: No change. Oral inspection: 2 small (5 mm Ø) ulcerations on the tongue base, that were not there the day before. The animal did not cooperate as good as she did on the first day. A standing sedation was performed using detomidine and butorphanol. A 2.4 m plastic tube and flexible endoscope could be advanced into the esophagus, reaching the stomach. No mouth opener or gag was used. Gastric fluids were seen, but no obstruction in the esophagus was encountered. Video 2. Regurgitation of water. Endoscope Plastic tube with endoscope advanced into the esophagus. Treatment Rectal fluids Antibiotic + flunixin meglumine + Vit E/selenium Day 3: Standing sedation using detomidine and butorphanol. Treatment: antibiotics, dexamethasone, vitamin B complex, 240 L rectal fluids Day 4: In the morning, the elphant was able to drink water. Nevertheless another standing sedation was performed using detomidine and butorphanol. 3.5 meter tube inserted in esophangus with mini-camera. Antibiotic + dexametasone +vit- sel + complex B + Buscopan Thirty minutes after finishing the procedure, the elephant started to drink and she ate a melon. From that moment on her appetite came back and she did not regurgitate anymore. Differential diagnosis: Esophagus spasm Esophagus constriction: unlikely because this would have been confirmed by endoscopic examination. Botulism . Botulism had occured in the same environment 200 kilometers from this place, resulting in paralysis of the entire body and the death of the 4 affected elephants. Comments: Esophagus spasms in elephants have not been described before. There is only anecdotal evidence of this phenomenon in horses (van der Kolk, pers. comm. 2021). Hypocalcemia is high on the list of the differential diagnoses. Hypocalcemia has also been associated with " hiccups " in Asian elephants, occuring in the cold seasons. The total calcium concentration in this elephant was 2.7 - 2.9 mmol/l while the hematocrite was 48-50% (average normal value 35%), which is an indication that the elephant was dehydrated. The actual total serum calcium concentration in non-dehydrated condition was probably lower: 35/50 x 2.7 = 1.89 mmol/l. Conclusion: Hypocalcemia may have played a major role in this case of esophagus spasm. To page top

This chapter describes (standing) sedation, general anesthesia, intubation and epidural anesthesia using xylazin, ketamine, azaperone, detomidine, medetomidine, etorphin, carfentanil, gas anesthesia and lidocain. To procedures This page describes the following procedures Standing sedation General anesthesia Epidural anesthesia Anesthesia Standing sedation Sedation: In case the elephant does not cooperate voluntarily with the manipulations needed for the diagnosis or treatment the animal should be sedated (including herd mates if needed to reduce stress in the herd) Standing sedation can be performed using xylazine or (preferred) detomidine in combination with butorphanol. Medetomidine works as good as detomidine, but is more expensive. Young elephants need the higher dose range compared to older elephants. Elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Detomidine 0.01-0.022 mg/kg IM (can be reversed by atipamezole at 3-5 times the dose of detomidine). Young calves may need a higher dose of detomidine (0.02-0.04 mg/kg). AND Butorphanol 0.015-0.025 mg/kg given at same time as detomidine. Butorphanol can be reversed with naltrexone at 2.5-5 times the dose of butorphanol in emergency situations, but reversal is not essential and should preferably not be carried out if the calf is considered to be in pain. Alternative option for sedation (if the above mentioned drugs are not available): Xylazine : 0.04-0.08 mg/kg IM for adult Asian elephants and 0.08-0.1 mg/kg for African elephants. Juvenile Asian elephants: 0.09–0.15 xylazine mg/kg IM (Jansson 2021) If insufficient sedation is obtained by xylazine alone, an additional (low) dose of ketamine (0.03 – 0.06 mg/kg) can be given IM or IV. Xylazine can be reversed with yohimbine (0.073-0.098 mg/kg slowly IV) or atipamezole (0.1 x xylazine dose IM or 30/70 IV/IM) Another alternative option for sedation of Asian elephants: Dexmedetomidine : 2 μg/kg BM IM will provide sufficient standing sedation for approximately 70 minutes. (Buranaprim, 2022). Dexmedetomidine can be antagonized by atipamezole (10 times the dexmedetomidine dosage). If a young calf needs to be sedated, it may be necessary to sedate the dam or other adult herd mates so they are not stressed during manipulations on a calf. This can be done by the administration of: Butorphanol 0.006 mg/kg IM and detomidine 0.0026 mg/kg IM (In adult female Asian elephants, 20mg butorphanol and 10mg detomidine have been effective) Sedation can be reversed as described above but is not necessary Alternatively, xylazine (0.04–0.08 mg/kg) or other sedative agents (e.g. Azaperone at 0.024–0.038 mg/kg) can be used if detomidine is unavailable. Laubscher LL et a. 2021 described a fixed drug combination of butorphanol, azaperone and medetomidine (BAM) for African elephants. The dose is given per cm shoulder height. The composition of this anesthetic mixture is: 30 mg/ml butorphanol, 12 mg/ml azaperone, and 12 mg/ml medetomidine. The use of this combination can be recommended in captive, trained African elephants at a dose of 0.006 6 ± 0.001 ml/cm shoulder height. Oral or rectal administration of detomidine in the form of a gel (Domosedan gel, 20-50 mcg/kg) to obtain mild sedation has been described (2020, Molter). The gel must be rubbed into the oral mucosa or rectal wall. Initial, mild sedation is seen after 15-20 minutes. The maximal effect is at 30-45 minutes. A full standard sedation is characterized by the following signs: Salivation Relaxation of the trunk; the tip of the trunk will touch the ground. Relaxation of the penis and (less obvious) relaxation of the vulva. Snooring sounds. It is important to cover the eyes with gauze pads (taped to the skin with Leucoplast or ducttape) and put cotton plugs in the ears. This will deepen the sedation and reduce the risk of sudden wakening. One should always be prepared that the elephant may wake up. Safety procedures need to be discussed in advance with everyone involved in the procedure. Summary agonist - antagonists Xylazine can be reversed by atipamezole : 0.1 x xylazine dose or yohimbine : 0,05-0,13 mg/kg IV Detomidine is reversed by: atipamezole: 3-5 times the detomidine dose IM or slow IV (30/70 IV/IM) Butorphanol is reversed by naltrexone: 2.5-5 x butorphenol dose IV. Skip naltrexone if pain relieve is desirable. The naltrexone dosage provided by Laubscher LL et a. 2020 is much lower: 1 mg naltrexone per mg butorphanol. References: Buranapim, N., Kulnanan, P., Chingpathomkul, K., Angkawanish, T., Chansitthiwet, S., Langkaphin, W., Sombutputorn, P., Monchaivanakit, N., Kasemjai, K., Namwongprom, K., Boonprasert, K., Bansiddhi, P., Thitaram, N., Sharp, P., Pacharinsak, C., Thitaram, C., 2022. Dexmedetomidine Effectively Sedates Asian Elephants (Elephas maximus ). Animals 12, 2787.. doi:10.3390/ani12202787 Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Jansson T., Vijitha P.B., Edner A., and Fahlman A. 2021. Standing sedation with xylazine and reversal with yohimbine in juvenile Asian elephants ( Elephas maximus ). Journal of Zoo and Wildlife Medicine, 52(2) : 437-444. Liesel L. Laubscher , Silke Pfitzer , Peter S. Rogers , Lisa L. Wolfe , Michael W. Miller , Aleksandr Semjonov , Jacobus P. Raath. 2021. Evaluating the use of a butorphanol-azaperone-medetomidine fixed-dose combination for standing sedation in African elephants (Loxodonta africana). J. of Zoo and Wildlife Medicine, 52(1) :287-294 (2021). Molter C. 2020. Diagnosis and treatment of EEHV-hemorrhagic disease. Proceedings of the annual AAZV- symposium 2020. Neiffer D.L. , Miller M.A., Weber M., Stetter M., Fontenot D.K., Robbins P.K., and Pye G.W. 2005. Standing sedation in African elephants (Loxodonta africana) using detomidine–butorphanol combinations. Journal of Zoo and Wildlife Medicine 36(2): 250–256, 2005. E. Wiedner. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Standing sedatin General Anesthesia General remarks: General anesthesia is required in those cases where standing sedation alone or in combination with local anesthesia does not suffice for the intervention that needs to be done. We can devide the indications in: Capture immobilization Immobilization for painful procedures Capture immobilization is mostly done in range countries. However, the escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It aslo nmeasn that the circumstances have not (or insufficiently) been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation : If possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select a place that is reachable for heavy equipment. Provide shadow whenever possible. Make sure you can ccol the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably a deep sand layer covered by a deep layer of straw or matrasses. Straps or belts are required in case the elephant needs to be rolled over. It is important to thraw them under the elephant before the animal will go down. It helps if the elephant lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. To protect the tusks against fractures, a car tyre can be placed under the head just before the elephant goes down. Trained elephant can be anesthetized when brought lateral recumbency. If the elephant is trained to ly down in sternal position, general anesthesia can be induced but this is very risky! Once the drugs have reached their effect, the elephant MUST be rolled over into lateral recumbency, which requires heavy equipment. Especially in trained elephants, ropes can be used to guide the elephant into lateral recumbency. Trained captive African elephant brought under general anesthesia while guided by ropes. Courtesy: Osterhaus and Fagan. For correct positioning of the elephant during general anesthesia, the use of a crane is highly recommended. First, a standing sedation is induced. After a net has been brought into position, this can be connected to the crane. This will support the elephant when the general anesthesia is induced by IV or IM injection of the narcotic drug (etorphine or ketamine). By lifting the elephant it can be positioned in the correct lateral recumbancy. Protecting cushions, matrasses and soft bedding materials should be placed underneath the head and the body. See the images of the use of a net below (Courtesy basel Zoo): Elephants should be fastened for 24-48 hours prior to anesthesia. Water should be withheld for 24 hours before the procedure. Capture immobilization is mostly done in range countries. The escape of a captive elephant may also require capture immobilization. Elephants from this category have not been prepared for the immobilization. This means that they have been able to take food an water shortly prior to the immobilization. It also means that the circumstances have not or insufficiently been prepared for the procedure as compared to an immobilization under full captive conditions. Preparation: if possible, prepare a safe area for the people and elephant involved. Avoid an area with water and select an area that is reachable for equipment. Provide shadow whenever possible. Make sure you cool the elephant with cold water when necessary. Heavy equipment to position the elephant in lateral recumbancy may be needed, as sternal recumbancy is highly associated with anesthetic death. If an elephant has gone down in sternal position and cannot be rolled over in lateral recumbancy, the anesthesia must be reversed immediately. Whenever possible, provide a soft bedding, preferably sand covered by a deep layer of straw or matrasses. If straps are required in case the elephant needs to be rolled over, it is important to thraw them under the elephant just before the animal will go down. It helps if the elephants lays on sand and straw to get straps or a belt under the elephant's body with the help of a hooked steel wire. The use of a suitable net is highly recommended as slings may slide away from the desired place of the elephant's body. Oxygen supplementation Oxygen must always be provided, even if the anesthetized elephant is not intubated. Arterial blood pressure will drop if no oxygen is provided (Heard 1986). An oxygen flow of 10-15 L/min for a juvenile up to 39-40 L/min for an adult elephant is required for maintaining arterial blood pressure at an acceptable level. Oxygen supply during general anesthesia of a 5 yr-old Asian elephant under field conditions. Due to lack of proper equipment, intubation was not possible. Oxygen was provided at a flow rate of 10 L/min via a small tube inserted in the trunk. Drugs used for general anesthesia: Captive elephants that are excited can be premedicated with azaperone (Asian elephant 0.024-0.038 IM, African elephant 0.056-0.107 IM, IV). Fast acting immobilizing drugs that are used for capture immobilization: Etorphine : 0.002-0.004 mg/kg IM (Asian elephant) and 0.0015-0.003 mg/kg IM (African elephant) OR Carfentanil : 0.002-0.004 mg/kg (Asian elephant) and 0.0013-0.0024 mg/kg IM (African elephant) These drugs can be antagonized with naltrexone 0.004 mg/kg IM (or 50/50 IV/IM) If carfentanil and etorphine are not available, xylazine (0.1 mg/kg) and ketamine (0.3-0.7 mg/kg) can be given together. The disadvantage is the large volume required for an adult elephant. For capture immobilization this combination is therefore not recommended. At the end of the procedure xylazine can be reversed with atipamezole (0.1 x dose of xylazine IM or slowly IV) or yohimbine (0.05-0.13 mg/kg IV). Under controlled conditions (if a crane is available) a standing sedation can be induced first, allowing to put a net or slings in place. When well secured, ketamine can be given i.m. (0.3-0.7 mg/kg). or i.v. using a long infusion tube for safety reasons. Once in lateral recumbancy, the elephant can be intubated and anesthesia can be maintained on isoflurane or halothane (1.5-3%). Inhalation anesthesia and intubation: Intubation in elephants is straightforward. A 30-50 mm diameter cuffed endotracheal tube can be inserted into the trachea. A rope around the lower jaw can be used to open the mouth. A gloved hand can reach the epiglottis and advance a lung tube (e.g. stocha tube for horses) into the trachea, while pushing the soft palate upward. Once in place, the endotracheal tube can be advanced into the trachea guided by the smaller tube. A special portable pressure ventilater has been developed and described by William et al. Jeff Zuba made some modifications to this design, which is now commercially available (http://www.incaseofanesthesia.com/Home_Page.html ). Schematic overview of a portable pressure ventilation device for elephants. "Zuba" ventilator used in an adult African elephant under field conditions Captive African elephant intubated for gas anesthesia using a "Zuba" ventilator. "Zuba" ventilator Under less favorable circumstances when a pressure ventilator is not available, intubation can be done in the trunk using 2 cuffed horse endotracheal tubes and 2 separate (portable) anesthetic machines (Tamas 1983). The advantages of this method are the easy intubation and the ample space in the oral cavity in the absence of the large tube. However the disadvantages are substantial: Two tubes increase the airway resistence Risk of regurgitation and aspiration of stomach contents An elephant can breath through its mouth, which will bypass the inhalation of the anethetic gas General anesthesia in a captive Asian elephant using bilateral trunk intubation (Rotterdam Zoo, 1989) Monitoring: Pulse oximetry is a reliable tool for monitoring heart frequency and venous oxygen saturation. A capnagraph is recommended to monitor the respiration. If not available, one individual should be assigned just to monitor respiratory rate and depth. ECG and arterial blood gases are recommended. As hypotension is quite common in anesthetized elephants, blood pressure measurement is also recommended. Hypotension has been treated successfully with ephedrine and dobutamine. Recovery support: Weak or debilitated animals may need help to get back on their feet during recovery. A deep sand layer is essential for the elephant to getting grip on the ground. A crane may be needed to lift the animal from the ground, using straps or belts applied around the body. References. Fowler M.E. and Mikota S.K. 2006. Chemical restraint and general anesthesia. In: Biology, medicine and surgery of elephants. Blackwell Publishing. Heard D.J., Jacobson E.R., and Brock K.A. 1986. Effects on oxygen supplementation on blood gas values in chemically restraint juvenile African elephants. J Am Vet Med Ass 189 (9)1071-1074. Tamas PM. and Geiser D.R. 1983. Etorphine analgesia supplemented by halothane anesthesia in an adult African elephant. JAVMA 183, 11 (1312-1314) . Wiedner E.. 2015. Proboscidea. In: Fowler's Zoo and Wild animal Medicine 8. Zuba J.R., Osterhaus J.E. 2012. Anesthetic complications and clinical intervention in opiod anesthetized captive elephants. In: Proceedings of the AAZV Conference, Oakland (1-6). Zuba J.R. http://www.incaseofanesthesia.com/Home_Page.html General anesthesia Always bring the elephant into LATERAL RECUMBANCY for general anesthesia Epidural anesthesia Epidural anesthesia in elephants is recommended when a vaginal vestibulotomy is performed in order to reduce tail movements of the elephant and provide additional analgesia in the perineal region. Procedure: Restrain the elephant as appropriate in a chute and sedated if necessary. Disinfect the injection site. Move the tail up and down to determine the position of the most mobile intercoccygeal space. Inject local anaesthetic (2% Lidocaine) into the skin over the injection site. Palpate the intercoccygeal space wearing a sterile glove and insert the needle (14 gauge, 3 inch) at approximately a 60 - 70 degree angle cranially. The epidural space is about 6.5 cm below the skin surface. Inject Lidocaine : 30 ml was sufficient to produce tail relaxation in a 3,000 kg elephant, and the elephant remained standing. Epidural anesthesia

Intramuscular, subcutaneous, intravenous and epidural injection techniques are described in this chapter. To procedures Injection techniques Hand injections Intramuscular injection: Subcutaneous injection: Intravenous injection: Epidural injection: An epidural injection in elephants is recommended when a vaginal vestibulotomy is performed in order to reduce tail movements of the elephant and provide additional analgesia in the perineal region. Procedure: Restrain the elephant as appropriate in a chute and sedated if necessary. Disinfect the injection site. Move the tail up and down to determine the position of the most mobile intercoccygeal space. Inject local anaesthetic (2% Lidocaine) into the skin over the injection site. Palpate the intercoccygeal space wearing a sterile glove and insert the needle (14 gauge, 3 inch) at approximately a 60 - 70 degree angle cranially. The epidural space is about 6.5 cm below the skin surface. Inject Lidocaine : 30 ml was sufficient to produce tail relaxation in a 3,000 kg elephant, and the elephant remained standing. Remote injections Make your own blow dart Blow dart injection: Jam-stick injection: Dart gun injection: To page top