In: Recent Advances in Veterinary Anesthesia and Analgesia: Companion Animals, Gleed R.D.

and
Ludders J.W. (Eds.). International Veterinary Information Service, Ithaca NY (www.ivis.org), Last
updated: 5-Aug-2001; A1409.0801

Injectable Anesthesia and Analgesia of Birds

J. Paul-Murphy and J. Fialkowski

School of Veterinary Medicine, University of Wisconsin, Madison, Wisconsin, USA.

Isoflurane is the anesthetic of choice for most avian anesthetic procedures. However, inhalation
anesthesia is not always available in field situations involving wild birds, although small portable
inhalation anesthesia units are available. Certain surgical procedures, such as tracheal resection, may
warrant the use of injectable anesthesia regardless of whether or not an anesthesia machine is available
[1]. Anesthetic gases can escape from the bird during surgical procedures that disrupt air sacs, or the
extension of air sacs into pneumatic bones, and thereby expose staff to anesthetic gases. Advantages of
injectable anesthetic agents include rapid administration, low cost, and minimal equipment. Some
anesthetic agents can be reversed, an important advantage when working in field situations. Injectable
anesthetics are frequently used in large, long legged birds, such as ratites, when physical restraint is
impossible or dangerous. Injectable anesthetics used in birds include barbiturates, chloral hydrate, alpha
chloralose, phenothiazines, dissociatives, alpha-² adrenergic agonists, alphaxalone/alphadolone and
propofol [2]. Some of these anesthetics, such as barbiturates, chloral hydrate, alpha chloralose and
alphaxalone/alphadolone, are no longer recommended and will not be discussed here.

The greatest disadvantage of injectable anesthetics is individual and species variation relative to drug
dose and response to a specific drug. Elimination of an injected drug depends on distribution,
biotransformation and excretion. While we recognize species differences within domestic animals and
tailor drug and dose accordingly, we nonetheless tend to treat all birds as if they belonged to one genus or
species; as if, for instance, the pigeon is the same as an ostrich when in fact these two birds are as
phylogenetically different from each other as the horse is from the cat. Pharmacokinetic studies of
antimicrobial drugs in different species of birds have shown that kinetics vary significantly between
species and even between birds of the same order such as cockatiels and Amazon parrots (both
Psittaformes). Therefore data collected on an injectable anesthetic using a pigeon may not be directly
transferable to another species of bird. Nevertheless, information collected on one avian species is likely
to be better for extrapolation to another avian species than are data from mammalian species.

It is important that the overall clinical condition of the bird be considered during selection of an anesthetic
protocol. Precise body weight in grams is essential for accurate dosing. When using injectable anesthetics
for birds it is difficult to maintain a surgical plane of anesthesia. The risk of cardiopulmonary depression
is high and warrants careful monitoring during an anesthetic procedure. Orotracheal intubation of the
anesthetized patient allows for supplemental oxygen and positive pressure ventilation if needed. A
ventilation rate of 2 breaths per minute assists the spontaneously ventilating bird. When birds are apneic,
the ventilatory rate should be 10 - 15 breaths per minute. In the bird, both inspiration and expiration
require skeletal muscle activity and most anesthetics depress muscular activity, thus reducing air flow rate
and oxygen exchange. Assisted or controlled ventilation ensures air flow and improves gas exchange at
the level of the parabronchus and air capillaries. Intubation provides a patent airway that permits easy
control of ventilation in emergency situations. Nevertheless, intubation is not recommended in very small
birds because dried mucus may obstruct very narrow endotracheal tubes and the endotracheal tube may
increase resistance to airflow because of a significant decrease in tracheal diameter.

It is recommended to calculate and prepare doses of standard emergency and supportive drugs such as
epinephrine, doxapram, lidocaine, and atropine before inducing anesthesia. The small size of many avian
patients requires accurate dosing of very small volumes or dilution of standard concentrations. Having
these drugs prepared and in labeled syringes saves time and anxiety in critical situations.
Rapid anesthetic recoveries are best for birds. Birds appear very disoriented during recovery and tend to
flap their wings and twist their head and neck. Holding the patient in a light towel wrap or rolling the bird
into a loose newspaper "burrito" provides mild restraint to prevent chaotic body movements. Keeping the
bird in a warm, quiet, dark place also aids a smooth recovery.
Injection Sites

In most birds, intramuscular injections are best given in the pectoral muscles. In flightless birds, such as
ratites, pectoral muscle mass is minimal, thus the thigh muscles are preferred. Subcutaneous injections are
not advocated because uptake of anesthetic is slowed, but if selected the recommended site is the inguinal
region. Intravenous sites for injection or catheterization include the right jugular vein, brachial vein, or
the medial metatarsal vein. Intraosseous catheters are useful when venous access is difficult, as occurs
with hypotensive birds or very small birds. Intraosseous catheters can be placed in the proximal ulna or
the cranial tibiotarsus. Uptake of the drug is comparable to intravenous injection of the drug [3].

Local Anesthetics

The toxicity of lidocaine is similar for birds as it is for mammals and it has been reported to cause
seizures and cardiac arrest [4]. Toxicity can be prevented by using appropriate concentrations and
volumes. Lidocaine (1 - 2 mg/Kg) can be used as a local anesthetic or to treat ventricular arrhythmias [4],
and the maximal dose is 4 mg/Kg. For the small avian patient this often requires that the stock
concentration of lidocaine (2%; 20 mg/ml) be diluted. Because of reluctance to use local anesthetics in
birds, information regarding long-acting local anesthetics, such as bupivacaine, is sparse. Topical
benzocaine has been used for local analgesia during repair of minor wounds in small birds [5]. A 1:1
mixture of bupivacaine and dimethyl sulfoxide (DMSO) was applied to amputated chicken beaks
immediately after amputation and feed intake was improved [6]. Intra-articular bupivacaine, at a dosage
of 3 mg in 0.3 ml saline, was reported to be effective for treating arthritic pain in chickens [7].

Benzodiazepines

Diazepam and midazolam can reduce anxiety during anesthetic induction and recovery. These sedatives
work best if given 10 - 20 min prior to further manipulations. The bird’s behavior does not often reflect
pre-anesthetic sedation, but birds appear to struggle less during restraint. High doses of midazolam
produced sufficient sedation in geese to facilitate restraint for diagnostic procedures [8]. This is highly
advantageous with dangerous birds such as large raptors, and long-legged birds such as cranes and ratites.
The sedative effect of these drugs is evident during recovery which is slow and smooth. No studies have
been done to determine the duration of effect for diazepam or midazolam. The benzodiazepines provide
muscle relaxation when used in conjunction with ketamine and reduce the level of Isoflurane needed for
anesthesia [9]. Flumazenil administered IV, helps to reverse benzodiazepine-induced sedation and restores
alertness as long as enough time has passed so that additional anesthetic agents are no longer effective.

Dissociatives

Ketamine is rarely used alone because it is associated with poor muscle relaxation, muscle tremors,
myotonic contractions, opisthotonus and rough recoveries [1, 10-12]. The dose of ketamine depends on
body weight, and its dosing follows the principles of allometric scaling so that large birds (>1 Kg)
respond to 10 - 20 mg/Kg whereas small birds (< 50 grams) require much higher doses, e.g. 70 - 80
mg/Kg. Additionally, there is inter-species variability in the response to ketamine. For example, ketamine
causes salivation, excitation and convulsions when given to vultures but these signs are rare in other birds
[12]. When effective, anesthesia occurs within 5 - 10 min of intramuscular injection and may last 5 - 20
min depending on the dose and size of the bird. Recovery from ketamine, until the bird can perch or
stand, can take 40 - 100 min, depending on dose, body temperature, metabolic health, and size of the bird.
It is recommended that ketamine not be used alone and be combined with benzodiazepines or alpha²-
adrenergic agonists to improve relaxation and depth of anesthesia.

Tiletamine and Zolazepam

Telazol® combines the effects of a dissociative drug (tiletamine) and a benzodiazepine (zolazepam). This
combination has similarities to ketamine plus midazolam, but the smaller volume of Telazol that is
typically used for anesthesia can be an advantage. At doses of 5 or 10 mg/Kg it was an effective and safe
anesthetic for great horned owls and screech owls although decreased heart and respiratory rates were
noted [13]. Telazol at the same dose was unsatisfactory for anesthesia of red tailed hawks as they
responded with salivation, and elevated heart and respiratory rates [13]. Despite the lack of information
on Telazol in a variety of avian species, the primary disadvantage seems to be that a high dose provides
anesthesia of short duration followed by a long (2 - 4 hour) and sometimes difficult recovery [11].

Alpha²-adrenergic agonists

Xylazine, detomidine and medetomidine are usually used in combination with ketamine. The alpha-²-
adrenergic agonists provide muscle relaxation, analgesia and sedation which smoothes induction and
recovery. The greatest advantage of this group of drugs is the availability of specific antagonists to
reverse the effects, allowing for smooth and rapid recovery. Atipamezole is recommended to reverse
medetomidine and detomidine, and will also reverse the effects of xylazine. yohimbine has been used in
raptors and psittacines to reverse the effects of xylazine, both alone or in combination with ketamine [14-
16]. Similar results were noted when tolazoline was used in turkey vultures to shorten xylazine plus
ketamine anesthesia [17]. When reversing an alpha²-adrenergic agonist used in combination with
ketamine, reversal must be timed so as to avoid the bird recovering under the effects of ketamine alone as
this can result in a rough recovery.
Alpha²-adrenergic agonist drugs are not recommended as single anesthetic or immobilization agents for
birds. In pigeons and Amazon parrots, high doses of medetomidine had a sedative effect but did not
immobilize the birds [18]. Xylazine administered alone causes respiratory depression, excitation,
convulsions and prolonged recovery [12]. All alpha²-adrenergic agonists have profound cardiopulmonary
effects. Xylazine and medetomidine cause decreases in HR, RR, blood pH, hypoxemia, and hypercarbia
[4,12,14,18]. The arrythmogenic effects of the alpha²-adrenergic agonists can lead to cardiovascular
instability and, when coupled with hypoventilation and hypercarbia, can have an irreversible, fatal effect.
Alpha²-adrenergic agonist drugs are a poor choice of anesthetic, alone or in combination, when a bird is
highly stressed. General excitement can effectively over-ride the sedative effects of alpha²-adrenergic
agonists, although the mechanism for this effect is not clear. Therefore, when using alpha²-adrenergic
agonist drugs, approach the bird quietly, inject the drug and place the bird back into a familiar, quiet and
dimly lit enclosure while waiting for the drug to take effect. The induction period is 5 - 10 min, depending
on dose and size of the bird. Ratites, raptors and long-billed birds can have a hood placed over the head
for calming when a dark cage is not available.
Xylazine plus ketamine combinations have been evaluated in several avian species. Blood pressure
becomes elevated, heart rate is decreased, and hypoxemia, hypoventilation, and hypercapnia occur [19-
20].
An anesthetic combination consisting of medetomidine, midazolam and ketamine was evaluated and
found to be unsafe for use in ducks [21] as it caused bradycardia, primarily attributed to the
medetomidine [21,22]. Medetomidine also decreases respiratory rate. Apnea followed by a fatal decrease
in heart rate and blood pressure was documented in four of twelve ducks receiving medetomidine [21].
Atipamezole and flumazenil were given intravenously to reverse medetomidine and midazolam,
respectively, and the ducks rapidly regained consciousness and voluntary movement [21].

Propofol

Propofol is an intravenously administered anesthetic with rapid onset, smooth induction, short duration of
effect, and smooth, rapid recovery. Intravenous catheters are highly recommended for its administration
because the drug must be given slowly for induction and often given repeatedly to maintain anesthesia. A
maximum of 2 mg/Kg bolus every 30 seconds is recommended for induction, after which 0.5 - 1.0
mg/Kg/min is used to maintain surgical anesthesia [1,23]. In a study using ducks, propofol was given as
an initial IV bolus and was constantly bolused at 1 - 4 mg/Kg every 5 min to maintain a light plane of
anesthesia [21]. In studies that monitored cardiopulmonary responses to propofol, mean arterial pressure
(MAP) decreased significantly [1,23]. A short period of apnea following induction is a consistent finding
[21,22,24] and respiratory depression can occur during induction and maintenance with propofol [23, 24].
Cardiac arrhythmias including ventricular premature contractions and ventricular tachycardia, were
common in chickens and profound bradycardia was noted in ducks after the initial bolus of propofol
[21,23]. Propofol has a narrow margin of safety in birds and supplemental oxygen and respiratory
assistance must be provided to counteract apnea, hypoventilation and hypoxemia [21,23-25].

Anticholinergics

The use of anticholinergics for birds is controversial. Indeed, atropine and glycopyrrolate are effective for
the treatment of vagally induced bradycardia [26]. Some argue, however, that they cause respiratory
secretions to become more viscous and thus more likely to plug narrow endotracheal tubes [27]. Others
[28] recommend anticholinergics for their ability to reduce respiratory mucus production and prevent
formation of mucus plugs in small endotracheal tubes [4]. The oculocardiac reflex has been reported in a
cockatiel and suggests that treatment with an anticholinergic prior to or during ocular surgery may
prevent this reflex which is thought to be caused by ocular manipulation resulting in cardiac dysrhythmias
[29].

Ratites (Ostriches, Emus, Cassowaries and Rheas)

In these large birds, injectable anesthetics are frequently used for short procedures and for induction of
anesthesia prior to inhalation anesthesia. Several reports have been written on anesthetic protocols for
ratites and a recent review compared the most common protocols [22,30-35]. These bird, when healthy,
are too strong and unpredictable for simple mask induction with inhaled anesthetics. Intravenous
injections can be given in the jugular vein or brachial vein, although the emu’s brachial vein is small and
difficult to access. Placing a catheter in the jugular, brachial, or medial metatarsal vein will facilitate IV
injection and induction. Injectable anesthetics most commonly used for ratites include combinations of
Alpha²-adrenergic agonists followed by ketamine, or a benzodiazepine followed by ketamine, tiletamine-
zolazepam, carfentanil or etorphine [28,34]. Benzodiazepines given prior to induction help produce
smooth inductions and smooth but slow recoveries. Induction with tiletamine/zolazepam is excellent and
rapid, although when given IV, violent recoveries have been reported [30,34]. Benzodiazepines given
with tiletamine-zolazepam will smooth recovery [30]. Induction with xylazine-ketamine is adequate, but
recovery can be difficult [34]. Carfentanil is not recommended due to an excitatory response even when
used with xylazine [34]. When etorphine was combined with medetomidine, recumbency occurred
rapidly, birds were sedate and muscle relaxation was adequate [33]. Other etorphine combinations, when
given to free-ranging ostriches, caused initial excitement [33], although darting procedures, regardless of
the anesthetic, can create a period of excitement. Medetomidine as a sole anesthetic agent is ineffective in
the ostrich [35]. When medetomidine was combined with ketamine and followed by intravenous propofol,
it was an effective combination for chemical immobilization of captive ostriches, although positive
pressure ventilation was recommended [22]. Apnea is a common occurrence during ostrich anesthesia,
regardless of the induction agents selected. Ventilatory support is highly recommended for this group of
birds.

Analgesia

Opioids -
The early literature regarding the use of opioids in birds is confusing and contradictory. For example, one
study used two different strains of chickens to evaluate the analgesic effect of equal doses of morphine.
Based on their response to a noxious thermal stimulus, one strain had a hyperalgesic response while
another strain had an analgesic response [36]. With many such conflicting results in the literature, it was
assumed that opioids were not effective analgesics for birds. More recently, the physiological effects of
opioids on birds have been documented using isoflurane-sparing techniques [37-39]. In these studies,
unpremedicated birds are anesthetized with Isoflurane. The minimal anesthetic concentration (MAC) is
determined in each bird, after which each bird is injected with an analgesic and MAC is again determined.
A significant reduction of MAC indicates that the drug being tested has analgesic properties. Using this
technique, the analgesic effects of butorphanol were evaluated in cockatoos, African grey parrots, and
Amazon parrots. Butorphanol at 1 mg/Kg was found to be analgesic in African gray parrots and
cockatoos, but not Amazon parrots [38,39]. Following injection of butorphanol, heart rate, tidal volume,
and inspiratory and expiratory times were all significantly decreased [38,39]. A similar study compared
mu and kappa opioids in chickens and both drugs had isoflurane-sparing effects [37].

Recent studies evaluated the effects of butorphanol and buprenorphine in conscious parrots [40,41]. In
African grey parrots, butorphanol (1 - 2 mg/Kg, IM) had an analgesic effect while large doses of
buprenorphine had no significant analgesic effect [41]. In Hispanolian parrots, higher doses of
butorphanol (3 mg/Kg) were needed to produce a similar analgesic effect (J. Paul-Murphy, personal
observation). Species variability in response to opioids does occur and caution is advised when
extrapolating butorphanol doses from one avian species to another. Fentanyl (0.02 mg/Kg, IM), a
synthetic mu agonist, was tested in a similar fashion in cockatoos, and was found to have little analgesic
effect; a higher dose (0.2 mg/Kg, SQ) was analgesic (S. Hoppes, unpublished data). This may be due to
fentanyl binding both mu and kappa receptors when given at high doses. An excitement phase was noted
in several of the birds shortly after fentanyl was injected (S. Hoppes, unpublished data). The duration of
effect of all of these opioids has only been evaluated empirically and their duration of effect may be as
short as 2 - 4 hours.

Pharmacodynamic studies have demonstrated that pigeons have more kappa opioid receptors than mu
opioid receptors [42]. This one piece of information in pigeons is used to explain why birds do not
respond as do mammals to mu agonists like morphine, buprenorphine and fentanyl, and why kappa
opioids, such as butorphanol, may be more efficacious analgesic in birds. Butorphanol is currently
recommended for opioid analgesia in birds, and it can be given as a pre-operative and post-operative
analgesic. When butorphanol is used as an induction agent and pre-operative analgesic the concentration
of Isoflurane needed for anesthesia will be reduced.

Non-steroidal anti-inflammatory drugs

There are several categories of nonsteroidal anti-inflammatory drugs (NSAIDS), but few have been
investigated in birds and even fewer have been evaluated for clinical application [26,43]. Much of the
information about doses and effects for birds has been gained through practical application. Studies using
chickens have provided pharmacokinetic information on oral dosing of a few NSAIDS and short half-life
and low bioavailability were common findings, but pharmacokinetic studies are a poor predictor of
analgesic efficacy [44-46].

In mammalian species, NSAIDS are synergistic with other classes of analgesic agents and may be most
effective for peri-operative analgesia when used in combination with opioids [47]. In birds, as in other
species, pre-emptive use of NSAIDS may decrease tissue sensitization caused by surgical trauma and may
reduce the period of post-operative opioid therapy.

The most commonly used NSAIDS in avian medicine today are carprofen and ketoprofen. The proprionic
acid class of NSAIDS are analgesic, anti-inflammatory and antipyretic in mammals and are expected to
have similar effects in birds. Chickens given a 1 mg/Kg subcutaneous dose of carprofen had peak plasma
levels 1 - 2 hours after injection and pain thresholds were raised for at least 90 min [48]. When carprofen-
treated feed was offered to chickens, lame chickens selected more drugged feed than sound birds and the
amount of carprofen consumed increased with the severity of lameness [49]. Low plasma concentrations
of carprofen (0.28 mg/ml) provided some analgesia for birds, but to reach plasma levels of 8.3 mg/ml,
similar to therapeutic plasma levels in mammals, an equivalent of 40 mg/Kg body weight per bird was
needed in the feed [48].

A documented side effect of NSAIDS in mammals is gastrointestinal ulceration and bleeding due to
inhibition of prostaglandin synthesis. A similar toxic effect in birds was reported when high dosages of
flunixin meglumide (10 mg/Kg) caused regurgitation and tenesmus in budgerigars [43]. The most serious
complication of in birds is renal ischemia. Bobwhite quail experimentally given daily intramuscular
injections of flunixin meglumide for 7 days had histological evidence of renal damage in all birds, even at
doses as low as 0.1 mg/Kg. Severity of the lesions was directly correlated to the dose of flunixin
meglumide with acute necrotizing glomerulitis, tophi in the renal tubules and visceral gout occurring at
32 mg/Kg [50]. Renal ischemia and necrosis has been documented in Siberian cranes treated with flunixin
meglumide (5 mg/Kg) for muscle and skeletal trauma [51]. The use of flunixin meglumide currently is
contraindicated in cranes and used with great caution with other avian species.
Piroxicam is used in mammals to treat chronic inflammatory conditions such as
arthritis. It as been used to treat chronic degenerative joint disease in cranes and other
species of birds and appears to provide mild to moderate improvement and willingness
to bear weight on affected limbs over extended treatment periods.

Drug Dosage (Dose), Route Species / Remarks Reference

Mallard ducks: to reverse medetomidine; rapidly regained
182 - 281 mg/Kg
Atipamezole consciousness, struggled & flapped wings; tachycardia and Machin [21]
(250 mg dose), IV
tachypnea observed.
0.2 mg/Kg, IV; and Ostriches: to reverse medetomidine; half of the total 0.4 Langan [22]
0.2 mg/Kg, SC mg/Kg dose was given IV, the other half SC; recovery was
 smooth and ranged from ≈14 - 28 min
Pigeons (Columbia livia) and Amazon Parrots (Amazona
spp.): Used to reverse medetomidine_hydrochloride; the dose
given was 2.5 or 5 times the medetomidine dose administered. Sandmeier
3.75 - 10 mg/Kg
No differences were seen between the higher and lower doses. [18]
Recovery was smooth and rapid; standing times were all
within 4 min
Various avian species: Recommends a dose 5 times that of
0.25 - 1.0 mg/Kg Jalanka [52]
medetomidine to reverse its effects.
Various avian species: Recommends a dose 5 times that of
0.5 - 2.5 mg/Kg Berthier [53]
medetomidine to reverse its effects.
(A) 40 - 161 mg/Kg
Red-necked ostriches (Struthio camelus): to reverse
Atipamezole (A) / (5 - 20 mg dose) Ostrowski
meditomidine/etorphine combination; lead to a fast but violent
Diprenorphine (D) (D) 12 - 20 mg/Kg [33]
recovery.
(15 - 25 mg dose), IV
(A) 182 - 281 mg/Kg
Mallard ducks: to reverse medetomidine/midazolam,
Atipamezole (A) (250 mg dose)
respectively; rapidly regained consciousness, struggled & Machin [21]
Flumazenil (F) (F) 18 - 28 mg/Kg
flapped wings; tachycardia and tachypnea observed.
(25 mg dose), IV
Atropine 0.006 mg/Kg, IV Ratite; used to treat bradycardia. Lin [30]
African grey parrots (Psittacus erithacus): 6/11 birds had an
increased pain threshold to a noxious electrical stimulus after
administration of 1 mg/Kg B (this may represent the ED50 for Paul-Murphy
Butorphanol (B) 1 - 2 mg/Kg, IM
the drug); higher dosages such as 2 - 3 mg/Kg have been used [41]
to treat pain in subsequent studies without adverse side effects
(unpublished findings).
Cockatoos (Cacatua spp.): reduced Isoflurane requirement in
cockatoos; heart rate was reduced by 12%; apnea was not
1 mg/Kg, IM observed; respiratory rate increased by 77%, while tidal Curro [38]
volume decreased by 25%, thus having no significant net
effect on minute ventilation.
Psittacines: significantly reduced Isoflurane ED50 in cockatoos
(Cacatua spp.) and African grey parrots (Psittacus erithacus),
1 mg/Kg, IM Curro [39]
but had no affect on the isoflurane ED50 in blue-fronted
Amazons (Amazona aestiva aestiva).
Ostrich (Struthio camelus): darted; marked initial excitement
phase, onset took 2 - 3 min, characterized as breaking away
≈0.03 mg/Kg (3.3 mg Raath, et al.
Carfentanil from the group and running in an uncontrolled manner;
dose), IM [31]
walking backwards, circling or courtship behavior prior to
recumbency; smooth reversal with naltrexone, 3.0 mg/Kg.
Ratites: initial excitement phase, 5 min; apnea while under 5%
Carfentanil (C) / Cornick and
(C) 0.3 mg/Kg, IM Isoflurane maintenance anesthesia and after isoflurane was
5% Isoflurane Jensen [34]
discontinued.
Ostrich (Struthio camelus): darted; initial excitement phase,
(C) 0.03 mg/Kg (3
onset took 2 - 3 min; recumbency in ≈ 5 min; subjective
Carfentanil (C) / mg dose) / Raath, et al.
assessment was that xylazine decreased the initial excitement
Xylazine (X) (X) 1.5 mg/Kg (150 [31]
level; smooth reversal with naltrexone/yohimbine, 3.0 / 0.125
mg dose), IM
mg/Kg, respectively.
McGeown, et
Carprofen 1.0 mg/Kg, SC Chickens: improved ability of moderately lame birds to walk.
al. [48]
Broiler Chickens: Self-selection of three doses of carprofen
coated feed (3.4, 34.3, and 343 mg/Kg of feed) or normal
feed; carprofen feeding improved gait in lame birds; lame Danbury, et
0.4 - 40 mg/Kg/day
birds selected more feed containing carprofen than did sound al. [49]
birds; consumption of carprofen-feed increased with the
severity of lameness.
Detomidine (D) / (D) 0.3 mg/Kg, IM / Chickens: (D) diluted to a 0.2% solution prior to use; (D) Mohammad,
Ketamine (K) (K) 10 mg/Kg, IM administered prior to K into opposite thigh muscles; smoothly et al. [55]
 induced anesthesia within 4 min and lasted ≈ 47 min;
analgesia evident in 8 min and lasted 28 min; muscle
relaxation good; respiratory rate significantly decreased from
baseline; corneal reflex remained present.
Chickens: duration of analgesia and anesthesia significantly
(D) 0.3 mg/Kg, IM / prolonged with 20 mg/Kg vs.10 mg/Kg dosage of K, as noted Mohammad,
(K) 20 mg/Kg, IM above; smoothly induced anesthesia within 3 min and lasted et al. [55]
for ≈94 min; analgesia was evident in 6 min and lasted 63 min
0.13 - 0.41 mg/Kg,
Diazepam Ratites: used to smooth recovery from tiletamine/zolazepam. Lin [30]
IV
≈100 - 240 mg/Kg Red-necked ostriches (Struthio camelus): to reverse etorphine; Ostrowski
Diprenorphine
(12 - 30 mg dose), IV lead to a fast but violent recovery. [33]
5 mg/Kg, IV or Ostriches (Struthio camelus): experiencing respiratory Ostrowski
Doxapram
intralingual distress; ventilated mechanically. [33]
Chickens: drowsiness observed 3 - 5 min after administration; Christensen,
Equithesin 2.5 ml/Kg, IM
pain reflexes remained and birds were easily aroused. et al. [10]
Chickens: D administered 15 min after E resulted in
Equithesin (E) / (E) 2.5 ml/Kg, IM / immediate surgical anesthesia which lasted 60 - 90 min, for Christensen,
Diazepam (D) (D) 2.5 mg/Kg, IV long-duration surgical procedures; depth of anesthesia et al. [10]
increased with increased diazepam doses.
(E) 40 - 72 mg/Kg Ostriches (Struthio camelus): darted; initial excitation phase;
(5 - 9 mg dose) / mean time to recumbency 12 min; deep sedation but short
Etorphine (E) / Ostrowski
(K) 1.0 - 1.5 mg/Kg duration, 9 - 15 min; risk of over-exertion myopathy, apnea,
Ketamine (K) [33]
(120 - 180 mg dose), and bradycardia; reversal with diprenorphine resulted in quick
IM but violent recoveries.
Ostriches (Struthio camelus): darted; initial excitation phase;
(E) 64 - 72 mg/Kg
mean time to recumbency 8 min; deep sedation but short
Etorphine (E) / (8 - 9 mg dose) / Ostrowski
duration, 8 - 16 min; risk of over-exertion myopathy, apnea,
Medetomidine (M) (M) 32 - 64 mg/Kg [33]
and bradycardia; reversal with diprenorphine/atipamezole
(4 - 8 mg dose), IM
resulted in quick but violent recoveries.
Flunixin African grey (Psittacus erithacus) and blue-fronted Amazon
meglumine (FM), 4 mg/Kg IM parrots (Amazona aestiva aestiva): Does not have an Curro [39]
(NSAID) isoflurane-sparing effect.
Northern bobwhite (Colinus virginianus): Six dosage groups
were administered FM, SID, for 7 days; all six groups had
significantly more mineralized deposits in renal glomeruli Klein, et al.
0.1 - 32.0 mg/Kg, IM
than seen in controls and the severity increased with dosage; [50]
no changes in renal function indicators; at highest dosage, 32
mg/Kg, necrosis was observed at the injection site.
Mallard ducks (Anas platyrhynchos): Thromboxane (TBX)
levels significantly suppressed for at least 4 hr; pain responses
were not assessed, so there was no correlation made between Machin et al.,
5 mg/Kg, IM
degree of TBX inhibition and degree of analgesia; muscle [56]
necrosis of ≈1 - 2 cc at the injection site; may not be suitable
for use in ducks.
Broiler Chickens: survival times improved when treated water
Oliver and
5.26 mg/liter of was supplied for three days prior to heat stress; peripheral
Birrenkott
drinking water prostaglandin F was unaffected by treatment; mechanism of
[54]
action unclear.
Quail (Colinus virginianus): reversal of midazolam (6
mg/Kg); time to complete recovery from heavy sedation Day and Roge
Flumazenil 0.1 mg/Kg, IM
averaged 1.6 min; birds progressed from dorsal recumbency to [57]
flight without relapse into sedation.
Ostrowski
Glycopyrrolate 0.011 mg/Kg, IV Ostriches (Struthio camelus): to treat bradycardia
[33]
Ibuprofen 25 mg/Kg, IV Chickens: pharmacokinetic study with no assessment of Roder, et al.
50 mg/Kg, IM, PO analgesic effects; shorter half-life than in dogs; low [44]
bioavailability (F= 46.7% IM and 24.2% PO) compared to
 mammals. high pH in the crop may have precipitated the drug
in the g.i. tract; unpredictable crop emptying and decreased
motility of the crop due to handling the birds could have
affected absorption.
Broiler Chickens: Acute toxicity! Exhibited hyperexcitability,
respiratory distress and death within 3 min; these central
nervous system signs have not been reported in other species; Roder, et al.
50 mg/Kg, IV
postulated that this may be a nonpharmacological effect such [44]
as the displacement of other albumin bound ions (Ca or Mg)
that leads to acute toxicity.
Chickens: pharmacokinetic study with no assessment of
analgesic effects; a large volume of distribution (suggesting
tissue retention by peripheral tissues and/or high binding to
plasma proteins with a slow return of the drug to the blood);
slow but sustained oral absorption, attributed to high pH and Cristofol, et
Indomethacin 2 mg/Kg, IV, PO
unpredictable emptying of the crop, lead to mean residence al. [45]
times that were five times larger with the PO route than by IV
administration; from the oral Cmax range of 0.5 - 1.1 mg/ml
observed, they inferred that this was an effective anti-
inflammatory dose based studies in mammals.
Chickens: tendency towards decreased heart rate and systolic
blood pressure after administration; failure rate for
30 mg/Kg, Valverde, et
Ketamine cannulation and induction of anesthesia was 21% (3/14); some
intraosseous al. [3]
thrashing during induction; time to induction ≈ 20 seconds;
time to recovery ≈ 19 - 34 min
Great horned owls (Bubo virginianus): The (+) isomer
10 mg/Kg (+), IV; or
Ketamine, D (+), L provided an equal duration of immobility and significantly
20 mg/Kg (+/-), IV; Redig, et al.
(-), or D/L (+/-) greater muscle relaxation compared to a three-fold greater
or [58]
racemic mixture dose of the (-) isomer. Apnea and cardiac irregularities
30 mg/Kg (-), IV
occurred only with the (-) isomer and the racemate.
Chickens: (K) administration brought on a tranquilized state,
arousal from which elicited excitation; pain reflexes remained
Ketamine (K) 75
Ketamine (K) / and handling brought on muscle contractions or tremor; D Christensen,
mg/Kg, IM /
Diazepam administration after 10 min deepened the tranquilized state but et al. [10]
(D) 2.5 mg/Kg, IV
did not reach a surgical plane of anesthesia; heart rate was
significantly decreased during the anesthetized period.
Pet Birds: (K) doses can be halved for IV use; less cardiac
10 - 50 mg/Kg, IM / depressant effect than a ketamine/xylazine combination; good
Wheler [59]
0.5 - 2.0, IM or IV choice for very sick birds, but only if Isoflurane anesthesia is
not available.
Raptors: diazepam decreased the ketamine dosage; owls may
Ketamine (K) / (K) 30 - 40 mg/Kg / require < half of this dosage; overweight individuals need
Redig &
Diazepam (D) / (D) 1.0 - 1.5 mg/Kg / divided doses; if the total dose of ketamine exceeds 50 mg it
Duke [60]
Atropine (A) (A) 0.05 mg/Kg, IV should be given in divided doses of < 50 mg at 2 - 3 min
intervals
Ostriches (Struthio camelus): preanesthesia: profound
sedation & sternal recumbency in 6/8 birds, two birds were
Ketamine (K) / (K) 2 mg/Kg, IM /
moderately sedated but remained standing; provided Langan [22]
Medetomidine (M) (M) 80 mg/Kg, IV
immobilization; reversed with atipamezole (after propofol
anesthesia was discontinued)
(K) 3 - 5 mg/Kg / (M) Raptors: induction 2 - 7 min, IM, and 10 - 30 sec., after IV
50 - 100 mg/Kg, IM; administration; induction period was calm; injection volumes
or were small; respiration deep and regular; myorelaxation was
Jalanka [52]
good; owls were especially susceptible to the anesthetic
(K) 2 - 4 mg/Kg / (M) effects; spontaneous recoveries were calm and began ≈10 - 20
25 - 75 mg/Kg, IV min after injection; Reversal with atipamezole was rapid.
(K) 3 - 7 mg/Kg / (M) Psittacines: induction 2 - 7 min, IM, and 10 - 30 sec., after IV Jalanka [52]
75 - 150 mg/Kg, IM administration; induction period was calm; injection volumes
were small; respiration deep and regular; myorelaxation was
 (K) 2 - 5 mg/Kg / (M) good; spontaneous recoveries were calm and began ≈10 - 20
50 - 100 mg/Kg, IV min after injection; Reversal with atipamezole was rapid.
Geese: induction 2 - 7 min, IM, and 10 - 30 sec., after IV
(K) 5 - 10 mg/Kg / administration; induction period was calm; injection volumes
(M) 100 - 200 were small; respirations deep and regular; myorelaxation was Jalanka [52]
mg/Kg, IM or IV good; spontaneous recoveries were calm and began ≈10 - 20
min after injection; Reversal with atipamezole was rapid.
16 avian species with 1 - 11 birds/species (60 birds total); the
(K) 4.6 - 28.0
median dosage of ketamine was 8.2 mg/Kg and the ≈ median
mg/Kg / (M) 93 - 500 Berthier [53]
dosage of medetomidine 250 - 300 mg/Kg; Reversal with
mg/Kg, IV
atipamezole
(K) 7.3 - 11.2 mg/Kg
Ketamine (K) / (10 mg dose) / (Me) Mallard ducks: 20 min duration; transient hypertension,
Medetomidine 36.5 - 56.2 mg/Kg bradycardia, and apnea; decreased respiratory rate after
Machin [21]
(Me) / (50 mg dose) / (Mi) induction; resuscitation often required; survival risk; reversal
Midazolam (Mi) 1.46 - 2.25 mg/Kg (2 with atipamezole, 0.25 mg, and flumazenil, 0.025 mg, IV
mg dose), IV
(K) 10 - 25 mg/Kg /
Ketamine (K) / Pet Birds: (M) is short-acting & contraindicated when severe
(M) 0.5 - 1.0 mg/Kg, Wheler [59]
Midazolam (M) hepatic disease is present.
IM
Pigeons (Columbia livia): ketamine followed by repeated
doses of propofol provided ≈ 3.5 min loss of muscle tone and
( (K)) 20 mg/Kg, IM / pedal reflexes for each dose of propofol. Increased heart rate
Ketamine (K) / Fitzgerald &
(P) 4.1 - 8.6 mg/Kg and decreased respiration within first minute after propofol
Propofol (P) Cooper [25]
(to effect), IV administration. Apnea occurred after 62% of the propofol
incremental doses. Assisted ventilation was necessary to
revive the bird if the apnea was prolonged.
Budgerigars (Melopsittacus undulatus): no response to toe
Ketamine (K) / (K) 40 mg/Kg / (X) pinch within 5 min; anesthesia was effective for 45 + min 2/14 Heaton and
Xylazine (X) 10 mg/Kg, IM birds died; one at 44 min and the other at 220 min after Brauth [16]
ketamine/xylazine administration. Reversal with yohimbine.
( (K)) 50 mg/Kg / (X)
Goshawks (Accipiter gentilis): lethal dose! Lumeij [20]
4 mg/Kg, IM
Great Horned Owl (Bubo virginianus): immobilization noted
within five min; transient apnea during initial 5 min; normal
( (K)) 15 mg/Kg / (X) ventilation returned after 10 min Advise caution in using Raffe, et al.
0.15 mg/Kg, IM repeated doses due to an observed deterioration in [19]
cardiopulmonary stability. Supplemental oxygen improved
cardiopulmonary performance.
( (K)) 50 mg/Kg / (X) Pigeons: no satisfactory induction of anesthesia was observed
Lumeij [20]
4 mg/Kg, IM at this dosage.
Red-tailed hawks (Buteo jamaicensis): adequate anesthesia for
( (K)) 4.4 mg/Kg / ≈ 15 min of diagnostic or surgical procedures; significant
Degernes [14]
(X) 2.2 mg/Kg, IV respiratory and cardiovascular depression; reversal with
yohimbine, 0.10 mg/Kg, IV
Ostrich (Struthio camelus) chicks (9 - 10 weeks): rapid
(K) 5.0 mg/Kg / (X) induction; corneal reflexes remained present while pedal Gandini, et al.
1.0 mg/Kg, IV reflexes were lost in 3 of 4 birds for 2 - 7 min; anesthesia [32]
maintained with the use of alphaxalone/alphadolone
Turkey vultures (Cathartes aura): Induction was observed in
Allen and
(K) 10 mg/Kg / (X) 1 ≈5 min and anesthesia (dorsal recumbency) lasted ≈110 min;
Oosterhuis
mg/Kg, IM good muscle relaxation was observed; reversal with tolazoline
[17]
was rapid.
Mallard ducks (Anas platyrhynchos): Thromboxane (TBX)
levels significantly suppressed for at least 4 hr; pain responses Machin et al.,
Ketoprofen 5 mg/Kg, IM
were not assessed, so there was no correlation made between [56]
degree of TBX inhibition and degree of analgesia.
 Quail: pharmacokinetic study (poor predictor of NSAIDS
2 mg/Kg, PO efficacy); "extremely short" half life and low bioavailability Graham [46]
(F= 23%) when administered orally.

Birds > 2 Kg: local anesthetic; standard formulary must be

Lidocaine 2 mg/Kg, IV Ludders [4]
diluted prior to use to accurately measure usable volumes.

Chickens (Gallus gallus domesticus): Used to treat ventricular

0.5 mg/Kg, IV Lukasik [23]
tachycardia causing an arrhythmia in one bird.

Amazon Parrots (Amazona spp.): Sedation characterized by

laying on sternum and just able to support their head; birds
could be placed in dorsal recumbency were they remained if
undisturbed. If disturbed they would stand up, open their eyes,
Sandmeier
Medetomidine 2.0 mg/Kg, IM and lift their heads. A 1.5 mg/Kg dose did not allow placing
[18]
the birds in dorsal recumbency. An anesthetic state was not
acheived. The sedation level may facilitate radiography,
venipuncture, or beak and nail trims. Reversal acheived with
atipamezole.
Pigeons (Columba livia): Sedation was characterized by
laying on their sternums and just able to support their head;
birds could be placed in dorsal recumbency were they
remained if undisturbed. If disturbed they would stand up, Sandmeier
2.0 mg/Kg, IM
open their eyes, and lift their heads. A 1.5 mg/Kg dose [18]
allowed placing only 3 out of 4 birds in dorsal recumbency;
the other pigeon remained standing. Reversal acheived with
atipamezole.
Red-necked ostriches (Struthio camelus) (two sub-adults):
≈18 mg/Kg (2 g Ostrowski
Metomidate Darted; showed no signs of sedation or behavioral
dose), IM [33]
abnormalities
Chickens: rapid tranquilization & loss of consciousness by ≈ 1
min; pain reflexes remained but were diminished; duration of
action was short, ≈ 5 - 10 min; adverse reactions to M in 2/8
birds, one bird recovered after 1 min of apnea, the other died;
Metomidate (M) / (M) 20 mg//Kg, IM / Christensen,
respiration & blood pressure increased, while heart rate
Diazepam (D) (D) 2.5 mg/Kg, IV et al. [10]
decreased after M admin; diazepam administered 10 min after
M resulted in surgical plane of anesthesia for ≈15 min in the
majority of the birds; 3 birds’ pain reflexes were abolished; 2
birds never reached a surgical plane of anesthesia.
Canada geese (Branta canadensis): moderate sedation at
15 - 20 min; 1.0 mg/Kg was inadequate for sedation;
Midazolam 2.0 mg/Kg, IM significantly increased respiratory rate at 10 - 30 min post Valverde [8]
injection; did not significantly affect blood pressure, heart
rate, or temperature
Quail (Colinus virginianus): induced heavy sedation (defined
as being in dorsal recumbency with both wings easily
extended) in 9/10 birds, and mild sedation in one bird; peak
Day and Roge
6 mg/Kg, IM time to heavy sedation was at 10 min but ranged from 5 - 30
[57]
min; no arousal due to noise was observed. Dosages of 2 & 4
mg/Kg were tested but the level of sedation varied and
inadvertent noise aroused the birds.
Naloxone 0.02 mg/Kg, IV Ratites to reverse Carfentanil, fair recovery Cornick [34]

Naloxone (N) / (N) 0.02 mg/Kg, IV /

Ratites to reverse Carfentanil, good recovery Cornick [34]
Diprenorphine (D) (D) 0.04 mg/Kg, IM

Naltrexone (N) / (N) 3.0 mg/Kg / (Y) Ostrich (Struthio camelus): reversal of Carfentanil/xylazine Raath, et al.
Yohimbine (Y) 0.125 mg/Kg, IV mixture [31]
Barn Owl (Tyto alba): induced anesthesia with 4 mg given in
1 mg boluses at 30-sec intervals; an additional 8 mg was given
over the next 10 min due to bird’s response to feather
4 - 12 mg, IV, for plucking; a constant infusion of propofol was used to maintain
induction / 0.5 a stable plane of anesthesia; transient decrease in SAP, DAP, Mama, et al.
Propofol
mg/Kg/min, IV, and MAP observed immediately after induction; after infusion [1]
maintenance was stopped wing movement occurred within 5 min and
ability to lift head up and maintain sternal posture within 30
min; appropriate for short surgical procedures (in this case a
tracheal resection) (case report).
Chickens (Gallus gallus domesticus); maintained by constant
infusion of propofol, 0.5 - 1.2 mg/Kg/min; arrhythmias
4.5 - 9.7 mg/Kg, IV common; significant respiratory and cardiovascular Lukasik [23]
depression; hypoxemia also common; narrow margin of
safety, 3 times the induction dose was fatal.
Mallard ducks; 1 to 4 mg IV bolus maintenance doses
(0.7 - 4.5 mg/Kg) at ≈ 5 min intervals; apnea after induction
7.3 - 11.2 mg/Kg (10
bolus, but increased in respiratory rate with time; risk of Machin [21]
mg dose), IV
severe bradycardia; light plane of anesthesia; intra-operative
analgesia required
Ostriches (Struthio camelus); ketamine/medetomidine
(preanesthetic) allowed sufficient sedation to place IV
3 mg/Kg (induction),
catheter; propofol induction & maintenance (0.2 mg/Kg/min Langan [22]
IV
constant rate infusion); apnea & bradycardia observed;
anesthesia rated good
Pigeon (Columbia livia): bolus dose produced a smooth, rapid
induction, with good muscle relaxation, and loss of voluntary Fitzgerald &
14 mg/Kg, IV
reflexes lasting 2 - 7 min. Lethal Dose determined to be ≈ Cooper [25]
20 - 26 mg/Kg if ventilation was not assisted.
Wild Turkeys; maintained surgical plane of anesthesia with
5 mg/Kg (in 20sec), 0.5 mg/Kg/min of propofol, IV; apnea immediately after Schmacher
IV induction lasted 10 - 30 sec; risk of hypoxemia; smooth [24]
recovery
Chickens: time to induction was ≈12 - 21 seconds; allowed
20 mg/Kg, intubation; increased respiratory rate; time to recovery ≈ Valverde, et
Thiopental
intraosseous 13 - 20 min; failure rate for cannulation and induction of al. [3]
anesthesia was 21% (3/14).
Great Horned Owls (Bubo virginianus): Induction times
ranged from ≈5.5 - 12 min; times to standing ranged from
Tiletamine (T) / ≈60 - 77 min. Rapid decrease seen in heart rate within 2 min Kreeger, et al.
5 mg/Kg, IM
Zolazepam (Z) after induction then remained constant. Respiration rates [13]
decreased for the initial 20 min of anesthesia. Inductions and
recoveries were smooth.
Great Horned Owls (Bubo virginianus): Induction times
ranged from ≈3.2 - 4.0 min; times to standing ranged from
≈81 - 95 min. Heart rates within first 2 min after induction
Kreeger, et al.
10 mg/Kg, IM remained higher than after a 5 mg/Kg dosage but decreased
[13]
over time. Respiration rates decreased for the initial 20 min of
anesthesia. Inductions and recoveries were smooth. Total
recover times ranged from ≈210 - 283 min.
Ratites: used to induce sternal recumbency; rapid and smooth;
2.3 - 5.8 mg/Kg, IV 3.4 - 4.9 mg/Kg for emus; 3.0 - 5.8 mg/Kg for rheas; 2.3 - 4.0 Lin [30]
mg/Kg for ostriches
Ratites: induced with tiletamine/zolazepam; maintained with
Isoflurane, 1 - 4%; bradycardia & apnea observed; diazepam
2.3 - 4.9 mg/Kg, IV Lin [30]
(0.21 - 0.41 mg/Kg, IV) administered post-op to smooth
recovery
 10, 15, 20, or 40 Red Tailed Hawks: None of these doses induced a loss of Kreeger, et al.
mg/Kg, IM consciousness. [13]
Screech Owls(2): Induction times ranged from 1.5 - 2.7 min;
Kreeger, et al.
10 mg/Kg, IM time to first raise their heads ranged from ≈60 - 63 min. Total
[13]
recover times were > 5 hours.
Turkey vultures (Cathartes aura): to reverse the effects of
xylazine (see ketamine/xylazine combination above); regained
Allen and
consciousness in ≈ 2 - 6 min; normal standing postures were
Tolazoline 15 mg/Kg, IV Oosterhuis
observed in under 20 min but appeared to have a dull
[17]
mentation and moderately sedated for 30 - 60 min after
administration.
≈1.1 - 1.3 mg/Kg Ostrich (Struthio camelus) (n=1): darted; marked excitation Ostrowski
Xylazine
(150 mg dose), IM but no immobilization and the bird was unapproachable [33]
(X) 1.06 - 2.03
Xylazine (X) / mg/Kg / (B) Ostriches & emus: produced a calming effect; drowsy and
Lin [30]
Butorphanol (B) 0.10 - 0.14 mg/Kg, ataxic 10 - 15 min after injection
IM
Rheas: higher dosages of xylazine/butorphanol needed to
(X) 2.26 - 2.75
produce a similar tranquilizing effect as seen in ostriches and
mg/Kg / (B)
emus; maintained on Isoflurane, 1 - 5%; midazolam (0.15 Lin [30]
0.12 - 0.20 mg/Kg,
mg/Kg, IV) or diazepam (0.33 mg/Kg, IV) administered post-
IM
op to smooth recovery
(X) 1.06 - 2.21
Xylazine (X) / Ratites: tranquilized with X/B; induced with Tz; maintained
mg/Kg / (B)
Butorphanol (B) / with 1 - 3.5% Isoflurane; bradycardia & apnea observed;
0.10 - 0.55 mg/Kg, Lin [30]
Tiletamine- diazepam (0.13 - 0.40 mg/Kg, IV) administered post-op to
IM / (Tz) 3.5 mg/Kg,
zolazepam (Tz) smooth recovery
IV
Xylazine (X) / (X) 0.5 mg/Kg, IM / Ratites: Xylazine given prior to carfentanil. good induction Cornick and
Carfentanil (C) (C) 0.15 mg/Kg, IV allowing intubation; apnea, hypercapnia, IPPV needed; Jensen [34]
Ostrich; used to reverse xylazine during a prolonged recovery
Yohimbine 0.11 mg/Kg, IM Lin [30]
period
Red-tailed hawks (Buteo jamaicensis): optimal dosage to
significantly reduce standing times after 20 min anesthesia
0.10 mg/Kg, IV Degernes [14]
with a 4.4 mg/Kg ketamine and 2.2 mg/Kg xylazine without
causing profound cardiovascular or respiratory responses
Budgerigars (Melopsittacus undulatus): reversal of
ketamine/xylazine combination. Significantly reduced Heaton and
Yohimbine 0.275 mg/Kg, IM
recovery times indicated by a head lift, standing unaided Brauth [16]
without ataxia, and perching.

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 Click on the author's name to view a list of his/her publications: J. Paul-Murphy and J. Fialkowski

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