Sedation and general anaesthesia of crocodilians: a systematic review

Sedation and general anaesthesia of crocodilians pose unique challenges due to their aggressive nature, poikilothermic physiology, and specific anatomical and physiological characteristics, all factors that complicate crocodilian anaesthesia. This review aimed to systematically review the literature regarding sedation and general anaesthesia of crocodilians with focus on efficacy and impact on vital parameters. A systematic literature search was performed according to PRISMA guidelines on May 2, 2023 in the databases Embase, PubMed, Scopus and Web of Science. Publications were excluded based on predefined exclusion criteria, which encompassed non-standard publications and publications unrelated to crocodilians, with fewer than five animals and/or with insufficient data on sedation and general anaesthesia. Five key factors were used to evaluate the strength of evidence: number of included animals, study design, definition of recovery time, blinded assessment of recovery and conflict of interest. Ten publications were included in this systematic review. Drugs used included alpha-2-adrenoceptor agonists, dissociative anaesthetics, benzodiazepines, neuromuscular blocking agents, propofol, alfaxalone, and inhalant gasses. The studies included in total 55 Alligator mississippiensis, 110 Crocodylus porosus, 15 Crocodylus johnstoni, and 15 Crocodylus niloticus. Factors such as temperature, administration route, dose, species, and age influenced protocols for sedation and general anaesthesia of crocodilians. The studies included used five different study designs. Only one study included a control group, done on retrospectively collected data. Blinded recovery assessments and declarations of no conflict of interest were noted in some studies. The use of four distinct recovery definitions posed challenges to comparability in this systematic review. The studies reported that medetomidine provided stable and reversible sedation, although it depressed heart rate. Alfaxalone was less stable outside the optimal temperature range. Intubation and inhalation anaesthesia were effective, and adrenaline reduced the length of the recovery period. Overall, the review provides valuable insights for veterinarians, researchers, and wildlife professionals involved in sedation and general anaesthesia of the crocodilian species, however, the literature is limited, and further research is needed to improve evidence-based medical management.