Immobilization of Wyoming bears using carfentanil and xylazine.

Seven grizzly (Ursus arctos; four male, three female) and three black (Ursus americanus; two male, one female) bears caught in culvert traps or leg snares were immobilized in northwestern Wyoming with carfentanil and xylazine at doses, respectively, of 0.011 ± 0.001 and 0.12 ± 0.01 mg/kg for grizzly bears and 0.014 ± 0.002 and 0.15 ± 0.04 mg/kg for black bears. These drugs were antagonized with 1 mg/kg naltrexone and 2 mg/kg tolazoline. Induction and recovery times, respectively, were 4.3 ± 0.5 and 7.1 ± 0.8 min for grizzly bears and 5.2 ± 0.4 and 9.1 ± 2.2 min for black bears. Inductions were smooth and uneventful. Recoveries were characterized initially by increased respiration followed by raising of the head, which quickly led to a full recovery, with the bears recognizing and avoiding humans and moving away, maneuvering around obstacles. All bears experienced respiratory depression, which did not significantly improve with supplemental oxygen on the basis of pulse oximetry (P=0.56). Rectal temperatures were normothermic. Carfentanil-xylazine immobilization of bears provided significant advantages over other drug regimens, including small drug volumes, predictable inductions, quick and complete recoveries, and lower costs. On the basis of these data, both grizzly and black bears can be immobilized effectively with 0.01 mg/kg carfentanil and 0.1 mg/kg xylazine.

Surgical management of failed endoscopic treatment of pancreatic disease.

INTRODUCTION: Endoscopic therapy of acute and chronic pancreatitis has decreased the need for operative intervention. However, a significant proportion of patients treated endoscopically require definitive surgical management for persistent symptoms. OBJECTIVE: Our aim was to determine which patients are likely to fail with endoscopic therapy, and to assess the clinical outcome of surgical management. Patients were identified using ICD-9 codes for pancreatic disease as well as CPT codes for endoscopic therapy followed by surgery. MATERIAL AND METHODS: Patients with documented acute or chronic pancreatitis treated endoscopically prior to surgical therapy were included (N = 88). The majority of patients (65%) exhibited chronic pancreatitis due to alcohol abuse. Common indicators for surgery were: persistent symptoms, anatomy not amenable to endoscopic treatment and unresolved common bile duct or pancreatic duct strictures. Surgical salvage procedures included internal drainage of a pseudocyst or an obstructed pancreatic duct (46%), debridement of peripancreatic fluid collections (25%), and pancreatic resection (31%). RESULTS: Death occurred in 3% of patients. The most common complications were hemorrhage (16%), wound infection (13%), and pulmonary complications (11%). Chronic pancreatitis with persistent symptoms is the most common reason for pancreatic surgery following endoscopic therapy. Surgical salvage therapy can largely be accomplished by drainage procedures, but pancreatic resection is common. CONCLUSION: These complex procedures can be performed with acceptable mortality but also with significant risk for morbidity.