When the pregnant patient has tusks, claws, or hooves: a case report

While obstetric anesthesia for humans and domesticated species is well-described, "exotic" species present unique physiological and logistical challenges. Zoological veterinarians are faced with a lack of species-specific information, necessitating extrapolation of anesthetic knowledge and expertise from related species. The North Sulawesi babirusa (Babyrousa babyrussa celebensis) is a vulnerable tusked pig with limited existing literature regarding its anesthetic or surgical management. Here we describe the successful cesarean delivery of two babirusa piglets after signs of challenging labor. General anesthesia was induced via remote intramuscular injection (i.e. dart) and maintained with isoflurane via an endotracheal tube. Airway management is notably different and a challenge distinct from other animals, even other exotic animals like the giraffe. We compare the similarities and "peculiarities" of human vs. zoological obstetric anesthesia care, including the reliance on general anesthesia over neuraxial techniques. Despite the many anatomical differences between humans, babirusas, and other animals, the fundamental goals of maternal safety and smooth neonatal transition remain universal. While human anesthesiologists may appreciate the luxury of a cooperative patient and a controlled environment, the successful management of our friends across the animal kingdom is important and offers valuable insights into the range of obstetric anesthesia.