Free CPD discussion: rabbit anaesthesia

RE: Free CPD discussion: rabbit anaesthesia

Jessica Bell — Tue, 13 Dec 2016 16:41:58 GMT

Thanks for the reply!

If you were to use alfaxan, or maybe more accurately not a triple combination. would you use a premed and what would it be and why?

Thanks!

RE: Free CPD discussion: rabbit anaesthesia

Sarahbeeee — Mon, 21 Nov 2016 18:39:11 GMT

For surgery, the rabbits have sub cut. or intra musc. injection of medetomidine and ketamine and during surgery oxygen and if necessary isoflurane given via a face mask. Also injected sub cut. with meloxidyl.

RE: Free CPD discussion: rabbit anaesthesia

Jo Hinde — Wed, 16 Nov 2016 11:38:56 GMT

[quote user="Jessica Bell"]

I am quite confident in placing catheters in rabbits but bandaging them in is a night mare! which catheters have you found work best for rabbits?

[/quote]

Hi Jessica,

i used to like the jelco ones but struggle to find them now, but the anicath, non winged ones work well. Millpledge do 26g & 24g can be used for marginal ear veins. it's important to understand the techniques needed - that's why our LagoLearn training events provide hands on, practical skills lile placing iv catheters in custom made rabbit ear mannequins!

RE: Free CPD discussion: rabbit anaesthesia

Jessica Bell — Fri, 11 Nov 2016 09:51:59 GMT

I am quite confident in placing catheters in rabbits but bandaging them in is a night mare! which catheters have you found work best for rabbits?

RE: Free CPD discussion: rabbit anaesthesia

Jo Hinde — Wed, 09 Nov 2016 17:03:30 GMT

We have had some great discussions so far and covered some of the pros and cons of different airway management techniques as well as some drug options.

What other aspects of rabbit GA's do you dislike? Are you all comfortable with placing IV catheters? Ventilation? Positioning etc?

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Sun, 06 Nov 2016 22:31:55 GMT

[quote user="Lucy Foster"]Hi. Can I ask about withholding food prior to anaesthesia, in my practice we leave food in up until the time of ga, but I read recently it was beneficial to withhold for an hour before ga. Any thoughts?[/quote]

I don't know if this has been properly researched and published. The point is to get a clean mouth so that your airway is not compromised by bits of hay...

I remove food for about 20 minutes, then check the mouth with an otoscope and clean once or twice with some 5ml syringes full of water - letting the rabbit drink or allowing it to dribble out of the mouth.

1 hour would seem a little long for me, but that's not a technical opinion. As long as the mouth is clean then you're good to move on to premed.

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Sun, 06 Nov 2016 22:26:52 GMT

[quote user="Kiri Martin-Smith"]I have a rabbit GA coming up tomorrow. My main concern is if the rabbit goes into cardiac/respiratory arrest. I have only recently qualified as an RVN, my final placement saw many rabbits and used v.gels and a capnograph, the only time I lost a rabbit there was when we were unable to place a v.gel and a catheter and were not able to use the capgnograph. Where I work we use a triple combo to sedate and we do not get venous access, our rabbits are masked and it terrifies me, since joining my current practice I have monitored 3 rabbit anaesthetics and 2 out of the 3 did not make it. I can't help but feel my practice is very money orientated. The head nurse has said that she has seen rabbits tubed that have died, does anyone have any thoughts on whether tubes make a difference? [/quote]

It's not too bad. Better to use a tube or v-gel - as it gives you more control over ventilation and protection from airway blockage - however - ventilation is the key. It is important to monitor breathing and to assist breathing wherever the rabbit is struggling, using IPPV. This monitoring is best done with a capnograph and assisting whenever the CO2 is rising too high. If you use a small face mask and tie it or tape it in place (see earlier photo), making sure the eyes do not touch the mask to avoid damage, then you can get a pretty good seal, sufficient to ventilate. Try to use an extractor fan in the room as this method does expose staff to a higher level of volatile anaesthetic agent. If the rabbit is not breathing - then breathe for it! I also look at the thoracic/abdominal movements and try to provide IPPV when the amount of movement is getting smaller, if I don't have a capnograph available.

It's true that a bad intubation can damage or kill, in the same way as in cats. The larynx is delicate and easily traumatised (in any species!). Good intubation practice (correct depth of anaesthesia, remove any foreign material, Intubeaze on larynx (as in cats), lubricate new 2.5-3mm Portex tube and guided/visualised placement) is unlikely to cause fatal trauma. Guided placement is not difficult as such but there is a technique that needs to be learned and practiced.

Merely using a tube or v-gel, without ventilating is probably not going to alter your risk too much - and tubes narrow the airway considerably so without ventilation some risks will actually increase in an intubated patient!

I have done many shelter spays with a face mask and triple combos and have had a very low rate of fatal anaesthetic related complications - so don't panic.

In summary - it's about overall technique, not just one thing:

Easy things to do:

House with partner rabbit

Remove from food and water 20min ish before induction and then check/flush mouth before induction so there's nothing for the rabbit to choke on.

Quiet induction, assisted ventilation if putting them on oxygen so that you know they are ventilating effectively. Ventilation should be just sufficient to raise the chest slightly.

Elevate chest slightly above abdomen to help breathing

Ventilate as described above, use capnograph if possible.

Ensure that pain relief is adequate - I use NSAIDs, opioids and local anaesthetics routinely. There's other pain relief things as well that can be done but that takes a while to go through - come to one of our anaesthetic days!

Pay attention to detail on depth of anaesthesia and top up with iso.

Assisted feeding once fully recovered, back in with partner rabbit as soon as possible. Gut stimulant drugs on discretion of vet (there's various opinions on this one!).

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Sun, 06 Nov 2016 22:11:13 GMT

Hi Jessica

Sorry for delay! The Domitor/dexdomitor although a very appropriate drug for healthy patients requires the body to make some pretty hefty cardiovascular adjustments. If there is any cardiovascular disease, this may increase anaesthetic risk significantly. I find rabbits with cardiac disease do not have obvious clinical signs in the early stages - and this could be easily overlooked. It's the same as trying to avoid these drugs in 15 year old cats, but still being happy to use them for a cat spay.

Alfaxan could still cause problems but if dosed correctly causes fewer cardiovascular changes. There is something to be said for 'safest anaesthetic being the one you're used to' - it's a good idea to try new things in a safe environment first to get used to the difference.

Gastric obstruction in rabbits is extremely serious - I suspect your crash would have happened with many combinations!

RE: Free CPD discussion: rabbit anaesthesia

kiri Simone — Sun, 06 Nov 2016 16:44:45 GMT

Whilst a student nurse I briefly worked at a practice where propofol was used to induce rabbits through their ear catheters. This had a very high success rate, the rabbits did well under the anaesthetic where sevoflurane was used and recovered very well

RE: Free CPD discussion: rabbit anaesthesia

kiri Simone — Sun, 06 Nov 2016 16:31:43 GMT

I have a rabbit GA coming up tomorrow. My main concern is if the rabbit goes into cardiac/respiratory arrest. I have only recently qualified as an RVN, my final placement saw many rabbits and used v.gels and a capnograph, the only time I lost a rabbit there was when we were unable to place a v.gel and a catheter and were not able to use the capgnograph. Where I work we use a triple combo to sedate and we do not get venous access, our rabbits are masked and it terrifies me, since joining my current practice I have monitored 3 rabbit anaesthetics and 2 out of the 3 did not make it. I can't help but feel my practice is very money orientated. The head nurse has said that she has seen rabbits tubed that have died, does anyone have any thoughts on whether tubes make a difference?

RE: Free CPD discussion: rabbit anaesthesia

Lucy Foster — Thu, 03 Nov 2016 19:20:26 GMT

Hi. Can I ask about withholding food prior to anaesthesia, in my practice we leave food in up until the time of ga, but I read recently it was beneficial to withhold for an hour before ga. Any thoughts?

RE: Free CPD discussion: rabbit anaesthesia

NuttyNu — Wed, 02 Nov 2016 17:07:49 GMT

we do buprenorphine and midazolam sedation with ketamine induction in to effect. We use meloxicam and renitadine for routine post op Procedures. Syringe feed and then continuing care regarding condition and care required. Anything other than neutering would get more melds care pain relief etc but this would be case specific. I think to have one fixed method can give rise to complacency of assessing the patient as individual just because the procedure should be the same.

All patients amaesthetised are intubated and these are reused but cleaned andsterilised in F10 as this is one of our preferred disinfectants and cold steriliser and causes little damage to the tubes that we have noticed.

one thing which helps reduce stress in rabbits when you give mask methods... the smaller the mask the better. Putting whole head in a mask is very stressful. They are obligate nasal breathers so you only need to cover the nose which is far less stressful and you also avoid oxygen drying out the eyes therefore reducing risk of post pop dry eye / eye ulcers.

RE: Free CPD discussion: rabbit anaesthesia

Jessica Bell — Wed, 02 Nov 2016 14:40:38 GMT

I find this very interesting and we have also used alfaxan for our reptile GA's, We did once use IV alfaxan for a rabbit needing surgery to correct a stomach obstruction and despite crashing on the table survived, recovered and went home. I've always wondered if the crash was due to the alfaxan, my unfamiliarity with its use in rabbits, or something more and i'm sure i'll probably never know the answer.

My question is (Hopefully its not to daft) what are your reasons for using alfaxan over triple in the oldies/sick buns and why would you choose to use a triple over alfaxan in the younger ones?

Thank you!

RE: Free CPD discussion: rabbit anaesthesia

Dawns — Tue, 01 Nov 2016 13:54:53 GMT

[quote user="Jo Hinde"]

[quote user="Stacey Brassington"]

We had some training but unfortunately we were going through a dry spell of rabbit ga's so couldn't arrange for one to be present on the day, also the demo rabbit was unavailable. I have since gone back through the videos and information on the website, but it's not quite the same as having someone there to give guidance

[/quote]

might be worth having more training on their use. One thing people often get wrong is choosing the right size. They tend to choose too small which means it doesn't fit correctly.

[/quote]

Hi Stacey

email me on dawn@Docsinnovent.com and I can sort more training for you

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Sun, 30 Oct 2016 18:45:25 GMT

Hi Elizabeth

Interesting question on Dexdomitor vs Domitor. Personally I've used both and can't tell the difference in terms of how the patient responds - I get decent results from both. Anyone else with an opinion on that?

In terms of anaesthetic protocols, none of the normal ones are a cause of gut stasis more than any other. There are a lot of reasons why gut stasis might happen - pain is probably the biggest, stress/fear, surgical manipulation of abdominal contents, drying of the intestines during surgery etc. Paying attention to good multimodal pain relief, managing and reducing fear and providing assisted feeding postoperatively are good ways to reduce stasis risk.

I use triple combos for younger healthy patients and IV Alfaxan more frequently these days for the older ones or rabbits with underlying disease. Propofol can be used but recovery is so rapid that it's very hard to stabilise them sufficiently to intubate or operate. The risk of overdosing them with propofol is also relatively high. I do use propofol for very rapid dental procedures where I only need them down for short periods and I like it a lot for that - but it's more of a sedation than an anaesthetic.

RE: Free CPD discussion: rabbit anaesthesia

Elizabeth Roodt — Fri, 28 Oct 2016 15:29:19 GMT

In my opinion, a well fitting face mask is better than tubing if rabbit can be maintained throughout surgery on injected triple. I have witnessed too many botched attempts at tubing which can injure and/or irritate the throat and exacerbate inappetence (not the only cause of inappetence, however)

Secondly, direct heat causes peripheral dilation and drops bp drastically. Wrapping in bubbles or fleece and keeping ambient temp warm is better.

Has anyone used dexdom instead of Dom and had any positive changes?

Lastly, excuse my ignorance but which one causes gut stasis and what is the alternative?

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Wed, 26 Oct 2016 23:34:28 GMT

...and no, I don't have any commercial relationship with Portex...

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Wed, 26 Oct 2016 23:32:10 GMT

[quote user="AliTee"]

We used to soak them in dilute Hibi!!!!!

Now more enlightened, we soak in Medizyme high level disinfectant for as long as it takes for someone to have time to scrub and rinse them - could be a few hours, then they are placed in the yellow Medizyme sterilant for 10 minutes, removed, rinsed and dried. We autoclave them about once a month.

[/quote]

Although this will almost certainly clean them and stop cross infection, we've found that the disinfectant (10 minute chemical bath) does react with the plastic of the Portex tubes. It doesn't seem to remain or puddle on the plastic, so as long as they are well rinsed, chemical risk to the patient is low - however the reaction causes the tubes to harden and that is more likely to cause physical trauma to the larynx or trachea.

It's another one of those practice problems - in the ideal world, single use of the Portex tubes is best - replace as often as possible to minimise risks. There's nothing wrong with using a new one and charging it out if the situation allows!

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Wed, 26 Oct 2016 23:27:35 GMT

[quote user="AliTee"]diluted Alfaxan[/quote]

What's the rationale for diluting the Alfaxan? That's not something that I've come across before.

RE: Free CPD discussion: rabbit anaesthesia

Ivan Crotaz — Wed, 26 Oct 2016 23:26:10 GMT

[quote user="AliTee"]buprenorphine and meloxicam for pre-med with ranitidine and metaclop. Then depending on the vet's preference a diluted Alfaxan induction or triple with ketamine might be used.[/quote]

This is excellent. It's good to think about rabbit analgesia in a similar way to dog and cat anaesthesia. I especially like the postoperative meloxicam. I have seen quite heavy sedation with Tramadol in rabbits, so care is needed on owner advice.

I find Alfaxan to be a very nice induction agent for rabbits (always through an IV ear catheter), good predictable induction and sufficient depth of anaesthesia to place an ET tube or v-gel. Is anyone out there having success with propofol?

RE: Free CPD discussion: rabbit anaesthesia

AliTee — Tue, 25 Oct 2016 23:05:54 GMT

[quote user="Jo Hinde"]for those that do re use ET tubes - what protocol do you use? What chemicals, in what order and how long in each etc? [/quote]

We used to soak them in dilute Hibi!!!!!

RE: Free CPD discussion: rabbit anaesthesia

AliTee — Tue, 25 Oct 2016 22:59:56 GMT

[quote user="Jo Hinde"]Thanks Allison - what pain relief protocols do you use in practice?[/quote]

We use buprenorphine and meloxicam for pre-med with ranitidine and metaclop. Then depending on the vet's preference a diluted Alfaxan induction or triple with ketamine might be used. All go home with meloxicam. In fact all our surgery patients go home with meloxicam unless contra-indicated, and then they are sent home with Tramadol or another equivalent. The only 'surgical' patients that go home without pain relief are the scale and polish dentals and possibly wart removals, depending on how many and their size.

RE: Free CPD discussion: rabbit anaesthesia

AliTee — Tue, 25 Oct 2016 22:49:54 GMT

[quote user="Ivan Crotaz"]

[quote user="Jess Ashby"]I'm sure everyone I have worked for only discards them if they are faulty[/quote]

There's two parts to this - the PVC that the blue ones are made out of is designed to be used but not cleaned and reused - so these ones are marked as single use. Red rubber and silicone tubes can be autoclaved and re-used - there is a guide to this included in the packaging of the red rubber tubes. Unfortunately the walls of these tubes are quite thick so it does narrow the airway a lot and makes ventilating rabbits under anaesthetic more important.

It's easy to see if a red rubber tube is cracked or faulty. The blue PVC ones have the problem that the sterilising chemicals strip the softening agents out of the plastic - so the tube looks the same but gets harder. Eventually it starts to go yellow which is a sign of severe chemical change and hardening.

So it's a good idea to sterilise and reuse silicone and red rubber tubes - just discard them when cracked. Wherever the practice allows, discard the blue PVC ones after use as they harden within just a few sterilisation cycles.

[/quote]

Thank you for this information. Some of our Portex tubes are rather yellow. I assumed this was just an ageing process but clearly there are more pertinent issues regarding the softening chemicals.

RE: Free CPD discussion: rabbit anaesthesia

Jo Hinde — Tue, 25 Oct 2016 14:06:32 GMT

Thanks Allison - what pain relief protocols do you use in practice?

RE: Free CPD discussion: rabbit anaesthesia

Allison Andrewartha — Tue, 25 Oct 2016 10:12:29 GMT

Great idea to get owners to bring in their own food and also vetergesic post-op. Pain relief makes a huge difference.