Rabbit GA deaths

Re: Rabbit GA deaths

Marie Kubiak — Mon, 29 Jul 2013 10:42:10 GMT

[quote user="Sarah Keir"]

What do people think about premeds in rabbits? I have a does for ACP and butorphanol/buprenorphine. I can see advantages in pre-emptive analgesia and reducing stress but as these drugs tend to be longer acting and non-reversible, will this affect their eating after the GA? And what about opioids reducing gut motility if there is no pain?

What about routinely giving prokinetics to post-anaesthetic bunnies? I routinely give metoclopramide but would ranitidine or cisapride be better?

Cheers, Sarah

[/quote]

I use buprenorphine for routine analgesia as it is effective and shown to produce no adverse effects on GI motility. For any painful procedure I will also include metacam (usually pre-op, but post-op if concerned about hypotension). Where they have had major surgery and seem to be uncomfortable or unsettled on recovery they get a top-up of butorphanol as necessary.

Fentanyl/fluanisone (Hypnorm) may be worth looking into for your anaesthetics if you want a reliable combination with analgesia? I have to say I haven't used this as the previous lack of availablility meant I got used to other combinations and stuck with them but other clinicians seem to like it.

I don't use prokinetics unless there is a pre-existing GI hypomotility.

Marie

Re: Rabbit GA deaths

Sarah Keir — Mon, 29 Jul 2013 09:42:55 GMT

Sorry for highjacking this thread! Myself and a couple of nurses are re-writing the practice protocol on anaesthesia of bunnies. I find the biggest factor for safety of anaesthetics in rabbits is reducing stress and intubating them so hopefully I can persuade all the other vets to follow this.

What about routinely giving prokinetics to post-anaesthetic bunnies? I routinely give metoclopramide but would ranitidine or cisapride be better?

Cheers, Sarah

Re: Rabbit GA deaths

Thomas Johnson — Wed, 17 Jul 2013 18:21:32 GMT

[quote user="CatherineThomas"]

I have some paediatric laryngeal masks which Mark Rowland suggested. They are easy to place but I found the problem with them was that they do twist easily and move out of position so we spent more time checking that it hadn't moved. Hence why I decided that it was not a good idea to use them without a capnograph. So I went back to blind tubing and keep the laryngeal masks for emergencies until I'm allowed a capnograph.

[/quote]

Docsinnovent (who make the v-gel tubes) make a stand that holds the circuit tubing to avoid any rotation, to be used when the animal is in dorsal recumbancy:

http://docsinnovent.com/products/product/d-grip-tube-holder

When the animal is in lateral recumbancy I tend to put a sandbag over the circuit tubing.

In either case if you move the animal the tubing won't move with it so it's a very good reminder to check the tube placement.

Re: Rabbit GA deaths

CatherineThomas — Wed, 17 Jul 2013 17:46:04 GMT

Re: Rabbit GA deaths

Thomas Johnson — Wed, 17 Jul 2013 17:26:28 GMT

[quote user="Anthony Dennison"]

[quote user="Bob Russell"]V-gels a little pricy for a single vet practice with a set up that works OK but would like to give them a go (supervised!).[/quote]

It's surprisingly easy! Hold the tongue out, push it in, look for condensation in the clear part of the mask. Done. (Though I'm sure the official documentation says a lot more than that)

[/quote]

I agree, almost unbelievably straightforward, you just then need to be careful to avoid rotating the tube once it's in place.

Re: Rabbit GA deaths

Anthony Dennison — Wed, 17 Jul 2013 16:36:10 GMT

[quote user="Bob Russell"]V-gels a little pricy for a single vet practice with a set up that works OK but would like to give them a go (supervised!).[/quote]

It's surprisingly easy! Hold the tongue out, push it in, look for condensation in the clear part of the mask. Done. (Though I'm sure the official documentation says a lot more than that)

Re: Rabbit GA deaths

Bob Russell — Wed, 17 Jul 2013 11:17:34 GMT

I 'blind tube' them. Not that difficult but you need a really quiet environment. All fans, buzzy, beepy things get switched off. Once you hear clear breath sounds through the tube gently push it forwards and as long as the anaesthesia is adequate it goes in the right place!

One issue with this is I bet I could get a larger tube in if I was visualising things! Still worked for me for a lot of years now.

V-gels a little pricy for a single vet practice with a set up that works OK but would like to give them a go (supervised!).

Re: Rabbit GA deaths

Anthony Dennison — Wed, 17 Jul 2013 10:32:47 GMT

Big fan of V-Gel masks. Incredible things, once my practice started using them rabbit GAs have been as smooth as anything, none of the nurses mind monitoring now (when before only 1 or 2 would).

Our practice policy is d/t/k, often given s/c, but I prefer i/v as they fall asleep much quicker so less waiting around. We also give metaclop intra-op, as we had some problesm with bunny GAs so talked to France Harcourt-Brown who suggested it.

Re: Rabbit GA deaths

Mark Holmes — Mon, 15 Jul 2013 20:01:31 GMT

Can I reiterate what was said earlier about minimising stress. This is anecdote - I appreciate that but means something to me. A few jobs ago I worked for a largish practice where everybody was encouraged to follow their interests. We had a few vets over the time I worked their with an interest in rabbits. They were very " hands on" each rabbit was subjected to an extensive pre ga exam. They had iv catheters and extensive monitoring. They lost a number of rabbits over the time I was there. I would also admit I lost a few following their protocol. Now one of the other vets in the practice ran a branch, had a lower interest in rabbits used a basic im D and K protocol, and didn't lose any. Now I cannot remember how things stacked up in terms of relative numbers or comparable disease states ( a greater interest may result in dodgier cases) but the notable difference between them was the amount of pre ga stress they experienced. Since being more aware if that I changed to a minimal handling/minimal stress approach and have lost far fewer and when I think back to the rabbit deaths I have witnessed I am convinced it plays a significant role.

Re: Rabbit GA deaths

Michael Woodhouse — Mon, 15 Jul 2013 19:41:49 GMT

Buy a capnograph. I have 2 decent ones both bought on ebay for around the £100, Work fantastically and the ultimate in anaesthesia monitoring.

(both ex human hospital machines)

Re: Rabbit GA deaths

James Laidlaw — Mon, 15 Jul 2013 19:24:57 GMT

What she said...!

Re: Rabbit GA deaths

Sarah Keir — Mon, 15 Jul 2013 18:09:24 GMT

[quote user="Jo Jones"]

[quote user="James Laidlaw"]intubate with an otoscope (medium size) which can be a bit fiddly but good because you can actually visualise the larynx.

[/quote]

I've tried to visualise using an otoscope in the last few rabbits I've done, but whatever position they are in, I just can't see the larynx - I can't seem to get over the back of the tongue. How do you do it?!

[/quote]

Rabbits are obligate nasal breathers so the edge of the soft palate is under the edge of the epiglottis - I use the ET tube to gently push up the soft palate so can see the vocal folds. I also use a urinary catheter as a stilet when intubating so can remove the otoscope without the stilet moving, just be swift at this point as not much air getting down the trachea at this time.

Sarah

Re: Rabbit GA deaths

Jo Cobbett — Mon, 15 Jul 2013 16:50:08 GMT

[quote user="James Laidlaw"]intubate with an otoscope (medium size) which can be a bit fiddly but good because you can actually visualise the larynx.

[/quote]

Re: Rabbit GA deaths

Jo Cobbett — Mon, 15 Jul 2013 16:47:56 GMT

[quote user="robloxley"]

[quote user="Jo Jones"]Molly Varga on her webinar (sponsored by Supreme and available FOC on Webinar Vet)[/quote]

Have you got a link?

[/quote]

http://thewebinarvet.com/supreme-rabbit-webinars/

Re: Rabbit GA deaths

HMC — Mon, 15 Jul 2013 15:24:00 GMT

[quote user="An On MRCVS"]

Hopefully I'll be back here just to update you with success stories rather than more tales of woe. I really do appreciate all the kind words and support.

[/quote]

I know you effectively signed off for now with your last post, but I'll throw my advice in anyway.

There's nothing wrong with medetomidine + ketamine + butorphanol for your routine castrates (that's the protocol I use). I use Hypnorm IM + midazolam IV for older bunnies (two rabbits today, in fact).

I would place more emphasis on the periop care rather than the drugs. ie, placing an et tube in rabbits large enough (>1.5kg seems to be my personal cut off), not taking the stethoscope off the rabbit's heart in terms of monitoring, calm environment away from barking dogs, warmth and regular temperature monitoring, bringing the companion rabbit in to reduce stress, encourage eating etc etc.

If you want tips on placing an et tube feel free to pm me.

Hannah

Re: Rabbit GA deaths

James Laidlaw — Mon, 15 Jul 2013 15:21:59 GMT

I give the triple combo injectables IM (Dom/Torb/Ket) at quite low dose rates and then intubate with an otoscope (medium size) which can be a bit fiddly but good because you can actually visualise the larynx. Doesn't work for everyone and hard to make sure tube is in and stays in place when withdrawing the scope head.

Re: Rabbit GA deaths

An On MRCVS — Mon, 15 Jul 2013 14:02:51 GMT

Thank you all very much for your understanding and your information. I have no fewer than five rabbit castrates to do in the next couple of weeks - usually we would do that many every 2-3months.

It seems that there are many different GA methods for rabbits being used. I think given recent experience that I might try light sedation and gaseous induction but still place the IV line. At least that way I have more control over GA depth. I'll persist more with my intubation efforts as well - I don't suppose there's any good reason why I can't do it. I thought that capnography was necessary for the V-gel but it's interesting that they seem to be fine without so I might explore that option also.

Hopefully I'll be back here just to update you with success stories rather than more tales of woe. I really do appreciate all the kind words and support.

Re: Rabbit GA deaths

Thomas Johnson — Mon, 15 Jul 2013 10:42:35 GMT

[quote user="An On MRCVS"]

I don't have capnography so I don't think the V-gel will work for me.

[/quote]

We don't have capnography, but are using the V-Gel tubes in rabbits without any problems, very easy to place and IPPV very straightforward when a rabbit decided to stop breathing under GA last month.

Re: Rabbit GA deaths

Carolyn — Sat, 13 Jul 2013 17:22:42 GMT

We used to use hypnorm and gas them but lost a couple, now we use hypnorm and iv alfaxan to induce. For short procedures just oxygen is enough. I attempt to intubate them all and can maintain with sevo if needed The good thing about having the iv line is that you can reverse the hypnorm really quickly with iv buprenorphine if you get into difficulties. Really awful situation, I feel for you, I've certainly been there...

Re: Rabbit GA deaths

Rob Loxley — Fri, 12 Jul 2013 23:04:24 GMT

My initial thought is it's probably bad luck - the odds aren't that high - but worth re-evaluating what you do.

IMHO the single thing that makes your life easier and safer is intubation, and practice is the answer.

I GA them using alpha-2 & ketamine, pre-oxygenate on mask then increase gas until pedal reflex gone and intubate (blind but capnograph to confirm), reverse with atipamezole at the end of surgery and pay close attention in the recovery period, keeping them comfortable and getting them eating.

[quote user="Jo Jones"]Molly Varga on her webinar (sponsored by Supreme and available FOC on Webinar Vet)[/quote]

Have you got a link?

Re: Rabbit GA deaths

Julie Innes — Fri, 12 Jul 2013 22:13:43 GMT

I premed them with acp/ vetergesic, which relaxes them so they don't panic when masked with iso and go down very smoothly. I'm not confident intubating, but am definitely going to look into v-gel (when I get a minute!) as I am doing more and more bunny GAs these days. My nurse keeps a stethoscope on them constantly throughout the op, and monitors breathing etc religiously, and I like the fact we can alter the depth of anaesthesia quite quickly with iso (I know sevo would probably be better!) I had a couple of deaths over the years with triple combo, and I really only use that now for dentals. I've also had a few slow recoveries. My iso bunnies are usually up and eating within an hour.

I'd like to intubate, but am a bit scared! Last CPD I did said you should intubate, but only if experienced!! How do you get experienced without doing it?! Keep thinking I will look into v-gel, but does this work for dentals?

Re: Rabbit GA deaths

James Laidlaw — Fri, 12 Jul 2013 16:34:09 GMT

Preoxygenation makes a difference. I'd hate to operate with no nurse to monitor. Have done it before and I know people who are in this setup too, but I can't help but feel its not the ideal situation, or maybe irresponsible...

Re: Rabbit GA deaths

Martin Atkinson — Fri, 12 Jul 2013 16:33:05 GMT

Just bad luck I feel. I use triple combo dose from BSAVA formulary, they are usually too light to intubate with this alone so I squirt a bit of lidocaine down the tube and withdraw it, mask them and put on some oxygen and Iso for a few seconds then intubate blindly by slowly inserting while listening for breathing sounds (bunny in sternal recumbancy me kneeling on the floor - you've got to get below bunny level to get the right angle of approach), by this method I can successfully intubate 99% of bunnies down to 1kg, then maintain on Isoflo. Respiratory monitors and pulse oximeter are used, nurse monitors plane of anaesthesia as necessary, they're so good the bunnies are usually coughing the tube as the last suture is being tied. Not wishing to tempt fate but I honestly can't remember the last rabbit anaesthetic death we had.

Re: Rabbit GA deaths

Jo Cobbett — Fri, 12 Jul 2013 16:21:39 GMT

[quote user="Jo Jones"]

have done two GAs so far,

[/quote]

Before anyone else says it, I know 2 doesn't proove anything yet!

Re: Rabbit GA deaths

Jo Cobbett — Fri, 12 Jul 2013 16:20:18 GMT

An On, PM me. We've been unhappy with the mortality of our rabbit anaesthetics so I've done a fair amount of research recently into rabbit GAs. I can email it to you if you want. We changed our protocol this week to a triple protocol with doses suggested by Molly Varga on her webinar (sponsored by Supreme and available FOC on Webinar Vet), and have done two GAs so far, which have been the smoothest rabbits GAs I've ever done!! Both rabbits were lifting their heads within 5-10 minutes of receiving their atipamezole and hopping round their cages very soon after.