Rabbit mortality related to general anaesthesia

RE: Rabbit mortality related to general anaesthesia

Martin Atkinson — Wed, 11 Nov 2015 09:09:54 GMT

[quote user="SER"]We use v-gels, we neuter rabbits almost everyday so are used to them.[/quote]I much prefer the security of an ET tube but I can see V-gels are a good second choice, better than just a mask, if you can't intubate.

RE: Rabbit mortality related to general anaesthesia

Sara Ramsey — Wed, 11 Nov 2015 00:37:15 GMT

We use v-gels, we neuter rabbits almost everyday so are used to them. The capnograph allows you to see if it has moved and rarely have any issues. I'm much happier than trying to intubate. You do need to ensure mouth has no food in it though.

RE: Rabbit mortality related to general anaesthesia

Martin Atkinson — Tue, 10 Nov 2015 10:41:45 GMT

[quote user="Emily Rainbow"]ive also struggled to visualise the larynx to try the urinary catheter/styler method. Will try the blind method next time and see![/quote]I've found the the key points are having your ear level with the rabbits head, going in straight and having a stiff tube - sometimes the tube softens after a few attempts so I'd get a fresh one. Often the tube will go in on first attempt but as often it goes into the oesophagus and the breathing sounds stop so you withdraw slightly and start again. Once its in the trachea, not wishing to state the obvious, the breathing sounds are clear and persistent and they often do a little cough, tie in, then connect to the respiratory monitor for added confidence. On average it takes me 2-3 attempts but can take several. How many attempts you make is up to you but I generally will give up after half a dozen on the rare occasions I don't succeed as I am wary of damaging the larynx.

RE: Rabbit mortality related to general anaesthesia

Emily Rainbow — Mon, 09 Nov 2015 20:24:05 GMT

[quote user="Liz white"] Emily, what was the course you did?

[/quote]

it was the CPD solutions one I think. 4wks of online material/forum for just over £100. Can't say I learnt a lot more but it was a very good refresher and always good to know what I'm doing is best practice! Now to persuade the others in my practice!

ive also struggled to visualise the larynx to try the urinary catheter/styler method. Will try the blind method next time and see!

RE: Rabbit mortality related to general anaesthesia

Robin Grimmer — Mon, 09 Nov 2015 19:54:54 GMT

[quote user="Martin Atkinson"]

[quote user="Robin Grimmer"]I use an auroscope to visualise the larynx.[/quote]Its odd how we have our techniques which work for us but I've universally failed trying to effectively visualise the larynx with any instrument to pass an ET tube but then I hadn't thought of the dog catheter technique, I've tried to pass the ET tube direct. Do you pre-place the ET tube on the catheter and shove it up the far end out of the way then slide it back down, or do you cut the luer fitting off so you can slide the tube over the catheter? I might try this if my blind technique lets me down.

This topic has been raise before and some people say they've use the V-gel devices. Does anyone still use them, the exotic vets I've talked to don't like them as they are not confident they are secure and that is very much my view.

[/quote]

Yes I remove the leur attachment from the catheter so I can just slide the et tube down over it. I use a fairly long auroscope head and the soft palate is usually in the way so need to poke it out of the way with the auroscope.

RE: Rabbit mortality related to general anaesthesia

Martin Atkinson — Mon, 09 Nov 2015 17:17:29 GMT

RE: Rabbit mortality related to general anaesthesia

Robin Grimmer — Mon, 09 Nov 2015 15:55:20 GMT

I use an auroscope to visualise the larynx. Squirt some intubease, pass a small dog catheter in to the airway. Then pass the et tube over the catheter so it enters the airway. Then carefully withdraw the catheter while keeping the et tube in place. Simples!

RE: Rabbit mortality related to general anaesthesia

Neil Wheadon — Mon, 09 Nov 2015 12:47:52 GMT

Thanks Martin

I will try this next time I get Bunny Boy in to neuter.

You've posted this technique before and now it's in this thread I might be able to find it.

Neil

RE: Rabbit mortality related to general anaesthesia

Martin Atkinson — Mon, 09 Nov 2015 12:41:43 GMT

[quote user="Neil Wheadon"]In the land of meer mortals (me) who have tried, failed, tried , failed to intubate. Here's an ingenious solution[/quote]What technique do you use Neill? I place the bunny in sternal recumbancy kneel down so my head is level with the table top, pass the tube blind and listen for breathing sounds as the tip nears the trachea, it will go in 50% of the time. If it won't I squirt a bit of local down the tube, put it on a mask for a couple of minutes then try again with 90% success rate down to below 1 kg. If we need to mask I use a mask with a rubber diaphragm.

RE: Rabbit mortality related to general anaesthesia

Neil Wheadon — Mon, 09 Nov 2015 12:33:42 GMT

[quote user="Martin Atkinson"] can then nearly always intubate them[/quote]

In the land of meer mortals (me) who have tried, failed, tried , failed to intubate. Here's an ingenious solution

1) Put a rubber glove over the face mask

2) Cut the thumb off

3) Push the rabbits nose through the hole

Airtight seal - brilliant

Picture enclosed

RE: Rabbit mortality related to general anaesthesia

Wren — Mon, 09 Nov 2015 11:16:23 GMT

The ones they publish in the VDS newsletter are excellent. Well written and salutary. They are, of course, anonymous though.

RE: Rabbit mortality related to general anaesthesia

Arlo Guthrie — Mon, 09 Nov 2015 10:55:23 GMT

[quote user="Neil Wheadon"]Anthony has touched a nerve that could be a major strength of this forum.

Vets4Pets analysed data last year highlighting the 10 commonest diseases (ears and Kennel Cough came top). Michael has highlighted a survey into mortality. If only we could harness this across all our experiences to get a true picture.[/quote]

That's got me thinking ...

[quote user="Anthony Todd"]There's been a lot of admiration for pilots' publishing their mistakes and this is the place for vets, anonymously if desired, to do the same. Will undoubtedly save someone someday.

[/quote]

As did that!

I particularly like the idea of publishing mistakes everyone can learn from. I really enjoyed them when I was a pilot, both for the educational value and the slightly vicarious feeling of: "Well of course, I would never have done that myself." (I probably would, just felt good to think I wouldn't.)

But I'm not sure if it would work in the veterinary profession: if you make a mistake in an aircraft, everyone knows anyway.

RE: Rabbit mortality related to general anaesthesia

Liz w — Mon, 09 Nov 2015 10:31:33 GMT

[quote user="Emily Rainbow"]

I've just competed a short online course on rabbit medicine including a section on anaesthesia

Whilst our current protocol was largely up to date I have tweeted a few things as a result.

We use 0.15ml/kg vetergesic IM 30mins before then place an IV catheter and induce with 0.08ml/kg domitor and 0.05ml/kg ketamine slow IV. We pre-oxygenate before starting induction and either intubate or use a v-gel intraop.

One thing we have changed following my CPD is to up our metacam dose to 0.6mg/kg BID. We also use ranitidine IV due to the risks of gastric ulcers. We don't routinely give metaclop. We do keep any inappetant rabbits in overnight for syringe feeding and bolus IV fluids but now that rarely happens compared to the previous protocol of gas induction!

[/quote]Emily, what was the course you did?

RE: Rabbit mortality related to general anaesthesia

Martin Atkinson — Mon, 09 Nov 2015 09:49:21 GMT

Having read the the above anaesthetic protocols I'm at a loss as to why people are making it so complicated. I give triple combo (torb/dom/ket) IM at cat dose and can then nearly always intubate them then maintain on Isoflurane. If they're a little light to tube at first they get some Iso by face mask until I can. Post op Carprieve and metoclopramide. I rarely need to give atipamazole they are nearly always waking up as I've put in the last stitch or as soon as they're off the table.

RE: Rabbit mortality related to general anaesthesia

Neil Wheadon — Mon, 09 Nov 2015 09:22:47 GMT

Here's the doses from a clinic that does a lot of rabbit anaesthesia

Premed

Metacam 0.1ml/kg (dog strength)

Metoclopramide 0.1-0.2ml/kg

Catheter placed in ear

Medetomidine 0.1ml/kg

Butorphanol 0.03ml/kg

Ketamine 0.03ml/kg

These are placed together IV. They do tend to jump when you inject, hence the catheter

Antisedan 0.05ml/kg

Hope that helps. I'm in another 'rabbit heavy' clinic tomorrow so will compare

Neil

RE: Rabbit mortality related to general anaesthesia

Stephanie Wellings — Sat, 31 Oct 2015 19:11:57 GMT

I use 5mg/kg ketamine, 0.1mg/kg medetomidine, 0.05mg/kg buprenorphine given iv via ear catheter. For dentals I give half then the other half if needed, castrates need it all, and spays sometimes need some iso in addition (i also keep an extra 1/2 dose ketamine drawn up - I find rabbits tend to start moving their limbs or chomping on the ET tube if they are too light, rather than subtle things like an increase in heart rate - and the ketamine acts much quicker than turning up the gas).

We also give fluids, metoclopramide and meloxicam s/c while they are under. Happy with recoveries, touch wood not had any anaesthetic deaths, and not many complications, although probably haven't done enough of them to compare to any statistics.

RE: Rabbit mortality related to general anaesthesia

Emily Rainbow — Sat, 31 Oct 2015 19:09:56 GMT

I've just competed a short online course on rabbit medicine including a section on anaesthesia

Whilst our current protocol was largely up to date I have tweeted a few things as a result.

RE: Rabbit mortality related to general anaesthesia

Evelyn Barbour-Hill — Sat, 31 Oct 2015 14:08:09 GMT

[quote user="Hannah Wynne Richards"]

No It did state IM

Wynne

[/quote]

And for a couple of years it stated the wrong dose in the BSAVA Formulary. That must have killed a few rabbits.

RE: Rabbit mortality related to general anaesthesia

Hannah Wynne Richards — Sat, 31 Oct 2015 12:39:32 GMT

No It did state IM

Wynne

RE: Rabbit mortality related to general anaesthesia

Robin Grimmer — Sat, 31 Oct 2015 12:09:18 GMT

Some of the BSAVA doses were higher because they were sub cut. I use low dose dtk im (0.1ml domitor per kg, 0.05ml ket and torb per kg) and have been very happy with it. I can't remember the last rabbit I lost. It's deep enough to allow intubation or a dental. They recover very quickly when you reverse it. The most important thing with a rabbit anaesthetic is to avoid a stressful induction - so no shoving their head in a mask.

RE: Rabbit mortality related to general anaesthesia

Hannah Wynne Richards — Sat, 31 Oct 2015 11:48:25 GMT

I don't do all that many rabbit anaesthetics, so not statistically valid.

BSAVA Manual of Rabbit Medicine and Surgery (2000) quotes ketaminf 15mgs/kg/medetomidine 0.25 mgs/kg.

BSAVA Manual of Small Animal Anaesthesia and Analgesia (1999) quotes 25mgs/kg ketamine/0.5 mgs/kg medetomidine.

Some 5/6 years ago, I lost 2 rabbits in succession under anaesthesia. I checked dosages, realised I'd been taking them fromthe wrong book, and haven't lost one since.

I think post-op pain relief is absolutely essential. Rabbits need vast quantities of metacam, and if they're in pain they won't eat, so you lose them to entreotaxaemia.

Wynne

RE: Rabbit mortality related to general anaesthesia

Robin Grimmer — Sat, 31 Oct 2015 11:46:10 GMT

I would think the increased risk of anaesthetic death in cats is due to cardiomyopathy, which is much commoner in cats and can be difficult to diagnose.

RE: Rabbit mortality related to general anaesthesia

Michael Woodhouse — Sat, 31 Oct 2015 11:44:42 GMT

[quote user="Anthony Todd"]In the over-65 age group, it’s one in 10.[/quote]

Do you know the risk of not living another year if you don't require surgery and are over 65?!

RE: Rabbit mortality related to general anaesthesia

Anthony Todd — Sat, 31 Oct 2015 11:42:40 GMT

Jeepers, here's one human quote; not good for oldies like me, and I'm sure dinovets are even worse1

the worldwide death rate during full anesthesia is back on the rise, to about seven patients in every million. And the number of deaths within a year after a general anesthesia is frighteningly high: one in 20. In the over-65 age group, it’s one in 10.

RE: Rabbit mortality related to general anaesthesia

Anthony Todd — Sat, 31 Oct 2015 11:34:40 GMT

[quote user="Michael Woodhouse"]Stop asking these questions, when I have given you the answer! [/quote]

Geez, you've got to be quick around here or someone will fire back before you have time to give your own inaccurate guesstimate!

Actually 1.1 per 1000 cats, which I think is 0.11%, is near enough to my figure as not all weeks had 25 desexings and I'm sure all deaths weren't registered accurately.

PS and that citation seemed to relate to sick rabbits!!