Rabbit Spay Complication?

Re: Rabbit Spay Complication?

Andrew Kent — Sat, 14 May 2011 21:56:16 GMT

I agree that a ruptured stomach is found in most rabbits quite quickly after death due to gas build up. I would be surprised if the choice of analgesic was to blame in any way here. I use a similar meloxicam dose, would choose buprenorphine over butorphanol (but usually give it at recovery) but have used butorphanol in the past and haven't found it problematic. I do also share some concern re Zantac use in rabbits due to the change in gastric ph. I tend to give all rabbits metoclop every 8 hours until they are passing faeces and will use cisapride as well in sick rabbits, major procedures or if faeces hasn't been passed within 12 hours of recovery. But I would find it hard to criticise your protocol so think it is just one of those unfortunate things. Andy

Re: Rabbit Spay Complication?

Ian Mostyn — Sat, 14 May 2011 20:39:13 GMT

[quote user="Rob Reid"]

I seem to recall from my path rotation (years ago now...!!!) that a ruptured stomach was generally considered a normal post-mortem finding in a rabbit unless there were any signs of inflammation/peritonitis?

[/quote]

Wasn't this the subject of a recent VDS newsletter article. Don't have it to hand but unless the PM was fresh, it is possibly a normal finding.

Ian

Re: Rabbit Spay Complication?

Bob Russell — Sat, 14 May 2011 10:03:15 GMT

[quote user="Gillian Mostyn"]

I'm not saying rabbits don't die under GA - I've had my fair share - just that the risk in healthy rabbits is small (as your 1:1200 statistic indicates). I get frustrated with the fatalistic attitude that 'rabbits die under GA', especially when this is used as an excuse when the fault was actually poor anaesthesia technique or lack of pre- and peri-operative support.

[/quote]

I think this sums the realities of the situation perfectly. Rabbit g/a's are challenging to do well which perhaps equates to time and cost. To keep rabbit ops cheap I suspect there are a number of practices that compromise safety and use this as an excuse.

Intubating a rabbit is not that difficult usually but takes practice. We get an occasional one that is a struggle but as I use the blind technique it is hardly surprising. Placing a yellow i/v cannula is a doddle once you have done one or two!

Can you justify this financially for an op you are going to charge £80 for? While rabbit ops are priced as 'shoe-box' animal procedures a practice has to chose between welfare and profitability. We have opted for welfare and a low risk that I have to make the 'I am sorry your pet died under anaesthertic' call and if I do the sums I suspect rabbit surgery is completely uneconomic for us.

We are probably still considerably more expensive than some of our neighbours but it is for the owner to decide cost v's compromise!

Re: Rabbit Spay Complication?

Rob Reid — Sat, 14 May 2011 08:29:02 GMT

[quote user="Niall Taylor"]

[quote user="depacey"]We did wonder if both the rabbits had eaten too much preGA, the packed lunch the owner sent in with them was extensive and quickly demolished?[/quote]

That was what caught my eye in the OP, particularly if the meal was succulent and leafy I'd be looking at that as a likely cause of bloat and gastric rupture in these two. We make sure our rabs. go for an hour or so without food prior to surgery but make sure they eat as soon after as possible.

Niall

[/quote]I seem to recall from my path rotation (years ago now...!!!) that a ruptured stomach was generally considered a normal post-mortem finding in a rabbit unless there were any signs of inflammation/peritonitis?

Re: Rabbit Spay Complication?

Niall Taylor — Fri, 13 May 2011 22:43:31 GMT

[quote user="depacey"]We did wonder if both the rabbits had eaten too much preGA, the packed lunch the owner sent in with them was extensive and quickly demolished?[/quote]

Niall

Re: Rabbit Spay Complication?

Gillian Mostyn — Fri, 13 May 2011 22:33:14 GMT

Re: Rabbit Spay Complication?

Gareth Dowdeswell — Fri, 13 May 2011 22:03:44 GMT

[quote user="Gillian Mostyn"]

I do think that this 'rabbits die under GA' myth is anecdotal from many years ago. You said yourself that you only recall losing one rabbit last year, and that one being not so fit as you'd like. How many dogs and cats died? Maybe the risk isn't as high as you think?

[/quote]

Think the statistics I was told when I did the anaesthesia elective at RVC a few years ago were 1 in 1200 for rabbit GA deaths vs 1 in 10000 for dogs and cats. Really small furries were something like 1 in 50... Not sure what those stats were based on, but I imagine rabbits are higher risk as vets/nurses are less familar with them, pre-op work-up is rarer and if there are problems intervention is more difficult - rabbit GAs may not have IV lines or be intubated.

Re: Rabbit Spay Complication?

Bob Russell — Fri, 13 May 2011 15:50:15 GMT

How do people tell if a rabbit is truly healthy? I cannot tell just looking at a rabbit if it has dental disease, E. cuniculi or sub-clinical pneumonia but I may just be a useless clinician.

We have (touch wood) a very good safety record for rabbit g/a's but I still warn owners that a general is more risky in rabbits than cats and dogs. I do this to prepare them (and me) for the anaesthetic death that may come at some stage in my career.

I am not sure if these were related rabbits, if they were did they have some undiagnosed problem in common? Cardiomyopathy? If in doubt blame sub-clinical E.cuniculi!

Re: Rabbit Spay Complication?

Gillian Mostyn — Thu, 12 May 2011 14:46:37 GMT

Rabbit GA does carry risks, but in my experience, the risk in a HEALTHY rabbit is no more than in any other commonloy anaesthetised species.

The bit I do tend to emphasize is that rabbit can have underlying disease (pneumonia, e cuniculi etc) which will increase the risk. I will happily investigate first if the owner asks, but most tend to just take the risk and go ahead with the surgery.

Re: Rabbit Spay Complication?

Rob Reid — Thu, 12 May 2011 14:12:43 GMT

[quote user="Gillian Mostyn"]

Apart from the fact that the GA didn't kill the rabbits (so not sure about the point you're trying to make) I also disagree totally. With it all. Sorry!

[/quote]

A few things

First - don't be sorry for having an opinion Gillian. I'm not going to take offence - I wouldn't have posted if I didn't expect brickbats, the good thing about this forum is it puts lot of different things out there and from my point of view I try to take on board other people's POV and use them to help. So don't be sorry, because you have nothing to apologise for

Second - you're right re the GA bit, I should have said post-operative period. My bad - sorry (!)

Third - I'm intrested that you and Mark both disagree with ALL my points. Are you therefore saying that I don't need to be telling my rabbit owners the bit about the GA/post-op period carrying a higher risk?

Re: Rabbit Spay Complication?

depacey — Thu, 12 May 2011 13:46:26 GMT

Thanks for all the replies, I think the painrelief is something I'm going to review (currently use metacam 0.5mg/kg but only SID), likewise with the catgut ligatures (i'm just a lot happier with knot security).

We did wonder if both the rabbits had eaten too much preGA, the packed lunch the owner sent in with them was extensive and quickly demolished?

To reply to earlier posts both rabbits were bright and eating small amounts at discharge.

Thanks again

Re: Rabbit Spay Complication?

Kate Richardson — Thu, 12 May 2011 13:36:58 GMT

Could there have been some other underlying problem with BOTH rabbits that predisposed them to this outcome? It just seems really odd to me that BOTH rabbits succumbed,?

Re: Rabbit Spay Complication?

Gillian Mostyn — Thu, 12 May 2011 13:30:16 GMT

[quote user="Mark Rowland"]

[quote user="Rob Reid"]

Ok - I know I'm probably going to get the brickbats for this, but this is where I'm going to get a bit cynical.

Am I the only one who is not surprised in the slightest by 2 rabbits dying under a GA? Don't get me wrong, this isn't something that happens to me regularly in practice (I can only recall losing one rabbit GA patient in the last year and that rabbit was fairly infirm in the first place) but do we not accept that rabbits are higher risk GAs due to 'the nature of the beast?'

I am always very keen to emphasise to rabbit clients that a GA carries a higher risk despite best intentions. The OP has followed good practice in this particular case, but rabbit GA deaths happen - it is a fact of veterinary practice and no degree of metoclopramide, metacam, syringe feeding and TLC will help in these individual acute cases.

I don't want to come over all Matthew Watkinson here but let's face it, physiologically rabbits aren't as designed to withstand a GA or stressful surgery. I am happy to treat all rabbits that come into my surgery and will give them the respect and concern for their welfare that any animal deserves, but let's face it they are not an animal I personally would recommend as a pet and owners have to be aware of how delicate an animal they are when it comes to both surgery and disease.

For me, I think the main lesson that comes from this case rather than a massive audit of ones rabbit GA technique, is to clearly communicate the risks the rabbit owner.

[/quote]

Im sorry but I disagree with all the above... but thats just me

[/quote]

Apart from the fact that the GA didn't kill the rabbits (so not sure about the point you're trying to make) I also disagree totally. With it all. Sorry!

Re: Rabbit Spay Complication?

Ian Mostyn — Thu, 12 May 2011 11:00:43 GMT

We probably do 200 - 300 rabbit anaesthetics each year without complications and survival rate is as good as a dog or cat. We intubate as much as possible and Sevoflurane seems better, they breathe more reliably than with isoflurane. I also have more luck intubating with sevo than iso. Rabbit anaesthesia shouldn't be any more problematic than any other species.

My metacam dose is generally 0.5mg/kg once daily by injection but twice daily when given orally, at least for the first few days. I see a lot of second opinion rabbits who have been on almost homeopathic doses of metacam. Pain relief is very important for rabbits.

I also use vicryl or pds internally as catgut causes too much reaction. The only time I use catgut is for castrations when I dont mind a bit of reaction in the ligature but I never use it abdominally or in skin.

Ian

Re: Rabbit Spay Complication?

CatherineThomas — Thu, 12 May 2011 10:30:45 GMT

[quote user="Mark Rowland"]

[/quote]

When would you use Zantac? And what do you mean by using it with caution? When I've been to rabbit CPD in the past they've said that ranitidine seems to work best to stimulate motility and metoclopramide doesn't seem to make much difference. If there are no studies about Zantac are there any about metoclopramide?

What protocol do you use for peri-operative medications in rabbits?

Catherine

Re: Rabbit Spay Complication?

Rob Reid — Thu, 12 May 2011 10:25:14 GMT

[quote user="Mark Rowland"]Im sorry but I disagree with all the above... but thats just me[/quote]

I'd be interested to hear your opinion, if you'd like to broaden your response......

Re: Rabbit Spay Complication?

Mark Rowland — Thu, 12 May 2011 10:22:10 GMT

[quote user="Rob Reid"]

Ok - I know I'm probably going to get the brickbats for this, but this is where I'm going to get a bit cynical.

For me, I think the main lesson that comes from this case rather than a massive audit of ones rabbit GA technique, is to clearly communicate the risks the rabbit owner.

[/quote]

Im sorry but I disagree with all the above... but thats just me

Re: Rabbit Spay Complication?

Rob Reid — Thu, 12 May 2011 09:53:20 GMT

Ok - I know I'm probably going to get the brickbats for this, but this is where I'm going to get a bit cynical.

For me, I think the main lesson that comes from this case rather than a massive audit of ones rabbit GA technique, is to clearly communicate the risks to the rabbit owner.

Re: Rabbit Spay Complication?

Mark Rowland — Thu, 12 May 2011 09:33:14 GMT

[quote user="Richard Carter"]

Doesn't anyone think all the enteric motility + pain relief treatments may be the cause? - If you rx post-op with opiods, they will induce slowed peristalsis but then at same time giving zantac/ metoclop etc - at the back of my mind is a lecture from 20+ years ago discussing the difference between circular muscle peristalsis stimulation and longitudinal muscle stimulation in colic in horses using various medications including buscopan / metoclopromide etc.

I don't send any bunnies home with any painkillers or stimulants if eating well by time discharge - don't trust them to not have the sort of side effects discussed above. Haven't lost one yet as far as I know. Also use catgut for ligatures, no problems yet.

[/quote]

Have you ever gone back into these bunnies (for another reason)

after catgut ligatures. I saw some horrendous pics when I was studying for my cert, I will try to dig them up for you.

Metoclop works best as a gut motility enhancer when given iv, With zantac there are no studies in rabbits that I am aware of. My potential problem is this. A rabbits stomach pH serves to keep bacteria out of the hindgut. It eats cecotrophs so the mucus lining protects the probiotics it has essentially eaten. If you raise the pH with antacids, are you removing that protective mechanism and allowing inappropriate bacteria to enter the hindgut and cause a dysbiosis. I dont know but the potential is there so I use zantac with caution. This as I have said was an exceptional case but I would review the pain management protocol. After all I would want painkillers post op. the dog and cat routines go home with them, client satisfaction increases as it is showing that you are addressing the pain issue,

Mark

Re: Rabbit Spay Complication?

Richard Carter — Thu, 12 May 2011 08:53:45 GMT

Re: Rabbit Spay Complication?

Kate Richardson — Thu, 12 May 2011 07:56:39 GMT

Hi Depacey,

The comments regarding pain relief are prudent and torbugesic is not great for pain relief in other species so I would assume same in rabbits, however I think you have been extremely unfortunate in this situation for both rabbits to suffer in this way. I usually use a similar protocol although give dom/torb/ket iv rather than im, and have had cases back with varied degrees of ileus, which respond to pain relief, metoclopramide and syringe feeding, but nothing as extreme as your situation.

What vetergesic dose do people use with dom/ket and do you give it im or iv?

Try not to dwell on it Depacey, I really feel for you and I hope you are being well supported by you boss and colleagues.

Re: Rabbit Spay Complication?

Mark Rowland — Wed, 11 May 2011 20:54:01 GMT

Yep thats the dose I use. Syringe feed if necessary but I dont normally have to. I dont keep in as the clients can monitor and use the ooh service if they are concerned.

Mark

Re: Rabbit Spay Complication?

Claire Edgington — Wed, 11 May 2011 20:05:53 GMT

Mark - just so I'm not misunderstanding you - you use 0.5mg/kg metacam BID? Just clarifying before I overdose something!! I've routinely kept rabbit spays in overnight to make sure they are eating/defaecating ok. Do you syringe feed asap post op?

Thanks Claire

Re: Rabbit Spay Complication?

Mark Rowland — Wed, 11 May 2011 16:52:50 GMT

I suppose the answer is that you are using a fairly low dose of a non steroidal to counter the pain following abdominal surgery in a pain sensitive species. Granted this case does sound a bit extreem but if you consider wether you would be happy with paracetamol following surgery, the answer lies therin. These animals need close monitoring post spey and if the owner had been able to give a dose of metacam at home that evening you might not be in the position you are in. Metoclop may help with gut motility. Pain ceases gut motility despite metoclop. I have my own issues with Zantac (i use it sometimes but thats for another thread). How were these rabbits on discharge? had they eaten, could they have benefited from another dose of pain relief to go home with?.

Mark

Re: Rabbit Spay Complication?

James Laidlaw — Wed, 11 May 2011 16:23:11 GMT

I think I give 0.1 mL per Kg which equates to 0.5 mg/kg. Formulary lists 0.3-0.6 but all the rabbit vets say 0.3 not enough. I don't usually use BID, haven't had any complications like the OP, but maybe should start using BID.

I was more wondering if the torb has worn off would the metacam not provide sufficient pain relief (even at BID dosing) to avoid ileus? Especially with inclusion of zantac and metoclop?