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ANESTHESIA - 2 > 27 – Exotic (Rabbit) Anesthesia > Flashcards

27 – Exotic (Rabbit) Anesthesia Flashcards

1
Q

Effects of size: difference to dogs and cats

A
  • Higher metabolic rate, smaller reserves of glycogen PREDISPOSES to HYPOGLYCEMIA
  • *higher oxygen consumption reduced tolerance to HYOXEMIA
  • HYPOTHERMIA
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2
Q

Hypothermia: effects of size

A
  • Higher body surface area to volume ratio
  • Radiant heat loss: cover patient!
  • Evaporative heat loss
    o *Clip as minimal as necessary
    o *minimize use of scrub and alcohol solution
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3
Q

Respiratory system of a rabbit

A
  • Visualization of larynx is difficult
  • Prone to laryngospasm
  • Obligate nasal breathers
  • Thoracic cavity: small, small tidal volume
  • Clinical and subclinical respiratory disease
  • Be careful with positioning!
    o *large abdominal organs push against diaphragm
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4
Q

Digestive system of a rabbit

A
  • Allow water up to premedication
  • Can NOT vomit
  • Fast rabbits for 1-2 hours
  • Check for food in oral cavity: clean with cotton swabs
  • Post operative ileus is common
  • Encourage to eat in post-anesthetic period
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5
Q

What are the predisposing factors for post operative ileus in rabbits?

A
  • Pain
  • Starvation
  • Stress
  • Diet change
  • Drugs
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6
Q

What do you need to consider for small mammal anesthesia?

A
  • Accurate dosing of drugs
    o Accurate body weight, dilate drugs if necessary, use appropriate syringe size
  • Anesthesia protocols
    o DO NOT extrapolate from other species
  • Compression of thoracic cavity
    o Hands, instruments, drapes
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7
Q

What is the blood volume of rabbits?

A
  • 50-78mL/kg
    o Less tolerance for hemorrhage
    o One cotton tip applicator=0.17ml blood
    o 4x4 gauze sponge=7ml blood
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8
Q

What are the anesthetic mortalities of rabbits?

A
  • Overall risk: 1.39-4.8%
  • Sick: 7.37%
  • Post anesthetic: 64% mortality occurred
  • Peri-anaesthetic GI complications: 38%
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9
Q

What increases the anesthetic risk?

A
  • Stress (prey)
  • Underlying disease
  • Failure to address perioperative issues
  • Lack of familiarity and expertise
  • Increased risk of hypothermia (slows metabolism and delays recovery)
  • *prolonged procedures: anesthesia time
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10
Q

How can you minimize stress in rabbits?

A
  • Provide rabbit friendly environment
  • Use premedication to reduce stress during induction
  • Minimize handling
  • Pain management
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11
Q

What are some underlying disease that can increase anesthetic risk?

A
  • malnourishment and dehydration
  • sub-clinical respiratory disease
  • uterine carcinoma
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12
Q

Lack of familiarity and expertise that increases anesthetic risk

A
  • size
  • endotracheal intubation is technically DEMANDING
  • fewer veins that are easily accessible for catheterization
  • pain
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13
Q

What can be done to reduce anesthetic morbidity and mortality?

A
  • Supportive care
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14
Q

Pre-operative blood tests

A
  • Get an idea of PCV, total protein, glucose, BUN
  • *glucose as a prognostic indicator for stress and clinical disease
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15
Q

How can you avoid disaster?

A
  • Be prepared
  • Know normal vital parameters
  • Full clinical examination and history
  • Consider pre-operative blood work
  • Stabilize condition before anesthsia
  • Don’t starve
  • Accurate weight
  • *always calculate dose for anesthetic agents, reversals and emergence drugs
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16
Q

What are the normal vital parameters of rabbits?

A
  • HR: 200-300
  • RR: 32-60
  • T: 38.5-39.5
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17
Q

What are the patient specific complications in rabbits?

A
  • Hypoglycemia, ileus
  • Possible underlying subclinical disease
  • Corneal ulcers
  • Increased risk of hypothermia
  • Injury (back fracture)
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18
Q

What are the 3 roles of premedication?

A
  • Reduce stress during handling, induction and pre-oxygenation
  • Anesthetic sparing
  • Analgesia
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19
Q

What are some examples of premedication?

A
  • Acepromazine
  • Midazolam
  • Dexmedetomidine
  • Opioids
  • Anticholinergic drugs
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20
Q

Acepromazine (pre-med)

A
  • Long duration
  • NOT reversible (prolonged recovery)
  • Peak effect after 30-45mins
  • Hypotension: peripheral alpha1 receptor blockage (vasodilation)
  • *only use in healthy animals
  • *don’t usually use in rabbits: long duration and prolongs recovery!
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21
Q

Midazolam (pre-med)

A
  • WATER soluble, can be administered IM
  • *Minimal cardiopulmonary effects
  • Produces moderate SEDATION and MUSCLE RELAXATION
  • *Reversal: Flumazenil
  • *combine with opioid
  • *good for rabbits and humans
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22
Q

Dexmedetomidine (pre-med)

A
  • Mild to profound sedation
  • Respiratory and CV depression (not great for older animals)
  • Peripheral vasoconstriction
  • Reversible: Atipamezole
  • *combine with an opioid
  • *alternative to midazolam
23
Q

Opioids (pre-med)

A
  • Provide analgesia and will increase sedation
  • Reversible: Naloxone
  • Ex. Buprenorphine: 6-8hrs
  • Ex. Butorphanol: 2 hrs
  • Ex. Hydromorphone and methadone
24
Q

Anticholinergic drugs (pre-med)

A
  • NOT routinely administered as premedication
  • Used to treat bradycardia
  • Negative effects on GI motility
  • Ex. Atropine: 61% possess atropine esterase (ineffective)
  • Ex. Glycopyrrolate: slower onset time
25
Q

Induction of anesthesia

A
  • ALWAYS pre-oxygenate
  • Always have a person monitoring
  • Have monitoring attached to patient
  • IV catheter
  • Have enough induction agent
  • Masking down should NOT be first option in rabbits
  • *prefer injectable
26
Q

Why should masking down NOT be first option in rabbits?

A
  • Humane exposure
  • Stressful
  • Not enough time to intubate
27
Q

Injectable induction agents: examples

A
  • Ketamine
  • Propofol
  • Alfaxalone
  • *titrate to effect to AVOID induction apnea
28
Q

Ketamine (injectable induction)

A
  • Combine with benzodiazepine (midazolam)
  • HIGH doses can provide surgical ANESTHESIA
29
Q

Propofol (injectable induction)

A
  • Requires IV access prior to induction
30
Q

Alfaxalone (injectable induction)

A
  • Could be given IM: large volume
31
Q

Induction of anesthesia: VOLATILE AGENTS

A
  • Should only be 2nd choice to IV induction
  • Always use with premedication to reduce stress and struggling
  • Beware of breath holding
  • Apnea induced bradycardia
  • Introduce volatile gradually
  • Pre-oxygenate if possible
  • *Oxygen flow rates greater than 100mg/kg/min with well fitted mask
32
Q

What are examples of volatile agents for induction of anesthesia?

A
  • Isoflurane
  • Sevoflurane
33
Q

Isofluarane

A
  • MAC: 2.5%
  • Pungent smell: breath holding likely
  • Induction apnea
34
Q

Sevoflurane

A
  • MAC: 3.5-4.1%
  • Less pungent: better tolerated
  • Faster induction?
  • Induction apnea
35
Q

Face mask for rabbits

A
  • Close fitting
  • Diaphragm can be adapted using an exam glove
  • Clear: visual assessment
  • Low volume: minimize dead space
  • *if condensation=O2 is too low!
36
Q

Anesthesia induction chambers

A
  • Multiple sizes
  • Bigger chamber=longer it takes
  • If get excitement phase=bounce of walls and can HURT themselves
  • *want it as small as possible
37
Q

Lidocaine constant rate infusions

A
  • Prokinetic effects
  • Improved food intake and fecal output in rabbits following ovariohysterectomy
  • Anesthetic sparing (reduces isoflurane MAC)
  • Analgesic
  • Anti-inflammatory/anti-endotoxin
38
Q

Intubation of rabbits: options

A
  • Blind
  • Direct visualization
    o Videoendoscope
    o Laryngoscope
    o Otoscope
39
Q

Why intubate a rabbit?

A
  • Protects airway
  • Allows efficient oxygen supplementation
  • Allows positive pressure ventilation
  • Reduces human exposure
40
Q

Rabbit intubation ‘steps’

A
  • 2.0-3.5mm (un) cuffed ET tube
  • Ensure rabbit is adequately anesthetized
  • Pre-oxygenate
  • Prone to laryngospasm: use lidocaine
  • Sternal recumbency with hyper-extended neck (nose to ceiling)
    o Align larynx and trachea with oropharynx
  • Continuously monitor HR during induction/intubation
41
Q

Blind method intubation technique

A
  • Difficult initially
  • Easy and quick to perform once experienced
  • No extra cost
  • Possible damage to glottis and risk of laryngospasm
  • Possible unsuccessful due to entrapment of epiglottis
  • Risk of aspiration if unnoticed presence of food in pharynx
42
Q

Steps for blind method intubation

A
  • Premeasure ETT to level of larynx
  • Sternal recumbency and hyper-extended neck
  • Interest ET tube to pre-measured point
  • Instill lidocaine 2% (neat) via small catheter through ET tube
  • Gently advance ET-tube during inspiration while
    o Listening to connecter end of tube
    o Watching capnograph
43
Q

How do you confirm tracheal intubation?

A
  • Ventilate and listen for respiratory sounds on BOTH SIDES OF THORAX
  • Use capnograph
  • Coughing
  • Watch for condensation
  • *repeated attempts of intubation is NOT recommended
    o Risk of laryngeal trauma and spasm=respiratory obstruction
44
Q

Laryngoscope/otoscope intubation technique

A
  • Direct visualization possible
  • Can move soft palate and expose glottis if necessary
  • Technically challenging compared to dog/cat
  • Unexperienced may cause damage
  • Minimal equipment necessary: laryngoscope/otoscope + stylet
45
Q

Intubation with direct visualization steps

A
  • Sternal recumbency and hyper-extend neck
  • Assistant to open mouth
    o Hold wide open: use bandage material as a retractor
  • Gently pull tongue out of mouth
  • Use small laryngoscope
  • Insert ET tube
46
Q

Endoscopic method

A
  • Direct visualization allows rapid and accurate intubation
  • Technical challenging
  • No RISK of aspiration or soft tissue damge
  • Expensive equipment needed
  • Side-by-side or endoscope can act as stylet
47
Q

What are some complications with rabbit intubation?

A
  • Difficult placement
  • Laryngospasm
  • Trauma to oropharyngeal soft tissue
  • Tube dislodgement, occlusion and kinking
  • Postintubation oropharyngeal swelling
48
Q

Supraglottic airway device: V-gel

A
  • Some experience necessary (online training)
  • Always use with capnograph
  • Can be easily dislodged if animal is moved
  • Faster placement than ET intubation
  • Less trauma than blind intubation
  • Disadvantages: Tongue can get blue or black OR occlude airway (use with capnograph)
49
Q

Rabbit anesthesia: IV access

A
  • Conscious rabbit: apply local anesthetic cream (EMLA)
  • Cephalic vein
  • Lateral saphenous
  • Marginal auricular vein
  • *fluids: 10mL/kg/hr (+/- 2.5-5% dextrose)
50
Q

What are some complications with using the marginal auricular vein?

A
  • Sloughing
  • Chemical phlebitis
  • Mechanical irritation from catheter or bandage
  • *do NOT use central auricular artery
51
Q

Monitoring anesthetic depth

A
  • Palpebral reflex, eye positions=unreliable (eye will stay central)
  • Nictitans membrane will move over cornea
  • *corneal reflex should be maintained
52
Q

Monitoring CV system

A
  • Auscultation
  • Doppler
  • Pulse oximetry: ear, tongue, digit
  • ECG
  • Temperature (avoid hypo and hyperthermia)
53
Q

Post operative care

A
  • Analgesia
    o NSAIDs: meloxicam
    o Opioids: buprenorphine, hydromorphone, butorphanol
  • Stress free environment
  • *Continue monitoring
  • Feed as soon as possible
54
Q

If a prolonged recovery, check for

A
  • Hypothermia
  • Hypoglycemia
  • Residual drug effects (reversal)

ANESTHESIA - 2 (17 decks)

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