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Anesthesia & Analgesia > Exotic Anesthesia > Flashcards

Exotic Anesthesia Flashcards

1
Q

How is exotic anesthesia different than in dogs & cats?

A
  • higher metabolic rate & smaller reserves of glycogen predisposes to HYPOGLYCEMIA
  • HIGHER OXYGEN CONSUMPTION, reduced tolerance to HYPOXEMIA
  • HYPOTHERMIA: high body surface area to volume ratio; radiant heat loss (cover patient); evaporative heat loss (clip as minimally as possible; minimize use of scrub & alcohol solution)
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2
Q

What is important about the respiratory system of a rabbit?

A
  • visualization of larynx difficult
  • prone to laryngospasm
  • obligate nasal breathers
  • thoracic cavity v sm, sm tidal volume (4-6 mL/kg)
  • clinical & subclinical respiratory disease (P. multocida)
  • be careful w/ positioning (large abdominal organs push against diaphragm)
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3
Q

What is important about the digestive system of a rabbit?

A
  • allow water up to premedication
  • CANNOT vomit
  • fast rabbits for 1-2 hrs to reduce presence of food in oral cavity
  • check for food in oral cavity (clean w/ cotton swabs in guinea pigs)
  • post operative ileus is common (predisposing factors: pain, starvation, stress, diet change, drugs)
  • encourage to eat in post-anesthetic period
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4
Q

What should you consider during small animal anesthesia?

A
  • Accurate dosing of drugs (accurate body weight, dilute drugs if necessary, use appropriate syringe size (insulin syringe))
  • anesthesia protocols (dont extrapolate from other spp)
  • beware of compression of thoracic cavity (hands, instruments, drapes)
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5
Q

What is important regarding blood volume in rabbits?

A

less tolerance for hemorrhage

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6
Q

What increases the anesthetic risk in rabbits?

A
  • stress
  • underlying disease
  • failure to address perioperative issues
  • lack of familiarity
  • increased risk of hypothermia (slow metabolism, delayed recovery)
  • prolonged procedures (anesthesia time -> ileus)

SUPPORTIVE CARE WILL REDUCE ANESTHETIC MORBIDITY & MORTALITY

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7
Q

How to reduce stress in prey spp?

A
  • provide rabbit friendly enviro
  • use premedication to reduce stress during induction
  • minimize handling
  • pain managment
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8
Q

What are potential underlying diseases in rabbits the increase anesthetic risk?

A
  • malnourishment (dental treatment) & dehydration
  • sub-clinical respiratory disease (Pasteurellosis)
  • uterine carcinoma
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9
Q

What are examples of lack of familiarity and expertise that increase anesthetic risk in rabbits?

A
  • size
  • endotracheal intubation is technically demanding
  • fewer veins that are easily accessible for catheterization
  • pain
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10
Q

what pre-operative blood tests should you do in rabbits?

A
  • PCV, TP, BG (can be used as a prognostic indicator for stress & clinical disease), BUN
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11
Q

What is normal heart rate in a rabbit?

A

200-300

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12
Q

What is normal respiratory rate in a rabbit?

A

32-60

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13
Q

What is normal temperature in a rabbit?

A

38.5-39.5 C

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14
Q

How do you avoid disaster during anesthesia in rabbits?

A
  • be prepared
  • know normal vital parameters
  • full clinical exam & hx
  • consider preoperative blood work
  • stabilize condition before anesthesia
  • dont starve
  • accurate weight
  • ALWAYS CALCULATE DOSES FOR ANESTHETIC AGENTS, REVERSALS, & EMERGENCY DRUGS!
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15
Q

Why should you use premedication in exotics?

A
  • reduces stress during handling, induction, pre-oxygenation
  • anesthetic sparing
  • analgesia
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16
Q

Acepromazine in rabbits?

A
  • IM, SC, IV
  • long duration, not reversible (prolonged recovery)
  • peak effect after 30-45 min
  • hypotension: peripheral A1 receptor blockade (vasodilation)
  • only use in healthy animals
  • DONT necessarily use this in sm mammals
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17
Q

Midazolam in rabbits?

A
  • IM, SC, IV
  • water soluble so can be administered IM
  • minimal cardiopulmonary effects
  • produces moderate sedation & muscle relaxation
  • reversal: flumazenil
  • combine w/ opioid
18
Q

Dexmedetomidine in rabbits?

A
  • IM, SC
  • mild to profound sedation
  • respiratory & cardiovascular depression
  • peripheral vasoconstriction
  • reversible w/ atipamezole
  • combine w/ an opioid
19
Q

Opioids in rabbits?

A
  • provide analgesia & will increase sedation
  • reversible w/ Naloxone
  • Buprenorphine (6-8 hrs IM, SC, IV); Butorphanol (2 hrs IM, SC, IV); Hydromorphone (IM, SC, IV); Methadone (IM, SC, IV)
20
Q

What is important about anti-cholinergic drugs in rabbits?

A
  • not routinely administered as premed
  • used to treat bradycardia
  • negative effects on GI motility!
  • Atropine: IM, SC, IV; 61% of rabbits possess atropine esterase
  • Glycopyrrolate: IM, SC, IV
21
Q

How do you induce anesthesia in rabbits?

A
  • always preoxygenate
  • always have a person monitor the patient during induction/intubation
  • have monitoring equipment attached to the patient
  • IV catheter
  • have enough induction agent
  • masking down should not be the first option in rabbits
22
Q

Which injectable agents do we use to induce anesthesia in rabbits?

A
  • Ketamine (IV, IM): combine w/ benzodiazepine (midazolam); high doses can provide surgical anesthesia
  • Propofol (IV): requires IV access prior to induction
  • Alfaxalone (IV): could be given IM - large volume

TITRATE TO EFFECT TO AVOID INDUCTION APNEA

23
Q

How to induce anesthesia in rabbits with volatile agents?

A
  • should only be 2nd choice to IV induction
  • always use w/ premed to reduce stress & struggling (back fracture)
  • beware of breath holding
  • apnea induced bradycardia
  • introduce volatile gradually
  • introduce volatile gradually
  • pre-oxygenate if possible
24
Q

Iso in rabbits?

A
  • MAC: 2.5%
  • pungent smell - breath holding more likely
  • induction apnea
25
Q

Sevo in rabbits?

A
  • MAC 3.5-4.1%
  • less pungent (better tolerated)
  • faster induction? (depth of anesthesia may alter more rapidly)
  • induction apnea
26
Q

Facemask in rabbits?

A
  • close-fitting
  • diaphragm can be adapted using an exam glove
  • clear: visual assessment
  • low volume: minimize dead space
27
Q

Lidocaine CRI in rabbits?

A
  • prokinetic effects
  • improves food intake & fecal output in rabbits following ovariohysterectomy
  • anesthetic sparing (reduces isoflurane MAC)
  • analgesic
  • anti-inflammatory/anti-endotoxin
28
Q

How do we maintain rabbit airways during anesthesia?

A
  • mask
  • V-gel (supraglottic airway device)
  • intubation
29
Q

Why should we intubate rabbits?

A
  • protects airway
  • allows efficient oxygen supplementation
  • allows positive pressure ventilation
  • reduces human exposure
30
Q

what is important regarding intubation of a rabbit?

A
  • ensure rabbit is adequately anesthetized
  • pre-oxygenate
  • prone to laryngospasm: use lidocaine (careful toxic dose)
  • sternal recumbency w/ hyper-extended neck (to align larynx & trachea w/ oropharynx)
  • continuously monitor heart rate during induction/intubation
31
Q

What is important about blind intubation in a rabbit?

A
  • technically difficult initially
  • easy & quick to perform once experienced
  • no extra cost
  • possible damage to glottis & risk of laryngospasm
  • possible to be unsuccessful due to entrapment of epiglottis
  • risk of aspiration if unnoticed presence of food in the pharynx
32
Q

how do you blind intubate a rabbit?

A
  • premeasure ETT/atomizer to level of larynx
  • sternal recumbency & hyper-extend neck
  • insert ET tube to pre-measured point
  • instill lidocaine 2% neat via small catheter/atomizer through ET tube
  • gently advance ET-tube during inspiration while listening at the connector end of the tube & watching the capnograph
33
Q

How do we confirm tracheal intubation in rabbits?

A
  • ventilate & listen for respiratory sounds on both sides of thorax
  • use capnograph
  • coughing
  • watch for condensation (fogging of the tube during expiration)

REPEATED ATTEMPTS OF INTUBATION ARE NOT RECOMMENDED. RISK OF LARYNGEAL TRAUMA & SPASM -> RESPIRATORY OBSTRUCTION

34
Q

What is important about intubation of a rabbit with a laryngoscope/otoscope?

A
  • direct visualization possible
  • can move soft palate & expose the glottis if necessary
  • technically challenging compared to dog & cat
  • unexperienced user can cause tissue damage
  • minimal equipment necessary: laryngoscope/otoscope + stylet
35
Q

How do you intubate a rabbit w/ direct visualization?

A
  • sternal recumbency & hyper-extended neck
  • requires an assistant to open the mouth
  • hold rabbit’s mouth wide open
  • gently pull tongue out of mouth
  • use small laryngoscope
  • insert ET tube
36
Q

How do you intubate a rabbit with the endoscopic method?

A
  • direct visualization allows rapid & accurate intubation
  • technically challenging (learning curve)
  • no risk of aspiration or soft tissue damage
  • expensive equipment needed
  • side-by-side or endoscope can act as stylet
37
Q

What are potential complications of rabbit intubation?

A
  • difficult placement
  • laryngospasm
  • trauma to the oropharyngeal soft tissue
  • tube dislodgement, occlusion, & kinking
  • postintubation oropharyngeal swelling
38
Q

What is a supraglottic airway device (V-gel) for rabbits?

A
  • some experience necessary (online training)
  • always use w/ capnograph!
  • can be easily dislodged when animal is moved
  • faster placement than ET-intubation
  • less trauma than blind intubation
39
Q

How do you get IV access in a rabbit for anesthesia?

A
  • in a conscious rabbit, apply local anesthetic cream (EMLA)
  • cephalic vein, lateral saphenous, marginal auricular vein
40
Q

How do you monitor anesthetic depth in a rabbit?

A
  • palpebral reflex, eye position: unreliable
  • nictitans mb will move over cornea
  • corneal reflex should be maintained
41
Q

How do you monitor the cardiovascular system in a rabbit?

A
  • auscultation
  • doppler
  • pulse oximetry: ear, tongue, digit
  • ECG
  • temperature (avoid hypo & hyperthermia)
42
Q

What kind of post operative care is important after rabbit anesthesia?

A
  • analgesia: NSAIDs (Meloxicam SC); opioids (buprenorphine, hydromorphone, butorphanol)
  • stress free environment
  • continue monitoring!
  • prolonged recovery -> check for hypothermia, hypoglycemia, residual drug effects (reversal)
  • feed ASAP

Anesthesia & Analgesia (30 decks)

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