Rabbit surgery – perioperative care

No longer are dogs and cats the only animals having routine investigations and surgery. Rabbits are also being operated on in most vet practices, so we thought it might be helpful to share with you some important tips on perioperative care.

Posted: 16 April 2018

Rabbit surgery – perioperative care

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Pre-op checks

On arrival at the surgery, take the time to check your patient carefully. Below we’ve listed the 9 most important things you do before continuing with an anaesthetic.

  1. History – take a detailed history, including diet, exercise, housing, vaccination and general health status. It’s particularly important to know if the patient has been eating normally. If there is a risk of gut stasis you need to take this into account.
  2. Heart and lungs – it’s particularly important with rabbits that you listen carefully to their lungs and hearts. Many of them suffer from chronic respiratory disease, often with markedly reduced lung function. Check for unusual sounds including muffled or consolidated areas.
  3. Cardiac function, pulse and mucus membranes – is there any evidence of tachycardia? The normal range for a rabbit is anything between 150 and 300bpm. Are the gums/mucus membranes pink or is there a hint of cyanosis?
  4. Breathing – is the pattern of inspiration and expiration normal? Perhaps there is a double “in-breath” or maybe signs of a chronic nasal or ocular discharge? How fast is the animal breathing? A normal rabbit might take between 30 and 60 breaths per minute.
  5. Weight and body condition score – check the animal’s weight and compare it to previous records. If there’s any evidence of weight loss? Use the Body Condition Score system to assess and animal’s health. Have you seen the Rabbit-size-o-meter?
  6. Stress – does the rabbit get stressed easily? Has it been separated from its companion? Can the owner bring in its companion for the day?
  7. Blood tests – many of us have in-house lab machines that allow us to perform general health screens in minutes. Are you offering this routinely to rabbits? See our article on “Blood Sampling Rabbits”.
  8. Urine – do you ask your clients to bring in a fresh urine sample from their rabbit? Many pet rabbits will use a litter tray, and by using a non-absorbent litter, a collecting pipette and bottle, you should be able to get a chance to check a sample. At the very least, ask about colour and volume.
  9. Faeces – rabbits should be continually producing small dry droppings. Ask the clients if the droppings are normal in shape, size and quantity. You should expect to see between 300 and 500 pellets per day, so the absence of significant numbers of pellets is a warning sign.

Pre-anaesthetic preparation

After a thorough physical examination in the consulting room, some rabbit patients may benefit from other investigations prior to an anaesthetic.

  • Radiography - any patient with a known respiratory problem would certainly warrant conscious radiographs of the lung field. A DV and lateral view of the lungs will help identify and locate any potential lung pathology.
  • Ultrasonography – this would be beneficial in cases being investigated for bladder, abdominal or cardiac issues. At this stage, an anaesthetic can always be delayed or cancelled based on any significant findings.
  • Withholding food - rabbits cannot vomit, therefore fasting is not necessary before anaesthesia. Fasting for longer periods of time may predispose them to post-operative ileus and decrease blood glucose levels. Food can, however, be taken away 1–2 hours before a GA to ensure no food is in the oral cavity.
  • Intravenous access – the placement of indwelling catheters is recommended, allowing you to provide fluid support during anesthesia. The best time to gain i/v access is prior to an anaesthetic being given. Prepare the area for catheter placement using a local anaesthetic cream to reduce any response to venepuncture. See our article on ‘Getting a vein – rabbit venepuncture’.
  • Pre-meds – choose your protocol carefully and give any medication in time. All premedicants and sedatives should be given 15-20 minutes prior to restraint or induction. Duration of action for sedative-analgesic combinations for use in minor procedures is generally 15-60 minutes depending upon combination used.

Care during anaesthesia

Probably the commonest problem we encounter in rabbits whilst under anaesthetic is respiratory arrest, usually due to an underlying respiratory problem. On top of this, some inhalational agents cause excessive breath holding and bradycardia. Because of this, the need for gaining and maintaining a reliable airway is essential.

Intubation – this is always recommended, as assisted ventilation is difficult to maintain using a facemask. Take a look at our video on Rabbit Intubation.

There are also a variety of other products available these days that help with airway access and anaesthesia. For example, the V-gel cuff for rabbits, produced by Docsinnovent, has proved to be very popular and is worth consideration.

Take a look at the V-gel in action >

If the planned surgery is on the oropharynx, nasal catheterisation can be used as a form of intubation.

Don’t forget the eyes – it’s important to lubricate the eyes during anaesthesia.  The globe is prominent and is at risk of becoming dry.

External heat source – it’s vital to keep an anaesthetised patient warm. Use warm bags of fluid or heated air bags, such as the Bair-hugger.

Monitoring equipment – 5 pieces of essential kit

In order to keep your patient safe during the anaesthetic, you need to be able to monitor the essentials. These days we are fortunate that we have plenty of affordable clinical equipment at our disposal, and it’s wise to take advantage of it. Make sure your staff are all familiar with using the kit appropriately. They need to understand how to interpret the information to make the most appropriate decisions.

  1. Pulse oximeter – these are probably considered essential these days. You’re able to check both the levels of oxygenation of blood and the heart rate. Don’t forget to record the readings throughout the anaesthetic so you can spot trends up and down.
  2. Capnograph – many vet practices use these routinely. Capnography has been shown to be more effective than clinical judgment alone in the early detection of hypoventilation, oesophageal intubation and circuit disconnection.
  3. Thermometer - most rabbits will become hypothermic during anaesthesia unless warmed. A cold patient will be at risk and will be slow to recover. Regular checks should be made of the core temperature using a rectal thermometer. Temperature should also be carefully monitored throughout recovery.
  4. Oesophageal stethoscope - allows monitoring of both cardiac and respiratory function in larger rabbits. This is a simple yet highly effective monitoring tool.
  5. ECG - bradycardia due to heart block is the most common abnormality and precedes cardiac arrest.

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