Hello, it's Anthony Chadwick from the webinar that welcoming you to another one of our live webinars with Burgess. Er really pleased always to, to welcome Burgess on the line and of course my old friend John Chitty, er there is, I think so much that Burgess have done to kind of raise the profile of exotic medicine, particularly rabbits, and also John, you know, he's been fantastic in this role. I hope everybody got the memo today that it's Christmas jumper day, so this is my RSPB effort.
Er if you have got any Christmas jumpers on, please do feel free to put them on social media with a I'm watching the webinar that and let's see your Christmas jumper. I think John's is, is red, so I think that's, that's quite good, I don't know if it's his Man United shirt or if it's a Christmas jumper, but we'll no doubt find out. And today we're gonna be talking about, and I naively said, have we not sorted this problem, John, I've been out of practise for a while, and he said hm.
Anthony, you've been out of practise a while, haven't you, so the title for today is. Does neutering rabbits have to be dangerous? Castration, day planning and anaesthetic management.
So a really important topic, you know, as John was talking to me before the webinar, obviously this is still a bigger problem than it should be, er we need to get better at it, er and and I'm sure John is gonna help us with that. And then Ellie's gonna come on after John and tell us a little bit about some of the advances that Burgess are making, really exciting, so do stay on for that and then we will do questions, . If you're on the webinar and you don't know who John Chitty is, then where have you been the last 20 years, but I will do your bio, John.
I'm gonna miss out a bit about how old you are, but just basically to say that you have a certificate in zoological medicine, a Royal College one, so the proper. You know, the proper one on on the certificate perspective and was employed in a small animal exotics practise in Andover, Hampshire. And you more or less spent all your time on avian exotics and small mammal caseload, referrals and first opinion, as well as consulting at various zoos, zoos and reintroduction projects and really excited, I think if people peer enough in the background on at John's or right shoulder as as it is John's right shoulder but over his, over our left is a great bustard, er and John's been really instrumental in in helping to bring that beautiful bird back into the UK.
And on his left shoulder, I think he's still working on Brachosaurus reintroduction, aren't you, John, that's not, that's still at the pilot stage. So we'll see how that goes. John's written loads of books and chapters and articles and everything and .
Was BSAVA president as well, so what he hasn't done probably isn't worth doing, as an aside, he's a Manchester United fan but don't hold that against him, and then Ellie is has a first degree in bioveterinary Science from Harper Adams, fantastic university in Shropshire. She recently completed her MSC in animal nutrition at the University of Nottingham, also another fantastic university, obviously now both fairly new, Nottingham older than. Harper Adams veterinary schools as well.
And her dissertation looked at the analysis of treats for rabbits and guinea pigs, owner perceptions and buying behaviours. Ellie's worked at Burgess for 6 years as a nutritional advisor, and she's gonna be giving us loads of interesting updates at the end of the webinar. So John, over to you, really looking forward to the webinar, and me and Ellie will disappear so we can all concentrate on your lovely dulcet tones.
Over to you, John. Lovely, thank you very much indeed, Anthony. I see, I slightly changed the title tonight, and we're gonna be looking at castration day basically.
First of all, again, as ever, because I'm always forget at the end, so apologies to Burgess, but thank you Burgess, for sponsoring this. As Anthony said, they do a lot of sponsoring of, small mammal education, and without that we, we wouldn't have half as much as we do, so thank you very much indeed. We've been very supportive sponsors over the years.
So, again, as Anthony alluded to, we have while it's come about, well, the big thing is. It's often regarded as being a dangerous procedure, but should it, I mean, really, ought this to be a dangerous thing? And so really it's what we're looking at, this is about planning that day and reducing the risks involved.
And because the key here is, is that we're talking about an elective procedure. It's not really a surprise that procedures coming into the practise, yet sometimes it seems like it can be. So is it really dangerous, or is it, just a simple op and and she's more right than I am.
And basically there's a lot of worry, with with people being both vets, nurses, and the public and the rabbit owners. And this may be worries about anaesthetic related deaths, it's maybe worried about complications from castration, things like swelling, hernias, infection, and gut stasis. The picture on the right of the X-ray here, you can see a calcified object there, that's actually, a lipomatous calcified reaction on the end of a spermatic cord, and this is a gut stasis case, you can see the the gas in the gut there, and this is a recurrent one, and basically this is on swinging on the spermatic cord and wrapping around the intestine every now and then and causing problems.
So these sorts of reactions can happen. And these are, what, what do these competitions do? They cause obviously suffering, pain, gut stasis, stress, and of course we all have a mentioned too is we worry about obesity post neutering as well.
So starting with the anaesthesia bit and this is where Antony and I are discussing it, it's still a bit of a risky business in some, in some people's eyes. The last big multicentric study in the UK was Kepsa, which is a bit data now but still is the last one, and that showed, OK, overall 1.83% of rabbits were dead within two days of anaesthesia.
The really worrying stat on that for the healthy ones, the young healthy animals coming for neutering, 0.76% were dead within within 48 hours. That's 1 in 150.
That is an absurdly high rate. More recently we got the Liam H and Adami paper, this is actually mixed group, so it was, . Both young healthies and ill rabbits and we're looking at nearly 5% per-anesthesia mortality.
So that's 2018, it's a particularly, it's a slightly strange paper but it it is one where it's still showing there are issues going on, and, and quite significant problems. So we look at all these worries and things, so do we actually need to castrate? And why do we do it?
Well, there may be direct health benefits, so things like testicular tumours are prevented. These will happen. How common they are is always hard to judge because of the number of rabbits who are castrated.
We may have a problem with the ability to mix or bond rabbits, and there's some, work showing that it's much harder to bond, entire males, especially in from rescue and stuff. We get fight injuries and you've got two males together, they do actually usually try and do the castration job for you as this picture shows, so I really quite severe injuries from, from, from entire males. This actually is one factor in preventing social isolation, and of all the ills happening to pet rabbits, probably social isolation is one of the biggest ones.
It can prevent unpleasant behaviours. Now it's a bit of an ethical point about do we, should we do that? But you know, male rabbits can be quite unpleasant, as anybody who's been urinated on by a marking male rabbit.
We'll confirm it's not all altogether nice, and there really is a bit of an absence of an alternative. So you can house an entire male with a spayed female, that can go pretty well. Sometimes it doesn't, so you've got to be a little bit careful and watchful with that.
Single sex groups for all males aren't a great move. There's usually a female rabbit somewhere within smell, and that does spark up a lot of aggression, a lot of fighting. Even worse than that is isolation, keeping a lone male, that, that's a, that's a really bad way to go.
And we look, where do hormone treatments work, well they don't really, even the the Deslorelin implants don't work very well in rabbits, so you know, we haven't really got a viable alternative if we want to do something. So basically we do, we usually do need to do this. So to make this better.
And make this a better benefit risk ratio, we've got to do things like mitigate those risks, we've got to reduce those deaths, reduce the complications, reduce suffering and reduce that post neuterring obesity which has its own health problems as well. So going to Kepsa, the deaths were really linked to pre-existing disease. So one thing we can do is we can identify and control pre-existing disease.
We can also look at reduction of stress and now especially more practise using alpha-twos, that combination of adrenaline and alpha-2 does play havoc with the rabbit's myocardial circulation and especially do not have a collateral circulation there, so if we get vasoconstriction, as this combination will do, then we can have, fatal effects, so we've gotta be a little bit careful with that, so reduction of stress is very important. If we want to reduce complications, we've got to look at our surgical technique, and also our post-operative advice and care, spend a lot more time with that. And we want to reduce suffering, and that's the big thing people do worry about there, so we wanna reduce that stress, reduce the pain and get have fewer complications will help with that.
So those are the areas look at, you see there's many common themes through about what we've got to do. And a big part of this is the day management, so castration day management is key as to how we do that and what we can influence. And this is the big thing, I'll say this many times through the evening, it's not a surprise.
This can all be, it's elective surgery, so it will be planned and ready to go, and the more planned we are, the better we're gonna do. And everybody's involved, so the vet, the nurse, the nurses on the ops, the opposite, the nurse on the wards, the receptionist, everybody's involved, so basically we want our protocols ready, we want everybody ready to expect that rabbit in for its castration. And here's the big thing too, when does castration day begin?
Well, obviously it begins with a telephone call. Or it may begin at the vaccination or routine appointment when you see that that animal for the first time. Either way, it's starting a long time before the actual day of the surgery.
And a receptionist will be involved, and this is really key with whatever your practises, SAPs, your your your your practise advice thing is. I've seen too many cases where receptionists aren't involved, and that really does show because that's the public facing bit, that's a bit of a first point of contact for for the owners, really important that they get the information they need from that receptionist. And they do need to give this preparation advice about what what people need to do.
So a big part of this too is a preoperative check. And this may be part of a routine procedure like a vaccination, in which case, how long before should we do this? And if it is a few weeks and things, do we need to redo a check before we admit the rabbit and probably good practise says, you know, at least do a basic check and make sure things haven't changed significantly from that that last time.
And what do you actually need? And some really key things here too, you know, weight and conditions are good, good starting point. Because you may want to, we've got a very obese rabbit, you may want to lose some weight first of all.
Another key question is, is it male? I mean, there are any number of times, it's not always easy in young rabbits, I'll concede, but any number of times where you've actually knocked an animal out and then you find that it's not actually male, and then you've got to contact, you've got to see whether they want the rabbit spayed, whether they do everything else there, and it's all a bit embarrassing and also it's all a bit logistical and it takes a lot more, a lot, a lot longer and it's just really causing problems there too. So is the animal male first of all?
And further are the two testes. It is different if there aren't. So we need to check we can find 2 there and just be prepared if we can't.
We need to see where there's signs of disease and we also need to see where there are possible signs of disease. So do we think he's a polio dermatitis, which may be a sign of various underlying issues, or is the rabbit thin, in which case there may be something chronic going on. I'd always advise people to do nasal capnography beforehand, this is a really great technique for assessing assessing the lung function, and many, many of the underlying health problems these animals are linked into respiratory disease, often very prevalent in young rabbits, especially out from from pet sellers and things, and so we really want to know how that lung function's doing, and they won't show signs very easily and it's very hard to pick up by any other method.
Especially conscious, and this method works very well and it's usually pretty well tolerated, and very, very easy to do, so I'd thoroughly recommend that, we've talked about this many times before, and we'll probably talk about it again hopefully, but that's a great technique and I really recommend it to anyone. And what if there are retained testes? Well, you know, we always use devices for young animals to wait and see if they descend.
And we always do that and sometimes we wait for a very long time and sometimes owners do forget, and, and so do we. So I think it's probably worthwhile if you are gonna do the waiting game is to actually have a have a programme for for regularly contacting or or at least book a next checkout for when they should be descending. Unless the testes is right, is palpable right above the scrotum, usually it's unlikely it's going to going to appear.
It can be difficult in rabbits to take that because they do have a fat pad, in that position, that can be a little bit difficult to distinguish, but if in doubt, probably I would say look, go in a bit sooner. Once the rabbits tend to hit 6 months, they tend to get a bit, bit fatter, and it can be much harder to find those testes internally. So, back to us, how long before do we do the pre-op check?
There's pluses and minuses to doing it the way before, there's pluses and minuses doing it on the day. On the day, obviously what you find is very relevant. The other problem is you may have some time issues, you know, we've all had busy operating days and you know pre-op checks, you know, how much time have you got before you have to start operating and get on with things, and that can be difficult.
What do you do if something is found, on that day, you know, everybody's turned up, everything's ready for the op, the owner's ready, expecting things. If you find something, they may be going straight off to work, what's gonna happen to that animal, in the meantime? Is it able to go straight home?
Do you have to hospitalise, which is going to cause stressful problem things too. I really would stress that you do the pre-op checks when the owner is still in the building because if something is a bit unusual, you can talk to them then. We've all had days when it's really difficult to get a hold of somebody, after when we need to talk to them before the operation, that just causes chaos and stress and difficulties.
If we do it beforehand, we avoid a lot of those problems, you know, if we're doing this at a vaccine check or anything, you know, we avoid a lot of those problems too, but if we're asking the owner to come in twice with their pet, that's a double stress on that animal and that can be a bit bit more of an issue too, so if you can combine it, it's a good idea if you're gonna do that before the actual day itself. There are ways we're gonna talk about too about how to mitigate that and how to reduce that too, and don't forget, here's the big thing I mentioned about time you've got to do this. The biggest stress in the whole room is gonna be you, and the biggest stress on you is time, and we all have busy days, we all have days, you've got lots of admits to do and lots of things like that too.
And so very often it's very, very easy, and I was an absolute devil for this at times when I'm having a really bad stressful day is, which corner would get cut, where would things happen, and you know, sometimes it seems easy, animal looks OK, is that a full pre-op check, and the answer's probably not. And you'll be fine almost all the time, but sometimes you'll be a little bit careful that you do make this a long procedure and you do make this a full proper consultation. And, you get better results from that and pick up a lot more of his underlying diseases that contribute to the problems.
So again, how are we gonna examine, and here's the big thing here too, make sure the companion's there as well. Companions, rabbits are not lone animals, they need to come in with their companions, and again, this will be repeated again and again through the evening as well. Make sure everything's like non-slip surfaces, tables and scales, towels and things, and the pheromone and essential oil combinations, do have some effectiveness in reducing certain stress so nice thing about towels, you can soak them in in in in pet remedy or whatever else there and that's really great.
And the big thing too is, you don't want to scare the patient during this, so if you are doing a vaccine check or you are doing a pre-op before the surgery. Don't scare the patient at this stage. Because it means when it comes in for the castration, he's going to be that much more scared because he knows something bad's gonna happen, so you can't make it into a very good day, but you can make it into a least worse day.
And a lot of that comes from handling and do rabbits really want to be handled, and many of them really don't. I mean, they haven't been socialised well, and they're often fearful, they may have had an injury when they were first picked up as young rabbits and therefore there's always this worry it's going to cause more pain and stuff too. And we are predators, you know, and we're there we are, we're vets, we're we're there in our our scrubs and we're we're there, they don't know us, the surgery smells weird, and they may have found a dog and things, so, you know, it's all very, very, very scary sort of thing.
And some of them have got long-term stresses going on in from home as well. So sometimes we're happy being kept away from people, but in this situation they can't, so you know, it might work well at home being kept away from people, but actually in the, surgery we, we don't have that option. Now this may depend on the animal, it may depend on socialisation, so here we go, how, when does castration day begin?
Castration day begins when they're weaning and when you're beginning to start . To start socialising them, and even when we see them for the first time, we've got a rabbit who's clearly scared of being handled, clearly not well socialised things, you know, there may be time to do some training and to teach people how to handle, how to do stuff, and again, try and get that in process so the rabbit's more used to being handled, more used to being examined and stuff before we get to a big castration day. Always speak to the owner when you're doing an examination about what their their pet actually likes, they're all different, how do they handle them, how do they do things?
And sometimes get the owner to hold because they know the animal much better. If it's gonna be a painful procedure, probably, you know, that's not always a good thing, but if it's not gonna be a basic examination, perhaps they know a lot more about how to hold that animal than we do, and you can tell some degree of that in fact a degree of trust and stuff is, how are they interacting, how are they getting on there too. And always explain what you need, what's gonna happen and what might happen if things don't go so well.
So again, examination again back to this thing about not liking being handled, where are we going to do this? Well, rabbits do have a habit of jumping, so you know, there's nothing wrong with doing this on the floor. This bit I always had trouble with because for bad back and bad knees is very often meant that somebody had to help me off the floor as much as the rabbit.
But whatever happens, don't suspend them in midair and hold them above the floor a long way below because they don't like that very much, they're not aerial creatures. And that can be a problem, but you can have a box on the table, and as here, just take the top off the box and just watch them for a bit sometimes, maybe a light hand on them just making sure you don't do anything silly, see how, how frightened they seem, see, see it out of their general, demeanour, and we can do an external exam, we can auscultate, we can palpate without actually picking the rabbit off, off the ground, and doing that. We will need to handle certain things, ocular exams, oral exams, dental exams, and, in particular for actually checking those testes.
Now you can feel underneath and that circums can be obvious in young rabbits, that's not easy, and it's gonna require some degree of, You know, holding a rabbit vertically or even slightly horizontally, be careful with that too, and this is the bit where you really do have to communicate with the owner, how you're going to have to, why are you're going to have to have to hold the rabbit like that, how are you going to do it and what what can happen because it's sometimes I really do resent that. For obvious reasons. So we've hope you've done our pre-op check, probably done this beforehand or at least we've done this during a vaccination or something.
So we're gonna book in for the opp, now which days are we gonna do this? Now if you've got a big enough caseload, hopefully you can get a non-dog or cat day, so you have a like a a a a a prey species only day and then you're not gonna have the smells of dogs and cats about to which which may be quite quite quite helpful, not always possible, but it's nice if you can. And again, which surgeon, you know, not all vets like dealing with rabbits, and you know, if you want to get stress levels up, it's it's, it's good to give them a few rabbit castrates to do because they don't want to do this.
And you know, it's horses for courses sometimes. I didn't operate on dogs and cats and not all my colleagues operated on rabbits. So it's really important that we get booked in on the right days.
Again, the reception needs to know that, everybody needs to know that. And again, when to booking we mentioned about the 2, and again it's important to note this is not a basic outpatient visit, they're not going to sit and wait. The animal is going to be admitted and it's going to stay in for a period after the surgery and go home later, so this is not a sit and wait and go home, you know, straight in, operate straight out again.
And again, even if, if you can't do a rabbit only day, fine, just have, try and keep away from dogs and cats, maybe separate times for admits would be very nice or separate waiting areas are really helpful. But try and make sure this rabbit is not hearing, seeing, smelling the, the, the, these predators because they don't like it and it can cause a lot of stress and start getting those adrenaline levels rising. Bear in mind the patient's bad day is gonna start with a box, and so this is where reception really come in in in in in in valuable because they're gonna advise people how to do this better.
So this may even start again with training, you know, people come in for for vaccines, and gosh, it's really difficult to get hold of my rabbit, really hard to get in the box, they didn't like it at all. Well, we can train that, you know, you can positive reinforcement training to go into that box, make life a lot easier. We want them to be quiet in there and warm and and dark.
And so that's a basic, need for the, for the, for the travelling box. And what's gonna make this less stressful? Well, first of all, companionship.
Bring the other rabbit, bring the bonded rabbit, really vital. You know, they are not sold, and if you separate them, you've not only got a a lonely, frightened rabbit, you've also got the the the problems with remixing them afterwards. Have a nice deep litter, have a covering and stuff so they can hide away.
Lots of hay through there, lots of hay through your room. Bring their usual toys, bring their usual treats, bring their usual food, bring all of these with them, so we've got everything that smells of them, and, and it, it's gonna reduce those, those stress levels. Pheromons and essential oils can be quite useful, soaked in cloths to get tight into the carriers nice, diffusers in the waiting areas, diffusers in the in the console room really nice as well.
So once they've arrived again, we've got quiet waiting, again, reception's gonna be responsible for making sure they're in the right places, so avoiding noisy dogs and and and noisy people and avoiding the smell of cats and ferrets and stuff, and ideally seen quickly. It can't be, sometimes it's better to just get them to wait in the car for a period. One of the things we learned in COVID is that the car makes a very convenient private waiting room.
And we'll see them soon, so you know, triage is important, hopefully no need in this case. Or non-predator rooms, even if they're in a consult room waiting, that's great, just get them out of the way of a noise or stress, just try and keep those adrenaline levels down. And we're gonna need to hospitalise them at some point too, we're gonna need to take them in, so we wanna get this ready too.
Again, what do we need for this? So warm, not a hot room, needs to be quiet again and again not hospitalised with dogs and cats. I'd honestly say I think it's better to be using a set of sky kennels somewhere quiet in the practise than it is to go into a mixed ward.
Somewhere you can observe them, somewhere they can get privacy, these hides are fantastic, originally sold for cats, and now being sold for rabbits too, these plastic sterilizable hides, absolutely brilliant, and rabbits love them. Hospitalise them together, really again, those banging, same old drum again, I know, but you know, make sure they're going to be together all way through. Light levels too are important.
Remember, rabbits are crepuscular, they like dim lighting, they don't like bright, bright lights, they don't really want total dark either, but just a dim, dimly lit room, so if you've got a dimmer switch on in that ward, that's really helpful too. And again, all their own stuff, their own bowls, etc. As mentioned.
Bit of space if you can, we gave you hiding, they'll come out and do things, so again, so I can do lots of normal behaviours and things really useful. And make sure everybody knows, this is one of the nurses I worked with, she did these for us and they were just fantastic. So all the wards had the instructions about how to set up the the the the the the the the bedding, how to set up set up a caging unit ready for the patient.
And I said, this is not a surprise, it's not a sudden, oh my goodness me, it's ill, it's got to come in. This is planned, this is ready. So at the start of the day, the ward nurses should have that this is what's coming in there, so these can be set up and ready to go as soon as as soon as as soon as the rabbit's admitted and it's really, really useful and I love the way Abby did these for us and with with both words and pictures and it just meant it was so simple for everybody to everybody to follow.
So I mention my companions a lot, I will again, is there a time you separate? Well, yeah, on the castration day you are gonna have to separate during surgery when the when the one's being operated on, they're gonna be separate then and potentially for part of recovery too, depending on how smoothly that's going, although I must admit I did like them to, if possible, to recover together too. But really keep that as short as possible, and where they're not actually together, if you possibly can make sure the companion is in sight.
And in smell, and if you've got separation via wire, dividers, then maybe even via touch then so they can actually snuggle up to a wire next to each other too, it's quite nice, and remixing can be a little bit difficult, but really make sure they're remixed before they go home, so we haven't any territorial effects once they get home, we're doing it just in the hospital area and that'll make things a lot that's a lot smoother. So hopefully by this stage, we've ruled out and treated any underlying diseases beforehand, so we've got no surprises. We've brought them in with a companion, we've kept them away from the dogs and cats, everything is quiet and calm as possible for rabbits and for surgeon, and our rabbits are now in a quiet dedicated area and this is now we can actually think about doing the op itself.
I'm a great fan of Checklist, I think it's absolutely fantastic. Again, they make sure we get things ready beforehand, . Again, it takes time to do this properly as well, so checklists are great.
And audits as well, and these are something I think we, we really should be doing more of, it was that time thing I know, but they're really great, and OK, anaesthetic mortality is a great thing to record, but don't forget to record those near misses, the things where something's gone wrong and OK the animal hasn't died, but something was happening that could have done, and those are the ones you really want to get a grip on because they're your, your, your early warnings. So near misses are great. So, is there an ideal anaesthetic combination?
I mean, the simple answer is no. But this is where audit comes in, so you may be doing all kinds of things, you may be doing a total injectable regime, you may be doing a pre-med induction and maintenance sort of thing too, and you may feel there's no problem. Do an audit, is there really a problem, is it, is it good?
And sometimes you think, oh she's terrible, and actually do an audit over the last 12 months and get a decent period of time there and actually find actually it's not going too badly, it's just a a maybe a bad spell or or a sick patient that we we didn't pick up. So all that's really helpful for is evaluating just how good that regime is and whether it needs changing rather than something we do knee jerk things, we have a, you know, rabbit dies in that setting, we change everything and it's not necessarily needed. They are licenced drugs, we're a licenced drug, alfaxolone and and also isoflurane, so are we using those?
And if not, then we need to plan if we're not doing that and and how we're going to communicate that. So always plan and review our plans. So we're gonna pre-med probably, we want that to provide pain relief, we want sedation, so we're gonna try and reduce that anaesthetic dose and hopefully reduce post-op pain as well.
We, I always like these to have, stress relief, and that's, you know, get some axiolysis on board, and that's one of the reasons I like midazolam so much as part of a premedicant regime. And that's the other reason I like midazolam is because it's amnesiac, and we talked before about if you give a patient a bad time, next time is worse. Take away its memory of that day, and actually we may not have that problem, and the benzodiazepines are definitely amnesiac and that's not a bad thing to do.
I would stress to give these subcutaneously rather than intramuscularly if you have that if that's that's the root there because you're gonna have much less pain and shouldn't take away any effectiveness either. And when you're gonna give those, and almost certainly as soon as you've done a check, as soon as you make sure mate Rabbit is healthy enough. And really sedate them as quickly as possible, get the axiolysis on board as soon as possible.
And then admit somewhere quiet and let them calm down. If you stress the patient enough, they're gonna have, they're gonna get upset. The this pre-med is not gonna work so well.
And make sure you wait a decent amount of time before you do anything else, because if you go straight in there, the drug's not working and actually you've undone all the good and probably caused more stress. An example of that is catheterization, and yes, I think we can recommend now that probably all cases in East side do have a catheter placed if at all possible, . And we can use that catheter obviously for reversing agents but also for induction agents and maybe for fluids and and and when we need to do that.
And we could, but we don't wanna place that straight away, you know, rabbits come in, it's frightened, 2 or 3 people jump on it, grab it's ear, which is a very sensitive part of a rabbit, and start putting a catheter in place, is not gonna do any favours with those adrenaline levels. So we pre-med, put somewhere quiet, 20 to 40 minutes, and then place that catheter, just to, . Just when I hope he's not karma and won't remember the process either.
And to remove it, again, don't forget how long afterwards a lot of these these problems were, so probably removal before they go home, but no sooner. And again, a good thing to do before you induce anaesthesia is don't forget to do a pain score or do a baseline. I think it's a good thing to do after they've been pre-med or as they're being admitted after they're pre-med, do a pain score, at that point there too, so you have a nice baseline, see what that rabbit normally looks like, there's again, individual variation within that.
So induction, again, you might be doing a fully injectable regime, so maybe a triple combination, maybe have a fax alone on its own, you can go by top-up and increment. You may be looking at injectable inductions with faxone or propofol, and then moving on to on onto gas from there. Or you may be looking at gas induction as well, which can be used, probably in this instance, probably not so much.
With all, whichever way you use, again anticipate what the likely problems are, so we're gonna we talk about triples, talk about, alpha 2 and, adrenaline combinations and hopefully we've got adrenaline level right down so this is now gonna induce those vasoconstriction issues, but hopefully we need to be ready because a common query I used to get was, you know, I gave the alpha, I gave the EV alpha 2 and the rabbit just died. And that's where we want to really want to try and avoid or have everything ready in case that does start to happen. And again, is everything ready?
Is the anaesthetic machine ready? Is the, are the, is the are the tubes ready? Are the, circuits ready?
Is all the stuff you need for maintenance ready to go once you start inducing? If you, if it's not, you may have a problem with rabbit coming around. So then, next question, do we intubate or do you use a V gel?
. Whichever we're doing, we'll probably have to check the mouth before we place anything and give it a clean if necessary, . Some, there is a lot of gross at the back of my mouth there, we don't want to be putting either V gel or or an AT tube through that and causing more problems later. So intubation, again, maybe we always wanna do that, we probably always want airway protection, that might be intubation, might be not, I've stressed all these cases should we have something in there.
There are various ways of doing this, maybe a blind method, maybe doing it over the scope a laryngoscope. Laryngoscope tends to be much better for the . For the bigger rabbits, so not quite difficult, very difficult with the the small ones, and personally I really liked doing a direct visualisation with the endoscope, see in the top right picture here, there's a soft palates really covering that area and it's quite hard to find and get into the larynx, and the blind methods sometimes can cause some trauma there, so it's worth, I think the direct endoscopy is really good, and these little scopes can be a lot cheaper than you think, and easy to use.
Alternative methods are V-Gel, I like these a lot, and I always use these a lot too, and they provide this lovely airway seal and you can do a lot with them. The big deal with, as we can see from a picture here, the CT showing one in place there, is that you get a lovely straight airway, and you, well, most of the problems from these are because we're used to the T tubes about moving the head round, which is a bit careless because the tube tube will kink, but we don't see an issue from that. Whereas with these, if they don't, if you kink that airway, then you're gonna have a real problem with the V gel, and I think that's why most people run into problems with them.
So we have to keep the airway straight. We also have to monitor properly, and so capnography is essential for making sure these are in place and working correctly, and we can see even slight changes pick up on the captograph quite quickly there too. That's brilliant, you know, it actually, these are devices that make us put the rabbit's head in the right place.
They make us monitor in a really good way, so that's quite good. And if you don't be, if you're not doing that, then you're gonna find the VGL gets compromised, then we get choking and compromised patients, which a lot of people do find. The tongue swelling is not such a great problem with these, .
Though it looks very dramatic, it's not a major problem, and normally if you just move the tongue around a bit carefully, then you can get a little bit more of a venous flow back again and, and, and it, it, it, it de-swells. Quick, reference here is regarding to the effectiveness of V gels, and they came out quite well in this particular review, worth a read though. Other papers, again comparing ET tubes versus V gels, really very much show little difference between, these two techniques.
Ventilation, as you can see, one of them was an issue. And here's the thing too, and you know, ventilation of these patients is a great thing if you have it, mechanical ventilation's fantastic. You can do this via both ET tube and VGel and adds an extra level of control into anaesthesia.
And again, mechanical ventilation is absolutely fantastic technique to be doing. Another set of papers again looking at the difference between these. Again, the study, studies have effects, but overall there are no real differences in anaesthetic performance between using an ET tube and a V gel.
So again, it's about how to use them, use them correctly, and we can get some good results. For, another problem we run into anaesthesia, we'll be keeping them warm enough. One way around, let's have a very warm theatre, does tend to annoy the other surgeons, but hey, it's good for your patients.
They don't forget rabbits do have because they're sort of tubular animals have this very big surface area to volume ratio and lose heat quite quickly, so you do need to have heating devices ready and stuff, like this bear hugger here, this is the pinning rather than the castration and monitor body temperature if necessary, rectal or or ear thermometers. And what else to monitor? Well, pulse ox is always one of those old favourites.
ECG can be used, they get a lot of wires everywhere too. Cainography, absolutely love it, and if you're using a V-Gel, it is absolutely essential, it's mandatory for those. We can do blood pressure monitoring, we can, or you just have a Doppler on the distal limbs or the ears so we can assess peripheral blood flow.
If you're using VGL, very hard to use esophageal stethoscope, you can do, but a really big thing to note is you want an anaesthetist sat on the patient with a stethoscope, fully giving her time, fully giving her attention. This is why it's important to have everything ready. We don't want them to be dashing off, finding a bit of equipment we might have needed and we haven't got ready beforehand, and therefore the patient is, is unmonitored.
You want your anaesthetist sat there and devoted entirely to this, so again, get everything ready beforehand. What do we do? I used to use a I was a dedicated anaesthetist, very important, and if you use a dedicated anaesthetist, don't forget things like CUS and stuff.
Concerned, uncomfortable, stop. All of these things where the anaesthetists can get through to a surgeon that something is going, is happening and then you need to stop. So in other words, surgeons, listen to your anaesthetist, there's a problem, explain what you're trying to do.
Or stop and give them a hand, it's really important. Capnography of course, occasionally we'd use Dopplers and occasionally use ECG depending on the patient and the anaesthetic regime. Have your emergency stuff ready too, again, it's too late if you've gotta look for it then, so your box needs to have Doxepram, adrenaline, you've got your catheter in place, this is when you're gonna need it hopefully, hopefully you won't need it, fluids at the end of that too, but one thing I would have, and some rabbits really are difficult to tube, if you haven't been able to get an airway protector in there, make sure you have a tracheotomy kit ready.
It is unlikely you're going to able to tube or V.jell a rabbit when it's stopped breathing, so you're gonna need to do a tracheotomy, and that's a little kit, they're quite easily available, or you can make one up yourself to have that ready to go straight into there and get that prepared. So ventilator 2 in those cases by the manual or mechanical has said.
And again, bear in mind why they die during anaesthesia, and that may be heart related problems or triples, that may be down to hypothermia, that kind of stuff too, so you need to look at that too. But above all, remember your A B C D. Have that mantra in your head and go through that in that order and that's gonna help an awful lot.
So I know there's a big thing what to have ready in an emergency is you and meestis acting correctly in right orders and things. So the op itself, we're finally going to get to that. So site preparation important.
Minimal hair removal, this partly to avoid drawing attention to the area afterwards, partly because we don't want the area to get cold or have problems from there too, so the nice thing about scrotal approaches, you can pluck the area, you can wet everything, get the rest of the hair out of the way, and it's all very simple to repair, we don't need massive areas clipped up. So it's not an extensive surgery, remember that too. However, things like tissue reactions, so bruising, long exposure of tissue to air is going to lead to problems.
So if you have a rough, slow surgery, you're gonna get increased pain, you can get tissue dehiscence, you get tissue damage, you're gonna get more complications, for example, surgical site, infections, and we're gonna get, possibly increased gut stasis from that too. So in some ways it's not always a day one op, it's something you've gotta build up to a bit cos you need to have a little bit of tissue handling skill before you get there. So what do we do, this is the easy bit, so we, everything's sterilised, we can open the testis through the scrotum, we can push the testes out, we can then .
Break the gubernaculum and clamp it, as you can see in this bottom picture here, we now have a cord exposed, that can be ligated. And then we can, remove that, push a tube back in there, strip back the, tunic, and tie it up as high as you can. If you're gonna have a hernia, make sure it's as high up in the inguinal canal as possible, so you're actually removing a section of a vaginal tunic as well.
And so we strip and ligate that, take that away, glue the skin, and we're gonna think about analgesia. And this is slightly out of order, but local anaesthesia is fantastic. This is our only real true an analgesic, we use, and we can do this in three ways for the castration.
We can pop some intrasticular, and the important thing is you calculate your maximum dose, so we can do that, we weigh the rabbit, we got that, we know the maximum dose either bupivacaine or lidocaine, we draw that up, we dilate a bit of saline, so we've got a bigger volume, we put some intratis. Do an incisional block and then at the end, do a splash block, and you've got 3 levels of blocking, and certainly in farm animals, intrasticular local anaesthetics has been shown to do a lot in terms of pain relief, so it's really important to do. Post-operatively, do we need antibiosis, now, we try and avoid that if possible, in many cases you will be able to, but just have some idea about where the rabbit's gonna go back to because in some instances it may not be very difficult to create those wounds, particularly in some rescue things, particularly for an animal that's very difficult to handle, and so we may need a bit of antibiotics in those situations to make sure we don't have to do any more work than we have to, but in most cases you probably don't need to use too much, if at all.
And again, have a regime where you're not using, if you are using antibiotic, not your criticals, so look at more like trimethrin sulfonamide than using, fluoroquinoline, for example. Analgesia again, we're probably gonna use NSAIDs, we're probably gonna give those at the end of the op when blood pressure can start to come up again rather than beforehand when blood pressure can drop, we may get more renal effects from it then too. We may have given opiate in the pre-med.
So we may not need to give more opiate or we may feel we need to give more afterwards or give it at the end of a surgery in place. And if we're using a triple combination, don't forget the alpha-2, the ketamine, they're all an analgesic agents, if we reverse them we do lose the analgesia that too, so don't rely if you're reversing. Most pain management is not a block, it is actually a perception of pain, and so things like opiates, things work on that.
Other route, other non-drug methods work into that too, so again, having the companion, Having a mental stimulation that companion there is going to help, enriching, so providing feeding enrichment devices, things like that too, can all help to reduce that pain and getting back to a normal regime is going to help as well. But we want a pain score, so we're gonna do that after the rabbit's recovered, we're gonna do that a few hours later before they go home, and we need to teach the owners how to do this as well, so they can pain score over the next few days and and let you know early if things are getting worse or are still ongoing pain problems. In other words, we've got to be able to recognise that pain, us in the surgery and the owners.
We may want to give additional pain relief drugs in those instances, but don't forget for most of these drugs there's very little evidence of effect or safety or dose rate. We don't always know the side effects of them, we don't always know if we need them, so this is why things like reviews are really important in pain school. Now there are issues with pain score about, you know, being difficulty in in facial recognition and stuff.
But also these new things like qualitative behavioural assessment where you take a holistic view of the whole patient is a great way to go, I really recommend people start looking more into that area, and we can look at phy physiological signs too, things like faeces, appetite, etc. So in other words, be prepared to be flexible with these analgesia plans. Wound care important as well, I really hate collars, I don't see a need for this.
One of the great things about using a scrotalum root is you don't have suture in the skin, you have just, just glue, and that helps a lot too. Local anaesthesia really helps as well, and when you do have suture, you are using like subcuticulars and stuff, well, you know, if you do need to do that too, again, sympathetic, suturing techniques will also help with removing the need to chew at them, but avoid collars if you possibly can, they cause mega stress. I haven't mentioned prokinetics, and that's because I never use them in these anaesthetic regimes too.
We might think that jab metoclopramte's gonna help prevent gut stasis, it's probably not. What we're more looking at is looking after that fuses coli, and that may be from using analgesia, from fluids, anti-inflammatories, that sort of thing, reducing stress, getting feeding going soon after the op as possible, so when the animal's not eating within an hour, I really would recommend syringe feeding takes place. And a return to normal, and then only then if nothing's working, getting a gut stasis might you think the prokinetics are probably going to help out a bit, but normally get that fuss coli OK, get those that'll be analgesia, anti-inflammatory and fluids right and stress down and you won't need prokinetics, and certainly when we stopped using them, we have absolutely no difference in in the current rate for gut stasis.
So on recovery, we're gonna get reversal drugs that need reversing, we'll give analgesic, we give fluids, oxygen to a fit to to D-tube or DV gel, keep them warm, and then move them to a companion reward and watch, this is a big risk period. Feed 36 minutes later and watch again after that and see how they're doing when they start eating food and stuff. So when to discharge them, again, when they're fully recovered, as soon as you can really, but when they're fully fit to go home.
Set an appointment, again, back to these pre predator free rooms, so it isn't gonna smell stressful, just because castration's OK, it's gone OK, doesn't mean we've gotta worry them for next time they come in too. And again, who's gonna do this, it can be nurses, it can be vets, it is important if there's been. Complications, and if you talk to the owners, one of the most things they get most worried about and most upset about is that nobody talked to them and nobody told them.
So in a busy day, yes, it may be difficult for a vet to discharge and explain everything about what happened, any problems with the surgery and stuff, but in that case, even more important to have a phone call first of all and go through it before the owner comes in. But bear in mind they're going to come in with questions and somebody's going to need to answer those and it can be difficult. And it's one way when something hasn't gone quite right of heading off something and becoming a major problem rather than just a bad day.
We'll need to do post-op checks again when it's really good to follow up 24 hours later to make sure the patient is eating OK, does appear to be comfortable, is behaving OK, it's worth checking a few days later, make sure the wound's OK and things too. And how are you gonna do that? Are you gonna do it by phone?
Are you gonna make an appointment, bring a patient back in again, remembering this isn't cause more stress, or can any of this be done by things like telemedicine with videos and photos? And actually you're saying like a castration, there's a lot that can be done by remote. And certainly even a basic phone call saying how are things going the day after, that's really great.
Is there a problem, right, OK, better, better have a look then. Just like triage from there. And a few days later, can you send me a picture of the wound if possible?
Can you, do we can have a video and you can show me the rabbit over the, over the, over the, app or over the, Zoom, that can be quite useful too. In other words, we probably want to use a combination of these methods, and if something looks a bit weird on, on remote, then we can, bring them in for a consultation. So in summary, Really, the castration day and the castration success rate should be the same as for a dog or a cat.
It's a simple op, it's short admission times, it's expected. Elective surgery, we know what's there, we should be ready, we're not always. And we do understand a lot more now of what rabbit needs, and so all of those should add up to those same success rates, we should not be looking at 1 in 150.
Thank you Thanks very much, John, and now we're gonna have Ellie who's gonna be talking a little bit about what's going on at er Burgess. While Ellie's getting her slides set up and everything, if people can tell us where they're listening in from, it's always exciting to know where about in the world you are, be you in the UK or further afield, so do tap that into the chat box, don't be shy, er it's always great to hear and obviously now. Although we can't have this live, on recordings, we now have 22 languages on the site, so you can actually go to the recording.
And if you've missed some things er and we are doing that language, then you can actually er look at it in that language as well and the translations are very good. Er Wollongong, I was there in September in Australia, Hamilton, Ontario, know Hamilton very well, New Zealand, Preston, Surrey, Athens, great to see you, Germany. So people listening in from all over, Aberdeenshire, Mostar, I've been to Mosnar in, Bosnia and Herzegovina, lovely place, the Philippines, the Wirral just across the way from us, we can probably wave at you, Claire, in the Wirral, Cleveland, Ohio, great to see, so many people listening in, and Ellie, I will turn my video off, but turn your video on and looking forward to hearing the presentation.
There we are, yeah, lovely to hear that you're coming from all. Tonight, so thank you very much for that John, even and I learnt a lot there, not a vet, but I definitely learned a lot of things about rabbits. So I'm from Burgess and I'm just gonna have a few slides to talk to you about what's going on with us, and we'll get onto them questions at the end cos I saw quite a few good ones coming through, so I will.
It goes along a little bit. So XL Dual Care is our recovery food, so dual care is it has a dual purpose, hence the name, so. The box that you can see on the screen, inside there is 10 sachets and inside that sachet is 60 grammes of nuggets, so you can see that on the screen, and the dual purpose is you can feed as a nugget or you can singe feed, so John was talking, just then about .
Got stasis and feeding after anaesthesia or at times of stress post op or just stressful periods, you can swing feed dual pair by adding water to the nuggets, you add warm water to the nuggets at a 2:1 ratio, give that a good mix once the nuggets have absorbed all the water and it's ready to sponge feed, . It's a great way to to get that gut going again. It has high levels of protective vitamin C, so it is suitable for both rabbits and guinea pigs and chinchillas if you do see them in practise.
There's probiotics in there to support the digestive tract. There's L tryptophan in there which is a serotonin precursor for the regulation of stress, and as Jan, John has alluded to, these rabbits might be stressed, more than likely are stressed when they're with you, . So that's really helpful and there's also extra magnesium in there to support the immune system and to help with stress regulation as well.
So that's a great product and as there's 60 grammes in the sachet, you often don't use all that in practise with your patient, chances are you probably use about 20 grammes and you probably do 2, singe feeding sessions before they go home. It does, vary depending on where, where you are and and what processes you have in practise, . But you can also offer them as a nugget once they've been spoonge fed to see if they are willing to eat the rabbits or guinea pigs in your care, and then the nuggets you don't use in that 60 gramme sachet you can send home with the, the bunny, so you know that, at least they've got something that they, they could potentially eat that might help with them stress levels and their recovery, once they get home.
So we always like to talk about what we've had coming up at Burgess and what we've been working on. So we've been working on some new product development. Sorry I've put a NPD on there instead of actually using the full words, so I do apologise for that cos not many people will know what that means.
So the new product development we'll be doing is mainly on our hay, which is mainly because rabbits. Eat mainly hay, so we've been developing lots of new hay products, so the two top ones that you can see, they're actually not new products, they're, existing products that we've developed, a little bit just changed their packaging size, so that uses, a little bit less plastic and it sits better on the shelf. So that's our Timothy Hayes, one with marigold and one, plain.
So the marigolds in there will encourage natural foraging behaviours. We've also got a hedgerow herbs feeding hay, which is a meadow hay er which has herbs in there from the British hedgerow. So that encourages the natural foraging behaviour.
And then our long stem feeding hay, so our long stem feeding hay has been a product for many years now. We've recently launched long stem for Timot the hay with marigold. Which is again there to encourage natural foraging behaviours.
All our hairs are grown on UK farms, which is around 30 minutes from where we manufacture our nuggets, so near our mill. All our hairs obviously promote good dental health. They are just extracted to help with, any respiratory issues.
It provides the beneficial fibre and as I've mentioned, it encourages lots of natural foraging behaviours. So I've talked a few, a bit about a few of our products, but the thing that I'm hoping is gonna be, really exciting, for you all is our new vet portal. So you might be aware of our posters, our care guides, our leaflets that we have, we have a vast amount of literature that we like to send to practises to help support them.
So the three posters you can see there, there's one about jaw care, there's one about, general anaesthesia in rabbits, and obviously the one in the middle is about hay. But these are now available from our vet portal, where you can download them, print them yourself, or you can put them on electronic screens that you might have in practise. So this, QR code, if you scan that, that will take you to where you can sign up for the vet portal.
It's completely free to access, you just need, an email and to make a password and then you'll have an account on our vet portal. So on there you'll find imagery of our products, you'll find posters, care guides, leaflets, our campaign packs, so our raw and GO packs are on there as well from earlier in this year. You'll also find blogs and webinars, so there's lots of CPD on there for you as well.
So hopefully that is useful to you all and it's. Quite a lot of practises have let us know that they're moving away from paper in practise and they have digital screens, so they're all PDFs so you can use them digitally as well and also share them with your clients too. So that's short and sweet for me, try to keep it nice and nice and quick so we can get onto them questions.
If you do have any questions or need any support from Burgess, that's the best email to contact me on and that's that QR code again to join the vet portal. That's great, Ellie, and I know you always produce such fantastic charts and so on, you know, we, when we see you at a conference, you're always rolling up charts. Everybody loves to go to the Burgess stand to, to pick them up and they looked pictorially really lovely there, but also with really great information and having them on a screen is also helpful, the the fact of, you know, the, the hay, the really high quality hay that you're producing.
And I know all of that kind of also keys into your commitment to sustainability which Suzanne and I and Peter often talk about, which, you know, perhaps people don't always know about, and just to let people know who are listening in, we're gonna be doing our veterinary green discussion forum for the 5th year in June, it's very much, you know, veterinary sustainability, environmental sustainability is a global problem, it's certainly a regional problem. And we're actually holding it in . The Camargue this year, so we took it into France last year, had about 10 nations coming, if sustainability is your thing, then do get in contact with us after this, webinar and we'd be happy to send you some information out about that.
It's really important that we can't run a business, we can't run a practise. If we have no planet, so it's something that we're very passionate about this webinar that we've been doing that conference now for nearly 5 years and there's some really good initiatives coming out of it, so, if you are interested in knowing more, get back to us. I have to say, John, do put your video back on, but Paula is watching from a yacht in Prickly Bay, Grenada, that sounds very exciting and the fact that you can watch a webinar from a yacht near Prickly Bay in Granada, is pretty amazing, so how webinars have brought us forward in the last 15 years since we introduced them.
So we've got some questions, I did notice one at the start, John, that I'll start you on while I start, delving through the questions, . Somebody said oh we're not doing over a hysterectomy as well, . You know, clearly for me a long time ago when I was doing this.
Castration always felt more routine. Than over, over a hysterectomy, but presumably, a lot of what you said could be applied to that, but it obviously is a bit more of a complicated operation, isn't it? I want, the original remit was to write about rabbit anaesthesia and I just thought, do you know, I wanted to show the day's journey, show the the anaesthetic journey.
And if you notice it's, probably the shortest parts of the talk were actually on the surgical technique itself, so you can change that for your ovarian hysterectomy. The actual anaesthetic techniques themselves, again I think with small mammals are probably more important parts are in the prep, are in the stress reduction around the surgery time. So I just want to do it as a day's journey really, and I picked castration because firstly, again, I don't want to do lots of operations, just get more confusing then.
I have a very confused mind. So I think I picked castration because it's a simple one, and I wanted it simple, and also because the results are surprisingly poor. And so there are problems, people do worry about it.
There are bad results, bad things happening from time to time, even from my postbag and phone calls still, people have some issues that occasionally and. Again, it's one of those things where even though things are improving in owner perception too, it's not great, and people do worry about it. So, they.
Some people are reluctant that makes them reluctant to go to the vet in the first place, so there are things not being done that maybe should be done because people are too worried to go there. So again, it's a way we need to reassure the client and we can do that through good results. So that's why I picked castration, because I want to show the journey rather than just an op.
Yeah, I, I remember again going into the mist of time a bit, but. Halothanee, I was much more reluctant to anaesthetize than with isoflurane, so I think we, we felt like we'd got better, but obviously there's there is with the gas one to think about. I would suspect probably a large number of our delegates tonight have never heard of halothane.
I found that to my shock, a few years ago, but also Io, very rabbits of Aquila iso, you know, birds and things like that too, ISO just changed the game completely. Yeah. Rabbits really don't like iso.
They, they, they, they, they, if you gas and don't iso, the apnea is horrendous. It's really irritating if you breathe something in an accident yourself, it's really irritant stuff. I don't like it smell wise, so, it's a difficult one.
Sevaflurane much better if you're gonna use gas like that. Because they find it less irritant, but yeah, it's a difficult one, and again I think we're using different techniques now anyway, we probably do use isoflurane for maintenance, once we got it through a tube rather than through a mask, but yeah, so, and, and actually it has a third of the greenhouse warming potential CO than ISO, so it's again it's a better one. And then there are human safety aspects too with all this as well, so you know, it's chain of problems sometimes with the the isofluorane.
Somebody's asked if inhalational anaesthesia is not available, you've only got injectables, which you know, we know happens in, in different places in the world, do we still need to assess the pulmonary function? Yeah, definitely, I mean the, the, the, it's going to be compromised, so you're gonna be using drugs which are probably going to reduce the respiratory rate and, and, and depth and things, those lungs do need to work, and if you haven't got ventilation thing, yeah, for goodness' sake, if you can provide oxygen support. So at least you've got a good level of oxygen going in there too, so you still need to get that airway, still need to have that going through there.
If you can't, and again sometimes you can't, even more important though, those lungs still have good function to them, so yes, definitely. Brilliant, thanks John. And Kiera say, would you recommend an open or a closed technique?
I tend to use sort of if you like, a mixture of the two really, I use like open then closed, so fully closed I always worried me because I have seen one where the cord has just slipped back through and you know, I do worry about that, so yeah, so I'd always open and then close. It's nice to get that ligature on nice and firmly, isn't it? Yeah, I think it's probably that control freak inside, I just want to see it and feel it and do it, so, yeah, yeah, no, exactly.
Now I'm not sure and I might have missed this part, but Manuela is asking, do we, should we avoid to fix rabbits with strings during OP or do we have to, to do this, I'm not sure, I presume maybe sutures. But maybe that was the skin, Manuel, if you want to sort of clarify that question, we'll come back to it, . Again, if you could give any brief advice for perioperative IVFT, what would your recommendations be?
Gonna vary with the patient, my feeling is we we if you've got a catheter in place, you might as well use it. So, you know, there's no harm in rigging up a drip line through through the procedure. Once induced through to recovery, or, you can bolus subcutaneous afterwards or you can, and just maintain the the catheter for, for, for emergency drugs, you know, there there there's choice in there too.
Again, somebody's asked, our, our practise has a history of rabbits not being at optimal plane of anaesthetic during surgery. How do I best approach updating our pre-med regime? Right, OK, this is where audit's fantastic, record these events and what happened, you know, how far in was it, how long ago since drugs were given, what drugs were given, you know, this is where you really look at, you know, how long do those drugs last for and things we'd use a pre-med.
You know, again, there's so many variables in there too. It's a way you just sort of sit down, record what happened, get a picture from various cases altogether, and then see, see what the problem is, and then that should hopefully give you more ideas about what the solution will be to that. So there's no simple answer to it unfortunately, there's many different things that could, could be having that that that bad effect.
Which is not the answer you probably want to hear, but it's a case of just, you know, write it down and it's much easier to see. It's a bit like, you know, it's like the fitting dogs and things is that you know you keep a diary because your mind remembers things wrongly and and and and and doesn't doesn't get that right. So the benefit of good notes and dosage rates and everything is really important.
And again, that benefit of recording near misses, you know, we we we we record the bad, really bad days, but certainly we don't record those quite bad days, and that's really important because that's where the initial problems are beginning and you know, investigate those, reflect on those, really helpful. And there is always a little bit of variation, you know, within patients, so the same size rabbit, same weight, you know, can react differently can't it to anaesthetics and drugs in general. Yeah, absolutely.
Lucy has said, do you find subcut pre-med is as effective as I am? Yes. Again, may vary with some drugs and things, but you know, check, check the the the deformities and stuff.
If you can give it subQ, please do, because they are . You know, they, they, they, they are much less painful and usually just, just the same degree of effectiveness. Yeah, yeah.
Patricia is asking, when are you doing capnography? What are you looking for as normal and what is a concern? Brilliant, lovely, how long have we got?
So this is, I think what would you need, John? Really, right, you need a capnograph, you need, a side stream adapter for an ET tube, so you've basically got the thing with plastic bit that goes into the ET tube, it connects to a circuit. And then the, the side stream goes into the side ro with a capnograph, OK, so you've got straight through.
Circuit or sit through airway through there, you put a bit of local anaesthetic in a rabbit's nostril, give it a couple of minutes to work, and then you carefully insert that into a rabbit's nose, so it's breathing still through there, but of course you're sampling from the capnograph all the time, and you're looking for it to be around about 4% carbon dioxide and exhaled breath. If you start going over 5.5, 6-ish, you've probably got issues within there.
If you've got very, very low readings, it probably means a rabbit's got a bit stressed and huffing and doing weird breathing patterns. Brilliant, thanks John. Chloe, you're allowed to ask this question, you say, I know it's not exactly relevant for today's webinar, but we can always stretch things out a bit.
John's very understanding. What's your opinion on pregnant spades and rabbits? Is this something that can be done like in cats?
Yes, I mean it can be, I mean, it's like all these things it's best not, and it'd be nice to avoid, and sometimes you find you've got no choice there, it's there. I think the important thing is, if you're not expecting it to find it, you've got to talk to the owners really, haven't you, so you've got that big delay and hopefully you get hold of them because that can be a really emotive issue if you've just gone ahead and they didn't know. So yeah, you've got to got to communicate, but yeah, and technique wise, exactly the same really.
Tina said we'd like to know John's preferred GA protocol with drug doses for routine surgery. It's probably how much is a, you know, there's a variation again, isn't there in experience. I think everybody has a standard and actually what I would do now is not what I did 3 years ago in practise, so you know, it's different, things are changing, it's quite good, dose rate wise, I can't remember, and to be honest, I made a practise of not remembering drug dosage because he had a habit of changing.
And also just get yourself a standard. It's the ones you're auditing and shows it works, record what that standard is and the dose rates there so you can do a nice, easy to use chart, people can look at it easily, less chance of mistakes, less chance of overdoses that way, and I think that that's a really important thing, having a really nice SAP, and make sure that's easily followed by everybody in practise, gets standardisation there too. For the routine surgeries, I do worry when I see something like standard.
Standards being applied the same anaesthetic being applied for a young rabbit undergoing castration as for a really old rabbit with an internal problem, you know, that that can be a problem, but yeah, so very vague answer. It's not something I'm very comfortable answering because I think that does vary a lot with, with how you get on with things. And I'm always very worried that people say, oh, you know, I'll do it because that person did it, and they take what's been a really successful regime that's worked really well for them in this situation, and it won't work so well if they do something different, so that's my concern.
I always used to say, John, you know, the best anaesthetic is the one that you're most familiar with. Yeah, and there's always that old adage, isn't there, there's no singer, safe anaesthetic, safe anaesthetist, and I think that really comes down to the whole point of a talk and why pick castration and stuff, is that it's the anaesthetic regime, it's the anaesthetic day, it's the anaesthetic, management as much as the exact dose rate and drug to use. So that, that's really what I think, that's what I would like to be the take home message tonight.
I was on a podcast yesterday. Somebody in America and . The amount of, you know, when we qualified, we had to learn a lot, now with all of the stuff that's on the internet, it is very accessible, obviously you've got the formularies, the BS saviour one is always amazing, small animal and exotics, and, almost trying to remember everything is impossible as long as we've got the book at our side, you know, it's something we can refer to because there is so much more knowledge.
I, you know, you may remember the, the stat, but you know there's gigabytes, terabytes, whatever bytes, being added all the time, so actually trying to stay current in everything, even, you know, in your area of exotic medicine, it is, you know, probably impossible, isn't it, so we have to have, you know, the, the internet resources. You know, video and written to be able to go in and say, right, OK, here's the formulary, these are the anaesthetics, etc. Etc.
Yeah, and really important. Yeah, really important you review as well and so you know you come on your station. If anybody's got long winter evenings and stuff, got time to sit and go through all the old textbooks and go through, you just look how the particular thing like the triple combinations, the dose rates have fallen and fallen and fallen.
And what we first used when meatomidine and stuff came out was massive competitors now, but of course these are protocols that came through from lab rabbits who are generally young, generally quite healthy, . And a certain loss rate is not unacceptable. Different in pet rabbits and of course different type of animals, and so you see with usage those those dose rates fall and fall and fall and fall, so it's always worth reviewing and and just making sure you know it hasn't changed again since you were last using them.
Yeah, and somebody's just again asked . You know, where can we watch or learn the right way to desex a rabbit, are their courses. I don't know, I mean you may know this better than I, obviously you can go to places to learn, you know, desexing dogs and cats.
Are there places where you can do rabbits, John? Not that I know of, no, I don't know, I haven't heard of one, so the best thing, you know, to the person asking that question is an anonymous person, so I can't er be a bit more personal with you. And I don't know where you're, you know, where you're based, but there will be vets in your area probably who are exotic specialists and, and I think it's a great way to do CPD, you know, can I come in for the day, have a look at what you're doing, yeah, if, if you're a small animal vet, you know, an exotic vet, you don't want loads of rabbits dying, so I think, People are usually pretty happy to share that sort of information, you know, you sit on their, on their shoulder and if they've, you know, if you've enjoyed the day, buy them a little present at the end of it or they may charge you, but you know there's, there's different ways of, Doing it, the best way is to see one, you know, then, kind of do one with somebody with you and then do one on your own, you know, that's kind of, the best way to learn these things but difficult obviously if not many people are doing rabbits in your area .
I'm lucky, we've still got quite a few people left in, the good thing about webinars is you can sneak out. And nobody knows you've gone, so that's all good, but maybe we'll ask you two or three more questions and we will call it a day cause John is, he needs his bed earlier now as he's. Bit late for beauty sleep for me though.
Gayle is saying, do you have a preferred opioid for your rabbit surgeries? I used to use a lot of buprenorphine and I do like that the for longevity of it as much as anything else. Yeah.
Amel's got a similar sort of statement question, she says, I use buprenorphine or methadone with midazolam and ketamine, with meditomidine if needed, the doses do seem to keep them quite sleepy for a while, I think this was the question about, you know, planes of anaesthetic, post-op, which the nurses hate, but I feel it's better for them to come around slowly, with them being a prey species, what are your preferences, I don't see gut stasis. As an issue and have not lost any with this, so sounds like a great protocol now. My feeling was always I wanted them around quicker, so I got me eating quicker and things like that too, but actually there's just as much mileage in in that approach as well.
If it's working, if it's going fine, you're not seeing problems, not seeing gut stasis, that's great, you know, absolutely fantastic, so that that that that's really good, so you know, you've not got any problems and you're auditing that, don't change it. And you know, there's, there's many different ways of doing this, and you know, there, there are many ways it can be successful. Brilliant, Emily said we've used both Gabapentin and buprenorphine post-op for analgesia when needed in addition to Meloxicam, haven't seen any significant difference, both seem to work very well, which is, which is great, er quite a few people saying thank you for the wonderful webinar which is always lovely to hear.
Can I pick up one of the comments too, to, to, to pull up on because they made a, a big comment in there which is actually absolutely fascinating, one of my sort of chosen areas, and somebody said, you're not wearing gloves. And that's a lot is about complication stuff is, and it's a really fascinating area because it is accepted norm too. When I was a young vet, I was taught to operate without them, and I'm probably sure you were too, Anthony, back in the day, because we didn't, and I find it very uncomfortable using gloves and things too.
And I got asked about this when I was doing some pictures for a surgery textbook and things and so I did some research on this and it's really interesting. That's why I wanted to pull this up because I think it's fascinating. There's very, very, very, very little associating use of gloves with reduction of surgical site infection.
There's data showing reduction of viral infection from patient to surgeon-human medicine, which is really weird, but not of reduction of surgical site infection, about the only stuff it shows is for some orthopaedic things is that you've got, if you double glove and you use two different colour gloves so you can see the breaches in them. Then you may get some reduction, but only equivalent to scrubbing up properly in the first place, and that some of the data is showing that sometimes it's it's this counter thing where people relaxing wearing gloves, don't scrub quite so well and actually can be shown to increase infections too. So it's a really difficult one too, and I think the established norm now is to wear gloves, that's great, fantastic, and if you're used to it, then then that that that's really good.
But do bear in mind that one of rabbits, I would not use tout gloves, whatever you do, but and also bear in mind that that's not the only route to reducing surgical site infections, it's actually much more about tissue handling, about tissue viability and not damaging that too. But it's a cracking point to raise, and I had to research this for for this book and justify what I was doing, and it's absolutely an amazing subject about something we think we know how little evidence is out there and it's really cool. I always, I always quote, and if, if I'm boring people because they've heard this before, apologies, but Mike Willard, Texas A&M professor in gastroenterology and a fantastic lecturer, retired now.
And he say everything I taught you 10 years ago was a lie, I just didn't realise. That was my Texan accent there. But I think things do go in, in circles and obviously, you know, again with our green hats on, our circular economy, generally globally is going worse rather than better, we're actually supposedly gonna double the amount of plastic that we produce virgin plastic in the next, 20 years, you know, the old stat of in 2050 there'll be more plastic in the sea than fish, so, I think we need to look at and and Zoey Halfari's done a lot of work, not so much on gloves but on, You know, gowns and drapes, do we need to use new ones, so I remember we always used to just have cloth ones, you know, drapes and gowns.
I was gonna say that because when I was when I was young we had cloth drapes and I, in fact I refused to throw them away, but we always had, had cloth drapes and I loved them and they're now back in fashion again because, you know, because of a disposability and things. But again, you know, things like you talk about the gowns, you talk about all the other things, there's no evidence at all they reduce any problems and. You know, why are we using those things which are having an environmental impact, if they don't do something.
If you prove there's a real reason for it, definitely, but, you know, it's a really great point with that. This is where Zoe's done some amazing work probably 5 or 6 years ago now, which, Provided everything is OK and as you say, you know, if you're not going to wash your hands, you're gonna have problems, but you know, with gowns and things, provided they're washed well, provided they're sterilised afterwards, you know, do you, and with some of these things, you know, also the pouches, instruments in stainless steel tins, which are obviously more expensive upfront, but it saves on the waste, and I think we've got to think that way because, You know the mountains of waste we're producing, we need to do something about it, so slightly off topic, but I think, you know, a great question and I, you know, did a lot of surgery with gloves, and I don't think, and obviously I didn't do any scientific studies on it, but I didn't feel, I was getting huge numbers of dogs and cats coming back with infections all the time, we, we, we did audit our surgical site infections and, I know what my surgical site infection rate was without gloves, and it was. Should we better than some who did wear gloves and no worse than anybody else.
So you know it was very, very unusual to have such a, such an infection, so yeah, so it doesn't, even from personal experience I wouldn't say that's necessarily the biggest factor there. But it's a great, great thing to raise and I just love the fact that you know we we we should always be questioning what we think we know and I think the thing about the lies I told 10 years ago, I just didn't know they're lies. It's it's so true, so true.
Yeah, yeah. We're gonna do one last question, there's been so many questions, so thank you everyone for, making that effort. Emily just wants to confirm, would you usually use subcut drugs for pre-med and then induce after 20 to 40 minutes, or just midazolam subcut then pre-med either IMIV followed by induction?
Personally I'd probably pre-med and then 2040 minutes later look at look at inducing, maybe up to an hour and stuff, so . But again, I know people who do midaz, then then do a pre-med, then do that and that's they work they works fine as well, so yeah. But I do like using midazolam early just to get that anxiolysis the amnesia effect, it's really good.
I think it is just in the end, the anaesthetic that you are most familiar with and and obviously the more, you know, multimodal you can be with the pre-med. You know, induction agent, gaseous anaesthesia, if that's the way you want to go, you get a more balanced anaesthetic than just. Putting a, putting a face mask on and and putting them down with SiO or ISO don't you, so it's that finesse there that will help, but it is what you're, yeah, I've I've I've done, I've done plenty of gas only anaesthetics too and it's that thing where it's very effective, very good results in terms of mortality.
But I would suspect probably less good results in terms of making it as stress-free day as as possible. Yeah, exactly, it's difficult. The other thing too, I think we've got a lot of questions, I think Dawn in the past has collated questions, I've answered them by email where possible later on, so if you're happy doing that, I'm happy.
We can also do a blog and and direct people to that for, you know, some of those other points. But listen, you know, really always love listening to you, John. It was a great webinar.
Ellie, thank you for filling us in. I think that, supplement, the, the probiotic supplement looks really interesting. I know your hay is always beautiful as well, so for those of you who can get hold of that, it's really worth looking at.
So yeah, thank you so much Ellie for your continued commitment to er our little fairy friends who are er so lovely and er you know you do amazing work raising the profile and raising the the level of exotics er knowledge within our profession, so thank you so much for that. Thanks everyone for listening. Particularly as we get so close to Christmas, this is impressive, er that so many people are are er on the call, I have stripped the er.
The Christmas jumper off cos it went a bit too warm, I've now just got my Liverpool shirt on, but I won't tease you with that, John, and yeah, hoping to see you all on a webinar, very soon, so thanks for for listening wherever you're listening from, and Ellie and John, thank you so much for your contributions as well. Thank you and happy Christmas and happy Christmas. Merry Christmas to you all.
