Professional Documents
Culture Documents
2 February 1999
Evaluating and
FOCAL POINT Stabilizing Critically
★Critically ill companion rabbits
must be handled gently in quiet
environments using diagnostic
Ill Rabbits—Part II*
and therapeutic techniques
University of Wisconsin University of California, Davis
designed to provide comfort
and reduce the stress of Jan C. Ramer, DVM Keith G. Benson, DVM
hospitalization. Joanne Paul-Murphy, DVM
KEY FACTS ABSTRACT: Performing diagnostic procedures and stabilizing critically ill rabbits require
knowledge of their general temperament as well as proper restraint, diagnostic, and support-
ive care techniques. Part I of this two-part presentation reviewed recommendations for clinical
■ A few special pieces of assessment, diagnostic differentials, and initial treatment plans. Many techniques used to
equipment can make urgent manage critically ill dogs and cats can be adapted to minimize stress in critically ill rabbits.
care procedures more efficient. Part II provides general guidelines for handling hospitalized rabbits and describes such diag-
nostic and therapeutic techniques as venipuncture, radiography, fluid therapy, nutritional sup-
■ Midazolam can reduce anxiety port, analgesia, and intubation.
during stressful procedures.
H
ospitalized critically ill rabbits need to be housed in a quiet, low-stress
■ Cystocentesis is performed with environment. For example, barking dogs or ferret scent can cause con-
the rabbit in dorsal recumbency; siderable stress in critically ill rabbits, thereby making evaluation of
performing cystocentesis through their response to treatment difficult. If a hospitalized rabbit has a companion
the lateral abdominal wall is not rabbit at home, it is sometimes comforting for the companion to accompany the
recommended. ill rabbit during the hospital stay.
Urgent care procedures can be accomplished more efficiently when practitio-
■ Pain management is an important ners utilize specific supplies and equipment. For example, digital gram scales
aspect of rabbit critical care; make weighing accurate and quick, and a skid-resistant surface helps the rabbits
buprenorphine and fentanyl feel more secure on the scale. Small-diameter feeding tubes (3.5 and 5.0 Fr) used
patches are effective. for nasogastric intubation are also ideal for implementing nutritional support
measures or completing pneumogastrograms. Small endotracheal tubes with and
■ Maintaining caloric and fiber without cuffs (2.0- and 2.5-mm outside diameter) should be used for endotra-
intake is an important aspect of cheal intubation. Body temperature can be taken quickly with an infrared tym-
caring for critically ill rabbits. panic temperature scanner. A stainless-steel nasal speculum or specially made
cheek dilators (Henry Schein) can facilitate dental examinations (Figure 1). Fi-
nally, low-flow infusion pumps should be used for accurate intravenous or in-
traosseous fluid therapy.
Mild sedation is recommended during some diagnostic procedures or if rabbits be-
come panicky. Intramuscular or intravenous midazolam (1 to 2 mg/kg) is an excel-
lent sedative in rabbits.1 It is fast acting and has shorter duration of action than di-
*Part I of this two-part presentation appeared in the January 1999 issue (Vol. 21, No. 1)
of Compendium.
Compendium February 1999 20TH ANNIVERSARY Small Animal/Exotics
Nasogastric tubes are generally tolerated by rabbits. nary catheter (flared end cut off after placement) can be
Elizabethan collars can be stressful for rabbits and advanced into the trachea as a guide. The laryngoscope
should be used only if well tolerated. For rabbits that blade should then be removed and the ET advanced over
do not accept a nasogastric tube or Elizabethan collar, the guide and into the trachea.14
other options such as feeding via percutaneous tube or Several other methods of endotracheal intubation de-
force feeding with a syringe should be considered. scribed in the literature involve insertion of a rigid
bronchoscope through the ET for better visualization
Percutaneous Gastrostomy Tube Feeding of the vocal folds15 and use of a special stethoscope fit-
Feeding by percutaneous gastrostomy tube may be ted with an ET for better auscultation of breathing
necessary for some rabbits. Percutaneous placement of sounds at intubation.16 Positive-pressure ventilation and
gastrostomy tubes adapted to use in rabbits follows a chest excursions should never be used to test placement
technique similar to that used for other companion ani- of the ET because air entering the stomach often mim-
mals.11 Because rabbits have a small oral cavity, however, ics true chest excursion.
a bronchoscope rather than a small endoscope is neces- ENDIU
sary. Caution must be exercised when passing the bron- Cardiopulmonary MP
M’
20th
CO
S
choscope over the base of the tongue (between the rab- Resuscitation 1 9 7
9 - 1
9 9 9
bit’s sharp molar teeth). In addition, rabbits must be at a Cardiopulmonary arrest is ANNIVERSARY
surgical plane of anesthesia before tube insertion. Appli- the sudden cessation of
cation of lidocaine gel on the tip of the bronchoscope
and the feeding tube facilitates insertion. The presence
spontaneous, effective venti-
lation and circulation. Re- A LookBack
of hair and digesta in the stomach should be anticipat- spiratory arrest generally oc-
Twenty years ago, domesticated
ed, even if a rabbit has been anorectic for several days. curs first, followed by cardiac
arrest several minutes later if rabbits were not as popular
Pharyngostomy Tube Feeding the respiratory arrest is not companion animals as were
Pharyngostomy tube feeding is apparently well toler- resolved. The goal of car- dogs and cats, and
ated by rabbits, although abscesses can develop along diopulmonary resuscitation veterinarians therefore did not
the subcutaneous tract of the catheter. Placement and (CPR) of rabbits is similar to have to address the issues raised
maintenance of pharyngostomy tubes have been de- that for other mammals— today. Because of our growing
scribed in the literature.12 We recommend practicing provide ventilation and cir-
awareness, however, today we
pharyngostomy tube placement on cadavers before at- culatory support until spon-
tempting the procedure on critically ill rabbits. taneous functions have been can utilize increased knowledge
restored. The chief difference of the gastrointestinal (GI)
Intubation between CPR for rabbits and system in general and therefore
The use of an uncuffed 1.0- to 2.5-mm endotracheal that for other companion an- of the nutritional needs of
tube (ET) is recommended for intubation of rabbits imals involves the rabbit’s rabbits. For example, we now
weighing 3 kg or less.13 Blind intubation of small rabbits small size and rapid metabol- know that high fiber is
can be either oral or nasal but should only be attempted ic rate and the difficulty of
necessary for proper GI motility
if the rabbit is breathing and not in respiratory arrest. establishing a patent airway.
Anesthesia can be induced by slow injection of intra- Because their rapid heart and and realize that the presence of
venous propofol (2 to 4 mg/kg) or mask inhalation of respiratory rates correlate trichobezoars is not a signal for
isoflurane. The rabbit should be placed in sternal recum- with more circulations per surgery but is a result of
bency with its head extended so the trachea is perpendic- minute, rabbits succumb to decreased GI motility. In fact,
ular to the table surface. To avoid laryngospasm, 1 ml of cardiopulmonary arrest more these rabbits generally do very
lidocaine should be applied topically to the larynx. quickly than do larger mam- well with medical manage-
While advancing the ET to the proximal larynx, practi- mals. The difficulty of estab-
ment, an option not recognized
tioners should listen at the end of the adapter for inspira- lishing a patent airway is
tion sounds. When the sound is at the loudest, the tube compounded by the in- 20 years ago.
can be slowly advanced into the trachea. In large rabbits creased urgency of time. If
(weighing 3 kg or more), the glottis can usually be visu- endotracheal intubation has
alized through a laryngoscope with a No. 1 Miller blade; not been accomplished with-
however, the oral cavity is often too small to maintain vi- in 60 seconds, the airway
sualization when the ET has been inserted into the should be assessed via tra-
oropharynx. A 5- or 8-Fr, 56-cm long polypropylene uri- cheostomy. Endotracheal in-
tubation can be extremely difficult when a rabbit is not 6. Anderson NL: Intraosseous fluid therapy in small exotic ani-
breathing. mals, in Kirk’s Current Veterinary Therapy. XII. Philadelphia,
WB Saunders Co, 1995, pp 1331–1335.
Although a tracheostomy tube can be placed with the 7. Eisele PH: Signs of pain in small mammals. Proc TNAVC:795–
rabbit under local anesthesia, often rabbits in cardiopul- 796, 1997.
monary arrest have lost consciousness and anesthesia is 8. Eisele PH: Analgesia in small mammals. Proc TNAVC:796–
unnecessary. Alcohol can be poured over the ventral 799, 1997.
neck region to part the hair and aid in visualization of 9. Donoghue S, Langenberg J: Clinical nutrition of exotic pets.
Aust Vet J 71(10):337–341, 1994.
the trachea. An incision should then be made over the 10. Donoghue S: Nutrition and pet rabbits, in Rosenthal KL (ed):
trachea immediately caudal to the larynx, the trachea Practical Exotic Animal Medicine (The Compendium Collec-
pulled toward the incision, and retracting sutures placed tion). Trenton, NJ, Veterinary Learning Systems, 1997, p
in the third and fourth rings. Next, an incision should 107.
be made between the cartilaginous rings and the retract- 11. Smith DA, Olson PO, Mathews KA: Nutritional support for
rabbits using a percutaneously placed gastrostomy tube: A
ing sutures gently pulled apart. We advise taking ex- preliminary study. JAAHA 33(1):48–54, 1997.
treme caution and exerting minimal force while guiding 12. Rogers G, Taylor C, Austin JC, et al: A pharyngostomy
the sterile 2.0-mm tracheostomy tube into the distal tra- technique for chronic oral dosing of rabbits. Lab Anim Sci
chea. After tube placement, oxygen should be provided 38(5):619–620, 1988.
and positive-pressure ventilation initiated. 13. Paul-Murphy J: Little critters: Emergency medicine for small
rodents. Proc Fifth Intl Vet Emerg Crit Care Symp:714–718,
1996.
SUMMARY 14. Eisele PH: Anesthesia for the rabbit. Proc TNAVC:792–794,
Because they can become stressed so quickly, critical- 1997.
ly ill rabbits can be challenging patients. The basic 15. Conlon KC, Corbally MT, Bading JR, Brennan MF: Atrau-
principles guiding emergency and critical care for rab- matic endotracheal intubation in small rabbits. Lab Anim
Sci 40(2):221–222, 1990.
bits are the same as those used for other mammals; 16. Patil VU, Fairbrother C, Dunham BM: Endotracheal intu-
however, the presenting signs and diagnostic approach- bation in the rabbit: A quick, reliable method. Lab Anim Feb:
es differ considerably. Practitioners need to assess a crit- 28–29, 1997.
ically ill rabbit while it remains in its cage We recom- 17. Wixson SK: Anesthesia and analgesia, in Manning PJ, Ring-
mend evaluating the general attitude, respiratory rate ler DH, Newcomer CE (eds): The Biology of the Laboratory
Rabbit, ed 2. New York, Academic Press, 1994.
and character, and fecal and urine consistency before 18. Flecknell PA: Post-operative analgesia in rabbits and rodents.
removing a companion rabbit from its cage. In addi- Lab Anim 20(2):34–37, 1991.
tion, once rabbits has been removed from a familiar en- 19. Smith DA, Burgmann PM: Formulary, in Hillyer EV, Que-
vironment, such as their cage, they can hide clinical senberry KE (eds): Ferrets, Rabbits and Rodents: Clinical
signs that would be more apparent in other companion Medicine and Surgery. Philadelphia, WB Saunders Co, 1997,
pp 392–403.
animals. Thus, practitioners must look for subtle indi- 20. Perrin A, Milano G, Thyss A, et al: Biochemical and phar-
cations of pain or discomfort. macological consequences of the interaction between metho-
When hospitalization is necessary, rabbits must be trexate and ketoprofen in the rabbit. Brit J Cancer 62:736–
housed in a quiet, low-stress environment separate from 741, 1990.
the sounds and scents of other animals. Because rabbits 21. Mason DE: Anesthesia, analgesia, and sedation for small
mammals, in Hillyer EV, Quesenberry KE (eds): Ferrets, Rab-
can become panicky or agitated, practitioners should bits and Rodents: Clinical Medicine and Surgery. Philadelphia,
make special efforts to provide a calming atmosphere. WB Saunders Co, 1997, pp 378–391.