Rabbit Sedation and Anes 2022 Veterinary Clinics of North America Exotic An

R a b b i t S e d a t i o n an d
Anesthesia
a, b
Sara Gardhouse, DVM, DABVP (ECM), DACZM *, Andrea Sanchez, DVM, DVSc, DACVAA
KEYWORDS
Rabbit Oryctolagus cuniculus Anesthesia Monitoring Premedication
Induction Local anesthesia Recovery
KEY POINTS
Rabbits (Oryctolagus cuniculus) are prey animals with several behaviors that make them
unique anesthetic candidates that require special considerations in the preanesthetic,
anesthetic, and postanesthetic periods.
As prey animals, the preoperative assessment of the rabbit patient is critical, as they
instinctually hide any signs of illness and disease.
Multimodal anesthesia (balanced anesthesia) using various drugs and routes of adminis-
tration helps to provide the safest anesthetic plan for rabbits.
There are various ways to obtain airway access in rabbits, each of which has its advan-
tages and disadvantages.
The recovery period following anesthesia in rabbits is as critical as the preanesthetic and
anesthetic periods, and should not be ignored for its importance.
INTRODUCTION
Increasingly, rabbits are presented to veterinarians for evaluation, diagnostics, and

treatment, and with them on the rise as one of the most common domestic pets in
North America, owners expect high-level medical and surgical care.1 Deep sedation
is often necessary for procedures requiring restraint, evaluation, or minor medical
needs, and general anesthesia is frequently required for medical and surgical proced-
ures. Successful management of the rabbit anesthetic case requires understanding of
basic anesthetic principles, awareness of the limitations, and the necessary require-
ments to ensure high standards of anesthetic care for the patient.
Disclosure: The authors have nothing to disclose.

a
Department of Clinical Sciences, Kansas State University, 1800 Denison Avenue, Manhattan,
KS 66506, USA; b Department of Clinical Studies, Ontario Veterinary College, 55 Stone Road
East, Ontario N1G 2W1, Canada
* Corresponding author.
E-mail address: sgardhous@vet.k-state.edu
Vet Clin Exot Anim 25 (2022) 181–210

https://doi.org/10.1016/j.cvex.2021.08.012 vetexotic.theclinics.com
1094-9194/22/ª 2021 Elsevier Inc. All rights reserved.
182 Gardhouse & Sanchez
ANAMNESIS
A thorough history and husbandry evaluation is critical to the understanding of rab-

bits.2 Evaluation must include a thorough evaluation of the husbandry and a chrono-
logic report of the presenting complaint.2 Asking detailed questions is key to the
assessment of the patient, and open-ended questions tend to provide better
information.2
PREANESTHETIC ASSESSMENT AND CONSIDERATIONS
Rabbits have a reputation of being difficult or dangerous to anesthetize.3–5 As a prey

species, they are adept at concealing illness, and suitability as an anesthetic candi-
date may not be as ideal as initially perceived on presentation. As a result, a thorough
preanesthetic evaluation is key to a good outcome. A complete physical examination
including cardiac, respiratory, and gastrointestinal assessment (Table 1), and prean-
esthetic bloodwork may reveal underlying disease that has been concealed.2 If there is
suspicion for fluid deficits or gastrointestinal ileus, stabilization should be performed
before sedation or anesthesia. An accurate body weight is critical to successful anes-
thesia and to ensure accurate dosing of drugs.
Overall anesthetic mortality reported in healthy rabbits ranges from 1.39%3 to
4.8%.4 Prevalence is even higher when evaluating anesthetic and sedation-related
deaths in systemically ill rabbits with a 7.37% risk of death in one of these studies’
populations.3 Although the mortality associated with anesthesia is generally consid-
ered to occur during the anesthetic event, this study also revealed that rabbits are
as likely to die in the immediate 3 hours following anesthesia, and that these deaths
can occur up to 48 hours postanesthetically.3
Owing to rabbits’ prey nature, a crucial consideration to reduce stress before anes-
thesia is ensuring suitable accommodations away from cats, dogs, ferrets, and birds
of prey that are their predators in natural settings.6 This can be enhanced with the pro-
vision of privacy shelters and hides, and administration of anxiolytics and/or sedatives
such as benzodiazepines.6 Other strategies to reduce stress include providing a litter
tray and housing with their bonded mate when possible.6
Another important consideration is the large surface-area-to-volume ratio and poor
thermal tolerance that makes small mammals, like rabbits, susceptible to hypothermia
during general anesthesia. Inhalant anesthetics can also alter thermoregulatory
thresholds for compensatory responses in a dose-dependent fashion and also have
a cooling effect on the respiratory membranes.7 Thermoregulatory systems can be
further depressed by other drugs used in the perioperative period such as opioids.8
Hypothermia has the potential to create substantial impairment in cardiovascular
performance, slow recovery from anesthesia, impair coagulation, and decrease meta-
bolism of anesthetic drugs.9,10 A significant association between hypothermia at the
time of admission and mortality has been demonstrated in rabbits.11,12 Therefore,
measurement of body temperature and thermal support during the perioperative
period are critical to improve outcomes.
Table 1
Normal vital parameters in the rabbit13
Parameter Reference Range

Heart rate (beats/min) 200–300
Respiratory rate (breaths/min) 32–60
Temperature ( C [ F]) 38.5–39.5 [101.3–103.1]
Rabbit Sedation and Anesthesia 183
PREOPERATIVE BLOOD TESTS
It is straightforward to obtain a blood sample from most rabbits without the aid of
sedation.6 At a minimum, a packed cell volume (reference interval 34%–43%),13 total
protein (5.0–7.5 g/dL),13 and blood glucose (4.1–8.2 mmol/L; 74–148 mg/dL)13 should
be performed before anesthesia, but ideally, a complete blood cell count and
biochemistry profile should be performed to provide a more complete picture of over-
all health.6 Additional diagnostics such as a urinalysis and diagnostic imaging may be
indicated depending on the reason for anesthesia.6
Blood glucose can be used as a prognostic indicator in rabbits.14 A significant rela-
tionship between blood glucose and food intake, signs of stress, and severity of clin-
ical disease has been demonstrated.14 Stressed rabbits demonstrate a higher blood
glucose than those with no signs of stress, and complete anorexia results in a higher
blood glucose than those with normal food intake or hyporexia.14 Severe hyperglyce-
mia (>20 mmol/L, 360 mg/dL) has been associated with a poor prognosis.14 In addi-
tion, in cases of diagnosed intestinal obstruction, the mean blood glucose was higher
(24.7 mmol/L, 444.6 mg/dL) compared with nonobstructive gastrointestinal ileus
(8.5 mmol/L, 153 mg/dL).14 Based on these results, blood glucose can be used as
an indicator of the severity of a rabbit’s condition on presentation, and aid in differen-
tiation of gastrointestinal ileus versus true gastrointestinal obstruction.14
In addition to blood glucose, cholesterol, non–high-density lipoprotein cholesterol,
and triglycerides are also indicators of disease in rabbits and are associated with ev-
idence of severe infection or sepsis, renal failure, and hepatopathy.15 These parame-
ters should be taken into consideration before anesthesia and included as part of the
conversation with the owner regarding prognosis and risks.
FASTING
Rabbits are unable to vomit because of a highly developed and muscular cardiac
sphincter.16 Contrary to other species, long fasting times are contraindicated and it
is typically recommended to provide access to food and water close to the time of
anesthesia to ensure ongoing gastrointestinal motility; however, removing food 1 to
2 hours before anesthesia and after premedication reduces the risk of finding food
in the oral cavity during intubation that could be aspirated into the respiratory tract.17
Following an anesthetic event, food should be available as soon as the rabbit is ambu-
latory and feeding support should be considered when alert and swallowing.17,18
FLUID THERAPY
Preoperative assessment of hydration can be challenging in rabbits and intraoperative

monitoring of blood pressure can also present unique challenges; however, preoper-
ative assessment of packed cell volume, total protein, blood urea nitrogen, creatinine,
and urine specific gravity can provide some assessment with respect to overall hydra-
tion.8 An important consideration is to ensure constant hydration of the gastrointes-
tinal tract to ensure there is normal gastrointestinal motility and function; without
attention to this detail, potential consequences such as a functional ileus can be
fatal.18,19
In human and small animal medicine, it is becoming more widely acknowledged that
intravenous (IV) fluid therapy should not be all encompassing as a volume per hour, but
rather as a goal-oriented therapy titrated to the needs of the individual.20 As significant
as hypovolemia and hypoperfusion can be, overhydration and fluid overload can be as
detrimental.20
Water intake in rabbits is comparatively higher than in other mammals.21,22 The

average daily water intake has been reported to range from 50 to 150 mL/kg of
body weight.2 In addition, with decreased food intake, polydipsia develops and water
intake may increase by as much as 6.5 times, which is an important consideration in
anorexic patients.2 This unique physiologic response, combined with their specialized
gastrointestinal anatomy, makes fluid therapy a critical part of the perianesthetic man-
agement plan.
INTRAVENOUS CATHETERS
Intravenous access should be obtained in any rabbit undergoing anesthesia and can
typically be achieved with adequate premedication/sedation protocols. The use of
topical, local anesthetic creams containing lidocaine 2.5% and prilocaine 2.5% over
the IV site 20 minutes before placement of a catheter can provide vasodilation and
comfort through full-thickness analgesia.23 Common locations for IV catheters include
the cephalic vein, lateral saphenous vein, and in certain situations, the marginal ear
vein.24 It is important to note that there is the potential for ear necrosis and sloughing
if certain medications leak perivascularly when the marginal ear vein is used.24 The
most common size of catheters that are appropriate are 22, 24, or 26 gauge, depend-
ing on the size of the vein and the rabbit (Fig. 1).24
INTRAOSSEOUS CATHETERS
In certain situations, such as very small or severely hypotensive rabbits, IV catheteri-

zation may not be possible. In these scenarios, the placement of an intraosseous (IO)
Fig. 1. Cephalic intravenous catheter placement. (Courtesy of Miranda Sadar, DVM, DACZM,
Colorado State University.)
catheter may be appropriate.25 Almost all products that can be administered IV can be
given via the IO route including crystalloids, colloids including blood products, various
medications, dextrose, and emergency drugs.25 Common locations for placement of
an IO catheter include the trochanteric fossa of the femur, the greater tubercle of the
proximal humerus, the wing of the ilium, or the tibial tuberosity.24 Details regarding the
placement of IO catheters have been described elsewhere.24
BALANCED MULTIMODAL ANESTHESIA
Multimodal or “balanced” anesthesia is a concept that uses a combination of drugs in

a sufficient amount to produce the desired effect of anesthesia at its optimum degree
but minimizes the undesirable effects that can occur.26 This technique targets the triad
of narcosis, analgesia, and muscle relaxation by acting on each element individually to
avoid deep levels of central brain depression.26
PREMEDICATION
As in small animals, premedication of rabbits is ideal. Anxiety and stress can induce
dyspnea, and result in the release of endogenous catecholamines and cortisol, which
can result in complications during anesthesia and result in a less stable patient.27 In
addition, effective premedication protocols facilitate IV access, decrease induction
drug doses, and often decrease the minimum alveolar concentration (MAC) of inhalant
anesthetics required for anesthetic maintenance.28–32 There are many premedication
protocols that have been successfully used in rabbits and the selection of the protocol
will depend, in part, on the procedure to be performed. In addition, certain breeds and
strains have demonstrated differing responses to sedation protocols, and there is little
information evaluating the influence of age, sex, or health status on drug effects.33
Given the lack of scientific data and the higher anesthetic risks, the preferential use
of reversible drugs should be considered to allow for better control of the depth of
anesthesia and expedite recovery times.
BENZODIAZEPINES
The most commonly used benzodiazepine in rabbits is midazolam. Midazolam is a

short-acting benzodiazepine that is water soluble and can be administered either
intramuscularly (IM) or subcutaneously (SC) for a premedication, or IV during induc-
tion.34 Midazolam is often used as a sole sedative for minor, noninvasive, nonpainful
procedures, but is also commonly used in combination with an opioid, ketamine, or an
alpha-2 agonist for more extensive procedures in the preoperative setting. Midazolam
alone administered at 2 mg/kg IM produces muscle relaxation, mild sedation lasting
for 30 to 60 minutes, and minimal to no respiratory depression characterized by a
decreased respiratory rate but no changes in PO2 or PCO2.35 More profound and longer
sedation is obtained when midazolam is combined with an opioid.35 Flumazenil is the
common reversal agent for benzodiazepines and can be titrated to effect.34 Diazepam
is typically avoided because of the presence of propylene glycol in the injectable for-
mulations that can result in hypotension and thrombophlebitis.36
Partial Opioid Agonists and Agonist/Antagonists

Butorphanol is a m antagonist to partial m agonist and k opioid agonist. It has less anal-
gesic potency than m-pure agonists, a ceiling effect at high doses, and minimal
MAC-sparing effects.37–39 Due to its unique pharmacologic profile, butorphanol admin-
istration is only appropriate to treat mild pain and is an excellent sedative for minor
diagnostic procedures.35 Butorphanol alone causes mild, short-term sedation in healthy

rabbits with minimal cardiorespiratory depression.35 More profound sedation, but also
significant respiratory depression, can be seen when it is combined with other sedatives
such as midazolam or alpha-2 agonists.35,40,41 Butorphanol is often administered IM or
IV, but it is also well absorbed when given intranasally.42
Buprenorphine is a m-partial agonist and an effective analgesic to treat mild to
moderate pain. Used alone, buprenorphine produces mild sedation, no cardiovas-
cular side effects, and mild respiratory depression.35,43 A study examining bupre-
norphine use in rabbits as a single dose demonstrated no adverse effects on
gastrointestinal motility44; however, other multidose studies have demonstrated po-
tential effects of buprenorphine on food intake and gastrointestinal motility.45 The
combination of midazolam and buprenorphine can result in marked sedation lasting
90 to 120 minutes.35
PURE m AGONISTS
Pure agonists such as morphine, methadone, hydromorphone, and fentanyl are

preferred as part of the premedication regimen when moderate to severe pain is pre-
sent, or before an invasive procedure. Comparison of the sedative effects of morphine
(2 mg/kg SC) and methadone (2 mg/kg SC) demonstrated more profound sedation
with methadone compared to morphine, with a maximum sedation score achieved be-
tween 30 and 60 minutes postinjection.46 Fentanyl is a short-acting potent opioid that
is commonly administered as a constant rate infusion (CRI) to provide analgesia and
MAC-reduction during surgery. At clinical doses, fentanyl has minimal cardiovascular
side effects except for mild to moderate bradycardia.47 In healthy rabbits anesthetized
with propofol, repeated boluses of fentanyl (5 mg/kg IV) caused no changes in cardiac
contractility but significant decreases in heart rate and mean arterial pressures
(MAPs).48 Therefore, high doses should be used with caution in ill patients or when
used concomitantly with drugs that depress the sympathetic system. Pharmacoki-
netics of fentanyl in rabbits after IV and sublingual administration have been described
elsewhere.49
Tapentadol is a novel, atypical opioid that behaves as an agonist at the m-receptor
and is also a norepinephrine reuptake inhibitor.50 Although few studies evaluate the
effectiveness of this drug in small mammals, tapentadol is reported to have similar
analgesic activity to morphine in humans, but lower affinity for the m-receptors.50 In
rabbits, 5 mg/kg IV was administered before sevoflurane induction to perform orchi-
ectomy and demonstrated rapid distribution, elimination, and no evidence of apnea.51
In addition, the pharmacodynamic evaluation of the drug demonstrated that tapenta-
dol provided adequate postsurgery analgesia.51
ALPHA-2 AGONISTS
Commonly used alpha-2 adrenergic receptor agonists include xylazine, detomidine,

medetomidine, and dexmedetomidine. These drugs are advantageous in premedica-
tion protocols because of their ability to provide excellent sedation and muscle relax-
ation, as well as commercially available reversal agents (yohimbine, atipamezole,
tolazoline).52 The cardiovascular effects can be significant and include vasoconstric-
tion, decreased cardiac output, second-degree heart block, and bradyarrhythmias.52
With cardiovascular compromise or concerns for cardiac disease, this class of drugs
should typically be avoided.
N-METHYL-D-ASPARTATE (NMDA) ANTAGONISTS
Ketamine is a noncompetitive NMDA receptor antagonist that results in the prevention

of central sensitization, provision of analgesia, and induction of dissociative anes-
thesia.53 In healthy patients, ketamine is well tolerated and can be an excellent adjunct
to a premedication or injectable anesthetic protocol for short procedures; however,
ketamine can cause muscle rigidity and should be used with drugs that are potent
muscle relaxants such as alpha-2 agonists or benzodiazepines. Ketamine also has
sympathomimetic properties that can result in an increased heart rate, increased
myocardial contractility, and increased peripheral vascular resistance.53 Ketamine is
commonly used to produce profound sedation, or as an induction agent combined
with midazolam.
Reports of tiletamine-zolazepam in New Zealand white rabbits demonstrated neph-
rotoxicity at certain dosages but provides the advantage of smaller drug volumes
compared to ketamine if given as an IM injection.54,55 This drug should be used
with caution.
ANTICHOLINERGICS
The most common indication for anticholinergics in a premedication protocol include

minimization of salivary and bronchial secretions, and reduction of vagally-induced
bradyarrhythmias56; however, their utility in these scenarios has been questioned in
the human medical field, and controlled studies in rabbits have not been performed.57
In addition, atropine is not recommended because of lack of efficacy and clinical ef-
fects. This has been traditionally explained by approximately 61% of rabbits having
a high level of atropine esterase activity that rapidly hydrolyses atropine from the sys-
temic circulation, with a higher prevalence in males.50,58 Even rabbits with low levels of
atropine esterase activity also metabolize atropine quickly, which results in doses up
to 2 mg/kg having no effect on heart rate.47 Glycopyrrolate has a longer duration of
action than atropine.56 In rabbits, 0.1 mg/kg IM of glycopyrrolate has been demon-
strated to increase heart rate for a period of 60 minutes.56 Owing to the lack of proven
efficacy and the confirmed negative effects on gastrointestinal motility in hindgut fer-
menters,59 the routine use of anticholinergics as part of the premedication protocol is
not recommended. Table 2 lists common premedication protocols and indications for
each protocol.
LOCAL ANESTHETICS
Local anesthetics such as lidocaine and bupivacaine are commonly used in small an-
imals to reversibly inhibit neural transmission.60 Routes of administration of local an-
esthetics include topical, infiltration, intraarticularly, or as a regional nerve block.60
EPIDURAL ANESTHESIA
For abdominal surgeries or painful procedures of the caudal half of the body, epidural
anesthesia and analgesia offer a useful adjunct to pain management. Epidural anes-
thesia offers many avenues for use, including management of surgical cases, obstetric
pain, postsurgical pain, and chronic pain.60 Epidural drugs allow for the achievement
of analgesia without the concern for systemic effects compared to when the same
drugs are given IM or IV.60 In addition, epidurals have been shown to reduce recovery
time and it could be assumed a similar advantage would be seen in rabbits.61
Epidurals also allow a decrease in the amount of gas anesthesia required during the
procedure, allowing for a safer and more stable anesthesia.62 The lumbosacral
188
Gardhouse & Sanchez
Table 2
Injectable preanesthetic sedation and premedication protocols commonly used in rabbits with reversal agents
Drug Dosage Common Uses Reversal Agents

Midazolam 1 Midazolam 0.5–2 mg/kg SC Excellent for sedation for Flumazenil 0.05–0.1 mg/kg IM or SC
butorphanol or IM 1 butorphanol nonpainful procedures
ketamine 0.5–2 mg/kg SC or IM such as radiographs,
ketamine 3–5 mg/kg SC or IM computed tomography scan,
and catheter placement
Midazolam 1 Midazolam 0.5–2 mg/kg SC or Excellent for sedation for Flumazenil 0.05–0.1 mg/kg IM or
hydromorphone IM 1 hydromorphone potentially painful procedures SC 1 naloxone 0.01–0.04 mg/kg IM or SC
ketamine 0.1–0.3 mg/kg SC or IM or as a premedication
ketamine 3–5 mg/kg SC or IM before surgery
Midazolam 1 Midazolam 0.5–2 mg/kg Useful in young healthy Flumazenil 0.05–0.1 mg/kg IM or
butorphanol 1 SC or IM 1 butorphanol rabbits when moderate to SC 1 atipamezole 0.1–0.5 mg/kg SC or IM
dexmedetomidine 0.5–2 mg/kg SC or IM profound sedation is necessary (depending on the dose of
dexmedetomidine dexmedetomidine)
0.01–0.05 mg/kg SC or IM
Midazolam 1 Midazolam 0.5–2 mg/kg SC or Useful in young healthy rabbits when Flumazenil 0.05–0.1 mg/kg IM or
hydromorphone 1 IM 1 hydromorphone moderate to profound sedation is SC 1 naloxone 0.01–0.04 mg/kg IM or
dexmedetomidine 0.1–0.3 mg/kg SC or necessary with analgesia in addition SC 1 atipamezole 0.1–0.5 mg/kg SC or IM
IM dexmedetomidine (depending on the dose of
0.01–0.05 mg/kg SC or IM dexmedetomidine)
These are suggested dosages and protocols based on published information and the authors’ clinical experience. Species and individual variation in response to a
drug can be unpredictable and therefore, each dose should be selected with knowledge of clinical status and underlying health concerns.
junction site is the most commonly used location in rabbits, with a technique similar to
dogs and cats. It is important to note that injection into the lumbosacral space may
result in intrathecal administration of drugs because the dural sac in rabbits extends
into the sacrum.63 The use of a shielded needle and electrical stimulation has been
described to allow for successful entry into the subarachnoid space.64 Successful
needle placement was described when a muscle contraction was noted at
0.3 mA.64 In one study, an epidural consisting of lidocaine and morphine were both
demonstrated to be effective adjunct analgesia when administered to rabbits under-
going pelvic limb orthopedic surgery.65
REGIONAL NERVE BLOCKS
A unique anatomic feature of rabbits is their elodont and hypsodont dentition that re-
sults in frequent presentations of dental disease in some form.66,67 The pain associ-
ated with dental disease and surgical treatment of dental disease can be
substantial. The use of locoregional dental blocks can help provide a multimodal anal-
gesic approach, and various dental blocks have been described in the literature.68–70
Sciatic and femoral nerve blocks have been successfully described in rabbits with
the use of a nerve stimulator and can provide intraoperative and postoperative anal-
gesia after pelvic limb surgery.71,72 Ultrasound-guided axillary brachial plexus nerve
blocks have also been described in rabbits.73
Many other ultrasound-guided blocks have been described in small animals
including paravertebral blocks, radial, ulnar, median, and musculocutaneous nerve
blocks; erector spinae plane blocks; intercostal blocks; transversus abdominis plane
blocks; and quadratus lumborum blocks.74 The details of these blocks are beyond the
scope of this article but are well described elsewhere (DiGeronimo PM, da Cunha A.
Local and regional anesthesia in zoological companion animal practice. Vet Clin Exot
Anim 2022;25:1: in press.].74
INDUCTION
Induction of anesthesia can be achieved through the use of injectable drugs or inhalant
gases. Induction using an inhalant agent is common practice in rabbits, but whenever
possible should be preceded by appropriate premedication. Premedication before
gas induction shortens the excitatory phase and the dose of inhalant agent required.
Preoxygenation via face mask can provide benefits before administration of the
inhalant anesthetic by increasing oxygen stores and delaying arterial hemoglobin
desaturation during apnea (Fig. 2).75 The mask should be loose, but well-fitted with
enough room to allow for escape of carbon dioxide and heat.76 Oxygen flow rates
greater than 100 mL/kg/min are needed with a mask that is well-fit.76 If the mask is
large and poorly fitted, higher oxygen flow rates (300 mL/kg/min) may be needed.76
Benefits of preoxygenation can be achieved in less than 1 minute in a healthy patient,
but may require greater than 5 minutes with compromised respiratory function.17
Induction with an appropriately sized mask allows for better depth control and moni-
toring and is preferred, but commercially available induction chambers can be advan-
tageous in very stressed rabbits that are resistant to facemask induction.77 As soon as
the righting reflex is lost, the patient should be removed and placed on a face mask to
allow for better control of anesthetic depth. A comparison of the advantages and dis-
advantages of face mask versus chamber induction is provided in Table 3. Given the
many benefits of safe injectable drugs available, the use of injectable techniques is
recommended, allowing for reduced anesthetic waste gas, readily available IV and
airway access, and less cardiovascular depression due to easier drug titration.
Fig. 2. Preoxygenation via face mask.
PROPOFOL
Propofol is a substituted isopropylphenol anesthetic. Its use as an injectable induction

agent in rabbits is common because of its ability to provide a rapid, excitement-free
induction and recovery.78 The use of propofol requires IV or IO access, and the ability
to rapidly intubate, as apnea is common after administration.78 Propofol given as a
bolus for induction causes a short-lived, dose-dependent vasodilation, and at supra-
therapeutic doses may decrease cardiac contractility.79–81 These side effects are
dose-related and may be exacerbated by rapid administration, and therefore, it is rec-
ommended to titrate propofol to effect. A calculated propofol induction dose can be
given in one-quarter increments, administered over 30 to 60 seconds, to minimize
side effects.17 Propofol can also be used for anesthetic maintenance with doses of
24 to 36 mg/kg/h reported.82 Pharmacokinetic data for propofol administered as a sin-
gle bolus, and short and long infusion are available in the literature and appear to be
affected by the time of the day with higher doses needed in the morning compared
with the afternoon to reach the same anesthetic depth.83–85
ALFAXALONE
Alfaxalone is a neurosteroid anesthetic that is suitable as an induction agent through IV

administration with a rapid onset and short duration of action.86 Cardiovascular effects
of the newest formulation of alfaxalone have not been well studied in rabbits but an
older formulation of alfaxolone/alfadolone was demonstrated to produce dose-
dependent cardiovascular depression similar to other general anesthetics.87 This
drug can also be administered IM or SC to provide sedation. Doses of 4 mg/kg and
6 mg/kg IM were reported to be well tolerated; however, one rabbit died following res-
piratory and cardiac arrest after a dose of 8 mg/kg was administered.86 In one study, a
combination of alfaxalone (6 mg/kg), dexmedetomidine (0.2 mg/kg), and butorphanol
(0.3 mg/kg) IM produced anesthesia lasting approximately 1 hour with a recovery time
of approximately two and a half hours.88 An additional study examined a dose of 2 and
3 mg/kg IV for induction, and intubation was possible in all rabbits, although apnea
was noted.89 Therefore, as with propofol, preoxygenation and preparation for intuba-
tion is advised when alfaxalone is administered IM and IV.89
Table 3
Advantages and disadvantages to face mask and chamber induction methods in rabbits17
Method of
Induction Advantages Disadvantages
Face mask Rapid induction Waste gas high
with a well-fitted mask Staff exposure to anesthetic gases
Chamber induction Waste gas lessened Staff exposure to anesthetic
Short induction time gases when patient is removed
from chamber
Inability to assess the depth of the patient
Trauma during the excitement phase
ETOMIDATE
Etomidate is a potent, nonbarbiturate hypnotic agent with a short duration of action

that is commonly used for induction and maintenance of anesthesia in animals and
humans.90 Similar to propofol and alfaxalone, etomidate does not possess analgesic
properties.90 Etomidate has been reported to cause hemolysis, thrombophlebitis, and
pain on injection because of the formulation containing propylene glycol.90 These side
effects have been reduced with the creation of an aqueous formulation of the drug.91
Although etomidate has been reported to have minimal cardiovascular side effects in
other species, both formulations resulted in decreases in MAP and increases in HR
when administered to rabbits.91 Other common adverse effects include laryngeal
reactivity and inhibition of cortisol secretion which preclude its use with adrenal
insufficiency.90
Commonly used injectable induction protocols are listed in Table 4. Table 5 de-
scribes reported combinations of drugs for premedication, induction, and mainte-
nance of anesthesia.
AIRWAY ACCESS
Nasotracheal Intubation
Nasotracheal intubation can be a useful method of intubation in specific situations,
including the emergency setting when respiration ceases or during dental procedures
where an endotracheal tube can impede the ability to perform the procedure.92,93
Commonly, nasotracheal intubation is used in cases where the oral cavity is the pri-
mary area of interest.94 The tube should be directed ventrally and medially into the
ventral nasal meatus.93 Nasotracheal intubation uses the fact that rabbits are obligate
nasal breathers.93 The epiglottis is entrapped on the dorsal surface of the soft palate,
and thus, facilitates the direct passage of air from the nasopharynx into the larynx and
trachea.93 Resultantly, a tube passed nasally should naturally traverse the pathway
from the nasopharynx, to the larynx, to the trachea.93 The flipped soft palate is one
of the described difficulties with orotracheal intubation and is beneficial when perform-
ing nasotracheal intubation. Contraindications for the use of nasotracheal intubation
include the presence of upper respiratory disease, preexisting edema of the nasal pas-
sages, and preexisting narrowing of the nasal passages, which may occur because of
apical elongation from the teeth associated with dental disease.93,95 Complications
are usually associated with traumatic nasotracheal intubation where repeated at-
tempts result in damage to the soft tissue structures and nasal turbinates which can
result in swelling and nasal passageway obstruction.94 Although there is little evidence
to support introduction of bacteria into the lungs, in cases of known upper respiratory
infection, it may be prudent to avoid the use of nasotracheal intubation.93,95 In very

small rabbits, this technique may not be feasible because of the small size of tube
that would be required. Step-by-step directions on nasotracheal tube intubation are
provided in Box 1.
Oral Endotracheal Intubation

Oral endotracheal intubation is the most common method of securing an airway in rab-
bits and allows for positive pressure ventilation to be performed throughout the anes-
thetic event. Orotracheal intubation presents challenges because of the narrow oral
cavity lined by premolars and molars on both sides, the long tongue with a large
base, decreased jaw opening ability, and potential for laryngospasm.96 Many tech-
niques have been described for intubation including the blind method, modified blind
method, videoendoscopic methods, and direct visualization.96 Complications with
orotracheal intubation include difficult placement, trauma to the oropharyngeal soft
tissue, laryngospasm, tube dislodgement, and postintubation oropharyngeal swelling
after intubation.96,97
For intubation using the blind technique, visualization of airflow through the endotra-
cheal tube, listening for respiration, or monitoring of end-tidal carbon dioxide (EtCO2)
followed by careful manipulation of the tube is required.96 This technique is not useful
in cases of respiratory arrest or prolonged apnea because of the absence of airflow
and the necessity for breathing.96 With inexperience, this technique can result in sig-
nificant laryngospasm and laryngeal trauma.96 Direct visualization of the larynx with a
laryngoscope can also be attempted; however, this technique presents significant
challenges, as often the laryngoscope blade is wider than the narrow oral cavity, pre-
molars, and molars, preventing appropriate visualization and an inability to depress
the tongue.96 Other techniques include the use of a fiberoptic laryngoscope or an
endoscope to visualize the larynx and guide placement of the endotracheal tube.96
The most common endotracheal tube sizes in rabbits range from 2.0 to 3.5 mm in-
ternal diameter.98 The size selected should be the largest possible to reduce airflow
resistance, and allow creation of a good seal to facilitate ventilation, but should also
avoid iatrogenic trauma to the tracheal mucosa. Commercially available tubes are
often too long and should be measured to the thoracic inlet and cut to ensure acci-
dental bronchial intubation does not occur.
It is important to keep in mind that with small diameter tubes, risk of occlusion of the
tube with saliva, or occlusion from kinking of the tube are significant risks and require
close anesthetic monitoring.99 Use of an EtCO2 monitor can be useful to help correct
tube placement and accidental detachments or obstructions.99
Confirmation of tube placement is similar to other species.99 The rabbit may cough
as the tube is passed, condensation may be seen on the inside of the endotracheal
tube or on a glass slide placed at the end of the tube, air movement can be detected
by listening for breath sounds, a wave form can be detected on the EtCO2 monitor, or
movement of the chest can be detected when a breath is provided with the rebreath-
ing bag.99
Although complications of intubation are rare, reports of subtracheal injury, ulcera-
tion, and postintubation tracheal stricture following intubation with both cuffed and
uncuffed endotracheal tubes have been documented.100,101 The clinical presentation
is typically dyspnea and upper respiratory tract obstruction signs, such as moist rales
and cyanosis.100,101 This highlights the importance of taking great care during the intu-
bation process and the consideration for alternatives such as a face mask or laryngeal
mask airway during very short procedures.100,101 Other factors that have been
Table 4
Commonly used induction protocols and dosages used in rabbits
Drug Dosage Comments

Propofol 2–8 mg/kg IV Apnea is common, especially
when administered rapidly
or at higher dosages
Dose-dependent hypotension
Alfaxalone 1–4 mg/kg IV Apnea is common, especially
when administered rapidly
or at higher doses
Potential dose-dependent
hypotension
Ketamine 1 Ketamine 2.5–5 mg/kg IV 1 Midazolam Apnea is uncommon
midazolam 0.5 mg/kg IV Increases MAP and HR
These are suggested dosages and protocols based on published information and the authors’ clin-
ical experience. Species and individual variation in response to a drug can be unpredictable and
therefore, each dose should be selected with knowledge of clinical status and underlying health
concerns.
implicated in tracheal injury and stricture include ventilation technique and disinfection
protocols for the endotracheal tubes.100,101
Laryngeal Mask Airway Devices and Supraglottic Airway Devices

The laryngeal mask was initially developed to serve as an alternative to mask ventila-
tion for people and also for use in an emergency setting for the management of chal-
lenging airways.102 The pediatric laryngeal mask airway (LMA) device has been used
as an alternative to endotracheal tube placement in rabbits, and may result in easier
placement than an endotracheal tube, especially in the emergency setting.103 It is
important to note that the LMA device results in more gas inhalant waste than when
endotracheal intubation of the rabbit is performed.103 In addition, as pediatric human
devices have not been specifically designed for use in rabbits, complications such as
lingual cyanosis, gastric tympany, and an incomplete airway seal have been docu-
mented with the use of these devices.103–105
More recently, a supraglottic airway device (SGAD), specifically designed to mirror
the pharyngeal airway anatomic structures of the rabbit (v-gel ADVANCED, DocsInno-
vent Ltd, Hemel Hempstead, UK), has been created. This device allows for rapid man-
agement of the airway and when properly placed can also allow for the application of
positive pressure ventilation (Fig. 3).106 This SGAD is beneficial in certain scenarios
because of its ease of placement by a novice clinician using EtCO2 guidance com-
bined with minimal to no airway trauma.106 Placement time is rapid, ranging from 14
to 38 seconds.106 In one study evaluating the placement of a v-gel compared to
oral endotracheal intubation, the longest time for placement was 38 seconds
compared to 171 seconds with an endotracheal tube.106 The combination of the
unique shape of the v-gel with the soft gel-like material allows for creation of a strong
seal with minimal trauma to the airway.106 In addition, it is suggested by the manufac-
turer that it does not result in narrowing of the airway which is seen with an endotra-
cheal tube and thus, may resultantly decrease work of breathing.107 The rabbit v-gel is
available in a wide variety of weights (0.6 kg to 4.51 kg).107 When positive pressure
ventilation is required, especially for an extended duration, placement of an endotra-
cheal tube is a recommended safer option due to potential for complications such as
194
Gardhouse & Sanchez
Table 5
Drug combination studies reported in rabbits for premedication, induction, and maintenance of anesthesia
Drug Protocol Purpose of Protocol Dosage Comments

Ketamine 1 xylazine149 Injectable anesthesia K 35 mg/kg 1 X 5 mg/kg IM Addition of butorphanol to protocol
Ketamine 1 xylazine 1 K 35 mg/kg 1 X 5 mg/kg 1 resulted in a prolonged reflex loss
butorphanol149 B 0.1 mg/kg IM (palpebral reflex, pedal reflex, righting
reflex), as well as mild alterations in
physiologic changes
Ketamine-propofol Induction K 1, 3, or 5 mg/kg 1 P 1 mg/kg Time to loss of righting reflex shortest
admixture150 and duration of action longest with
the highest dose of ketamine
Mild to moderate sedation only achieved
in the lowest dose ketamine group
Hypoxemia observed at highest doses
Medetomidine 1 Induction 1 maintenance of anesthesia Med 0.2 mg/kg IM 1 Propofol at 0.5 mg/kg/min maintained
midazolam 1 Mid 0.5 mg/kg IM 1 general anesthesia with few side
atropine IM 1 atropine 0.5 mg/kg IM 1 effects to the cardiopulmonary system
propofol IV82 P to effect IV apart from mild hypotension,
hypercapnia, and respiratory acidosis
Smooth recovery
Two rabbits died within 24 h of the
procedure
Ketamine 1 Induction K 15 mg/kg 1 Mid 3 mg/kg IM Time to loss of righting reflex was shorter
midazolam151 K 15 mg/kg 1 with medetomidine
Ketamine 1 Med 0.25 mg/kg IM Intubation was not possible with 3
medetomidine151 rabbits in the medetomidine protocol
and 4 rabbits in the midazolam
protocol
Mean heart rate, SPO2, and vaporizer
setting (isoflurane sparing) were lower
in the medetomidine group
Medetomidine rabbits were more prone
to laryngospasm
Ketamine 1 midazolam152 Injectable anesthesia K 25 mg/kg 1 Mid 2 mg/kg IM Faster time to loss of righting reflex and
Ketamine 1 midazolam 1 K 25 mg/kg 1 Mid 2 mg/kg 1 to standing with inclusion of tramadol
tramadol152 T 4 mg/kg IM Inclusion of tramadol did not provide
additional analgesia in the protocol
Ketamine 1 medetomidine153 Injectable anesthesia K 35 mg/kg 1 Med 0.25 mg/kg Surgical anesthesia induced in most
Medetomidine 1 fentanyl 1 Med 0.2 mg/kg 1 F 0.02 mg/kg 1 animals receiving medetomidine-
midazolam153 Mid 1 mg/kg based protocols
Xylazine 1 ketamine153 X 4 mg/kg 1 K 50 mg/kg Apnea was noted in the fentanyl
protocol and endotracheal intubation
is essential
Supplemental oxygen needed for all
protocols
Quality of surgical anesthesia greatest
with the medetomidine 1 ketamine
protocol
Ketamine 1 medetomidine SC154 Injectable anesthesia K 15 mg/kg 1 Med 0.25 mg/kg SC All groups lost righting reflex and ear
Ketamine 1 medetomidine IM154 K 15 mg/kg 1 Med 0.25 mg/kg IM pinch response with time to loss of
Ketamine 1 medetomidine 1 K 15 mg/kg 1 Med 0.5 mg/kg 1 reflexes similar among all groups
butorphanol SC154 B 0.4 mg/kg SC Higher dose of medetomidine and
Ketamine 1 medetomidine 1 K 15 mg/kg 1 Med 0.25 mg/kg 1 B addition of butorphanol produced a
butorphanol IM154 0.4 mg/kg IM greater duration of loss of ear pinch
response
Rabbit Sedation and Anesthesia

Moderate hypoxemia and moderate
bradycardia in all rabbits
SC and IM administration were
equivalent
Addition of butorphanol increased the
duration of anesthesia with a slight
increase in the degree of respiratory
depression
These are suggested dosages and protocols based on the published information. Species and individual variation in response to a drug can be unpredictable and
therefore, each dose should be selected with knowledge of clinical status and underlying health concerns.
195
Box 1
Step-by-step instructions for the placement of a nasotracheal tube in the rabbit
To place a nasotracheal tube, adequate muscle relaxation and appropriate anesthetic depth
are required. Supplemental oxygen via face mask or flow by should be provided over the dura-
tion of the procedure. A 2% lidocaine solution (1–2 mg/kg) can be infused into the nasal pas-
sages with a syringe or catheter 60 seconds before tube placement. Correct positioning is
critical for successful intubation allowing for optimal alignment of the nasopharynx with the
trachea. The rabbit is positioned in sternal recumbency with hyperextension of the head and
neck. The diameter of the nasal passage, even in large individuals, is small, and therefore it
is usually not possible to pass a tube larger than 2.0 to 2.5 mm. In small rabbits, it may not
be feasible. Conservative application of sterile lubricant should be applied on the end of the
tube before placement. Excessive lubricant can result in obstruction of the Murphy eye of
the tube. The bevel of the endotracheal tube is inserted into the ventral nasal canal and
directed in a ventromedial direction. A small degree of resistance is considered normal because
of the nasal passageway anatomy, but if significant resistance or a “crunching” sound is
encountered, it may be indicative of a tube that is too large or it is passing in the wrong direc-
tion through the nasal turbinates and requires redirection.95 The rabbit often coughs when the
tube enters the trachea.95
lingual edema and cyanosis, gastric tympany, and v-gel dislodgement.108 A common
challenge is dislodgement when the head is shifted. When performing surgical pro-
cedures, or an anesthetic event that may require substantial movement of the head,
endotracheal intubation should be considered. A recent study demonstrated that
the v-gel is a practical alternative to both endotracheal tubes and laryngeal masks.109
MAINTENANCE OF ANESTHESIA
Once the airway is secured, the maintenance stage of anesthesia begins. At this point,
the most important considerations include monitoring the depth of anesthesia,
providing supportive care to the rabbit as needed, and ensuring adequate monitoring
is in place.
Active warming should occur after premedication and should continue until the rab-
bit is fully recovered, alert, and normothermic. Active warming options include
warmed IV fluids, warmed anesthetic gases, warmed air beds, hot water bottles,
circulating water blankets, or heat pads. In rabbits breathing a heated anesthetic
mixture, the average body temperature was shown to be 1.01 C (1.8 F) higher than
breathing a nonheated anesthetic mixture.110 With any warming device, caution
should always be used to ensure there is no direct contact that could result in thermal
burns. Constant monitoring of temperature with either an esophageal probe or rectal
thermometer is critical throughout the anesthesia.
In select situations (short-term procedure), maintenance of anesthesia with a face
mask can be considered. Examples include a brief incisor trim or simple dental pro-
cedure, a biopsy for histopathological analysis, or endoscopic evaluation of the oral
cavity; however, though face masks are easily placed, significant leakage occurs dur-
ing controlled mechanical ventilation.109
ISOFLURANE, SEVOFLURANE, AND DESFLURANE
In most situations, maintenance of anesthesia is performed with an inhalant gas, either

isoflurane, sevoflurane, or desflurane.111 Sevoflurane has a less noxious smell and
may be better tolerated for mask induction.112 Very little of the anesthetic gases are
metabolized, which reduces the impact on hepatic and renal function.112
Fig. 3. Appropriate placement of a commercially available rabbit-specific supraglottic

airway device.
Inhalant anesthetic can result in cardiovascular and respiratory depression. Most in-
halants act in a dose-dependent manner to reduce systemic vascular resistance and
cause decreases in stroke volume as a result of decreased myocardial contractility.
Both these undesirable side effects result in dose-dependent hypotension.111 Rabbits
appear to be more sensitive to the vasodilatory effects of inhalant anesthetics than
other species, with hypotension occurring at levels as low as 1 MAC and may be a
contributing factor to the higher anesthetic mortality seen.113,114 The underlying cause
is unclear but a lower systemic vascular resistance and substantially lower arterial
blood pressures have been reported at equipotent doses of inhalants.115
The negative effects of inhalant gases can be minimized by using a balanced anes-
thetic approach and the administration of sympathomimetics. Dopamine is commonly
used to combat isoflurane-induced hypotension but has been ineffective in rabbits,
where phenylephrine was only minimally effective at 2 mg/kg/min114 Norepinephrine
0.5 to 1.0 mg/kg/min has been demonstrated as a potentially effective treatment to
combat isoflurane-induced hypotension.116
Various drugs and drug combinations have been reported to reduce MACs, and
should be considered (Table 6).
TOTAL AND PARTIAL INTRAVENOUS ANESTHESIA
Intravenous CRIs of anesthetic drugs have been used to provide total intravenous
anesthesia (TIVA) in rabbits. These medications can be titrated to effect and support
a balanced anesthetic approach by reducing other drug dosages. These techniques
require IV or IO access. Studies examining propofol and fospropofol continuous IV
infusion for anesthetic maintenance in rabbits demonstrated prolongation of recovery
time with increasing infusion time for both drugs.117 Fospropofol, the water-soluble
prodrug of propofol, demonstrated greater prolongation of recovery time compared
to propofol.117 An additional study compared the physiologic effects of sufentanil-
midazolam TIVA to sevoflurane for surgical anesthesia in premedicated rabbits.118
This study demonstrated that both protocols provided similar quality of anesthesia
and required mechanical ventilation.118
Table 6
Anesthetic drugs with clinically significant minimum alveolar concentration sparing effects in
rabbits
Minimum Alveolar
Concentration Commonly Used Clinical
Drug Dose Reduction Doses
Fentanyl114 Plasma concentration up to 63% Loading dose: 3–10 mg/
2 0.1 ng/mL to (Isoflurane) kg
36.8 2.4 ng/mL Intraoperative rate: 5–
20 mg/kg/h
Postoperative rate: 2–
5.0 mg/kg/h
Ketamine120 1 mg/kg loading dose 35% (Isoflurane) Loading dose: 0.5–2 mg/
IV 1 40 mg/kg/min IV kg
Intraoperative rate: 0.5–
3 mg/kg/h
Postoperative rate:
0.25–1 mg/kg/h
Lidocaine125 50–100 mg/kg/min 10.5% to 21.7% Loading dose:1–2 mg/
(Isoflurane) kg
Intraoperative rate: 50–
100 mg/kg/min
Postoperative rate: 10–
50 mg/kg/min
Butorphanol39 0.4 mg/kg IV 2.30% to 2.33% Significantly reduced
(Isoflurane) MAC alone or in
combination with
meloxicam (more
significant reduction
with combination)
Both tramadol (4.4 mg/kg IV) and meloxicam (0.3 mg/kg IV, 1.5 mg/kg IV) have also been evaluated
for MAC reduction in rabbits and did not show clinically significant effects.39,155
CRIs can be used to supplement inhalant anesthesia and provide analgesia. Keta-
mine as a CRI is useful for intraoperative analgesia, MAC reduction, and the benefit of
minimal respiratory depression.119 A ketamine CRI of 9 mg/kg/h resulted in a signifi-
cant decrease in the MAC of isoflurane in rabbits.120 m-Receptor agonist opioids are
also commonly used as CRIs during anesthetic maintenance, with fentanyl citrate be-
ing one of the more common. An IV fentanyl CRI resulted in a reduction of the MAC of
isoflurane by up to 63% in rabbits, depending on the plasma concentrations that were
evaluated.121 In addition, the higher concentrations of fentanyl caused increases in
blood pressure with no change in cardiac output.122 Another study examined the
use of sufentanil in combination with midazolam for use as TIVA, and demonstrated
similar quality surgical anesthesia to sevoflurane anesthesia in ovariohysterectomized
rabbits with both protocols requiring mechanical ventilation.123
Lidocaine as an IV infusion has the potential for multiple benefits including visceral
analgesia, promotion of gastrointestinal motility, MAC reduction, and an increase in
visceral perfusion.124,125 In rabbits, lidocaine CRI (100 mg/kg/min for 2 days)
decreased pain behavior; increased gastrointestinal motility, food intake, and fecal
output, and decreased heart rate compared to buprenorphine (0.06 mg/kg IV q 8 h
for 2 days) in the postoperative period following ovariohysterectomy.126 Commonly
used drugs for CRIs are listed in Table 7.
Table 7
Commonly used constant rate infusions in rabbits
Drug Dose Comments

Ketamine17,120 Loading dose: 2–5 mg/kg Less respiratory depression was
Perioperative rate: 1–2 mg/kg/h noted compared to opioids that
Postoperative rate: 0.25–1 mg/kg/h are administered as a CRI
Fentanyl citrate17,122 Loading dose: 5–10 mg/kg Apnea is common and ventilation
Perioperative rate: 10–40 mg/kg/h of the rabbit is often necessary
Postoperative rate: 1.25–5.0 mg/kg
h
Lidocaine126 50–100 mg/kg/min
These are suggested dosages and protocols based on the published information. Species and indi-
vidual variation in response to a drug can be unpredictable and therefore, each dose should be
selected with knowledge of clinical status and underlying health concerns.
MONITORING OF ANESTHESIA
Common anesthetic complications in rabbits include hypothermia, respiratory

depression, hypotension, and bradycardia.
CARDIOVASCULAR SYSTEM
Thoracic auscultation should be performed throughout anesthesia to allow for evalu-

ation of the heart rate, rhythm, and presence of abnormal cardiac sounds. The normal
anatomy of the heart, including the differences from common domestic species has
been well described.127–129 Pulse strength can be evaluated with the femoral artery,
the dorsal pedal artery, and the auricular artery.130,131 Mucous membrane color and
capillary refill time should be assessed as part of a thorough evaluation of the cardio-
vascular system throughout the anesthetic procedure.132
Doppler evaluation of the cardiovascular system is useful to evaluate the rate and
rhythm of the heart.130 The Doppler transducer can be placed directly on a superficial
artery such as the carotid, radial carpal artery (medial aspect of forelimb), auricular,
dorsal pedal (dorsal aspect of hindlimb), or femoral.131,133–136
Blood pressure measurement in rabbits can be challenging. Arterial blood pressure
is evaluated as a function of heart rate, blood volume, stroke volume, and arterial
compliance.137 The evaluation of blood pressure should be used in conjunction with
other diagnostics as part of the cardiovascular assessment and evaluation of tissue
perfusion.138 A low blood pressure can be indicative of reduced blood flow and
impaired oxygenation of major organs.138 Blood pressure can be measured directly
or indirectly.130 Direct arterial blood pressure monitoring can be reliable and accurate
when an over-the-needle catheter is placed in the central auricular artery (Fig. 4).134 In
small rabbits, less than 2 kg, the arterial wave may be overdamped, making interpre-
tation challenging, and are also at increased risk of thromboembolism.139
Indirect blood pressure measurement is more commonly used and is less inva-
sive.130 There are 2 main methods of indirect blood pressure: oscillometry and
Doppler ultrasonic sphygmomanometry.130 In other species, systolic arterial pressure
is measured by the Doppler technique, although in cats, there is evidence that Doppler
blood pressure may be more reflective of MAP.140 Regardless, the cuff width to limb
circumference ratio should be 30% to 40%.141 Typically, Doppler is recommended
over oscillometric monitoring in rabbits for several reasons. Oscillometric techniques
Fig. 4. Placement of a catheter in the central auricular artery for invasive blood pressure
monitoring.
can fail to obtain accurate measurements in animals with rapid heart rates (>200 bpm),
of small size, and with hypothermia.133,134
Attempts to validate noninvasive blood pressure monitors in rabbits have been
made with mixed results. One study (n 5 17) found good agreement between Doppler
measurements at the dorsal carpal branch of the radial artery and those that directly
obtain auricular systolic pressures; in addition, the same study found that Doppler
measurements below 80 mm Hg were a reliable indicator of arterial hypotension.133
On the contrary, a second study with a smaller sample size (n 5 6) concluded that
both oscillometric and Doppler blood pressure measurements were poor substitutes
for carotid blood pressure measurement because of changing bias and large limits of
agreement.115
When using oscillometric devices, the forelimb is preferred because measurements
from the pelvic limb have a poor correlation with the abdominal aorta (criterion stan-
dard) readings, but measurements from the forelimb appear to correlate well at low
and normal pressure ranges.134
Electrocardiograms
Cardiac muscle cells produce electrical activity and this can be monitored with the use
of an electrocardiogram (ECG) tracing.131 The ECG tracing is composed of 3 primary
complexes, which includes the P wave, QRS complex, and T wave.142 An ECG eval-
uation is useful when detection of arrhythmias occurs, which is common with acid-
base and electrolyte abnormalities. Given that rabbits have rapid heart rates, low-
voltage machines and fast recording speeds (up to 100 mm/s) are
recommended.136,143 Rabbits have very delicate skin and the standard alligator clips
can tear it. It is preferred that the clips be attached to small-gauge hypodermic nee-
dles placed through the skin. Adhesive pads can be used but may tear the skin on
removal. These pads do not work well on the feet of rabbits as they require the protec-
tive fur on the plantar and palmar aspect of the feet to be shaved, which can lead to
severe pododermatitis because of a lack of protective foot pads.
Pulse Oximeter
Pulse oximetry is commonly used in rabbits, but with limited information available
about its accuracy. Pulse oximetry measures oxygen saturation of the blood through
illumination of the skin and detection of changes in light absorption between oxygen-
ated blood (oxyhemoglobin) and deoxygenated blood (reduced hemoglobin).144 The
pulse oximeter determines the ratio of absorbance between these wavelengths with
calibration against direct measurements of arterial oxygen saturation (SaO2) to deter-
mine the measurement of arterial saturation (SpO2) by the pulse oximeter.144 In
humans, the difference between SpO2 and SaO2 is less than 2% when the SaO2 value
is above 90%; however, the precision of the reading worsens when the SaO2 is lower
than 90%.144 The use of pulse oximetry has been validated in rabbits, with accuracy at
hemoglobin saturation values greater than 85%.145 The pulse oximeter can be placed
in various locations, working most effectively on unpigmented regions of the skin (toe,
ear, perianal region). Pulse oximeters may also provide valuable information on heart
rate.
Capnograph
Capnography is a useful tool in anesthetized rabbits that are intubated.146 Capnome-
try measures the maximum value of carbon dioxide that is measured at the end of
expiration, which in turn is a reflection of the amount of CO2 that is present in the alve-
olar gas.146 Measurement of the EtCO2 has demonstrated utility in determining the
arterial concentration of carbon dioxide (PaCO2).146 Normocapnia in mammals is asso-
ciated with an EtCO2 of 35 to 45 mm Hg.147 Values less than 35 mm Hg are hypo-
capnic, and values from 65 to 75 mm Hg are hypercapnic.147 Both hypoventilation
and hypercapnia are concerns for rabbits under general anesthesia.146 The capno-
graph wave is useful for assessing the adequacy of ventilation and perfusion to the
lungs as it has been well correlated with arterial CO2.146 Capnography has been
demonstrated to provide useful estimations of the PaCO2 in rabbits.148
THE POSTANESTHETIC PERIOD
The recovery period following an anesthetic event requires equally intense monitoring
as the preanesthetic and intra-anesthetic periods. As previously noted, many anes-
thetic deaths occur in the postanesthetic period.3–5 If the endotracheal tube is
removed too soon, there is risk of airway obstruction, hypoventilation, and hypoxemia.
As a result, rabbits should be maintained on oxygen until spontaneous respiration and
movement returns. Even after extubation, maintain the rabbit on a face mask or in an
oxygen cage until they are fully alert and aware of their surroundings.
Following extubation, it is critical to continue close monitoring and provide any
necessary supportive care. Once sufficiently recovered, the rabbit should be placed
into a stress-free, warm, dark, recovery cage. Given that many anesthetic deaths
occur in the postanesthesia recovery period, ongoing monitoring of body temperature,
heart rate, respiratory rate, and comfort should be assessed on a regular basis, with
issues addressed as needed.
Once the rabbit can stand and move confidently about the cage, provision of food
and water is critical, to not only preserve energy requirements but also to ensure resto-
ration of gastrointestinal motility. If hyporexia, anorexia, or reduced or lack of fecal
output is noted, supplemental feeding and analgesia should be instituted.
SUMMARY
Rabbits are increasingly presented to their veterinarian for evaluation and treatment.
Owners frequently expect high-level medical and surgical care, which often results
in the need for intensive and thorough anesthetic management. Successful anesthetic
management requires knowledge of general anesthetic principles, awareness of the
limitations and risks of anesthesia, and knowledge of the current literature to all for
continuation of provision of high standards of care.
REFERENCES
1. AVMA. In: AVMA pet ownership and demographics sourcebook. Schaumburg,

IL: American Veterinary Medical Association; 2017.
2. Donnelly TM, Vella D. In: Quesenberry KE, Orcutt CJ, Mans C, et al, editors.
Basic anatomy, physiology, and husbandry of rabbits. 4th edition. St. Louis, Mis-
souri: Elsevier; 2020.
3. Brodbelt DC, Blissitt KJ, Hammond RA, et al. The risk of death: the confidential
enquiry into perioperative small animal fatalities. Vet Anaesth Analg 2008;35:
365–73.
4. Lee HW, Machin H, Adami C. Peri-anaesthetic mortality and nonfatal gastroin-
testinal complications in pet rabbits: a retrospective study on 210 cases. Vet
Anaesth Analg 2018;45:520–8.
5. Ishida T, Onuma M, Ono S, et al. Anesthesia-associated death in 160 rabbits.
Jpn J Vet Anesth Surg 2014;45:7–12.
6. Brandão J, Graham J, Quesenberry KE. In: Quesenberry KE, Orcutt CJ,
Mans C, et al, editors. Basic approach to veterinary care of rabbits. 4th edition.
St. Louis, Missouri: Elsevier; 2020.
7. Carrero EJ, Fàbregas N. Thermoregulation and neuroanesthesia. Saudi J
Anaesth 2012;6:5–7.
8. Brodbelt D, Flaherty D, Pettifer G. Anesthetic risk and informed consent. In:
Grimm K, Lamont L, Tranquilli W, et al, editors. Lumb and Jones veterinary anes-
thesia and analgesia. 5th edition. Ames, Iowa: Wiley Blackwell; 2015. p. 11–22.
9. Clarke K, Trim C, Hall L, editors. Veterinary anesthesia. 11th edition. China:
Elsevier; 2013.
10. Shimokawa M, Kitaguchi K, Kawaguchi M, et al. The influence of induced hypo-
thermia for hemostatic function on temperature-adjusted measurements in rab-
bits. Anesth Analg 2003;96:1209–13.
11. Di Girolamo N, Toth G, Selleri P. Prognostic value of rectal temperature at hos-
pital admission in client-owned rabbits. J Am Vet Med Assoc 2016;248:288–97.
12. Oparil KM, Gladden JN, Babyak JM, et al. Clinical characteristics and short-
term outcomes for rabbits with signs of gastrointestinal tract dysfunction: 117
cases (2014-2016). J Am Vet Med Assoc 2019;255:837–45.
13. Nowland MH, Brammer DW, Garcia A, et al. Biology and diseases of rabbits. In:
Laboratory animal medicine. 3rd edition. London: Academic Press, Elsevier;
2015. p. 411–61.
14. Harcourt-Brown FM, Harcourt-Brown S. Clinical value of blood glucose mea-
surement in pet rabbits. Vet Rec 2012;170:674.
15. Sharma D, Hill AE, Christopher MM. Hypercholesterolemia and hypertriglyceri-

demia as biochemical markers of disease in companion rabbits. Vet Clin Pathol
2018;47:589–602.
16. Harcourt-Brown FM. Gastric dilation and intestinal obstruction in 76 rabbits. Vet
Rec 2007;161:409–14.
17. Hawkins MG, Pascoe PJ. In: Quesenberry KE, Orcutt CJ, Mans C, et al, editors.
Anesthesia, analgesia, and sedation of small mammals. 4th edition. St. Louis,
Missouri: Elsevier; 2021.
18. Jang SJ, Kang SS, Son SJ, et al. Cortisol levels and gastrointestinal disorders
after stressful surgery in rabbits. In Vivo (Brooklyn) 2017;31:637–40.
19. Lichtenberger M, Lennox A. Updates and advanced therapies for gastrointes-
tinal stasis in rabbits. Vet Clin North Am Exot Anim Pract 2010;13:525–41.
20. Muir W. Rethinking your approach to preoperative fluid therapy. Vet Med 2013;
108:67–70.
21. Tschudin A, Clauss M, Codron D, et al. Water intake in domestic rabbits (Oryc-
tolagus cuniculus) from open dishes and nipple drinkers under different water
and feeding regimes. J Anim Physiol Anim Nutr (Berl) 2011;95:499–511.
22. Cizek L. Relationship between food and water ingestion in the rabbit. Am J
Physiol 1961;201:557–66.
23. Keating SCJ, Thomas AA, Flecknell PA, et al. Evaluation of EMLA cream for pre-
venting pain during tattooing of rabbits: changes in physiological, behavioural
and facial expression responses. PLoS One 2012;7:e44437.
24. Paul-Murphy J. Critical care of the rabbit. Vet Clin North Am Exot Anim Pract
2007;10:437–61.
25. Petitpas F, Guenezan J, Vendeuvre T, et al. Use of intra-osseous access in
adults: a systematic review. Crit Care 2016;20:102.
26. Mori K, Ohmura A, Toyooka H, et al. In: Mori K, Ohmura A, Toyooka H, et al, ed-
itors. New balanced anesthesia. Tokyo: Elsevier; 1998. p. 1–384.
27. Baias A, Bodnariu A, Nichita I, et al. Stress in laboratory juvenile rabbits: phys-
iological indicators. Lucr tiințifice - Zooteh i Biotehnol Univ tiințe Agric i Med Vet
A Banat Timișoara 2012;45:142–5.
28. Monteiro ER, Figueroa CDN, Choma JC, et al. Effects of methadone, alone or in
combination with acepromazine or xylazine, on sedation and physiologic values
in dogs. Vet Anaesth Analg 2008;35:519–27.
29. Monteiro ER, Coelho K, Bressan TF, et al. Effects of acepromazine-morphine
and acepromazine-methadone premedication on the minimum alveolar concen-
tration of isoflurane in dogs. Vet Anaesth Analg 2016;43:27–34.
30. Ko JCH, Weil AB, Inoue T. Effects of carprofen and morphine on the minimum
alveolar concentration of isoflurane in dogs. J Am Anim Hosp Assoc 2009;45:
19–23.
31. Hellyer PW, Mama KR, Shafford HL, et al. Effects of diazepam and flumazenil on
minimum alveolar concentrations for dogs anesthetized with isoflurane or a
combination of isoflurane and fentanyl. Am J Vet Res 2001;62:555–60.
32. Credie RG, Teixeira Neto FF, Ferreira TH, et al. Effects of methadone on the min-
imum alveolar concentration of isoflurane in dogs. Vet Anaesth Analg 2010;37:
240–9.
33. Avsaroglu H, Versluis A, Hellebrekers LJ, et al. Strain differences in response to
propofol, ketamine and medetomidine in rabbits. Vet Rec 2003;152:300.
34. Lingamchetty T, Alireza Hosseini S, Saadabadi A. Midazolam - StatPearls. In:
NCBI bookshelf. Treasure Island, Fl: StatPearls Publishing LLC; 2020.
35. Schroeder CA, Smith LJ. Respiratory rates and arterial blood-gas tensions in
healthy rabbits given buprenorphine, butorphanol, midazolam, or their combina-
tions. J Am Assoc Lab Anim Sci 2011;50:205–11.
36. Korttila K, Aromaa U. Venous complications after intravenous injection of diaz-
epam, flunitrazepam, thiopentone and etomidate. Acta Anaesthesiol Scand
1980;24:227–30.
37. Dyson DH. Update on butorphanol tartrate: use in small animals. Can Vet J
1990;31:120–1.
38. Bortolami E, Love EJ. Practical use of opioids in cats: a state-of-the-art, evi-
dence-based review. J Feline Med Surg 2015;17:283–311.
39. Turner PV, Kerr CL, Healy AJ, et al. Effect of meloxicam and butorphanol on min-
imum alveolar concentration of isoflurane in rabbits. Am J Vet Res 2006;67:
770–4.
40. Santangelo B, Micieli F, Marino F, et al. Plasma concentrations and sedative ef-
fects of a dexmedetomidine, midazolam, and butorphanol combination after
transnasal administration in healthy rabbits. J Vet Pharmacol Ther 2016;39:
408–11.
41. Kirihara Y, Takechi M, Kurosaki K, et al. Effects of an anesthetic mixture of me-
detomidine, midazolam, and butorphanol and antagonism by atipamezole in
rabbits. Exp Anim 2019;68:443–52.
42. Santangelo B, Micieli F, Mozzillo T, et al. Transnasal administration of a combi-
nation of dexmedetomidine, midazolam and butorphanol produces deep seda-
tion in New Zealand White rabbits. Vet Anaesth Analg 2016;43:209–14.
43. Shafford HL, Schadt JC. Respiratory and cardiovascular effects of buprenor-
phine in conscious rabbits. Vet Anaesth Analg 2008;35:326–32.
44. Deflers H, Gandar F, Bolen G, et al. Influence of a single dose of buprenorphine
on rabbit (Oryctolagus cuniculus) gastrointestinal motility. Vet Anaesth Analg
2018;45:510–9.
45. Martin-Flores M, Singh B, Walsh CA, et al. Effects of buprenorphine, methylnal-
trexone, and their combination on gastrointestinal transit in healthy New Zealand
white rabbits. J Am Assoc Lab Anim Sci 2017;56:155–9.
46. Touzot-Jourde G, Nino V, Holopherne-Doran D. Comparison of methadone and
morphine sedation and analgesia in the NZW rabbit. J Vet Pharmacol Ther 2015;
38:70–1.
47. Bowery NG. Fentanyl. In: xPharm: the comprehensive pharmacology reference.
London: Elsevier Inc; 2007. p. 1–5.
48. Baumgartner CM, Koenighaus H, Ebner JK, et al. Cardiovascular effects of fen-
tanyl and propofol on hemodynamic function in rabbits. Am J Vet Res 2009;70:
409–17.
49. Malkawi AH, Al-Ghananeem AM, Crooks PA. Development of a GC-MS assay for
the determination of fentanyl pharmacokinetics in rabbit plasma after sublingual
spray delivery. AAPS J 2008;10:261–7.
50. Hartrick CT, Rozek RJ. Tapentadol in pain management: a m-Opioid receptor
agonist and noradrenaline reuptake inhibitor. CNS Drugs 2011;25:359–70.
51. Giorgi M, Mills PC, Tayari H, et al. Plasma concentrations of Tapentadol and clin-
ical evaluations of a combination of tapentadol plus sevoflurane for surgical
anaesthesia and analgesia in Rabbits (Oryctolagus Cuniculus) undergoing or-
chiectomy. Isr J Vet Med 2013;68:141–8.
52. Nguyen V, Tiemann D, Park E, et al. Alpha-2 Agonists. Anesthesiol Clin 2017;35:
233–45.
53. Sinner B, Graf BM. Ketamine. In: Schüttler J, Schwilden H, editors. Handbook of
Experimental pharmacology, vol. 182. Berlin, Heidelberg: Springer Science and
Business Media, LLC; 2008. p. 313–33.
54. Brammer DW, Doerning BJ, Chrisp CE, et al. Anesthetic and nephrotoxic effects
of Telazol in New Zealand white rabbits. Lab Anim Sci 1991;41:432–5.
55. Doerning BJ, Brammer DW, Chrisp CE, et al. Nephrotoxicity of tiletamine in New
Zealand white rabbits. Lab Anim Sci 1992;42:267–9.
56. Olson ME, Vizzuti D, Morck DW, et al. The parasympatholytic effects of atropine
sulfate and glycopyrrolate in rats and rabbits. Can J Vet Res 1994;58:254–8.
57. Cowl CT, Prakash UBS, Kruger BR. The role of anticholinergics in bronchos-
copy: a randomized clinical trial. Chest 2000;118:188–92.
58. Liebenberg SP, Linn JM. Seasonal and sexual influences on rabbit atropinester-
ase. Lab Anim 1980;14:297–300.
59. Bachrach WH. Anticholinergic drugs - survey of the literature and some exper-
imental observations. Am J Dig Dis 1958;3:743–99.
60. Barter LS. Rabbit analgesia. Vet Clin North Am Exot Anim Pract 2011;14:93–104.
61. Liu J, Cui F, Li S, et al. Nonintubated video-assisted thoracoscopic surgery un-
der epidural anesthesia compared with conventional anesthetic option: a ran-
domized control study. Surg Innov 2015;22:123–30.
62. Souza SS, Intelisano TR, De Biaggi CP, et al. Cardiopulmonary and isoflurane-
sparing effects of epidural or intravenous infusion of dexmedetomidine in cats
undergoing surgery with epidural lidocaine. Vet Anaesth Analg 2010;37:106–15.
63. Greenaway JB, Partlow GD, Gonsholt NL, et al. Anatomy of the lumbosacral spi-
nal cord in rabbits. J Am Anim Hosp Assoc 2001;37:27–34.
64. Otero PE, Portela DA, Brinkyer JA, et al. Use of electrical stimulation to monitor
lumbosacral epidural and intrathecal needle placement in rabbits. Am J Vet Res
2012;73:1137–41.
65. Antonczyk A, Liszka B, Skrzypczak P, et al. Comparison of analgesia provided
by lidocaine or morphine delivered epidurally in rabbits undergoing hindlimb or-
thopedic surgery. Pol J Vet Sci 2019;22:31–5.
66. Harcourt-Brown FM. The progressive syndrome of acquired dental disease in
rabbits. J Exot Pet Med 2007;16:146–57.
67. Lennox AM. Diagnosis and treatment of dental disease in pet rabbits. J Exot Pet
Med 2008;17:107–13.
68. Peña T, Campoy L, de Matos R. Investigation of a maxillary nerve block tech-
nique in healthy New Zealand white rabbits (Oryctolagus cuniculus). Am J Vet
Res 2020;81:843–8.
69. Capello V. Diagnosis and treatment of dental disease in pet rodents. J Exot Pet
Med 2008;17:114–23.
70. Lennox AM. Clinical technique: small exotic companion mammal dentistry-
anesthetic considerations. J Exot Pet Med 2008;17:102–6.
71. D’Ovidio D, Rota S, Noviello E, et al. Nerve stimulator-guided sciatic-femoral
block in pet rabbits (Oryctolagus cuniculus) undergoing hind limb surgery: a
case series. J Exot Pet Med 2014;23:91–5.
72. Kluge K, Larenza Menzies MP, Kloeppel H, et al. Femoral and sciatic nerve
blockades and incision site infiltration in rabbits undergoing stifle joint arthrot-
omy. Lab Anim 2017;51:54–64.
73. Fonseca C, Server A, Esteves M, et al. An ultrasound-guided technique for axil-
lary brachial plexus nerve block in rabbits. Lab Anim (NY) 2015;44:179–84.
74. Otero P, Portela D. In: Otero P, Portela DA, editors. Manual of small animal
regional anesthesia: illustrated anatomy for nerve stimulation and ultrasound-
guided nerve blocks. 2nd edition. Buenos Aires, Argentina: 5m Publishing;

2019.
75. Nimmagadda U, Salem MR, Crystal GJ. Preoxygenation: physiologic basis,
benefits, and potential risks. Anesth Analg 2017;124:507–17.
76. Boysen SR, Mathews KA. Respiratory emergencies. In: Mathews KA, editor. Vet-
erinary emergency and critical care manual. 3rd edition. Guelph, ON: Lifelearn,
Inc; 2017. p. 37–84.
77. Schmid RD, Hodgson DS, McMurphy RM. Comparison of anesthetic induction
in cats by use of isoflurane in an anesthetic chamber with a conventional vapor
or liquid injection technique. J Am Vet Med Assoc 2008;233:262–6.
78. Bryson HM, Fulton BR, Faulds D. Propofol: an update of its use in anaesthesia
and conscious sedation. Drugs 1995;50:513–59.
79. Baumgartner C, Bollerhey M, Henke J, et al. Effects of propofol on ultrasonic in-
dicators of haemodynamic function in rabbits. Vet Anaesth Analg 2008;35:
100–12.
80. Royse CF, Liew DFL, Wright CE, et al. Persistent depression of contractility and
vasodilation with propofol but not with sevoflurane or desflurane in rabbits.
Anesthesiology 2008;108:87–93.
81. Ouattara A, Langeron O, Souktani R, et al. Myocardial and coronary effects of
propofol in rabbits with compensated cardiac hypertrophy. Anesthesiology
2001;95:699–707.
82. Rozanska D. Evaluation of medetomidine-midazolam-atropine (MeMiA) anes-
thesia maintained with propofol infusion in New Zealand White rabbits. Pol J
Vet Sci 2009;12:209–16.
83. Cockshott ID, Douglas EJ, Plummer GF, et al. The pharmacokinetics of propofol
in laboratory animals. Xenobiotica 1992;22:369–75.
84. Campos S, Monteiro J, Valenzuela B, et al. Evidence of different propofol phar-
macokinetics under short and prolonged infusion times in rabbits. Basic Clin
Pharmacol Toxicol 2016;118:421–31.
85. Bienert A, P1otek W, Zawidzka I, et al. Influence of time of day on propofol phar-
macokinetics and pharmacodynamics in rabbits. Chronobiol Int 2011;28:
318–29.
86. Huynh M, Poumeyrol S, Pignon C, et al. Intramuscular administration of alfax-
alone for sedation in rabbits. Vet Rec 2015;176:255.
87. McGrath JC, Mackenzie JE. The effects of intravenous anaesthetics on the car-
diovascular system of the rabbit. Br J Pharmacol 1977;61:199–212.
88. Bradley MP, Doerning CM, Nowland MH, et al. Intramuscular administration of
alfaxalone alone and in combination for sedation and anesthesia of rabbits (Or-
yctolagus cuniculus). J Am Assoc Lab Anim Sci 2019;58:216–22.
89. Grint NJ, Smith HE, Senior JM. Clinical evaluation of alfaxalone in cyclodextrin
for the induction of anaesthesia in rabbits. Vet Rec 2008;163:395–6.
90. Williams L, Boyd K, Fitzgerald B. Etomidate. In: StatPearls. Treasure Island, FL:
StatPearls Publishing; 2020.
91. McIntosh MP, Narita H, Kameyama Y, et al. Evaluation of mean arterial blood
pressure, heart rate, and sympathetic nerve activity in rabbits after administra-
tion of two formulations of etomidate. Vet Anaesth Analg 2007;34:149–56.
92. Roppolo LP, Vilke GM, Chan TC, et al. Nasotracheal intubation in the Emergency
Department, revisited. J Emerg Med 1999;17:791–9.
93. Devalle JMS. Successful management of rabbit anesthesia through the use of
nasotracheal intubation. J Am Assoc Lab Anim Sci 2009;48:166–70.
94. Prasanna D, Bhat S. Nasotracheal intubation: an overview. J Maxillofac Oral

Surg 2014;13:366–72.
95. Varga M. Airway management in the rabbit. J Exot Pet Med 2017;26:29–35.
96. Thompson KL, Meier TR, Scholz JA. Endotracheal intubation of rabbits using a
polypropylene guide catheter. J Vis Exp 2017;2017:56369.
97. Lee LY, Lee D, Ryu H, et al. Capnography-guided endotracheal intubation as an
alternative to existing intubation methods in rabbits. J Am Assoc Lab Anim Sci
2019;58:240–5.
98. Dehn S. Intubation of select exotic species for the veterinary technician. In:
NAVC conference. 2009. p. 36. Orlando, FL.
99. Johnson DH. Endoscopic intubation of exotic companion mammals. Vet Clin
North Am Exot Anim Pract 2010;13:273–89.
100. Grint NJ, Sayers IR, Cecchi R, et al. Postanaesthetic tracheal strictures in three
rabbits. Lab Anim 2006;40:301–8.
101. Phaneuf LR, Barker S, Groleau MA, et al. Tracheal injury after endotracheal intu-
bation and anesthesia in rabbits. J Am Assoc Lab Anim Sci 2006;45:67–72.
102. Verghese C, Mena G, Ferson DZ, et al. Laryngeal mask airway. In: Hagberg CA,
editor. Benumof and Hagberg’s airway management. 4th edition. Philadelphia,
PA: Elsevier; 2013. p. 443–65.
103. Smith JC, Robertson LD, Auhll A, et al. Endotracheal tubes versus laryngeal
mask airways in rabbit inhalation anesthesia: ease of use and waste gas emis-
sions. Contemp Top Lab Anim Sci 2004;43:22–5.
104. Bateman L, Ludders JW, Gleed RD, et al. Comparison between facemask and
laryngeal mask airway in rabbits during isoflurane anesthesia. Vet Anaesth An-
alg 2005;32:280–8.
105. Kazakos GM, Anagnostou T, Savvas I, et al. Use of the laryngeal mask airway in
rabbits: Placement and efficacy. Lab Anim (NY) 2007;36:29–34.
106. Engbers S, Larkin A, Rousset N, et al. Comparison of a supraglottic airway de-
vice (v-gel) with blind orotracheal intubation in rabbits. Front Vet Sci 2017;
4:49.
107. Anon. Docsinnovent. Available at: https://docsinnovent.com/products/product/
rabbit-v-gel. Accessed November 16, 2019.
108. Crotaz IR. An observational clinical study in cats and rabbits of an anatomically
designed supraglottic airway device for use in companion animal veterinary
anaesthesia. Vet Rec 2013;172:606.
109. Wenger S, Müllhaupt D, Ohlerth S, et al. Experimental evaluation of four airway
devices in anaesthetized New Zealand White rabbits. Vet Anaesth Analg 2017;
44:529–37.
110. Nogradi AL, Battay M, Cope I. Effects on intraoperative body temperature in
rabbits (Oryctolagus cuniculus) and guinea pigs (Cavia porcellus) by heating
the inhalational gas mixture. Magy Állatorvosok Lapja 2019;141:93–100.
111. Lopez LA, Hofmeister EH, Pavez JC, et al. Comparison of recovery from anes-
thesia with isoflurane, sevoflurane, or desflurane in healthy dogs. Am J Vet Res
2009;70:1339–44.
112. Behne M, Wilke HJ, Harder S. Clinical pharmacokinetics of sevoflurane. Clin
Pharmacokinet 1999;36:13–26.
113. Imai A, Steffey E, Ilkiw J, et al. Comparison of clinical signs and hemodynamic
variables used to monitor rabbits during halothane- and isoflurane-induced
anesthesia. Am J Vet Res 1999;60:1189–95.
114. Gosliga JM, Barter LS. Cardiovascular effects of dopamine hydrochloride and
phenylephrine hydrochloride in healthy isofluraneanesthetized New Zealand
White rabbits (Oryctolagus cuniculus). Am J Vet Res 2015;76:116–21.
115. Barter LS, Epstein SE. Comparison of Doppler, oscillometric, auricular and ca-
rotid arterial blood pressure measurements in isoflurane anesthetized New Zea-
land white rabbits. Vet Anaesth Analg 2014;41:393–7.
116. Uccello O, Sanchez A, Valverde A, et al. Cardiovascular effects of increasing
dosages of norepinephrine in healthy isoflurane-anesthetized New Zealand
White rabbits. Vet Anaesth Analg 2020;47:781–8.
117. Li R, Zhang WS, Liu J, et al. Minimum infusion rates and recovery times from
different durations of continuous infusion of fospropofol, a prodrug of propofol,
in rabbits: a comparison with propofol emulsion. Vet Anaesth Analg 2012;39:
373–84.
118. Hedenqvist P, Jensen-Waern M, Fahlman Å, et al. Intravenous sufentanil-
midazolam versus sevoflurane anaesthesia in medetomidine pre-medicated Hi-
malayan rabbits undergoing ovariohysterectomy. Vet Anaesth Analg 2015;42:
377–85.
119. Tobias JD, Leder M. Procedural sedation: a review of sedative agents, moni-
toring, and management of complications. Saudi J Anaesth 2011;5:395–410.
120. Gianotti G, Valverde A, Sinclair M, et al. Prior determination of baseline minimum
alveolar concentration (MAC) of isoflurane does not influence the effect of keta-
mine on MAC in rabbits. Can J Vet Res 2012;76:261–7.
121. Barter LS, Hawkins MG, Pypendop BH. Effects of fentanyl on isoflurane mini-
mum alveolar concentration in New Zealand White rabbits (Oryctolagus cunicu-
lus). Am J Vet Res 2015;76:111–5.
122. Tearney CC, Barter LS, Pypendop BH. Cardiovascular effects of equipotent
doses of isoflurane alone and isoflurane plus fentanyl in New Zealand white rab-
bits (Oryctolagus cuniculus). Am J Vet Res 2015;76:591–8.
123. Hedenqvist P, Edner A, Fahlman Å, et al. Continuous intravenous anaesthesia
with sufentanil and midazolam in medetomidine premedicated New Zealand
White rabbits. BMC Vet Res 2013;9:21.
124. Eipe N, Gupta S, Penning J. Intravenous lidocaine for acute pain: an evidence-
based clinical update. BJA Educ 2016;16:292–8.
125. Schnellbacher RW, Carpenter JW, Mason DE, et al. Effects of lidocaine admin-
istration via continuous rate infusion on the minimum alveolar concentration of
isoflurane in New Zealand White rabbits (Oryctolagus cuniculus). Am J Vet
Res 2013;74:1377–84.
126. Schnellbacher RW, Divers SJ, Comolli JR, et al. Effects of intravenous adminis-
tration of lidocaine and buprenorphine on gastrointestinal tract motility and signs
of pain in New Zealand white rabbits after ovariohysterectomy. Am J Vet Res
2017;78:1359–71.
127. Heatley JJ. Cardiovascular anatomy, physiology, and disease of rodents and
small exotic mammals. Vet Clin North Am Exot Anim Pract 2009;12:99–113.
128. Truex RC, Belej R, Ginsberg LM, et al. Anatomy of the ferret heart: an animal
model for cardiac research. Anat Rec 1974;179:411–22.
129. Pariaut R. Cardiovascular physiology and diseases of the rabbit. Vet Clin North
Am Exot Anim Pract 2009;12:135–44.
130. Flecknell P. Managing and monitoring anaesthesia. In: Flecknell P, editor. Labo-
ratory animal anaesthesia. 4th edition. Boston: Elsevier; 2015. p. 77–108.
131. Ozeki L, Caulkett N. Monitoring. In: West G, Heard D, Caulkett N, editors. Zoo
animal and wildlife immobilization and anesthesia. 2nd edition. Ames, Iowa: Wi-
ley-Blackwell; 2015. p. 149–65.
132. Reineke EL. Evaluation and triage of the critically ill patient. 2nd edition. Elsevier
Inc; 2014.
133. Harvey L, Knowles T, Murison PJ. Comparison of direct and Doppler arterial
blood pressure measurements in rabbits during isoflurane anaesthesia. Vet
Anaesth Analg 2012;39:174–84.
134. Ypsilantis P, Didilis VN, Politou M, et al. A comparative study of invasive and os-
cillometric methods of arterial blood pressure measurement in the anesthetized
rabbit. Res Vet Sci 2005;78:269–75.
135. Kuwahara M, Yagi Y, Birumachi JI, et al. Non-invasive measurement of systemic
arterial pressure in guinea pigs by an automatic oscillometric device. Blood
Press Monit 1996;1:433–7.
136. Heard D. Lagomorphs (Rabbits, hares, and pikas). In: West G, Heard D,
Caulkett N, editors. Zoo animal and wildlife immobilization and anesthesia.
2nd edition. Ames, Iowa: Wiley-Blackwell; 2015. p. 1558–9.
137. Shahoud JS, Aeddula NR. Physiology, arterial pressure regulation. Treasure Is-
land, Fl: StatPearls Publishing LLC; 2019.
138. Cooper E. Hypotension. In: Silverstein DC, Hopper K, editors. Small animal crit-
ical care medicine. 2nd edition. Elsevier Health Sciences; 2015. p. 46–50.
139. Heard D. Anesthesia. In: Speer B, editor. Current therapy in avian medicine and
surgery. St. Louis, Missouri: Elsevier Inc; 2016. p. 612.
140. Caulkett NA, Cantwell SL, Houston DM. A comparison of indirect blood pressure
monitoring techniques in the anesthetized cat. Vet Surg 1998;27:370–7.
141. Acierno MJ, Brown S, Coleman AE, et al. ACVIM consensus statement: Guide-
lines for the identification, evaluation, and management of systemic hyperten-
sion in dogs and cats. J Vet Intern Med 2018;32:1803–22.
142. Hancock EW, Deal BJ, Mirvis DM, et al. AHA/ACCF/HRS recommendations for
the standardization and interpretation of the electrocardiogram. Part V: electro-
cardiogram changes associated with cardiac chamber hypertrophy a scientific
statement from the American Heart Association electrocardiography. J Am Coll
Cardiol 2009;53:992–1002.
143. Heard D. Rodents. In: West G, Heard D, Caulkett N, editors. Zoo animal and
wildlife immobilization and anesthesia. 2nd edition. Ames, Iowa: Wiley-Black-
well; 2014. p. 893–903.
144. Jubran A. Pulse oximetry: review. Crit Care 2015;19:272.
145. Vegfords M, Sjöberg F, Lindberg LG, et al. Basic studies of pulse oximetry in a
rabbit model. Acta Anaesthesiol Scand 1991;35:596–9.
146. Stanford M. Practical use of capnography in exotic animal anesthesia. Exo-
ticDVM 2004;6:57–60.
147. Beck C, Barthel F, Hahn AM, et al. Evaluation of a new side-stream, low dead
space, end-tidal carbon dioxide monitoring system in rats. Lab Anim 2014;
48:1–5.
148. Evans JM, Hogg MIJ, Rosen M. Correlation of alveolar PCO 2 estimated by infra-
red analysis and arterial PCO 2 in the human neonate and the rabbit. Br J
Anaesth 1977;49:761–4.
149. Marini RP, Avison DL, Corning BF, et al. Ketamine/xylazine/butorphanol: a new
anesthetic combination for rabbits. Lab Anim Sci 1992;42:57–62.
150. Santos M, Viñuela A, Vela AA, et al. Single-syringe ketamine–propofol for induc-
tion of anaesthesia in rabbits. Vet Anaesth Analg 2016;43:561–5.
151. Grint NJ, Murison PJ. A comparison of ketamine-midazolam and ketamine-

medetomidine combinations for induction of anaesthesia in rabbits. Vet Anaesth
Analg 2008;35:113–21.
152. Oguntoye CO, Oyewande OA, Afolabi OO. Evaluation of tramadol-midazolam-
ketamine anaesthesia in rabbits. Niger J Physiol Sci 2018;33:145–9.
153. Henke J, Astner S, Brill T, et al. Comparative study of three intramuscular anaes-
thetic combinations (medetomidine/ketamine, medetomidine/fentanyl/midazo-
lam and xylazine/ketamine) in rabbits. Vet Anaesth Analg 2005;32:261–70.
154. Hedenqvist P, Orr HE, Roughan JV, et al. Anaesthesia with ketamine/medetomi-
dine in the rabbit: Influence of route of administration and the effect of combina-
tion with butorphanol. Vet Anaesth Analg 2002;29:14–9.
155. Egger CM, Souza MJ, Greenacre CB, et al. Effect of intravenous administration
of tramadol hydrochloride on the minimum alveolar concentration of isoflurane in
rabbits. Am J Vet Res 2009;70:945–9.

Rabbit Sedation and Anes 2022 Veterinary Clinics of North America Exotic An

Uploaded by

Copyright:

Available Formats

Rabbit Sedation and Anes 2022 Veterinary Clinics of North America Exotic An

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Rabbit Sedation and Anes 2022 Veterinary Clinics of North America Exotic An

Uploaded by

Copyright:

Available Formats

R a b b i t S e d a t i o n an d

Increasingly, rabbits are presented to veterinarians for evaluation, diagnostics, and

Disclosure: The authors have nothing to disclose.

Vet Clin Exot Anim 25 (2022) 181–210

A thorough history and husbandry evaluation is critical to the understanding of rab-

PREANESTHETIC ASSESSMENT AND CONSIDERATIONS

Rabbits have a reputation of being difficult or dangerous to anesthetize.3–5 As a prey

Parameter Reference Range

PREOPERATIVE BLOOD TESTS

Preoperative assessment of hydration can be challenging in rabbits and intraoperative

Water intake in rabbits is comparatively higher than in other mammals.21,22 The

In certain situations, such as very small or severely hypotensive rabbits, IV catheteri-

BALANCED MULTIMODAL ANESTHESIA

Multimodal or “balanced” anesthesia is a concept that uses a combination of drugs in

The most commonly used benzodiazepine in rabbits is midazolam. Midazolam is a

Partial Opioid Agonists and Agonist/Antagonists

diagnostic procedures.35 Butorphanol alone causes mild, short-term sedation in healthy

Pure agonists such as morphine, methadone, hydromorphone, and fentanyl are

Commonly used alpha-2 adrenergic receptor agonists include xylazine, detomidine,

N-METHYL-D-ASPARTATE (NMDA) ANTAGONISTS

Ketamine is a noncompetitive NMDA receptor antagonist that results in the prevention

The most common indication for anticholinergics in a premedication protocol include

Drug Dosage Common Uses Reversal Agents

REGIONAL NERVE BLOCKS

Fig. 2. Preoxygenation via face mask.

Propofol is a substituted isopropylphenol anesthetic. Its use as an injectable induction

Alfaxalone is a neurosteroid anesthetic that is suitable as an induction agent through IV

Etomidate is a potent, nonbarbiturate hypnotic agent with a short duration of action

infection, it may be prudent to avoid the use of nasotracheal intubation.93,95 In very

Oral Endotracheal Intubation

Drug Dosage Comments

Laryngeal Mask Airway Devices and Supraglottic Airway Devices

Drug Protocol Purpose of Protocol Dosage Comments

Rabbit Sedation and Anesthesia

ISOFLURANE, SEVOFLURANE, AND DESFLURANE

In most situations, maintenance of anesthesia is performed with an inhalant gas, either

Fig. 3. Appropriate placement of a commercially available rabbit-specific supraglottic

TOTAL AND PARTIAL INTRAVENOUS ANESTHESIA

Drug Dose Comments

Common anesthetic complications in rabbits include hypothermia, respiratory

Thoracic auscultation should be performed throughout anesthesia to allow for evalu-

THE POSTANESTHETIC PERIOD

1. AVMA. In: AVMA pet ownership and demographics sourcebook. Schaumburg,

15. Sharma D, Hill AE, Christopher MM. Hypercholesterolemia and hypertriglyceri-

guided nerve blocks. 2nd edition. Buenos Aires, Argentina: 5m Publishing;

94. Prasanna D, Bhat S. Nasotracheal intubation: an overview. J Maxillofac Oral

151. Grint NJ, Murison PJ. A comparison of ketamine-midazolam and ketamine-

You might also like