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Anaesthesia and Dentals

LagomorphLion

LagomorphLion

Warren Scout
Hi All,

I was hoping you could give me some information about GAs in general. Kirsty my 9 year old dwarf lop has a small spur on one of his molars which he has had for a few years now and has been managing with it pretty well. Our vet looks at it at least every 3 months to keep an eye on it and has never seen any signs of redness/inflammation/cuts/etc (although this has only been with a scope). He has been a little bit on and off with his hay this year after completely going off it when he had a bladder sludge issue- which caused the spur to develop slightly. He is also just quite a fussy hay eating which doesn't help in the first place!! At the moment he's doing ok and putting on weight, as he lost a fair bit back when he had the bladder issue. Being 9 we (including our vet) have been more hesitant to do a dental because of the increased risks of the GA itself.

I always get in such a fluster whenever theres even just one tiny possible sign he's going off his hay so I want get and process information now so that if a time comes when we need to decide whether to perform one or not, I can make the best decision possible.

I'm just wondering how big the risks are now with anaesthetics, as i've heard a lot of conflicting advice. Our vet has said that some rabbits do just not respond to them well and pass away whilst they're under, is that true and a quite a regular thing? And how much can his age affect the risks too? Are conscious dentals an option?

Sorry this is all quite vague, I would really just appreciate any advice or experience you guys have had.

Thank you so much

Side note: He had his blood and urine tested back in February which came back clear, apart from some bacteria in his urine which he was treated for. (Just thought this might be some handy info)
 
LagomorphLion said:
Hi All,

I was hoping you could give me some information about GAs in general. Kirsty my 9 year old dwarf lop has a small spur on one of his molars which he has had for a few years now and has been managing with it pretty well. Our vet looks at it at least every 3 months to keep an eye on it and has never seen any signs of redness/inflammation/cuts/etc (although this has only been with a scope). He has been a little bit on and off with his hay this year after completely going off it when he had a bladder sludge issue- which caused the spur to develop slightly. He is also just quite a fussy hay eating which doesn't help in the first place!! At the moment he's doing ok and putting on weight, as he lost a fair bit back when he had the bladder issue. Being 9 we (including our vet) have been more hesitant to do a dental because of the increased risks of the GA itself.

I always get in such a fluster whenever theres even just one tiny possible sign he's going off his hay so I want get and process information now so that if a time comes when we need to decide whether to perform one or not, I can make the best decision possible.

I'm just wondering how big the risks are now with anaesthetics, as i've heard a lot of conflicting advice. Our vet has said that some rabbits do just not respond to them well and pass away whilst they're under, is that true and a quite a regular thing? And how much can his age affect the risks too? Are conscious dentals an option?

Sorry this is all quite vague, I would really just appreciate any advice or experience you guys have had.

Thank you so much

Side note: He had his blood and urine tested back in February which came back clear, apart from some bacteria in his urine which he was treated for. (Just thought this might be some handy info)
Click to expand...

With a 'Rabbit Savvy' Vet GAs are far less risky now than they were a few years ago. Whilst there will always be some risk for any animal under-going a GA a Rabbit Savvy Vet will use the most appropriate GA drug protocol and also give a lot of supportive care . A pre op' blood profile may also be suggested if the Rabbit is elderly/debilitated. The blood test your Rabbit had in February would not give accurate information about his current state of health.

http://www.medirabbit.com/EN/Surgery/Anesthesia/Anes_main/anes_main_en.htm

This is the statement policy of the RWAF (Rabbit Welfare Association and Fund) about the option of 'Conscious Dentals'( dental treatment without sedation/GA) which my Vet will not do for ethical/efficiency/safety reasons.


Conscious Dental Treatment

We are often asked whether it is possible, or advantageous, to perform dental procedures on rabbits without anaesthesia or sedation. This is a complex question, as it depends entirely on the character of the rabbit, the nature of the dental problem, the equipment available and the expertise of the Veterinary Surgeon and Veterinary Nurses involved. Trimming of overlong incisors may be performed with powered dental equipment with gentle but firm physical restraint. Towel wrapping, the "bunny burrito" technique, may be very useful here. Sedation may be required in some rabbits.

Cheek (back) teeth treatment is more complicated, requiring visualisation of the teeth. Difficulty arises because they are hidden at the back of the mouth, in contrast to the easily visible incisors, as well as greatly limiting the safe use of effective dental equipment in this area.

Gags are occasionally recommended to keep the mouth open. These are widely used in anaesthetised rabbits to hold the mouth open and the head in position, but are not safe to use in a rabbit which is not adequately anaesthetised due to the risk of tooth or jaw fracture if the rabbit tries to close its mouth. Without this, visibility is limited, which makes it easy to miss significant dental problems, especially at the very back of the mouth, and increases the risk of damaging the soft tissues of the mouth when carrying out conscious dentistry.

Powered dental equipment rotates rapidly and may cause significant injuries to the tongue, cheek or gums if it comes into contact with them. It is therefore wise not to use where visibility is not sufficient to avoid the risk of damage. Furthermore there is the danger of conscious animals moving, causing power tools to slip and inflict injury on the mouth

The choice of equipment for use in conscious dentistry is therefore limited to hand held ie non powered equipment. Whilst this is appropriate for small spurs on the inside edge of the lower teeth, it is much more difficult to use these elsewhere, should other teeth require attention. If the entire back tooth is leaning it, rather than just spurring, it is inappropriate to use hand equipment to clip the tooth, as this can fracture and loosen the tooth.

Files can be used in the mouth to avoid clipping. However, large blood vessels at the back of the mouth are vulnerable to being caught with the tip of a file, and potentially fatal haemorrhage may result.

The experience of the veterinary surgeon performing such a procedure, and the expertise of the veterinary nurse handling the rabbit strongly influence the safety and end result of any dental procedure. The decision on whether to carry out dental work and how to do so is the clinical responsibility of the veterinary surgeon, after a discussion of the relative risks and benefits with the owner of all techniques available. It is impossible here to categorically state what should and should not be done in each circumstance, but conscious dentistry should not simply be considered as a short cut alternative to dentistry under GA. Whatever method is employed, a full clinical examination of the rabbit, with particular reference to the mouth and associated structures, should be performed first (eg intra and extra-oral examination, and assessment of eyes and ears to look for associated pathology).

Our opinion at the RWAF is that incisor dental shortening can be carried out conscious in the majority of rabbits, (but that this should be done using appropriate tools, and not by clipping which can shatter or split teeth) but that cheek tooth dentistry is best carried out under a short, well maintained anaesthetic to allow full visualisation and assessment of dental disease. However, there may be circumstances where a limited amount of cheek tooth dentistry may be more safely performed conscious. A typical situation is the presence of a single or small number of dental spurs in an easily visualised position, in a calm rabbit, particularly when the animal is not considered a suitable candidate for an anaesthetic (eg through severe dehydration or malnutrition for the dental lesion present, or other underlying disease). This may perhaps be carried out to relieve pain in a seriously unwell rabbit in order to improve his or her fluid and nutritional status prior to a full dental under GA. However, if conscious dentistry is considered the default option due to the risks of anaesthesia generally, it is worth reviewing practice anaesthetic protocols for rabbits.

The risks of the procedure must be balanced against the potential advantages in every case, and fully discussed with your veterinary surgeon.

Please note that this advice is not aimed at the equivalent situation in guinea pigs, whose dental pathology is different, usually involving whole teeth and a significantly increased risk of severely and permanently damaging the teeth involved.
 
LagomorphLion said:
Hi All,

I was hoping you could give me some information about GAs in general. Kirsty my 9 year old dwarf lop has a small spur on one of his molars which he has had for a few years now and has been managing with it pretty well. Our vet looks at it at least every 3 months to keep an eye on it and has never seen any signs of redness/inflammation/cuts/etc (although this has only been with a scope). He has been a little bit on and off with his hay this year after completely going off it when he had a bladder sludge issue- which caused the spur to develop slightly. He is also just quite a fussy hay eating which doesn't help in the first place!! At the moment he's doing ok and putting on weight, as he lost a fair bit back when he had the bladder issue. Being 9 we (including our vet) have been more hesitant to do a dental because of the increased risks of the GA itself.

I always get in such a fluster whenever theres even just one tiny possible sign he's going off his hay so I want get and process information now so that if a time comes when we need to decide whether to perform one or not, I can make the best decision possible.

I'm just wondering how big the risks are now with anaesthetics, as i've heard a lot of conflicting advice. Our vet has said that some rabbits do just not respond to them well and pass away whilst they're under, is that true and a quite a regular thing? And how much can his age affect the risks too? Are conscious dentals an option?

Sorry this is all quite vague, I would really just appreciate any advice or experience you guys have had.

Thank you so much

Side note: He had his blood and urine tested back in February which came back clear, apart from some bacteria in his urine which he was treated for. (Just thought this might be some handy info)
Click to expand...


You say that your vet is reluctant to give GA due to age and other reasons - does your vet perform conscious dentals? Yes there are definitely risks with anaesthetics. The last time one of my rabbits had a dental his heart stopped under the GA - he was 7 years old at the time. The vet got a tremendous shock, and fortunately managed to revive him. Obviously after that she was certainly not keen to give a GA for a dental! In fact she said that her heart almost stopped when his did :shock:

So in that situation what do you do? If a vet can only perform dentals with anaesthetic, but acknowledge the risk is too great and so won't give GA, it creates a dilemma .. What does your vet advise?

The Rabbit Welfare Association and Fund acknowledge the need for conscious dentals and I have witnessed many over the last 20 years. A very skilled vet (and one vet will freely admit she does not have the confidence, for which I respect her) will perform the task within a couple of minutes or so and of course there's no recovery time. My rabbits are all eating straight away they get home :D


I hope this helps you a bit? x
 
Scarlet had her 15th GA for dental work this week and she's between 8 and 9 years old. The problems she had in her mouth were not on this occasion, and have mostly not been, visible during a conscious examination so personally, I would always opt for a GA and full evaluation. The only thing she has and done without a GA is removal of one small spur but that was only possible because she particularly subdued and unwell. The vet was very much working blind and explained that at the time (he was having to feel with the clippers) and he made it quite clear who could accidentally cut her tongue. I think this is in line with the following part of RWAFs advice.
Our opinion at the RWAF is that incisor dental shortening can be carried out conscious in the majority of rabbits, (but that this should be done using appropriate tools, and not by clipping which can shatter or split teeth) but that cheek tooth dentistry is best carried out under a short, well maintained anaesthetic to allow full visualisation and assessment of dental disease. However, there may be circumstances where a limited amount of cheek tooth dentistry may be more safely performed conscious. A typical situation is the presence of a single or small number of dental spurs in an easily visualised position, in a calm rabbit, particularly when the animal is not considered a suitable candidate for an anaesthetic (eg through severe dehydration or malnutrition for the dental lesion present, or other underlying disease). This may perhaps be carried out to relieve pain in a seriously unwell rabbit in order to improve his or her fluid and nutritional status prior to a full dental under GA. However, if conscious dentistry is considered the default option due to the risks of anaesthesia generally, it is worth reviewing practice anaesthetic protocols for rabbits.
 
Jack's-Jane said:
With a 'Rabbit Savvy' Vet GAs are far less risky now than they were a few years ago. Whilst there will always be some risk for any animal under-going a GA a Rabbit Savvy Vet will use the most appropriate GA drug protocol and also give a lot of supportive care . A pre op' blood profile may also be suggested if the Rabbit is elderly/debilitated. The blood test your Rabbit had in February would not give accurate information about his current state of health.

http://www.medirabbit.com/EN/Surgery/Anesthesia/Anes_main/anes_main_en.htm

This is the statement policy of the RWAF (Rabbit Welfare Association and Fund) about the option of 'Conscious Dentals'( dental treatment without sedation/GA) which my Vet will not do for ethical/efficiency/safety reasons.


Conscious Dental Treatment

We are often asked whether it is possible, or advantageous, to perform dental procedures on rabbits without anaesthesia or sedation. This is a complex question, as it depends entirely on the character of the rabbit, the nature of the dental problem, the equipment available and the expertise of the Veterinary Surgeon and Veterinary Nurses involved. Trimming of overlong incisors may be performed with powered dental equipment with gentle but firm physical restraint. Towel wrapping, the "bunny burrito" technique, may be very useful here. Sedation may be required in some rabbits.

Cheek (back) teeth treatment is more complicated, requiring visualisation of the teeth. Difficulty arises because they are hidden at the back of the mouth, in contrast to the easily visible incisors, as well as greatly limiting the safe use of effective dental equipment in this area.

Gags are occasionally recommended to keep the mouth open. These are widely used in anaesthetised rabbits to hold the mouth open and the head in position, but are not safe to use in a rabbit which is not adequately anaesthetised due to the risk of tooth or jaw fracture if the rabbit tries to close its mouth. Without this, visibility is limited, which makes it easy to miss significant dental problems, especially at the very back of the mouth, and increases the risk of damaging the soft tissues of the mouth when carrying out conscious dentistry.

Powered dental equipment rotates rapidly and may cause significant injuries to the tongue, cheek or gums if it comes into contact with them. It is therefore wise not to use where visibility is not sufficient to avoid the risk of damage. Furthermore there is the danger of conscious animals moving, causing power tools to slip and inflict injury on the mouth

The choice of equipment for use in conscious dentistry is therefore limited to hand held ie non powered equipment. Whilst this is appropriate for small spurs on the inside edge of the lower teeth, it is much more difficult to use these elsewhere, should other teeth require attention. If the entire back tooth is leaning it, rather than just spurring, it is inappropriate to use hand equipment to clip the tooth, as this can fracture and loosen the tooth.

Files can be used in the mouth to avoid clipping. However, large blood vessels at the back of the mouth are vulnerable to being caught with the tip of a file, and potentially fatal haemorrhage may result.

The experience of the veterinary surgeon performing such a procedure, and the expertise of the veterinary nurse handling the rabbit strongly influence the safety and end result of any dental procedure. The decision on whether to carry out dental work and how to do so is the clinical responsibility of the veterinary surgeon, after a discussion of the relative risks and benefits with the owner of all techniques available. It is impossible here to categorically state what should and should not be done in each circumstance, but conscious dentistry should not simply be considered as a short cut alternative to dentistry under GA. Whatever method is employed, a full clinical examination of the rabbit, with particular reference to the mouth and associated structures, should be performed first (eg intra and extra-oral examination, and assessment of eyes and ears to look for associated pathology).

Our opinion at the RWAF is that incisor dental shortening can be carried out conscious in the majority of rabbits, (but that this should be done using appropriate tools, and not by clipping which can shatter or split teeth) but that cheek tooth dentistry is best carried out under a short, well maintained anaesthetic to allow full visualisation and assessment of dental disease. However, there may be circumstances where a limited amount of cheek tooth dentistry may be more safely performed conscious. A typical situation is the presence of a single or small number of dental spurs in an easily visualised position, in a calm rabbit, particularly when the animal is not considered a suitable candidate for an anaesthetic (eg through severe dehydration or malnutrition for the dental lesion present, or other underlying disease). This may perhaps be carried out to relieve pain in a seriously unwell rabbit in order to improve his or her fluid and nutritional status prior to a full dental under GA. However, if conscious dentistry is considered the default option due to the risks of anaesthesia generally, it is worth reviewing practice anaesthetic protocols for rabbits.

The risks of the procedure must be balanced against the potential advantages in every case, and fully discussed with your veterinary surgeon.

Please note that this advice is not aimed at the equivalent situation in guinea pigs, whose dental pathology is different, usually involving whole teeth and a significantly increased risk of severely and permanently damaging the teeth involved.
Click to expand...


Wow, thank you so much, just the statement policy on its own has helped me out a lot! I'm just about to read the information on the website!

Thank you again! :D
 
MightyMax said:
You say that your vet is reluctant to give GA due to age and other reasons - does your vet perform conscious dentals? Yes there are definitely risks with anaesthetics. The last time one of my rabbits had a dental his heart stopped under the GA - he was 7 years old at the time. The vet got a tremendous shock, and fortunately managed to revive him. Obviously after that she was certainly not keen to give a GA for a dental! In fact she said that her heart almost stopped when his did :shock:

So in that situation what do you do? If a vet can only perform dentals with anaesthetic, but acknowledge the risk is too great and so won't give GA, it creates a dilemma .. What does your vet advise?

The Rabbit Welfare Association and Fund acknowledge the need for conscious dentals and I have witnessed many over the last 20 years. A very skilled vet (and one vet will freely admit she does not have the confidence, for which I respect her) will perform the task within a couple of minutes or so and of course there's no recovery time. My rabbits are all eating straight away they get home :D


I hope this helps you a bit? x
Click to expand...

I have asked my vet whether there are any alternative treatments and she has said she would only be comfortable to do a GA. Oh my gosh - that must have been terrifying!

We have been very back and forth for quite a while now, not too long ago we were going to go for it and then the next day Kirsty started eating hay like nobody's business! Him being so on and off has also been a factor which has been making it difficult to decide as it could just be that he is extremely fussy! For the moment, we've come to the conclusion that as long as he is happy, comfortable and eating fairly well we will hold off.

Wow, that must be having been amazing!

Yes it has - its really handy to hear from someone who has been through this, thank you so much!

Since you have a fair bit of experience, do you know anything about pre-oxygen before a GA? Our vet has an oxygen tent which she said would be beneficial to him, however I've also heard that once they are taken out of it, it makes no difference? No worries if not!
 
RedFraggle said:
Scarlet had her 15th GA for dental work this week and she's between 8 and 9 years old. The problems she had in her mouth were not on this occasion, and have mostly not been, visible during a conscious examination so personally, I would always opt for a GA and full evaluation. The only thing she has and done without a GA is removal of one small spur but that was only possible because she particularly subdued and unwell. The vet was very much working blind and explained that at the time (he was having to feel with the clippers) and he made it quite clear who could accidentally cut her tongue. I think this is in line with the following part of RWAFs advice.
Our opinion at the RWAF is that incisor dental shortening can be carried out conscious in the majority of rabbits, (but that this should be done using appropriate tools, and not by clipping which can shatter or split teeth) but that cheek tooth dentistry is best carried out under a short, well maintained anaesthetic to allow full visualisation and assessment of dental disease. However, there may be circumstances where a limited amount of cheek tooth dentistry may be more safely performed conscious. A typical situation is the presence of a single or small number of dental spurs in an easily visualised position, in a calm rabbit, particularly when the animal is not considered a suitable candidate for an anaesthetic (eg through severe dehydration or malnutrition for the dental lesion present, or other underlying disease). This may perhaps be carried out to relieve pain in a seriously unwell rabbit in order to improve his or her fluid and nutritional status prior to a full dental under GA. However, if conscious dentistry is considered the default option due to the risks of anaesthesia generally, it is worth reviewing practice anaesthetic protocols for rabbits.
Click to expand...


Thank you, that has helped me out a lot!

I hope Scarlet is doing well - how quickly did she recover?
 
LagomorphLion said:
I have asked my vet whether there are any alternative treatments and she has said she would only be comfortable to do a GA. Oh my gosh - that must have been terrifying!

We have been very back and forth for quite a while now, not too long ago we were going to go for it and then the next day Kirsty started eating hay like nobody's business! Him being so on and off has also been a factor which has been making it difficult to decide as it could just be that he is extremely fussy! For the moment, we've come to the conclusion that as long as he is happy, comfortable and eating fairly well we will hold off.

Wow, that must be having been amazing!

Yes it has - its really handy to hear from someone who has been through this, thank you so much!

Since you have a fair bit of experience, do you know anything about pre-oxygen before a GA? Our vet has an oxygen tent which she said would be beneficial to him, however I've also heard that once they are taken out of it, it makes no difference? No worries if not!
Click to expand...


I will PM you a bit later about this, if that's OK :D
 
LagomorphLion said:
Thank you, that has helped me out a lot!

I hope Scarlet is doing well - how quickly did she recover?
Click to expand...

She's still not quite eating properly and she had it done Tuesday. Up until last year she used to bounce back very quickly (she'd eat straight away) but it takes her a little while now as she's an littleold lady. She has had all the teeth on one side of her mouth removed now.
 
Bramble my Netherland dwarf is just 9 and has had 3 dentals under GA in the last year, the last being a fortnight ago. She's been absolutely fine and on the second also had X-rays done so was obviously under longer. My vet explained that they don't put rabbits as deeply under as a cat or dog because of the history of risk. With Bramble's last dental they also gave her iv fluids, I forgot to ask why when I picked her up, but on that occasion she was eating within an hour or so of being woken up whereas she normally won't eat properly til she gets home. Whether that was down to the fluids or whether it was because I'd remembered to put a couple of drops of Bach rescue remedy in their water bowl the night before or whether it was just coincidence who knows!
It's always worrying putting a much loved pet through a GA but if they are suffering, it needs to be done. An experienced vet that you trust makes it a lot easier to make that decision. Hope all goes well for your little one x
 
Glingle said:
Bramble my Netherland dwarf is just 9 and has had 3 dentals under GA in the last year, the last being a fortnight ago. She's been absolutely fine and on the second also had X-rays done so was obviously under longer. My vet explained that they don't put rabbits as deeply under as a cat or dog because of the history of risk. With Bramble's last dental they also gave her iv fluids, I forgot to ask why when I picked her up, but on that occasion she was eating within an hour or so of being woken up whereas she normally won't eat properly til she gets home. Whether that was down to the fluids or whether it was because I'd remembered to put a couple of drops of Bach rescue remedy in their water bowl the night before or whether it was just coincidence who knows!
It's always worrying putting a much loved pet through a GA but if they are suffering, it needs to be done. An experienced vet that you trust makes it a lot easier to make that decision. Hope all goes well for your little one x
Click to expand...

Thank you so much, I'm not feeling nearly as stressed out as I was before! I'm much happier knowing rabbits the same age as Kirsty are not only having a dental but multiple of them! That's interesting about them not being put as deeply under as cats/dogs, I wonder if thats a universal thing with all vets or if your vet is just particularly good! I've got some rescue remedy and another rabbit safe brand of calming drops so I'll keep that in mind if ever he does have to have a GA- just incase!

I am thinking of moving vets as whilst our vet does have experience with rabbits, she's not an outright exotic vet. I've contacted the RWAF asking for access to their vet list so I'll see whats in my area.

Thank you again, you've helped me a lot!I hope Bramble is managing ok. :D
 
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