Rabbits

The size guide, copied below, is based on the ideal body weight of the patient. After selecting the largest size based on the chart, further confirmation can be done before placement by laying the device against the patient. Once inserted, the device should feel snug and should not move easily.

v-gel® devices are very useful for rabbit dentistry. They can be used for many routine and advanced procedures. Once the mouth is opened with a dental gag and cheek dilators, there is enough space around the v-gel® to examine and rasp/burr the molar teeth. The v-gel® can be flexed either side of the incisors allowing good access to the mouth. Docsinnovent recommend the use of a D-grip® to support the circuit tubing.

Cats

The size guide, copied below, is based on the ideal body weight of the patient. After selecting the largest size based on the chart, further confirmation can be done before placement by laying the device against the patient. Once inserted, the device should feel snug and should not move easily.

v-gel® devices are safe and appropriate for use during feline dental procedures. Such procedures are mainly performed on adult cats, where a C3 or larger should be the device of choice. The v-gel® should be securely tied in place to prevent rostral displacement and the head should be positioned in a gentle downwards slope to encourage fluid to flow out of the mouth. Docsinnovent recommend the use of a D-grip® to support the circuit tubing.

v-gel ® can safely and effectively be used for establishing and maintaining the patent airway of cats during anaesthesia or resuscitation. Cat v-gel ADVANCED devices;
• are far easier and faster to place than an endotracheal tube with an airway being established in 1 to 5 seconds.
• allow a trauma-free airway
• give a leak-free seal – you can use lower gas flows and protect your staff against the hazards of leaking volatile anaesthetic agents.
• eliminate the cross-contamination risk to your clients’ pets as they are single use devices

An endotracheal tube increases
• the risk of trauma to the upper airway structures and larynx. Trauma can result in post-operative glottic oedema resulting in morbidity (coughing, laryngospasm, bronchospasm, bleeding, breath-holding, sore throat, dysphagia, dysphonia, infection etc.) and mortality – gross glottic oedema can occasionally lead to airway obstruction resulting in death. Incidence of anaesthesia mortality in rabbits is about 1.69% and in cats about 1%, whilst in humans its 0.001%.
• the work of breathing especially for a spontaneous breathing patient, by reducing the internal diameter of the patient’s airway (trachea) by about 40%
• the risk of gas leakage into the atmosphere as uncuffed tubes have limited sealing capability against the trachea. This exposes staff to potentially toxic volatile anaesthetic agents, increases the cost of anaesthesia and means that your patient is getting suboptimal doses of anaesthetic agent

General

Most serious spasms result from endotracheal intubation. The v-gel® doesn’t touch or travel through the arytenoids, therefore the occurrence of spasm is greatly reduced.

However, laryngospasm is a condition that a v-gel ® user should be aware of in all species, as they can result from a painful stimulus if the patient is in a sub-optimal plane of anaesthesia. Therefore, users must ensure that the patient is at a surgical plane of anaesthesia and the v-gel ® is properly lubricated before inserting it into the patient. If the user experiences a transient laryngospasm with the v-gel ® in situ, gently ventilating the patient while simultaneously deepening the plane of anaesthesia using an appropriate agent will resolve the spasm.

Using a safe volume of lidocaine spray on the larynx 60-90 seconds prior to v-gel® insertion in cats and rabbits provides some protection against laryngospasm.

With the correct sized v-gel® in place, secured with a tie tightly behind the patient’s head, the design features of the v-gel® stabilises it; so that with normal turning and re-positioning, the v-gel® will not dislodge. The v-gel® should always be disconnected from the anaesthetic circuit, and the patient’s head supported, during repositioning. Always check the position and placement of your v-gel after turning or moving the patient by gently ventilating and checking that there is no gas leakage and that the airway is patent.

Most importantly the volatile agent should be turned off and the v-gel® size and position re-evaluated.
Most commonly the reason for gas leaking would be under-insertion, either at induction or during the anaesthetic if it’s not secured in well and circuit not supported well thus pulling the v-gel® rostrally off the airway.

Pre-oxygenating a patient is generally a good idea before induction of any anaesthetic.  It increases the time that a patient can tolerate apnoea and prolongs the time to onset of arterial hypoxaemia.  Pre-oxygenation can increase stress, especially in rabbits and may not always be appropriate.

The pre-oxygenation of a patient should ideally be used before induction of any general anaesthesia. It is to provide a maximum time that the patient can tolerate apnoea, it prolongs the time to onset of arterial hypoxemia increasing the body’s oxygen stores, primarily the functional residual capacity (FRC) of the lungs.

The tip of the v-gel® locates itself in the upper oesophagus, which provides additional protection against reflux material reaching the airway.

The dog v-gel® has secondary channel exiting out into the oesophageal tip allowing for the draining of reflux material. A gastric tube can be inserted into this channel to actively suction out material.

v-gel® ADVANCED devices have no metal parts, so they can be used in MRI/CT machines. The original cat v-gel® has a metal spring in the one-way valve, so if required in an MRI, this inflator valve should be cut off to allow the original v-gel® to be used safely in spontaneously-breathing cats

Yes, it is possible to use the v-gel ® with both spontaneous respiration and manual/powered ventilation in all three species. It is important that the correct size v-gel ® is placed to completely seal the pharynx and secure a tight seal in order to achieve IPPV.

If a procedure is longer than 4 hours, the v-gel® should be removed with the patient placed on oxygen face-mask for 30-60 secs, before being replaced.

There are many published papers on the incidence of both reflux and regurgitation.
In dogs, reported incidence of reflux is over 70% in dogs (Raptopolous 2019, Rodriguez-Alarcon et al 2015) and 33.3% in cats (Garcia et al 2017)

The incidence of regurgitation is up to 48% in dogs (Viskier and Sjöström 2017), leading to aspiration in 0.17% (Ovbey et al. 2014)

The v-gel® devices have low dead space connectors fitted. However, it is impossible to simultaneously widen the airway and decrease dead space. At normal fresh gas flow rates this change is clinically insignificant. Docsinnovent’s veterinary consultants have not found clinically significant rebreathing to occur using the v-gel® and most clinicians agree that airway diameter is the most important thing to optimise ventilation for small patients.

The v-gel ® will be the best airway management device in most procedures involving the oral cavity, but there are limitations: There is obviously visibility and accessibility restrictions in the oral cavity when the v-gel ® is in situ: this will restrict the usage during major oral or pharyngeal procedures. It is also not possible to place a gastroscope whilst the v-gel® is in situ.

Docsinnovent advocates excellent standards of patient monitoring for the delivery of safe anaesthesia. During any anaesthetic procedure it is necessary to ensure that a patient’s ventilation is adequately maintained and monitored. There are several methods of doing this including:
– Observation of thoracic wall movement or observation of breathing bag movement when thoracic wall movement cannot be assessed.
– Auscultation of breath sounds with an external stethoscope, an oesophageal stethoscope, or an audible respiratory monitor.
– Capnography (end-expired CO2 measurement)
– Arterial blood gas analysis for partial pressure of CO2 (PaCO2)
– Respirometry (tidal volume measurement)
If the patient is being monitored with at least two of the above in combination, then it is possible to safely monitor the patient where capnography is not available.

Yes, both oesophageal stethoscopes and temperature probes can be used in all v-gel devices®, however, this can be difficult in very small patients.
It is possible to use them in conjunction with the cat v-gel® by placing the probe first followed by the v-gel®.

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