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Endotracheal intubation
Introduction
- Placing a tube in the trachea:
- Ensures that airways remain patent in unconscious animals.
- Prevents inhalation of substances (blood, saliva, stomach contents, etc).
- Allows administration of oxygen and anesthetic gases.
- Allows closed anesthetic circuit with no atmospheric pollution.
Uses
- Providing supplementary oxygen.
- Manual ventilation of patient in respiratory failure.
- Maintenance of anesthesia with volatile anesthetic.
- Prevention of aspiration during:
- Oropharyngeal surgery.
- Dentistry.
- Gastric lavage Gastric lavage.
- High risk of vomiting or regurgitation:
- Esophageal obstruction.
- Ileus.
- Unfasted patients.
Advantages
- Safe if carried out correctly.
- Simple and requires only equipment usually found in veterinary practice.
- Effective.
- Cheap.
Disadvantages
- Risk of laryngospasm.
Technical problems
- Small risk of damage to larynx or trachea.
- May not be possible to intubate patient if difficulty opening jaw or pharyngeal/laryngeal mass.
Alternative techniques
- Nasal oxygen administration Nasal oxygen administration.
- Oxygen by face mask.
- Supraglottic airway device:
- Cat v-gel®.
- Tracheotomy Tracheostomy, temporary tracheostomy. (Prognosis of tracheotomies in cats is not very good.)
Time required
Preparation
- In most cases anesthesia required before intubation (unless animal very depressed).
Procedure
- 1-2 minutes.
Decision taking
Risk assessment
- If difficulty opening jaw or intubation anticipated make preparation for tracheotomy Tracheostomy, temporary tracheostomy should be made in advance.
- However cats do less well with tracheotomy compared to dogs.
- A dog urinary catheter connected via a small endotracheal connector to a T-piece breathing system may be placed into the trachea in case a very narrow larynx is encountered.
Requirements
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Preparation
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Technique
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Aftercare
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Outcomes
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Further Reading
Publications
Refereed papers
- Recent references from PubMed and VetMedResource.
- Prasse S A, Schrack J, Wenger S et al (2016) Clinical evaluation of the v-gel supraglottic airway device in comparison with a classical laryngeal mask and endotracheal intubation in cats during spontaneous and controlled mechanical ventilation. Vet Anaesth Analg 43 (1), 55-62 PubMed.
- van Oostrum H, Krauss M W, Sap R (2013) A comparison between the v-gel supraglottic airway device and the cuffed endotracheal tube for airway management in spontaneouls breathing cats during isoflurane anesthesia. Vet Anaesth Analg 40 (3), 265-271 PubMed.
- Hofmeister E H, Trim C M, Kley S et al (2007) Traumatic endotracheal intubation in the cat. Vet Anaesth Analg 34 (3), 213-216 PubMed.
- Cassu R N, Luna S P, Teixeira Neto F J et al (2004) Evaluation of laryngeal mask as an alternative to endotracheal intubation in cats anesthetized under spontaneous or controlled ventilation. Vet Anaesth Analg 31 (3), 213-221 PubMed.
- Mitchell S L, McCarthy R, Rudloff E et al (2000) Tracheal rupture associated with intubation in cats: 20 cases (1996-1998). JAVMA 216 (10), 1592-1595 PubMed.
Other sources of information
- Hughes L (2016) Breathing systems and ancillary equipment. In: BSAVA Manual of Canine and Feline Anaesthesia and Analgesia. 3rd edn. Duke-Novakovski T, De Vries M, Seymour C J. Chapter 5.