The effects of extubation with an inflated versus deflated endotracheal tube cuff on endotracheal fluid volume in the dog

Objective The purpose of this study was to investigate the effect of extubation with the endotracheal tube (ETT) cuff inflated versus deflated on endotracheal fluid volume in normal canine cadavers. Study Design Prospective randomized blinded controlled cadaver study. Animals Sixteen adult Beagle cadavers weighing 10.7 ± 1.7 kg (mean ± SD) and <2 years of age. Methods Cadavers were orotracheally intubated in lateral recumbency, and the ETT cuffs were inflated to a closing pressure of 20 cm H₂O before barium was introduced orad to the cuff. The dogs were randomly assigned to an ETT cuff extubation condition of deflated or unchanged from the original closing pressure. After extubation, lateral thoracic radiographs of the cadavers were obtained and scored by three independent blinded reviewers. Each reviewer ordered all 16 lateral radiographs from most to least intratracheal contrast and also estimated residual intratracheal contrast volume. Results Dogs extubated with a deflated ETT cuff had a median rank of 13 and dogs extubated with an inflated ETT cuff had a median rank of 4.5 (p < 0.0001). Dogs extubated with a deflated ETT cuff had an estimated intratracheal volume of fluid of 1.8 mL ± 0.7 mL (mean ± SD) and dogs extubated with an inflated ETT cuff had an estimated volume of 0.9 mL ± 0.5 mL (p < 0.0001). Fleiss Kappa for agreement among evaluators was 0.875. Conclusions and clinical relevance Extubation with the cuff inflated removed more liquid contents from the trachea than extubation with the cuff deflated and may assist in the prevention of pulmonary aspiration when fluid is present in the proximal trachea. The technique did not remove all fluid so the potential for pulmonary damage remains.     

Tracheal trauma and pneumonia secondary to endotracheal intubation in a horse undergoing general anaesthesia,computerised tomography and myelography

Endotracheal intubation is commonly performed in horses undergoing general anaesthesia to avoid fluid aspiration and provide mechanical ventilation and inhalational anaesthetic agents. Secondary laryngeal and tracheal trauma following intubation is not rare. This case report describes the successful treatment of a horse with laryngeal and tracheal trauma secondary to intubation during myelography. Based on other clinical reports and clinical experience, movement of the endotracheal tube during myelography was considered the most likely cause of the damage. This case underscores the importance of monitoring horses for development of respiratory signs after general anaesthesia for computerised tomography and myelography.     

Broken nasotracheal tube aspiration in a horse during anaesthetic recovery

A horse was presented for soft palate thermocautery and surgical advancement of the larynx under general anaesthesia, following a history of respiratory noise and poor athletic performance. Physical examination prior to surgery was unremarkable. The horse was anaesthetised and a 20 mm cuffed endotracheal tube (ETT) used to intubate the trachea via the right nostril. The cuff was deflated at the end of the procedure and the tube secured in place around the head of the horse for the recovery. The horse was assisted to standing and during this process the end of the nasotracheal tube broke and was observed hanging from the head collar. The remainder of the tube was aspirated into the trachea of the horse. The remaining length of endotracheal tube was removed using a modified endoscopic technique. The horse recovered with no further problems. An unusual complication of a nasotracheal tube left in situ for recovery in a horse is reported and possible reasons for this complication are discussed.     

Guttural pouch perforation caused during nasogastric intubation

A 19‐year‐old gelding presented with swelling of the pharyngeal region following evaluation for an episode of colic. Endoscopy, radiography and ultrasonography were utilised in diagnosis of a guttural pouch perforation, secondary to nasogastric intubation. Conservative treatment resulted in a fibrin seal over the perforation. Unfortunately, the horse succumbed to colitis and was subjected to euthanasia before resolution of the injury.     

Comparison between facemask and laryngeal mask airway in rabbits during isoflurane anesthesia

OBJECTIVE: To determine whether a laryngeal mask airway (LMA) provides a better airway than a facemask in spontaneously breathing anesthetized rabbits, and to test if it can be used for mechanically controlled ventilation. STUDY DESIGN: Randomized prospective experimental trial. ANIMALS: Sixteen young, healthy, specific pathogen-free Giant Flemish cross Chinchilla rabbits (10 females and 6 males) weighing 4.1 +/- 0.8 kg. METHODS: Rabbits were assigned randomly to one of three treatment groups: facemask with spontaneous ventilation (FM-SV; n = 5), LMA with spontaneous ventilation (LMA-SV; n = 5), and LMA with controlled ventilation (LMA-CV; n = 6). In dorsal recumbency, and at 2.3% end-tidal isoflurane concentration, Fé isoflurane, Fi isoflurane, partial pressure of expired isoflurane (PECO(2)), partial pressure of inspired carbon dioxide (PiCO(2)), heart rate, respiratory rate, minute volume, arterial oxygen tensions (PaO(2)), arterial carbon dioxide tensions (PaCO(2)), arterial pH (pH(a)), arterial standard base excess (SBE(a)) values were measured for 120 minutes. Results Two individuals in the FM-SV group had PaCO(2) > 100 mm Hg. One rabbit in the FM-SV had PaO(2) < 80 mm Hg. All FM-SV rabbits showed signs of airway obstruction, and two were withdrawn from the study at 45 and 90 minutes, respectively, because cyanosis was observed. No signs of airway obstruction were observed in either LMA group. Four rabbits in the LMA-CV group developed gastric tympanism, one of which refluxed gastric contents after 110 minutes. There were no differences between FM-SV and LMA-SV in any variable tested. PaCO(2) and PECO(2) were decreased, while PaO(2) and minute volume were increased in the LMA-CV group compared to the LMA-SV group. CONCLUSIONS: An LMA provided a better airway than a facemask during spontaneous breathing in rabbits, as the use of a facemask was associated with hypercapnia and low partial pressures of oxygen. Although an LMA can be used for intermittent positive pressure ventilation (IPPV), gastric tympanism may develop, especially at a peak inspiratory pressure of 14 cm H(2)O. CLINICAL RELEVANCE: The LMA can be used in rabbits but further work is needed before it is applied routinely.     

Reduced risk of pneumonia after changes in anesthetic procedures for dogs receiving repeated anesthesia for radiation treatment

Radiation therapy requires repeated anesthetic administration to patients who often have multiple comorbidities contributing to an increased rate of anesthetic complications such as pneumonia. This is a retrospective observational study in which data were collected from 146 medical records of dogs receiving repeat anesthesia for radiation treatment from prior to management changes and compared to data from 149 cases treated after completion of management changes. The objective was to determine if changes in case management protocol that were put in place decreased the risk of pneumonia development among these patients. Management changes that were made included the following: decrease in anticholinergic and pure‐mu opioid use, change in positioning during intubation and recovery, prophylactic treatment of nausea, timing of cuff inflation and deflation, and aseptic handling of intubation equipment. There was a significant association between diagnosis of pneumonia and the following: pre‐ vs. post‐changes to protocol, presence of a neurologic tumor, presence of respiratory disease, presence of megaesophagus, and number of radiation fractions completed. Diagnosis of pneumonia did not vary significantly by age group, body weight category, or sex. In a multivariable logistic regression model that controlled for the effects of the three concurrent diseases and fractions completed, the odds of being diagnosed with pneumonia were approximately 10 times greater among dogs anesthetized prior to management changes (odds ratio = 9.9, 95% CI = 2.0–48.7, P = 0.005).     

Selection of appropriate endotracheal tube size using thoracic radiography in Beagle dogs

Objective

To determine the optimal endotracheal tube size in Beagle dogs using thoracic radiography.