Endotracheal intubation

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Sections available in full article Introduction, Uses, Technical problems, Alternative techniques, Time required, Decision taking, Requirements, Materials required, Preparation, Procedure, Aftercare, Immediate Aftercare, Sequelae, Complications, Reasons for treatment failure, Sources, Vetstream contributor(s),
Contributors Dr Sheilah Robertson BVMS(Hons) PhD DipACVA DipECVA MRCVS

Introduction

  • Placing a tube in the trachea:
    • Ensures that open airway maintained.
    • Prevents inhalation of substances.
    • Allows administration of oxygen or anesthetic gases.

Uses

  • Providing supplementary oxygen.
  • Manual ventilation of patient in respiratory failure.
  • Maintenance of anesthesia.
  • Prevention of aspiration during:
    • Oropharyngeal surgery.
    • Dentistry.
    • Gastric lavage Gastric lavage.

Advantages

  • Safe if carried out correctly.
  • Simple and requires only equipment usually found in veterinary practice.
  • Effective.
  • Cheap.

Preparation

  • In most cases anesthesia required before intubation (unless animal very depressed).

Requirements

Materials required

Minimum equipment

  • Rubber or silicone or polyvinylchloride endotracheal tube of appropriate size (depends on size of dog).
  • There may be substantial individual variation in size of tube that can be placed and some breeds, eg Bulldogs have relatively small tracheas for body weight.
  • Choose the largest tube that can be placed without force:
    Measure length - should read from incisors to point of shoulder.
  • <4 kg: tube size internal diameter 6-8 mm.
  • 5-10 kg: tube size internal diameter 9-10 mm.
  • 12-20 kg: tube size internal diameter 11-12 mm.
  • Approximate size of tube can be calculated using formula:
    • Tube size (Magill) = square root of (bodyweight in kg x 5).

    Brachycephalics, such as Bulldogs Bulldog , often have hypoplastic tracheas and will require small tubes for their bodyweight.

Ideal equipment

  • Laryngoscope with light source.
  • Mouth gag, or second person to hold mouth open.
  • Method of maintaining cuff inflation (if not integral to tube), ie hemostat or hypodermic needle cap.

Minimum consumables

  • Water-soluble lubricant.
  • Syringe (5 ml) to inflate cuff of tube.
  • Gauze tie to secure tube in place.

Sequelae

Complications

  • Tracheal damage due to over inflation of cuff.
  • Many animals with show some evidence of tracheitis, eg coughing for several days after intubation.

Reasons for treatment failure

  • Inability to pass tube due to:
    • Mass obstructing larynx.
    • Laryngospasm.

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