Endotracheal intubation

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    .

Advantages

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

Disadvantages

• Risk of laryngospasm.

Requirements

Materials required

Minimum equipment

• Rubber or silicone endotracheal tube of appropriate size (depends on size of cat).
• Usually tube size between 3-6 mm internal diameter is appropriate.

Ideal equipment

• Laryngoscope with light source.
• Mouth gag.
• If cuffed tube used method of maintaining cuff inflation (if not integral to tube), ie hemostat or hypodermic needle cap.

Minimum consumables

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

Ideal consumables

• Local anesthetic spray for larynx.

Preparation

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

Sequelae

Complications

• Tracheal damage due to over inflation of cuff.
• Many animals will 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.

Sources

Publications

• Cassu R N, Luna S P L, Teixeira Neto F J, Braz J R C, Gasparini S S & Crocci A J (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. DOI