Lapis ISSN 2398-2969

Endotracheal intubation

Contributor(s): Vetstream Ltd, Joanna Hedley, Lesa Longley, Lesa Thompson, David Perpinan

Introduction

  • Placing a tube in the trachea:
    • Ensures that open airway is maintained.
    • Allows administration of oxygen and/or anesthetic gases.
    • Minimizes leakage of waste gases into the environment.
    • Permits IPPV (intermittent positive pressure ventilation) and minimizes the adverse effects of apnea.
    • Allows the use of capnography.

Uses

  • Providing supplementary oxygen.
  • Manual/mechanical ventilation of patient during routine anesthesia to check/help maintain tube patency, during thoracotomies, or in respiratory failure.
  • Maintenance of anesthesia.
  • Permits passage of catheter for bronchoalveolar lavage.
  • Prevention of aspiration during:

Advantages

  • Safe if carried out correctly.
  • Safer for operators.
  • Simple and requires only equipment usually found in veterinary practice.
  • Effective.
  • Cheap.
  • Component of 'best practice' anesthesia.

Disadvantages

  • Risk of laryngospasm and laryngeal edema (fatalities can occur), especially after failed attempts. More than 2 attempts are not recommended. Laryngospasm aned laryngeal edema may be more likely to occur when the blind technique for intubation is used.
  • Hemorrhage/edema of oral soft tissues or larynx.
  • Iatrogenic introduction of food and debris into the airway. Restricting access to greens and pellets 1-2 h before intubation may help prevent this conditon.
  • Risk of esophageal intubation.
  • Risk of tracheal damage with the development of tracheal strictures and tracheal stenosis. This could happen when rough technique is used during intubation or even during anesthesia, eg changing position of the patient without disconnecting the ET tube from the anesthetic circuit.

Requirements

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Preparation

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Procedure

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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.
  • Lee L Y, Lee D, Ryu H et al (2019) Capnography-guided endotracheal intubation as an alternative to existing intubation methods in rabbits. J Am Assoc Lab Anim Sci 58 (2), 240-245 PubMed.
  • Qin E, Xu M, Gan L et al (2018) Erythromycin combined with corticosteroid reduced inflammation and modified trauma-induced tracheal stenosis in a rabbit model. Therap Advances Resp Dis 12, 1753466618773707 PubMed.
  • Engbers S, Larkin A, Rousset N et al (2017) Comparison of a supraglottic airway device (v-gel®) with blind orotracheal intubation in rabbits. Front Vet Sci 4, 49 PubMed.
  • Thompson K L, Meier T R & Scholz J A (2017) Endotracheal intubation of rabbits using a polypropylene guide catheter. J Vis Exper (129) PubMed.
  • Wenger S, Müllhaupt D, Ohlerth S et al (2017) Experimental evaluation of four airway devices in anaesthetized New Zealand rabbits. Vet Anaesth Analg 44 (3), 529-537 PubMed.
  • Crotaz I R (2013) Observational clinical study in cats and rabbits of the use of an anatomically designed supraglottic airway device intended for companion animal veterinary anaesthesia. Vet Rec 172 (23), 606 PubMed.
  • Johnson D H (2010) Endoscopic intubation of exotic companion mammals. Vet Clin North Am Exot Anim Pract 3 (2), 273-289 PubMed
  • Stephens Devalle J M (2009) Successful management of rabbit anesthesia through the use of nasotracheal intubation. J Am Assoc Lab Anim Sci 48 (2), 166-170 PubMed.
  • Lennox A M & Capello V (2008) Tracheal intubation in exotic companion mammals. J Exotic Pet Med 17 (3), 221-227 VetMedResource.
  • Longley L (2008) Clinical refresher: Intubation of rabbits. UK Vet: Companion Animal 13 (5), 68-70 VetMedResource.
  • Morgan T J & Glowaski M M (2007) Teaching a new method of rabbit intubation. J Am Assoc Lab Anim Sci 46 (3), 32-36 PubMed.
  • Grint N J, Sayers I R, Cecchi R et al (2006) Postanaesthetic tracheal strictures in three rabbits. Lab Anim 40 (3), 301-308 PubMed.
  • Phaneuf L R, Barker S, Groleau M A et al (2006) Tracheal injury after endotracheal intubation and anesthesia in rabbits. J Am Assoc Lab Anim Sci 45 (6), 67-72 PubMed.
  • Smith J C, Robertson L D, Auhll A et al (2004) Endotracheal tubes versus laryngeal mask airways in rabbit inhalation anesthesia: ease of use and waste gas emissions. Contemp Top Lab Anim Sci 43 (4), 22-25 PubMed.

Other sources of information

  • Muir W W, J A E Hubbell, R M Bednarski & R T Skarda (2007) Handbook of Veterinary Anesthesia. 4th edn. Mosby Elsevier.
  • Flecknell P A (2006) Anaesthesia and Peri-operative Care. In: Manual of Rabbit Medicine & Surgery. 2nd edn. Eds: Meredith A & Flecknell P A. BSAVA. pp 154-156.
  • Harcourt-Brown F (2002) Anaesthesia and Analgesia. In: Textbook of Rabbit Medicine. Ed: Harcourt-Brown F. Butterworth-Heinemann, Oxford. pp 121-139.
  • Mason D E (1997) Anesthesia, Analgesia and Sedation for Small Mammals. In:Ferrets, Rabbits & Rodents: Clinical Medicine & Surgery. 2nd edn. Eds: Hillyer E V & Quesenberry K E. W B Saunders. pp 378-391.
  • Gillett C S (1994) Selected Drug Doses and Clinical Reference Data. In: The Biology of the Laboratory Rabbit. Eds: Manning P J, Ringler D H & Newcomer C E. 2nd edn. Academic Press, London. pp 468-472.


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