Use of a gum elastic bougie in a cat with severe upper airway stenosis.

Background: Gum elastic bougie (GEB) is an airway management device for patients who are difficult to intubate and its use has been reported in human medicine. However, to our knowledge, no reports in veterinary medicine have described oxygenation using GEB. We describe a case in which GEB was used to maintain oxygenation in a cat with severe upper airway stenosis. Case Description: A 10-year-old neutered male domestic shorthair cat was diagnosed with a laryngeal tumor with severe upper airway stenosis. During anesthesia induction, the normal laryngeal structure could not be confirmed; orotracheal intubation was difficult, resulting in a "cannot intubate, cannot oxygenate" status. The GEB was inserted, making it possible to oxygenate the cat until a permanent tracheostoma could be created, but hypoventilation was noted. Conclusion: Although GEB are not useful for proper ventilation, they can be useful for temporary oxygenation in veterinary medicine when airway management is difficult.

Effects of airway management and tidal volume feedback ventilation during pediatric resuscitation in piglets with asphyxial cardiac arrest.

To compare the effect on the recovery of spontaneous circulation (ROSC) of early endotracheal intubation (ETI) versus bag-mask ventilation (BMV), and expiratory real-time tidal volume (VTe) feedback (TVF) ventilation versus without feedback or standard ventilation (SV) in a pediatric animal model of asphyxial cardiac arrest. Piglets were randomized into five groups: 1: ETI and TVF ventilation (10 ml/kg); 2: ETI and TVF (7 ml/kg); 3: ETI and SV; 4: BMV and TVF (10 ml/kg) and 5: BMV and SV. Thirty breaths-per-minute guided by metronome were given. ROSC, pCO2, pO2, EtCO2 and VTe were compared among groups. Seventy-nine piglets (11.3 ± 1.2 kg) were included. Twenty-six (32.9%) achieved ROSC. Survival was non-significantly higher in ETI (40.4%) than BMV groups (21.9%), p = 0.08. No differences in ROSC were found between TVF and SV groups (30.0% versus 34.7%, p = 0.67). ETI groups presented lower pCO2, and higher pO2, EtCO2 and VTe than BMV groups (p < 0.05). VTe was lower in TVF than in SV groups and in BMV than in ETI groups (p < 0.05). Groups 1 and 3 showed higher pO2 and lower pCO2 over time, although with hyperventilation values (pCO2 < 35 mmHg). ETI groups had non significantly higher survival rate than BMV groups. Compared to BMV groups, ETI groups achieved better oxygenation and ventilation parameters. VTe was lower in both TVF and BMV groups. Hyperventilation was observed in intubated animals with SV and with 10 ml/kg VTF.

Evaluation of supraglottic airway device use during inhalation anesthesia in healthy African pygmy hedgehogs (Atelerix albiventris).

OBJECTIVE: To evaluate a supraglottic airway device (SGAD) designed for rabbits in African pygmy hedgehogs (Atelerix albiventris) during inhalation anesthesia. STUDY DESIGN: Prospective, randomized, blinded experimental study. ANIMALS: A total of 12 adult African pygmy hedgehogs (seven male, five female). METHODS: Hedgehogs were placed in a chamber and anesthesia was induced using isoflurane in oxygen. Oropharyngeal endoscopy was performed and video recorded. The SGAD (v-gel R1) was inserted and connected to a Mapleson D circuit. Capnography, pulse oximetry and physiologic variables were measured during anesthesia, and lung inflation was tested at 10 and 20 cmH2O. With the SGAD temporarily disconnected, anesthetized hedgehogs were randomly positioned into right and left lateral, dorsal and sternal recumbency to evaluate the effect of a change in body position on SGAD placement. Oropharyngeal endoscopy was repeated at the end of anesthesia, and recovery time was recorded. Pre- and post-SGAD placement endoscopy videos were retrospectively reviewed and scored for gross trauma. RESULTS: The median [interquartile range (IQR)] time to successful SGAD placement was 38 (16-68) seconds. The time to SGAD placement decreased as the study progressed. SGAD required repositioning in six hedgehogs, median 2.5 (IQR, 1-3.5) adjustments each, to successfully perform lung inflation or maintain capnography readings. Lung inflation at 10 cmH2O was successfully performed without leakage in nine animals, and in the other three animals after adjusting the SGAD at 1-2 time points. Inflation at 20 cmH2O was rarely achieved without an air leak. Changes in heart and respiratory rates during anesthesia were not clinically relevant. Median endoscopic scores were 0 (no lesions) for both pre-and postplacement. CONCLUSIONS AND CLINICAL RELEVANCE: The SGAD was relatively quickly and easily placed, permitted lung inflation and caused no significant oropharyngeal damage. The SGAD is a practical option for airway management in African pygmy hedgehogs.

Technological Advances in Exotic Pet Anesthesia and Analgesia.

Even when performed by skilled operators, locating the nerves can be challenging in small exotic pets; in such cases, the use of an electrical nerve stimulator may be useful to confirm the correct identification of the target nerve. Exotic animal anesthesia and analgesia have dramatically progressed over the past decade and continue to do so as more research and technologies develop. Technological advancements such as airway devices, endoscopic intubation techniques, positive intermittent pressure ventilators, and invasive and noninvasive blood pressure monitors have played a significant role in improving patient safety and the anesthetic outcomes of exotic animals.

Retrograde intubation in a dog with severe temporomandibular joint ankylosis: case report.

BACKGROUND: Orotracheal intubation in dogs is a common and easily-performed procedure that provides a patent airway during anaesthesia. In dogs with temporomandibular joint ankylosis or pseudo-ankylosis, airway management can be a challenging procedure since these dogs have a limited ability to open their mouth. Methods to provide safe, uneventful intubation in such patients may include minimally invasive techniques such as retrograde intubation using a guide wire and fibre-optic-aided laryngoscopy. CASE PRESENTATION: We report a case of a 16-month-old, intact female Bull Terrier weighing 17 kg, admitted to the hospital for surgical treatment of bilateral ankylosis of the temporomandibular joint. Intubation was achieved, without direct observation of the larynx, by retrograde intubation using a vascular access catheter and a vascular wire guide through cricothyroid membrane. Bilateral condylectomy was performed and the dog recovered uneventfully. CONCLUSIONS: In conclusion, retrograde intubation was relatively simple to perform with the guide wire technique and no specific training or equipment were necessary.

How does multilevel upper airway surgery influence the lives of dogs with severe brachycephaly? Results of a structured pre- and postoperative owner questionnaire.

Brachycephalic airway syndrome in dogs is typified by a variety of anatomical abnormalities causing a diverse spectrum of clinical signs of varying intensity. This variability makes the assessment of the surgical outcome after upper airway surgery difficult. Using a structured questionnaire, the present study investigated the dog owner-perceived severity and frequency of a broad spectrum of welfare-relevant impairments 2 weeks before and 6 months after brachycephalic dogs underwent a recently developed multi-level upper airway surgery. All dogs underwent surgical treatment of stenotic nares (ala-vestibuloplasty), the nasal cavity (laser-assisted turbinectomy, LATE), the pharynx (palatoplasty and tonsillotomy), and if indicated, laryngeal surgery (laser-assisted ablation of everted ventricles and partial cuneiformectomy). Owners of brachycephalic dogs (n = 102) referred for upper airway surgery were eligible to participate. Questionnaire data from owners of 37 Pugs and 25 French bulldogs were evaluated. In all dogs, the clinical signs associated with brachycephaly improved markedly after surgery. Most encouraging was the striking reduction in life-threatening events by 90% (choking fits decreased from 60% to 5% and collapse from 27% to 3%). The incidence of sleeping problems decreased from 55% to 3%, and the occurrence of breathing sounds declined by approximately 50%. There was a marked improvement in exercise tolerance and a modest improvement in heat tolerance. Dogs with severe brachycephaly benefitted substantially from multi-level surgery, and there were particular improvements in the incidences of severe impairment and life-threatening events. However, despite the marked improvement perceived by dog owners, these dogs remained clinically affected and continued to show welfare-relevant impairments caused by these hereditary disorders.

Comparative analysis of lung function of rats using a new intubation technique and tracheostomy / Análise comparativa da função pulmonar de ratos usando uma nova técnica de intubação e a traqueostomia

Several studies use intubation or tracheostomy for data collection in lung function of rats. Due to the difficulty of performing intubation, tracheostomy is most commonly used. Knowing this difficulty, this paper demonstrates a new way to perform the intubation technique and compares pulmonary function variables obtained using intubation or tracheostomy. For the analysis of our new technique of intubation, 30 rats were used, and the comparative analysis of lung function data obtained through the use of our technique of intubation and tracheostomy, 16 rats were used, divided into two groups. The T group underwent tracheostomy. The IT group underwent initial intubation and, awaiting recovery, a week later was again subjected to intubation group, which was then called IT-1W. Our intubation technique is performed with the aid of a wedge, inclined bed and percutaneous transillumination. No animals died during the intubation procedure, and about 77% of the animals were intubated at the first attempt. We did not obtain statistically significant differences in the pulmonary function variables between the groups. Our intubation technique is easily learned and reproduced. The implications of such a technique can be generalized to all laboratories dealing with intubation of rats.(AU)

Vários estudos utilizam a intubação orotraqueal ou traqueostomia para coleta de dados na função pulmonar de ratos. Devido à dificuldade de realização da intubação, a traqueostomia é mais comumente utilizada. Conhecendo esta dificuldade, este trabalho demonstra uma nova maneira de realizar a técnica de intubação e compara as variáveis de função pulmonar obtidas por intubação ou traqueostomia. Para a análise de nossa nova técnica de intubação, foram utilizados 30 ratos, e para a análise comparativa dos dados da função pulmonar obtidos pelo uso de nossa técnica de intubação e traqueotomia, 16 ratos foram utilizados, divididos em dois grupos. O grupo T foi submetido a traqueostomia. O grupo de IT foi submetido inicialmente a intubação e, esperada sua recuperação, uma semana depois foi novamente submetido a intubação, que foi então chamado de grupo IT-1W. Nossa técnica de intubação é realizada com a ajuda de uma cunha, cama inclinada e transiluminação percutânea. Nenhum animal morreu durante o procedimento de intubação, e cerca de 77% dos animais foram intubados na primeira tentativa. Não foram obtidas diferenças estatisticamente significativas nas variáveis de função pulmonar entre os grupos. Nossa técnica de intubação é facilmente aprendida e reproduzida. As implicações de tal técnica podem ser generalizadas para todos os laboratórios que lidam com a intubação de ratos.(AU)

Transmylohyoid orotracheal intubation in surgical management of canine maxillofacial fractures: an alternative to pharyngotomy endotracheal intubation.

OBJECTIVE: To describe the surgical technique of transmylohyoid orotracheal intubation in surgical management of maxillofacial fractures in dogs. STUDY DESIGN: Case series. ANIMALS: Dogs (n = 4) with maxillofacial fractures. METHODS: Transmylohyoid orotracheal intubation was used for airway management of dogs undergoing surgical repair of maxillofacial trauma. A stoma was surgically created by an incision through the skin, subcutaneous tissue, and mylohyoideus muscle immediately medial to the lingual cortex of the mandible at the level of the mandibular 1st molar tooth, so that an endotracheal tube could exit the oral cavity between the mandibular bodies bypassing the dentition. RESULTS: Transmylohyoid orotracheal intubation allowed excellent surgical visibility of the oral cavity and intraoperative control of occlusion during surgery. No complications were encountered during the procedure and the stoma healed without complication. CONCLUSIONS: Transmylohyoid orotracheal intubation is a safe, simple, and effective technique for bypassing the rostral oral cavity and dentition during surgical management of maxillofacial fractures.

Airway management using a supraglottic airway device without endotracheal intubation for positive ventilation of anaesthetized rats.

Endotracheal intubation is often necessary for positive pressure ventilation of rats during open thoracic surgery. Since endotracheal intubation in rats is technically difficult and is associated with numerous complications, many techniques using various devices have been described in the scientific literature. In this study, we compared the effectiveness of airway management of a home-made supraglottic airway device (SAD), which is cheap to fabricate and easy to place with that of an endotracheal intubation tube in enflurane-anaesthetized rats. Twenty male Sprague-Dawley rats (200-300 g) were randomly assigned to two equal groups for positive pressure mechanical ventilation using either the SAD or an endotracheal intubation tube. The carotid artery of each rat was cannulated for continuous blood pressure measurements and obtaining blood samples for determination of oxygen tension, carbon dioxide tension, and blood acidity before, during and after SAD placement or endotracheal intubation. Proper placement of the SAD was confirmed by observing chest wall movements that coincided with the operation of the mechanical ventilator. No complications and adverse events were encountered in the rats in which the SAD was placed, during SAD placement and immediate removal, during their mechanical ventilation through the SAD, and one week after SAD removal. From the results of blood gas analyses, we conclude that anaesthetized rats can be successfully ventilated using an SAD for open thoracic surgery.

Retrospective evaluation of postoperative nasotracheal tubes for oxygen supplementation in dogs following surgery for brachycephalic syndrome: 36 cases (2003-2007).

OBJECTIVE: To assess the utility of nasotracheal tubes in postoperative oxygen supplementation in dogs following corrective surgery for brachycephalic syndrome. DESIGN: Retrospective study 2003-2007. SETTING: University teaching hospital. ANIMALS: Thirty-six client-owned dogs that underwent corrective surgery for brachycephalic syndrome. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Medical records were reviewed for animals that underwent surgical interventions for brachycephalic syndrome including palatoplasty, ventriculectomy, and rhinoplasty. Data collected included signalment, presenting complaints, analgesic and surgical interventions, type of supplemental oxygen therapy, complications and mortality occurring during hospitalization. A nasotracheal tube (NTT) was placed in 20 dogs at the end of surgery; 16 dogs received other forms of oxygen supplementation (8) or no oxygen supplementation (8) during recovery. The total number of postoperative complications was similar in both groups (8/20 dogs with NTTs and 7/16 in those without NTTs). However, respiratory distress was observed in 5 dogs without NTTs but was not observed in any dog while an NTT was in place. One dog in each group died postoperatively. CONCLUSION: Placement of an NTT was found to be easy and may offer benefit in dogs with brachycephalic syndrome as a noninvasive means of delivering oxygen. The use of NTT may minimize severe postoperative morbidity, in particular by reducing postoperative respiratory distress.