Introduction
The significance of tracheal intubation
· Keep the airway unconscious
· Prevent the inhalation of other substances (blood, saliva, stomach contents, etc.)
· Permit the delivery of oxygen and anesthetic gases
· Close the anesthesia circuit and isolate air pollution
Use
· Replenish oxygen
· Manual ventilation for sick animals with respiratory failure
· Maintain anesthesia with respiratory anesthetic status
· Prevent the aspiration in the case of oropharyngeal surgery, dental surgery, or gastric lavage
· Use in situations with high risk of vomiting or reflux, such as esophageal obstruction, intestinal obstruction, and animals without fasting
As long as the operation is correct, it is safe
· Simple and easy to use, the equipment required is generally prepared in clinics
· Beautiful price
· Disadvantages
· Risk of laryngeal spasm
· There is a low probability of damage to the larynx or trachea
· If the animal has difficulty opening its mouth or has a lump in the throat/laxatric region, it may not be possible to intubate the technology
· Nasal catheter oxygen supply
· Mask oxygen supply
· Supergloscopic airway device: Cat special cannulation V-gel
· Tracheotomy (the prognosis of tracheotomy in cats is not very ideal)
Time requirements
Preparation
· In most cases, anesthesia is required before intubation (unless the animal is in a very sluggish state)
· 1-2 minutes
Decisions
Risk Assessment
· If the animal is expected to have difficulty opening or intubation, a tracheotomy should be prepared in advance
· Compared with dogs, the cat has poor tracheotomy effect
· If you encounter a very narrow larynx, use a small intratracheal connector to connect the dog's catheter, and then connect it to the T-tube to put it in the trachea
Required materials
Minimum equipment requirements
· Appropriate size rubber/silica tracheal intubation (depending on the cat's size).
· Usually, the cannula size with an inner diameter between 3-6mm is suitable.
· The length of the cannula should reach the midpoint from the incisor to the throat-thoracic entrance. Choose the shortest catheter that can be properly secured:
1. Reduce respiratory workload
2. Reduce respiratory ineffective cavity
3. Reduce risk of endotrachal cannula
· Non-spiral wire-enhanced tracheal catheters can be cut as long as needed. To cut, make sure the connector is tightly connected to the tracheal catheter again to prevent it from falling off.
· Choose the maximum catheter that can be placed without force: A narrow catheter increases the resistance to gas flow, thereby increasing the amount of breathing.
· It is recommended to prepare multiple sized catheters for each animal.
Ideal equipment requirements
· Laryngoscope with light source
· Opener
· If using a tracheal catheter, maintain the inflatable cuff (if the cuff is not part of the catheter itself)
Minimum consumables requirements
· Water-soluble lubricant or local anesthetic gel
· Syringe (2.5-5ml) inflating the catheter cuff (2}
· Gauze tape for fixing the catheter
· Sweets for cleaning the mouth/throat/throat before intubation, if necessary, prepare cotton swabs for cleaning the mouth/throat/throat before intubation
· Ideal consumable cumulative spray
· Lidocaine hydrochloride syringe (with catheter)
· Spray/apply directly on the throat and vocal cords, be careful about the amount used (if too many local anesthetics are used, there may be aspiration and potential toxicity risks due to the superposition effect).
Preparation
Prevention medication
·Atropine or preferably glycopyrrolate (with less cardiovascular impact) can be used as part of preoperative anesthetic medication (to reduce the incidence of arrhythmias caused by the vagus nerve during induction of anesthesia).
! Because atropine increases the viscosity of respiratory secretions, atropine is not recommended as a medication before routine anesthesia.
! Do not give atropine or glycopyrrolate when using α-2 adrenaline receptor agonist.
Other preparations
· Ensure the catheter is clean and the lumen is unobstructed
· If using a catheter with a tracheal tube, inflate the cuff before inserting to ensure no leakage, keep inflated for more than 10 minutes, and then deflate.
· Tie a gauze strip or bandage at the end of the catheter that will enter the mouth! Do not tie the tape too tightly to avoid compressing the lumen.
Animals Baoding
·General anesthesia is required unless the animal is in an unconscious state due to the disease process.
Technical Method
Operation Method
Step 1 Induce anesthesia
· Induce anesthesia (usually injecting drugs into the intravenous injection until effective)
Step 2 Animal positioning
· Place the animal in a lateral or chest position: In the case of reflux, place it in the thoracic position and raise the head
· The assistant grasps the upper jaw, raises the head and stretches the neck
· Grasp the tongue with the left hand (if right-handed), pull the tongue out of the mouth, and press down the jaw down to open the mouth
At this time, it may be helpful to place the oral opening.
Step 3 Present the larynx
· Place the front end of the laryngoscopy at the base of the tongue and lower the epiglottis.
! Do not touch epiglottis, this may cause laryngeal spasm.
·If there is no laryngoscope, you can gently pull the tongue and press the tongue down with the end of the tracheal intubation to expose the throat
·If the long soft palate hinders the view of the throat, you can gently push the soft palate and loosen the epiglottis with the laryngoscope or the front end of the tracheal catheter.
· Check whether the mouth, pharynx and throat are clean and whether there is saliva, mucus, and blood. If necessary, clean with a suction or gauze before intubation.
· If necessary, you can spray local anesthetic on the epiglottis and wait for 15 seconds to relieve laryngeal spasm/local anesthetic before trying to intubate.
Core Step
Step 1 Insert the catheter
· Lubricate the front end of the catheter with a water-soluble lubricant, pay attention to the dosage
· Wait for the throat to open when you breathe deeply. This may require some patience!
· Slowly and gently insert the vocal cords with a rotating catheter
! Do not force the tube into the closed vocal cords, as this may cause traumatic damage.
Step 2 Fix the catheter
· Fix the catheter behind the animal's ear (using a swipe knot)
Step 3 Check the catheter position
· Always make sure the tracheal intubation is correctly placed in the tracheal
· The correctly placed catheter is invisible at the position of the blood vessels in the neck If the animal is breathing, the flow of gas in the tracheal intubation should be felt
· If the animal is breathing and connected to the respiratory system, the movement of the airbag/repeat breathing bag should be seen
· If the animal is breathing and connected to the carbon dioxide detector, the exhaled carbon dioxide should be displayed
Step 4 Inflatable
· The catheter should be located above the epiglottis and inflated
· The cuff should be gently inflated until no gas leakage is detected when manually inflated with normal inflation.
! Do not over-inflate the cuff.
· If the cuff needs to be filled with >2ml of air, it means that the catheter size is too small
· If necessary, cover or clamp the inflatable tube of the cuff
Step 5 Connect the catheter
· Connect the catheter to the first aid bag (Ambu bag) for artificial respiration, or to an anesthesia machine/oxygen cylinder for gas delivery.
! Remember to turn on the oxygen after connecting to the machine.
· Continuous monitoring of airways during tube insertion may require suction to remove secretions that block the tube.
· When moving animals, always remember to disconnect and reconnect the catheter to prevent trauma to the trachea.
Anaesthesia ends
Step 1 Extubation
· Untie the strap fixed to the head· If a cuff is used, deflate the cuff
! Extubation of the cuff may cause serious throat trauma
· Since the cat's throat is prone to spasms, the tube should be removed in time· When the ear tingling reflex recovers (usually before swallowing reflexes), you can usually prepare to decant the cat
· Remove the catheter slowly and steadily at the end of the anesthesia procedure· Check whether the catheter is damaged and whether there is any blood, mucus, etc. Postoperative care
Instant care
Monitoring
· Stretch your head and neck until the animal is fully awake: the cat's body tends to flex its head and neck after the tube is extubated.
Potential complications
· Inserting the catheter into the esophagus instead of the trachea
· Inserting the catheter into the bronchial (miss-selected catheter)
· Twisted or blocked by the catheter
· Air leakage around the catheter
· Swelling of the throat after extubation
· Laryngeal spasm after extubation
· Catheter is inhaled (usually when an animal wakes up during anesthesia, and the catheter is still bitten in the mouth)
Results
Complications
· Laryngeal or soft tissue damage
· Tracheal damage due to excessive inflated cage:
· Flipping the animal's body without disconnecting from the respiratory system increases this type of risk.
· Many animals will show some symptoms of bronchitis after intubation, such as coughing for several days
Causes of failure of treatment
· Intubation of tracheal intubation due to the following reasons: lumps block the throat, laryngeal spasm