1. Endotracheal Intubation of Dogs and Cats (Anesthetist)
A&A Pages &

3. Endotracheal Intubation
Flexible tube, placed inside trachea of an anesthetized (induced) patient, used to transfer gases directly from the anesthesia machine to the patient’s lungs, therefore securing the airway.
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4. Advantages to Cuffed ET Tubes
Dead air space reduced  increase efficiency of gas exchange with inhalation anesthetics
Anatomic dead space –
This is good for two reasons: 1. 2.
Efficient manual ventilation can be provided
PPV
Reduces the risk of pulmonary ______________
What might be aspirated?

5. More advantages
Secretions can be removed with suction catheter through the ET tube
Drugs can be easily administered in emergency (route = ____)
Dosage =

6. Challenges to Intubating
Overzealous efforts to intubate can damage anatomy
Esophageal intubation
Tube can be left too far cranial
Tube can be inserted past tracheal bifurcation
Pressure ___________ from over inflation of cuff

7. Types of ET Tubes- Materials

8. Types of ET Tubes Murphy tubes Magill tubes: Cuffed or non-cuffed
Murphey eye- distal end of tube
Purpose:
Magill tubes:
No Murphey eye

9. Types of Cuffs High volume, low pressure cuffs are ideal
Posey Cuff Inflator

10. Cuff Inflation
Recheck every 30 min of surgery – especially after moving or repositioning patient
How can you check cuff inflation?
Most important for which type of procedures??
If you are running anesthesia for longer than 2 hours, you can reposition the ET tube slightly to ensure pressure necrosis does not happen.
IMPORTANT: Must deflate cuff before moving tube!
*Even in emergencies*

11. Additional Types of ET Tubes
Cole tubes Laser specific tubes

12. Selecting an ET Tube DIAMETER Weight based is only a guideline!
Brachycephalics:
Obese patients:
Palpation is more accurate; requires more practice
Cats: mm tubes
Can use width of space between the nostrils as a guide

13. Positioning an ET Tube LENGTH- measured in centimeters
If you extend into only one bronchus:

14. Positioning an ET Tube LENGTH If tube extends past patient’s nose
 Increased _____________ dead space
How might we solve this?

17. Intubation Techniques
1. Visual
2. Blind
Used in dogs and horses
NOT suitable for cats, very small dogs, or patients with edema, swelling or trauma
3. Tactile
Cattle, large exotics, a few large dogs
Finger holds down the epiglottis
Slide tube into trachea using your finger as a guide

18. Feline Intubation Small oral cavity and sensitive larynx
Vocal cords tend to quickly close and push tube to side
Due to swallowing reflex or contact with end of ET tube  causes ______________________.
Can be reduced by application of topical anesthetic
Apply 0.1 cc of _______________ on glottis
*Try to get 0.05 ml on each arytenoid

24. Page

25. Maintaining an ET Tube
Once you have checked placement and patient is stable, watch for:
Kinks or bends
ALWAYS disconnect from breathing system when repositioning
Watch for weight of breathing system tugging on ET tube
Don’t place items on patient’s chest!
If you have a “bad lung” keep that one down
Positioning require head tilted down?
Regurgiation?

26. Extubation Process
Removal of tube too early can cause respiratory distress
Waiting too long can cause patient to bite tube in half
Pay close attention to reflexes during this time!
Exceptions to completely deflating the cuff:
VIDEO

27. Post-op Advice to Owner
Patients may cough immediately post-op
Should not be severe or continue to get worse
Is noticed if there was a rough intubation
Advising owner will avoid phone calls and later explanations!

28. Complications Before You Even Start
Unclean equipment (we reuse ET tubes!)
Leaky cuff/damage
Check before use, during surgery, and while cleaning

29. Complications While Placing
Tube too small
Not getting enough inhalant ax 
Like breathing through a straw 
Easily become blocked with mucus 
Tube too large
Damage to anatomy
Tube is too long
Hypoxemia and atelectasis/decreased tidal volume

30. Complications While Placing
Over-inflation of cuff:
Under inflating cuff = No seal created
Breathing room air
Staff breathing inhalant
Aspiration likely:
Vagus nerve stimulation:
Parasympathetic response  bradycardia, apnea, cardiac arrhythmias
What class of premed can help prevent this response?

31. Complications During Ax
Dislodged tube
Not tied securely?
Coughs out (cats)
Not disconnected while repositioning
Weight of hoses & machine pulls tube out
Restricted air flow
Bevel against wall of trachea
What can help prevent this?
Kinks-extreme head position,
over edge of table, floppy tube

33. Videos
OZk&NR=1 - intubation of a dog
Bs0 – intubation with cuff