Cuffed endotracheal intubation in cats
Abstract
Cuffed endotracheal (ET) intubation is used by many veterinary practitioners when anaesthetizing the feline patient. Cuffed ET intubation can, however, result in tracheal injury due to the delicate feline trachea and is a well-documented cause of Veterinary Defence Society claims.
This article examines the anatomy and physiology of the trachea and considers why it is susceptible to trauma relating to cuffed ET intubation. It explores current research into tracheal trauma and the findings relating to the cause of injury and suggests specific practical techniques which can minimize the potential damage to the trachea as a result of cuffed ET intubation. These include the choice of ET tubes, the mode of inflation, precautions that can be taken while moving the animal and intra-operative monitoring.
It concludes that there are relatively simple ways in which the likelihood of such iatrogenic tracheal trauma can be minimized.
The use of cuffed endotracheal (ET) tubes in cats is a controversial subject. For many years there has been reluctance by some veterinary surgeons to use cuffed tubes, while others use them on a daily basis without considering them cause for concern. The aim of this article is to examine current literature and research, from both the veterinary and human field, with the aim of highlighting causative factors that may contribute to tracheal damage as a result of intubation using cuffed ET tubes. The article will also suggest good practical techniques that can be employed to reduce tracheal damage if cuffed intubation is utilized in practice.
Over the past 10 years the Veterinary Defence Society (VDS), a mutual insurance company that insures the practising profession against claims of negligence, reported 11 feline claims involving ruptured tracheas as a direct result of cuffed ET tube intubation (Hird, 2010). The 11 claims amount to nearly 1% of all VDS feline claims, and although small, the significance increases when you consider that not all veterinary practices are insured by the VDS and not all tracheal injuries result in a VDS claim. It is therefore fair to suggest a higher number of feline patients may have been exposed to tracheal damage related to intubation with cuffed ET tubes. Interestingly, all of the 11 claims reported were in cats anaesthetized for dental treatment and all 11 cases were intubated with red rubber high pressure, low volume (HPLV) cuffed ET tubes (Figure 1).
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