All in a tangle: a mishap with an oesophagostomy tube in an intubated cat

A 12-year 11-month-old, 8.3 kg Jack Russell terrier presented following three episodes of respiratory distress. On initial presentation, conservative management was successful; however, the dog re-presented 10 weeks later with identical clinical signs. On the second presentation, investigations were unremarkable, so conservative management was continued. On discharge, the dog collapsed, following which, it was referred to the emergency and critical care department, within the same hospital. Examination under a light plane of general anaesthesia revealed left-sided laryngeal paralysis; therefore surgical management was indicated. During cricoarytenoid laryngoplasty suture placement, a leak was noted in the circle breathing system based on alteration of the capnograph trace, collapse of the ventilator bellows, and noise on inspiration. The pilot balloon of the endotracheal tube had deflated, necessitating re-intubation with a new endotracheal tube; a urinary catheter was used as a guidewire to facilitate this. The leak was abolished, and the procedure was completed successfully.

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inadvertent endotracheal tube cuff rupture during unilateral arytenoid lateralisation for laryngeal paralysis in a dog

Daly¹,

Pratschke²,

Lord³

2022

“…Difficult extubation is seldom reported in the veterinary literature. Failure of the endotracheal tube cuff to deflate due to kinking of the pilot tubing and entangling of the endotracheal tube pilot tube with an oesophagostomy tube were reported in cats 3 4. Formation of an annulus increasing the external diameter of a silicone tube and impairing extubation has been reported in a cat with a PVC endotracheal tube5 and in a dog with a silicone endotracheal tube 6.…”

Section: Discussionmentioning

confidence: 99%

Difficult extubation with silicone endotracheal tubes in three dogs

Romano

Portela

2020

Three dogs were anaesthetised for various procedures. Endotracheal intubation was achieved with cuffed silicone tubes. No difficulty was reported during the intubation in two out of the three cases, whereas in one case the tube could only be advanced a few centimetres past the glottis. Before extubation, the cuff was deflated in all cases, but the tubes could not be withdrawn past the point where the cuff was positioned within the arytenoids. Endoscopy was performed in two of the three cases and revealed no visible causes of movement hindrance. Computed tomography (CT) previously performed in one of the cases revealed that the outer surface of the tube was in contact with the tracheal wall. In all cases, the tubes could eventually be removed with lubrication and movement. These cases suggest that large silicone endotracheal tubes relative to the airway diameter may result in difficult extubation, and care should be taken with tube size selection.

“…Inability to extubate the trachea at the level of the larynx has previously been reported in the veterinary literature, following annulus formation within the deflated ETT cuff and suspected due to traction from the attached breathing system 7 8. Total inability to extubate the trachea due to inadvertent entrapment of the pilot balloon tubing following oesophagostomy tube placement is an additional reported complication 9 10. In the human literature, failure to deflate the ETT cuff due to occlusion of the pilot balloon tubing with tape, bite blocks and artery forceps is reported and could be a differential for inability to extubate the trachea 11–13.…”

Section: Discussionmentioning

confidence: 99%

Endotracheal tube complication during extubation following surgical repair of a traumatic tracheal laceration

Miller

Pryke

Panti

et al. 2020

Difficult or impossible tracheal extubation has previously been reported in the veterinary literature as a result of endotracheal tube (ETT) faults or due to their entanglement with oesophagostomy tubes. Inadvertent transfixation of the ETT to the trachea during oral–maxillofacial surgery is a reported cause of extubation complications in the human literature. In this case, an incident of accidental ETT cuff transfixation to the trachea of a dog undergoing surgical repair of a traumatic tracheal laceration is reported. General anaesthesia for tracheal surgery requires special consideration of airway management to reduce complications. While precautions can be taken to avoid ETT placement within the surgical field, this cannot always be avoided and measures should be implemented for detection of transfixation. If tracheal extubation complications do arise, it is important to consider the differential causes and act quickly to resolve the problem and ensure minimal distress to the animal.