Comparison of endoscopic endotracheal intubation and the v‐gel supraglottic airway device for spontaneously ventilating New Zealand white rabbits undergoing ovariohysterectomy

Comolli, Jessica R.; Schnellbacher, Rodney; Beaufrère, Hugues; Blás-Machado, Uriel; Quandt, Jane; Mayer, Jörg; Divers, Stephen J.

doi:10.1136/vr.105746

Cited by 12 publications

(17 citation statements)

References 43 publications

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“…Endoscopic and histological assessment of intubation techniques for rabbits has been performed using the v-gel ® and endotracheal tubes ( 3 , 8 , 11 ). In this study, gross macroscopic findings indicated mild to moderate upper airway trauma.…”

Section: Discussionmentioning

confidence: 99%

“…Finally, sacrifice at the conclusion of this study for histologic assessment of laryngeal and tracheal tissue was not performed in this study as rabbits were destined for a long-term survival study. This last limitation is noteworthy as gross endoscopic evaluation of the larynx has shown to underestimate laryngeal trauma secondary to ETI when compared with histology ( 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…In addition, multiple attempts may be required to successfully intubate the animal, and thus the intubation process can be prolonged (7,8). Alternatives to the traditional blind approach have been described, including endoscopic-guided intubation (9)(10)(11), direct visualization through laryngoscopy (12), nasotracheal intubation (13), retrograde orotracheal intubation (14), tracheostomy (15), capnography guided intubation (16), and intubation supported by esophageal cannulization (17). Another alternative method that has been proposed is intubation using a polypropylene catheter as a guide for insertion of the ETT (5).…”

Section: Introductionmentioning

confidence: 99%

“…However, some disadvantages, such as laryngeal compression and lingual cyanosis, have been reported together with an increased risk of gastric tympanism and a greater gas leakage during controlled mechanical ventilation (CMV) compared with an ETT ( 19 ). In addition, the v-gel ® is sensitive to movement and can be shifted out of place with positional changes of the patient ( 11 ). The overall objective of this prospective, randomized, non-blinded, cross-over study was to improve the safety of ETI in rabbits.…”

Section: Introductionmentioning

confidence: 99%

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V-Gel® Guided Endotracheal Intubation in Rabbits

et al. 2021

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Background: General anesthesia in rabbits is associated with higher morbidity and mortality relative to other mammalian species commonly anesthetized. Unique challenges related to endotracheal intubation (ETI) in rabbits contribute to this risk.Objective: To improve the safety of ETI in rabbits, we developed two new ETI methods using a supraglottic airway device (v-gel®) to facilitate ETI and compared them to traditional “blind” technique. We hypothesized that relative to blind ETI, v-gel® guided ETI provides more successful placement of the endotracheal tube (ETT) in a shorter time. Outcomes included number of intubation attempts, time for achievement of ETI, endoscopic findings, and serial arterial blood gas (ABG) analysis.Study Design: Prospective, randomized, and crossover study.Methods: Ten female, New Zealand White rabbits aged 1–2 years old, weighing 4.3 ± 0.4 kg, were anesthetized four times. Each time, ETI was performed with one of the following techniques: Method 1: v-gel® guided, polypropylene catheter facilitated, intubation using a cuffed ETT; Method 2: v-gel® guided intubation using an uncuffed ETT directly inserted through the device airway channel; Method 3 and 4: Blind intubation with uncuffed or cuffed ETT. Upper airway endoscopy was performed before intubation attempts and after extubation. Serial ABG analysis was performed during the peri-intubation process.Results: V-gel® guided techniques allowed successful ETI on the initial attempt for 9/10 subjects using Method 1 and 10/10 using Method 2. Relative to the v-gel® guided techniques, the blind techniques required more intubation attempts. A median of 2 attempts (range 1–4, p < 0.007) were required for the uncuffed ETT, and a median of 4 (range 1–4, p < 0.001) attempts were performed for the cuffed ETT. The time to perform successful ETI was positively correlated with the number of attempts (ρ = 0.82), while successful ETI was negatively correlated with number of attempts (ρ = −0.82). Endoscopic findings showed mild to moderate laryngeal trauma. In the absence of oxygen supplementation, ABG analysis demonstrated low PaO2, while PaCO2 remained consistent.Conclusions: Facilitated ETI using the v-gel® guided techniques allows for the rapid establishment of a secure airway to provide ventilatory support for rabbits undergoing general anesthesia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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V-Gel® Guided Endotracheal Intubation in Rabbits

et al. 2021

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“…Randomised controlled trials are strong study designs however all studies had small sample sizes which would have affected the power of the results. The studies looked at only two breeds, Norfolk rabbits and New Zealand White rabbits, making it difficult to generalise the results to the general rabbit population (Cruz et al, 2000;Engbers et al, 2017;Comolli et al, 2020;Toman et al, 2015;and Wenger et al, 2017). All studies also only looked at healthy, adult rabbits with low anaesthetic risk based on the American Society of Anesthesiologists (ASA) (2020) physical status grading scale.…”

Section: The Evidencementioning

confidence: 99%

A comparison of supraglottic airway devices versus endotracheal intubation for use in rabbit anaesthesia

Foo

2022

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PICO question In domestic rabbits undergoing anaesthesia, how does the use of supraglottic airway devices compare to endotracheal intubation for ease of use in achieving a patent airway and maintaining a stable anaesthesia? Clinical bottom line Category of research question Treatment The number and type of study designs reviewed Five papers were reviewed to answer this clinical question including four randomised controlled trials, one of which was a randomised crossover trial and one peer-reviewed conference proceeding Strength of evidence Moderate Outcomes reported There is evidence to support that supraglottic devices were easier and faster to insert than endotracheal tubes and were used effectively to achieve and maintain a patent airway and anaesthesia. They were however, more easily displaced and took up more space in the oral cavity. Evidence also supports endotracheal intubation can be used to effectively achieve a patent airway and maintain a stable anaesthesia however, can result in more damage to tracheal mucosa when attempted blindly and required higher doses of induction drugs to use Conclusion Based on current available evidence, endotracheal intubation is an excellent option for maintaining a patent airway and anaesthesia in rabbit patients as it is a tried and tested method, however, can cause tracheal damage if conducted blindly. Supraglottic airways devices can be used as an alternative where endotracheal intubation is unsuccessful. They can also be used where speed of obtaining a patent airway is imperative such as in an emergency as they may be easier and faster to apply, especially in inexperienced practitioners without the necessary equipment for safe endotracheal intubation. Supraglottic devices are unsuitable for procedures that require access to the oral cavity and / or patient movement, due to the size and easier loss of seal during movement potentiating risk of aspiration. Both supraglottic devices and endotracheal intubation are superior to face masks which evidence shows have more leakage, dead space and increased risk of hypercapnia How to apply this evidence in practice The application of evidence into practice should take into account multiple factors, not limited to: individual clinical expertise, patient’s circumstances and owners’ values, country, location or clinic where you work, the individual case in front of you, the availability of therapies and resources. Knowledge Summaries are a resource to help reinforce or inform decision making. They do not override the responsibility or judgement of the practitioner to do what is best for the animal in their care.

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Does using an endotracheal tube or a supraglottic airway device result in better unassisted ventilation in rabbits?

Bruce

2021

Veterinary Record

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Supporting veterinary clinicians in making evidence-based decisionsIn rabbits does an endotracheal tube or v-gel result in better unassisted ventilation? Clinical ScenarioYou are a veterinary surgeon anaesthetising a healthy pet rabbit for a routine midline spay. To secure the rabbit's airway you have the choice of using an endotracheal (ET) tube, with an array of different sizes available, or three different sizes of v-gel® (small, medium or large). You sometimes struggle to place an ET tube in rabbits because you do not perform this skill often, and using a mask worries you because the airway is not secured. Your nurse tells you that she does not trust v-gels® and that she does not think they are safe because they cause cyanosis of the tongue and often become misplaced. However, another vet in your practice tells you that v-gels® are quicker and easier to place compared to ET tubes and that they seem to be just as safe and allow good ventilation, but they havent used v-gels® enough to be sure. You wonder whether using v-gel devices results in better unassisted ventilation than using ET tubes in rabbits....

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Comparison of endoscopic endotracheal intubation and the v‐gel supraglottic airway device for spontaneously ventilating New Zealand white rabbits undergoing ovariohysterectomy

Cited by 12 publications

References 43 publications

V-Gel® Guided Endotracheal Intubation in Rabbits

V-Gel® Guided Endotracheal Intubation in Rabbits

A comparison of supraglottic airway devices versus endotracheal intubation for use in rabbit anaesthesia

Does using an endotracheal tube or a supraglottic airway device result in better unassisted ventilation in rabbits?

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