Difficult extubation with silicone endotracheal tubes in three dogs

Abstract

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 Before extubation, the cuff was deflated in all cases, but the tubes could not be withdrawn past the point where the cuff was positioned within the arytenoids.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.

Complications of orotracheal intubation in the horse

“…A similar case study has been described in the dog where extubation was assisted via a tracheostomy (Grzywa & Barker, 2022). It is interesting to note that the majority of similar case reports describe the use of either silicone (Romano & Portela, 2020;Sanchis Mora & Seymour, 2011) or red rubber tubes (Grzywa & Barker, 2022).…”

“…The use of lubrication gel is commonly applied to the endotracheal tube to both help facilitate the passage of the tube through the glottal opening and to aid with the formation of a seal around the endotracheal tube cuff and the tracheal wall (Nishioka et al, 2017). The instillation of lubrication gel has also been used to help remove endotracheal tubes that were stuck in the trachea (Romano & Portela, 2020) as was the case in this report.…”

“…A similar case study has been described in the dog where extubation was assisted via a tracheostomy (Grzywa & Barker, 2022). It is interesting to note that the majority of similar case reports describe the use of either silicone (Romano & Portela, 2020; Sanchis Mora & Seymour, 2011) or red rubber tubes (Grzywa & Barker, 2022). There was one report in a cat where a reused polyvinyl chloride tube was difficult to remove and required the instillation of extra lubrication around the ET cuff (Norgate & Jimenez, 2017).…”

Complications of orotracheal intubation in the horse

“…A similar case study has been described in the dog where extubation was assisted via a tracheostomy (Grzywa & Barker, 2022). It is interesting to note that the majority of similar case reports describe the use of either silicone (Romano & Portela, 2020;Sanchis Mora & Seymour, 2011) or red rubber tubes (Grzywa & Barker, 2022). There was one report in a cat where a reused polyvinyl chloride tube was difficult to remove and required the instillation of extra lubrication around the ET cuff (Norgate & Jimenez, 2017).…”

Extubation failure and surgical removal of a lodged endotracheal tube in a Welsh Mountain Pony

“…Conversely, in a cat intubated with a low‐pressure high‐volume polyvinyl chloride (PVC) ETT, extra lubrication and manipulation was needed to allow extubation (Norgate & Jimenez, 2017). Additional lubrication and manipulation were also sufficient to facilitate extubation in three dogs with silicone ETTs that could not be withdrawn past the arytenoid cartilages (Romano & Portela, 2020). Merlin and Mileham (2020) reported two incidents related to the pilot balloon valve, where the valve needed either to be cut off or the spring depressed with forceps to deflate the cuff before extubation.…”