Elective cricothyrotomy in a dog with transient laryngeal paralysis secondary to Australian paralysis tick (Ixodes holocyclus) envenomation

Abstract

The tube cricothyrotomy (CTT) has recently been introduced to small animal medicine as a viable surgical airway access procedure; however, there are no reports documenting its clinical use. The author's objective is to describe the clinical application, complications, and management of an elective CTT in a dog. Furthermore, the characteristics of CTT that may be clinically advantageous over temporary tube tracheostomy (TT) will be discussed. A 2‐year‐old female spayed German shepherd dog required mechanical ventilation (MV) due to unsustainable work of breathing as a result of tick paralysis and aspiration pneumonia. After successful weaning from MV, the dog was diagnosed with laryngeal paralysis. A surgical airway was performed using CTT to allow extubation and patient management whilst conscious. Complications included frequent tube suctioning due to accumulation of airway secretions in the tube and a single dislodgement event. The dog made an uneventful recovery with complete stoma healing by the second intention within 15 days. To the authors' knowledge, this is the first clinical report of an elective CTT performed to successfully manage upper airway obstruction in the dog. Its efficacy, clinical management and patient outcome are described.

Paralisia de laringe unilateral esquerda pós intubação em braquicefálico: Relato de caso

“…Em casos que o paciente não tenha uma evolução positiva, apresentando baixos valores de saturação em oximetria mesmo após sedação e oxigenioterapia de forma adequada, são necessárias outras abordagens para manter a via aérea patente como intubação orotraqueal ou traqueostomia temporária em casos de obstrução laríngea significativa como no presente relato (Hardjo et al, 2022;Kitshoff et al, 2013;MacPhail, 2020). Ricart et al (2020) e Théron & Lahuerta-Smith (2022), sugerem o uso de stents laríngeos para manutenção da via aérea em casos emergenciais de estabilização de pacientes com PL.…”

Mechanical ventilation in dogs and cats with tick paralysis

“…Proposed mechanisms of respiratory compromise include respiratory muscle paralysis in isolation or combination with upper respiratory tract (URT) obstruction ( 18 , 19 ), central respiratory depression ( 20 , 21 ), cardiopulmonary disease ( 16 ) and aspiration pneumonia ( 8 , 9 ).…”

“…Temporary tracheostomy (TT) and cricothyrotomy (CTT) tubes are recommended in animals with generalized LMN disease requiring long-term ventilation ( 51 ) or to facilitate weaning in animals with URT obstruction. Their use has been described in cats and dogs with TP ( 18 , 52 ). Benefits of a surgical airway include tracking of neurological progress, reduction of costs associated with anesthetic drugs, shorter ventilation times and improved weaning rates for animals with laryngeal paralysis secondary to TP ( 52 ).…”

“…One case report describes the successful use of a cricothyrotomy tube in a dog undergoing MV for TP and aspiration pneumonia that failed weaning due to persistent laryngeal paralysis ( 18 ). This was the first reported use of a CTT in clinical practice and the author noted a less technically challenging procedure, ease of tube replacement due to an anatomically robust stoma and the need for only one stay suture as potential benefits over the more traditional TT ( 18 ). Studies comparing outcomes and complication rates of each procedure are required before recommendations can be made for one technique over another.…”

“…Optimal ventilator settings in cats and dogs with naturally occurring tick paralysis, neuromuscular, or pulmonary disease are unknown. Pressure-control, volume-control and synchronized intermittent mandatory ventilation (SIMV) modes of ventilation have been described for use in TP ( 18 , 30 ), however, no literature exists (human or veterinary) that compares their use or outcomes for this patient subset. The general recommendations for initial settings in patients with pulmonary and non-pulmonary disease are described elsewhere ( 39 ) and are predominantly extrapolated from small studies in healthy animals and available human clinical trials.…”