Suspected tracheal tear during anaesthesia of a cat

Abstract

This case report describes the occurrence of a rapidly-developing pneumoretroperitoneum during coeliotomy in an anaesthetised cat. This was the first indication of a problem, however inadvertent endobronchial intubation initially, and accidental extubation, had occurred in the period immediately prior to surgery. The presence of the pneumoretroperitoneum alerted the clinicians to the likelihood of airway trauma, and mechanical ventilation was discontinued immediately. After completion of the coeliotomy, surgical exploration of the cervical trachea failed to detect an obvious tracheal tear. Subsequent chest radiographs confirmed the presence of pneumoretroperitoneum, pneumomediastinum, mild pneumothorax and subcutaneous emphysema in the cervical region. No further diagnostics were performed, thus the site of the tear could not be definitively diagnosed but was suspected to be distal to the thoracic inlet. The cat recovered uneventfully and was discharged three days later after conservative management. This report highlights the ability to rapidly recognise acute airway trauma by the presence of pneumoretroperitoneum, prompting immediate cessation of positive-pressure ventilation which, if continued, could have exacerbated the pneumothorax in this case.

Optimising endotracheal length in adult cats: a retrospective CT study

“…Each of these can lead to hypoxaemia, which may result in significant morbidity and mortality. [1][2][3][4]14 While adequate monitoring of the capnography trace, spirometry, pulse oximetry and simultaneous movement of the thorax and reservoir bag may be useful to recognise some of these complications, 15 ETT misplacement can only be confirmed by visualisation of the ETT within the trachea. ETT misplacement has been recognised as an incidental finding in human and veterinary patients undergoing diagnostic imaging techniques (bronchoscopy, radiography, CT).…”

“…Tracheal tears commonly affect not only the cervical region, but may also appear intrathoracically, which typically have a poorer prognosis the closer they are to the carina. 1–8…”

“…Tracheal tears commonly affect not only the cervical region, but may also appear intrathoracically, which typically have a poorer prognosis the closer they are to the carina. [1][2][3][4][5][6][7][8] Several methods have been described in veterinary medicine to select the appropriate ETT diameter, including tracheal palpation, measuring the distance between nares or measuring the tracheal internal diameter on a lateral thoracic radiograph. 9,10 However, none of these strategies would prevent misplacement of the ETT in the vicinity of the larynx or EBI.…”