MIS: Home > Exotics > Small mammal > Tracheal intubation
In addition to limiting access to oral structures, the small oral commissure of the small herbivore drastically limits access to the caudal oropharynx, including the glottis.
As a result, tracheal intubation tends to be a "blind" procedure with varying degrees of success.
This limited ability to routinely and consistently establish a patent airway may pose significant problems during the anesthetic management of these species.
Further complicating the problems associated with intubation is the significant trauma to which laryngeal structures may be subjected during attempts to blindly pass an endotracheal tube.
The larynx of the rabbit, consistent with other small herbivores commonly encountered in practice, is situated caudal and slightly ventral to the angle of the jaw.
Being obligate nasal breathers, the anatomy of the larynx is somewhat different than that encountered in the dog or cat.
The epiglottis is a relatively large structure with a "butterfly-shaped" distal aspect, which is normally located entrapped on the dorsal surface of the soft palate.
This arrangement permits passage of air directly from the naso-pharynx into the larynx and trachea without entry into the oral cavity.
The rigid endoscope can be easily utilized as an aid in the placement of endotracheal tubes.
This may be accomplished either by slipping the tube over the endoscope or by passing the tube along side the scope.
It must be remembered that only tubes with an inside diameter greater than that of the telescope, in most cases 3.0 mm and greater, can be fit over the instrument.
As the instrument is slowly advanced caudally, gentle dorsally directed pressure on the soft palate will free the epiglottis, revealing the glottal opening.
An endotracheal tube, the tip of which has been lubricated with a xylocaine gel, may then be slowly advanced between the arytenoids cartilages and into the trachea.
The beveled tip of the endotracheal tube should be manipulated in such a manner as to facilitate the movement of the tube between the vocal folds.
The endoscope may then be removed and the tube secured to the rabbit in a normal fashion.
Normal endoscopic view of the glottis following displacement of the epiglottis from the soft palate.
Endoscopic view of tracheal intubation using a stylet within an endotracheal tube.
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