A modified temporary tracheostomy in dogs: outcome and complications in 21 dogs (2012 to 2017)

The successful use of a subcutaneous catheter in the management of severe subcutaneous emphysema in a dog with laryngeal crush injury and tracheostomy tube placement

OBJECTIVE

To describe the placement of a subcutaneous catheter in a dog for the management of severe subcutaneous emphysema secondary to severe laryngeal crushing injury and temporary tracheostomy tube placement.

CASE SUMMARY

A 6-year-old male neutered Kelpie suffered a severe laryngeal crushing injury following a dog attack. Case management included the placement of a temporary tracheostomy tube due to severe respiratory compromise and inspiratory dyspnea associated with the crush injury. During hospitalization, the patient developed severe subcutaneous emphysema, pneumomediastinum, and a pneumothorax as a complication of the laryngeal crushing injury and temporary tracheostomy. A subcutaneous catheter was placed to manage the recurrent subcutaneous emphysema while the tracheostomy stoma healed. Five months posttrauma, the dog returned to normal with mild stridor during excitement and while panting.

NEW OR UNIQUE INFORMATION PROVIDED

This is the first report in veterinary medicine describing the use of a subcutaneous catheter for the management of subcutaneous emphysema secondary to laryngeal crush injury and temporary tracheostomy tube placement.

Outcomes and Complications Associated With Caudal Thoracic and Abdominal Air Sac Cannulation in 68 Birds

Air sac cannulation is used both as an emergency procedure in avian patients with severe upper respiratory compromise, as well as a means of routine ventilation for surgery of the head and neck. The objective of this retrospective study was to describe and quantify the complications associated with air sac cannulation in birds. Medical records were retrieved for all patients that underwent caudal thoracic or abdominal air sac cannulation at a single center between August 2004 and October 2020. Patient signalment, indication for air sac cannulation, location of air sac cannula (ASC) placement, occurrence and category of complications encountered, and survival data were recorded. Eighty-four ASCs were placed in 68 birds across 6 orders; 95.2% (80/84) of cases survived general anesthesia for initial ASC placement. The side and position of ASC placement were known in 33.3% (28/84) and 21.4% (18/84) of cases, respectively. Survival to ASC removal was known in 91.3% (73/80) of cases; 43 (58.9%) of these 73 cases survived to ASC removal. Complications were observed in 32.5% (26/80) of cases, and 11.5% (3/26) of cases died as a direct result of the complication. The most common reported ASC complication was loss of patency in 23.8% (19/80) of cases. Increased likelihoods for complications were seen in cases where exercise intolerance (P = 0.04) or abnormal respiratory sounds (P = 0.04) were reported at presentation. Increased likelihoods for survival to ASC removal were seen with intercostal placements (P = 0.049) and peri-interventional antibiotic therapy (P = 0.005). Decreased likelihood for survival to ASC removal was seen in cases where voice change was reported at presentation (P = 0.02). This study demonstrates a moderate risk of ASC complication, with a guarded overall prognosis for survival to ASC removal.

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

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.

Cricothyrotomy Is Faster Than Tracheostomy for Emergency Front-of-Neck Airway Access in Dogs

Objectives: In novice final year veterinary students, we sought to: (1) compare the procedure time between a novel cricothyrotomy (CTT) technique and an abbreviated tracheostomy (TT) technique in canine cadavers, (2) assess the success rate of each procedure, (3) assess the complication rate of each procedure via a damage score, (4) evaluate the technical difficulty of each procedure and (5) determine the preferred procedure of study participants for emergency front-of-neck access.

Materials and Methods: A prospective, cross-over, block randomised trial was performed, where veterinary students completed CTT and TT procedures on cadaver dogs. Eight students were recruited and performed 32 procedures on 16 dogs. A generalised estimating equation approach to modelling the procedure times was used.

Results: The procedure time was significantly faster for the CTT than the TT technique, on average (p < 0.001). The mean time taken to complete the CTT technique was 49.6 s (95% CI: 29.5–69.6) faster on average, with a mean CTT time of less than half that of the TT. When taking into account the attempt number, the procedure time for a CTT was 66.4 s (95% CI: 38.9–93.9) faster than TT for the first attempt, and for the second attempt, this was 32.7 s (95% CI: 15.2–50.2) faster, on average. The success rate for both procedures was 100% and there was no difference detected in the damage or difficulty scores (P = 0.13 and 0.08, respectively). Seven of eight participants preferred the CTT.

Clinical Significance: CTT warrants consideration as the primary option for emergency front-of-neck airway access for dogs.