Page 115 - BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery, 2nd Edition

BSAVA Manual of Canine and Feline Head, Neck and Thoracic Surgery

available. For smaller patients, such as cats, small dogs and effective management the majority of patients survive until
some brachycephalic dogs with hypoplastic tracheas, it is tube removal or definitive diagnosis (Guenther-Yenke and
VetBooks.ir their small size the tube is a simple design without a remov- tracheostomy tubes were found to be more likely to have an
necessary to use paediatric tubes (Figure 8.6). Owing to
Rozanski, 2007; Nicholson and Baines, 2012). Dogs with
unsuccessful outcome if they were Bulldogs, younger dogs
able inner cannula. This means that cleaning and main-
tenance of the tube requires removal and reinsertion,
and Baines, 2012). The main major complications are tube
therefore complicating management. Larger patients can or if they experienced episodes of bradycardia (Nicholson
accommodate a tube with a removable inner cannula occlusion (Figure 8.8) and tube dislodgement. Equipment
(Figure 8.7); this facilitates regular cleaning to ensure that must be prepared to facilitate rapid replacement of a
mucus plugs do not build up within the tube. The risks of tracheostomy tube; spare tubes of a range of sizes should
tube occlusion, dyspnoea and fatal respiratory obstruction be close at hand. The conformation of certain dog breeds
are accordingly lower in larger patients. (e.g. abundant skin folds or short necks) can make it more
Following placement of a temporary tracheostomy, the challenging to secure the tube; Bulldogs were three times
patient requires constant monitoring and regular manage- more likely to dislodge the tube than other breeds in one
ment of the tube. Complication rates are high, but with study (Nicholson and Baines, 2012).

Complete obstruction of a tracheostomy tube with mucus
8.8
secretions.

Bypass of the upper airways does not allow filtering,
warming and humidification of air prior to entry into the
trachea. The loss of these functions, in addition to disrup-
tion of the mucociliary escalator following tracheostomy,
predisposes to the development of copious tenacious
mucous, which can increase the risk of respiratory obstruc-
tion. The patient should receive intravenous fluid therapy to
A paediatric tracheostomy tube used for management of ensure they remain well hydrated, and regular saline nebuli-
8.6 upper respiratory tract obstruction in a puppy; owing to the zation should be performed. Minor complications include
small size of the tube there is no removable inner cannula. maceration of the skin around the tracheostomy site asso-
ciated with drainage of respiratory secretions on to the skin.
Regular cleaning should be performed followed by applica-
tion of a barrier cream. Whilst careful management of these
patients is essential, it should be noted that an increase in
complications has been documented in patients under
more frequent tube management regimens (Nicholson and
Baines, 2012) and therefore excessive interference should
be avoided. In particular, suction of the airway must be used
only when absolutely required; suction can cause a drop in
arterial oxygen saturation and will further irritate the air-
ways, encouraging additional mucus production.
The tracheostomy tube is removed once it is no longer
required and the stoma is left to heal via second intention.
Brief temporary occlusion of the tracheostomy tube can be
performed to assess upper airway patency in medium to
large dogs; however, this should not be performed in cats,
small dogs or brachycephalic breeds, because the tube
can occupy up to 75% of the tracheal lumen and the test is
not, therefore, representative of their functional airway and
A tracheostomy tube with a removable inner cannula, which
8.7 may compromise the patient. In some animals, airway
facilitates regular cleaning of the tube to prevent obstruction.
The inner cannula can be interchanged between a cannula that can examination under a light plane of general anaesthesia
connect to an anaesthesia breathing circuit, for use during placement (as may be indicated to determine whether removal of the
shown), and a shorter cannula for use in the conscious patient. tracheostomy tube is appropriate.

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