How to Intubate a Cat in Lateral Recumbency

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October 2024

In this VETgirl online veterinary continuing education video, we demonstrate how to intubate a cat in lateral recumbency. Being able to intubate in lateral is important in veterinary medicine, as your patient may accidentally become extubated during surgery or a patient may require intubation without interruption during cardiac compressions as described by the 2024 RECOVER guidelines.1

Cats are already challenging enough to intubate! Here are a few VETgirl pro-tips.

Supplies: Have all your supplies readily available. This should include the following:  laryngoscope with functioning light bulb, appropriate size Murphy endotracheal (ET) tubes, lubricant for the end of the ET tube and cuff (Be sure not to occlude the Murphy’s eye), a tie for securing the tube (e.g. tie-gauze, IV tubing), additional induction drugs if necessary, and +/- lidocaine spray (applied to the arytenoids to decrease laryngeal spasm).

Patient Positioning: The KEY to lateral intubation is patient positioning! The assistant extends the head and neck outwards from the body so that the nose, larynx, and thorax are aligned. This position improves visualization through the oral cavity of the epiglottis, arytenoids, and trachea. The most common mistake during lateral intubation is improper positioning of the head and neck – often we end up pulling the nose toward the ventral midline, thus bending the neck and obscuring visualization of the back of the oropharynx. **NOTE: While this video utilized a cat head model designed to help train users how to intubate, don’t open a cat’s lower jaw to the degree shown here!

Intubation: Once the patient is positioned, lateral intubation is fairly similar to sternal intubation in cats… just with the operator having to contort their own body into position! We premeasure the intended ET tube depth from the cat’s nose to the thoracic inlet, use the laryngoscope to visualize the larynx, apply a drop or spray of lidocaine to the arytenoids to limit spasm (optional step), and insert the ET tube between the vocal folds on inhalation in spontaneously breathing patients. In anesthetized cats, patience is key – wait for the patient to take a breath and gently yet deliberately, insert the beveled edge of the ET tube through the vocal folds (which are between the arytenoids on either side of the airway). In cardiopulmonary arrest (CPA) or in apneic patients, the arytenoids will not be moving, and here’s where a stylet can be incredibly helpful! Place the tip of the ET tube’s beveled edge between the arytenoids, and with a slight twist and gentle pressure, advance the ET tube into the trachea. Confirm placement via direct visualization during insertion, capnography, visualization of the chest rising with a delivered breath, and/or by auscultation of air sounds in the chest during manual breath. Be sure to secure the ET tube and then inflate the ET tube accordingly to create a seal to effectively deliver a breath up to a maximum inspiratory pressure of 20 cmH2O.

Interested in more information on veterinary CPR? Check out this VETgirl continuing education blog to learn more. And for a refresher on sternal intubation in the cat, check out this VETgirl continuing education video HERE.

This specialized education is brought to you by an exclusive partnership between VETgirl and the BluePearl EmERge program. The BluePearl EmERge program is an immersive emergency veterinarian training program, putting you on the fast track to becoming a highly experienced, confident, and capable emergency veterinarian, ready to provide lifesaving care for pets in need. The program gives you everything you need for a successful career in emergency medicine, including the critical, hands-on experiences, immersive training and personal mentorship needed to thrive. The EmERge program is for new graduates or practicing veterinarians interested in transitioning to emergency medicine. For more information about the program visit https://careers.bluepearlvet.com/us/en/emerge-program.

References:
Hopper K, Epstein SE, Burkitt-Creedon JM, et al. 2024 RECOVER Guidelines: Basic Life Support. Evidence and knowledge gap analysis with treatment recommendations for small animal CPR. J Vet Emerg Crit Care. 2024;34(1):16-43.

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