Inducing anesthesia in your veterinary patients can be challenging. Complications may arise, and we can make mistakes. But
you can decrease the likelihood for error by taking steps to ensure you and your colleagues eschew practices that can lead
to blunders. Taking the time to consider the following smart practices hopefully will help you offer better patient care.
(Also see the Related Article "4 anesthesia mistakes you might not know you're making" below)
1. Watch for mismanagement of endotracheal tubes.
Failure to measure the tube length correctly can cause inadequate anesthesia and oxygen delivery, bronchial intubation, and
atelectasis, which is the collapsing of alveoli. It can also cause dead space, which is when the tube extends out too far,
causing an inadequate exchange of gases. This inadequate exchange can lead to a buildup of arterial carbon dioxide (hypercapnia),
which causes respiratory acidosis, thus greatly increasing the possibility for other complications.
Cuff inflation also can be done incorrectly. Overinflation can cause tracheal necrosis and trauma, while underinflation may
expose team members to anesthetic gas and can cause inadequate anesthesia delivery. What's more, the potential for aspiration
is increased if the patient vomits, regurgitates, has an abundance of saliva, or is undergoing a dental procedure in which
its mouth is continuously being rinsed.
Because of these risks, a technician should inflate the cuff and check that there are no leaks before continuing with the
anesthetic procedure. This process can entail slowly inflating the cuff while listening for an airway leak at the level of
the animal's mouth and administering a positive pressure breath. It can be helpful to ensure the chest rises with inflation
to indicate tracheal intubation. Proper endotracheal tube cuff inflation is achieved when the sound of air escaping is no
longer heard at a pressure of 20 mm Hg. Since relaxation can cause air to leak around the cuff, the technician should check
the cuff after the patient goes deeper into anesthesia.