Effective airway management strategy for tracheal resection in a dog with cervical tracheal stenosis.

Abstract

A female Border Collie, aged 1 year and weighing 21.8 kg, was referred for surgical correction of a cervical tracheal stenosis located at the level of the sixth cervical vertebra. The stenosis was thought to result from an intubation injury caused by endotracheal cuff inflation 1 month earlier during an ovariohysterectomy. Premedication consisted of intravenous dexmedetomidine (2 μg kg) and methadone (0.2 mg kg). Anaesthesia was induced with intravenous propofol to effect and maintained with a variable-rate propofol infusion (0.1-0.3 mg kgminute) and dexmedetomidine infusion (0.5 μg kghour). After initial intubation cranial to the stenosis with an 11 mm cuffed endotracheal tube (ETT), volume-controlled ventilation was established. Intraoperative endoscopy confirmed the location and severity of the stenosis. Reintubation was attempted with progressively smaller sterile ETTs; a 5.5 mm ETT was successfully advanced through the stenosis using a sterile bougie and extended intraorally with an elbow connector. After surgical exposure of the trachea, two tracheal rings were resected and a second sterile 5.5 mm ETT was placed under sterile conditions into the caudal trachea to maintain ventilation across the surgical field. An arterial blood gas analysis performed at this stage was unremarkable. Two additional cranial tracheal rings were resected, and a retrograde bougie-guided reintubation was performed to place a final 8.0 mm ETT across the anastomosis. An intraoperative leak test confirmed the integrity of the repair, and final endoscopy demonstrated a patent airway with no residual stenosis or haemorrhage. The dog recovered uneventfully. This case illustrates a staged and flexible airway management strategy using progressively smaller sterile tubes, bougie guidance and intraoperative endoscopy to maintain effective ventilation during complex tracheal surgery in dogs.