Rabbit Medicine and Surgery: Self-Assessment Color Review, Second Edition, Q&A 01

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Question	Answer		Article
Describe the techniques available for endotracheal intubation of an anaesthetized rabbit (1a, b, c, d)?	1. DIRECT VISUALIZATION. Place the anaesthetized rabbit in sternal recumbency, extend the neck vertically by elevating the head, grasp the tongue gently and retract it through the diastema and hold to one side. Visualize the larynx using a Wisconsin size 1 laryngoscope blade (1a) and insert a 2.5–3.0 mm endotracheal tube (1b). Alternatively, position the rabbit as above, visualize the larynx using an otoscope or Wisconsin size 1 laryngoscope blade or similar, place an introducer (e.g. 3–5 Fr urinary catheter) into the larynx through an otoscope or over a laryngoscope, remove the otoscope/laryngoscope and introduce an endotracheal tube gently over the introducer and then remove the introducer. A further alternative is to use the otoscope and place the endotracheal tube with its connector removed directly through the otoscope cone, replacing the connector after removal of the otoscope. The larynx can also be visualized using a small rigid endoscope while the endotracheal tube is passed alongside it into the larynx. All the above methods can also be performed with the rabbit in dorsal recumbency with the neck extended. 2. BLIND TECHNIQUE. Hold the anaesthetized rabbit in sternal recumbency with the head and neck extended. Pass an endotracheal tube over the tongue and advance it until exhalation is heard loudly either by placing the end of the tube to the ear (1c) or by the presence of condensation at each breath if using a clear tube, then advance the tube gently as the rabbit inhales and it will pass into the trachea. For all these techniques, positioning is important. Rabbits are obligate nasal breathers so normally the epiglottis is engaged on the dorsal aspect of the soft palate and will require disengagement in order to gain access to the glottal opening via the mouth. As with many techniques, there are several options and personal preferences. The author prefers to extend the neck vertically with no weight on the forelimbs. The neck is fully extended by holding the back of the rabbit’s head and elevating this. Insertion of the laryngoscope or otoscope is generally all that is required to disengage the epiglottis from the soft palate and expose the glottis (1d). If using a rigid endoscope, gentle dorsal pressure on the soft palate will dislodge the epiglottis. The anaesthetized rabbit should be allowed to breathe 100% oxygen by mask for a few minutes before intubation is attempted. With all these techniques, never force the tube into the larynx as this will cause haemorrhage and oedema and increase the risk of laryngospasm. A good rule is to make three attempts only and, if unsuccessful, revert to a mask. Topical lidocaine spray applied to the larynx may be used. This can be done under direct visualization with a spray. Some practitioners prefer to insert the tube blind to the level of the larynx and trickle or gently blow a few drops of lidocaine down the inside of the tube on to the larynx. An alternative to endotracheal intubation is to use a laryngeal mask.		Link to Article

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