Despite this alternative method being available , the v-gel was used in only 1.2 % of cat spays and 0.8 % of cat castrations . Adequate sample size suggests that this is a true reflection of the methods used , and that the v-gel device is not widely utilised . The reasoning for this remains unknown . One theory is that there is a possibility of epiglottic folding and the loss of the airway when utilising an SGAD ^{[ 8 ]} . This can be monitored by capnography and rectified by repositioning . However , this risk , and lack of equipment , may be a barrier to exploring and implementing this method . Further research is required , specifically on the use of the SGAD in veterinary practice .

Traumatic intubation has been identified as a risk factor for tracheal damage and feline mortality ^{[ 9 ]} . Various methods can be used to aid and encourage a smooth intubation process and therefore reduce the risk of trauma , such as the application of lidocaine . However , no information was collected on the length of time given for lidocaine to take effect , and whether 60 – 90 seconds were given before intubation was attempted to allow the larynx to desensitise ^{[ 10 ]} . Again , further study , beyond the scope of this study , is required .

In addition to intubation protocols , respondents were asked about cuff inflation . The most common method was using a leak testing method with minimal occlusive volume ( 72.4 %). This method was evaluated in dogs by Hung et al . ^{[ 11 ]} , who showed that over-inflation of the cuff in 80 % of cases may be a likely contributor to any complications experienced with endotracheal intubation . Only a small portion of respondents ( 12.7 %) used a cuff inflator and manometer . Hung et al . ^{[ 11 ]} explained that the two most commonly available cuff inflator devices inflated cuffs to a safe pressure in 50 % and 87 % of cases , respectively . Despite not knowing which device was used in these scenarios , it is fair to say that cuff inflation would have been more accurate with this method in comparison to leak testing or other subjective methods .

Of the participants who responded , 72.2 % said they had never experienced a complication when intubating or because of intubation . Mitchell et al . ^{[ 9 ]} listed possible explanations for tracheal trauma as inappropriate cuff inflation , traumatic intubation and removing the ETT without deflating the cuff . No data were gathered on the practices of caring for intubated patients , so this would be an area for future study , in addition to exploring whether veterinary professionals are able to identify complications and evaluate their severity .

Participants were also asked if they agreed with the airway management methods used in practice . Of those who disagreed with the methods used in their practice , responses indicated that practices were unwilling to change and VNs felt undervalued by VSs . The RCVS survey of the veterinary nursing profession ^{[ 12 ]} highlighted that VNs felt taken for granted and undervalued , and felt they deserved more recognition and respect from VSs . Feeling undervalued may prevent VNs from sharing their clinical opinions and advocating for contextualised care – creating a divide and contributing to a lack of job satisfaction .

VNs also opted to choose airway management for castrations far more than VSs . An explanation for this could be that VNs usually monitor these procedures and may feel uncomfortable with no airway management . The RCVS legislative reform consultation ^{[ 13 ]} has made recommendations to bolster the VN role . This will potentially allow VNs to perform cat castrations and extend their role in anaesthesia ^{[ 13 ]} . These changes may increase VNs ' confidence in their role and may encourage them to practise evidence-based veterinary medicine ( EBVM ). Future studies could monitor the effects of any changes approved .

Conclusion

This study discovered that the most common airway management methods used for feline patients include ETTs for cat spays , and masks and no airway management for cat castrations . The v-gel device was found not to be widely used by veterinary professionals , although it was mentioned by several respondents as their preference for feline patients . The utilisation of v-gels may change as the profession becomes more focused on EBVM and more literature is published .

The study also discovered that the barriers to intubation were mostly due to time constraints or protocols rather than the risks associated with ETTs . The occurrence of complications associated with intubation was found to be relatively low , with fatal complications having been experienced by only 5.6 % of respondents . Further education on intubation techniques and management may reduce this number further .

Need to make notes ?

We ’ re trialling an easier-to-navigate layout . Instead of having space for professional development notes at the end of articles , we ’ ve set aside a couple of pages at the end of the journal . Like it or loathe it ? Please let us know via vnj @ bvna . co . uk .

48 Veterinary Nursing Journal