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1.
Tracheal rupture and stenosis are well-reported problems in human beings and cats following endotracheal intubation. However, this problem has been rarely reported in dogs. This case report describes a case of tracheal necrosis 5 days following endotracheal intubation in a dog associated with overinflation of the endotracheal tube cuff and multiple changes in position.  相似文献   

2.
OBJECTIVE: To characterize clinical features of tracheal rupture associated with endotracheal intubation in cats and to evaluate the most appropriate treatment for this condition. DESIGN: Retrospective study. ANIMALS: 20 cats with a history of endotracheal intubation that subsequently developed dyspnea or subcutaneous emphysema. PROCEDURE: Medical records of cats with a presumptive diagnosis of tracheal rupture associated with intubation were reviewed. Clinical and clinicopathologic data were retrieved. RESULTS: Cats were evaluated 5 hours to 12 days after a surgical or medical procedure requiring general anesthesia with intubation had been performed. Fourteen (70%) cats were evaluated after dental prophylaxis. All cats radiographed had pneumomediastinum and subcutaneous emphysema. Eighteen of 19 cats were initially treated medically. Duration of medical treatment for cats that did not have surgery ranged from 12 to 72 hours. Cats that had surgery received medical treatment 3 to 24 hours prior to the surgical procedure. Medical treatment alone was administered to 15 cats that had moderate dyspnea, whereas surgical treatment was chosen for 4 cats that had severe dyspnea (open-mouth breathing despite treatment with oxygen) or worsening subcutaneous emphysema. Eighteen cats had improvement of clinical signs, 1 cat died after surgery, and 1 cat died before medical or surgical intervention. CONCLUSIONS AND CLINICAL RELEVANCE: Most cats with tracheal rupture associated with intubation can be treated medically. Cats with worsening clinical signs (severe dyspnea, suspected pneumothorax, or worsening subcutaneous emphysema) should have surgery performed immediately to correct the defect.  相似文献   

3.
OBJECTIVE: To investigate the effect of endotracheal tube cuff inflation pressure on the occurrence of liquid aspiration and tracheal wall damage. STUDY DESIGN: Prospective, randomized experimental study. ANIMALS: Ten healthy horses, weighing 535 +/- 55 kg. METHODS: Horses were anesthetized, orotracheally intubated, placed in dorsal recumbency, and maintained on isoflurane in oxygen with controlled ventilation for 175 +/- 15 minutes. The horses were randomly assigned to an endotracheal cuff pressure of 80-100 or 120 cm H2O. The cuff pressure was continuously monitored and maintained at a constant pressure. Methylene blue in saline was instilled proximal to the cuff. After euthanasia, the trachea was opened distal to the endotracheal tube tip to check for evidence of dye leaking past the cuff. The cervical trachea was then resected and opened longitudinally for gross and histologic examinations. RESULTS: No blue staining was found distal to the cuff in any horse. Visual examination of the tracheal mucosa revealed hyperemic and hemorrhagic lesions at the site of the cuff contact. Histologic changes included epithelium attenuation or erosion, submucosal neutrophilic infiltration, and submucosal hemorrhages. Lesions were absent or less extensive in the lower cuff pressure group as compared to the high cuff pressure group. CONCLUSIONS: The endotracheal tube cuff produced a seal sufficient to prevent leakage in both groups. Tracheal wall damage was more severe and occurred more frequently in the higher cuff pressure group. CLINICAL RELEVANCE: Tracheal mucosal damage induced by cuff inflation is pressure-dependent. Cuff pressure monitoring is recommended.  相似文献   

4.
Objective The purpose of this study was to investigate the effect of extubation with the endotracheal tube (ETT) cuff inflated versus deflated on endotracheal fluid volume in normal canine cadavers. Study Design Prospective randomized blinded controlled cadaver study. Animals Sixteen adult Beagle cadavers weighing 10.7 ± 1.7 kg (mean ± SD) and <2 years of age. Methods Cadavers were orotracheally intubated in lateral recumbency, and the ETT cuffs were inflated to a closing pressure of 20 cm H2O before barium was introduced orad to the cuff. The dogs were randomly assigned to an ETT cuff extubation condition of deflated or unchanged from the original closing pressure. After extubation, lateral thoracic radiographs of the cadavers were obtained and scored by three independent blinded reviewers. Each reviewer ordered all 16 lateral radiographs from most to least intratracheal contrast and also estimated residual intratracheal contrast volume. Results Dogs extubated with a deflated ETT cuff had a median rank of 13 and dogs extubated with an inflated ETT cuff had a median rank of 4.5 (p < 0.0001). Dogs extubated with a deflated ETT cuff had an estimated intratracheal volume of fluid of 1.8 mL ± 0.7 mL (mean ± SD) and dogs extubated with an inflated ETT cuff had an estimated volume of 0.9 mL ± 0.5 mL (p < 0.0001). Fleiss Kappa for agreement among evaluators was 0.875. Conclusions and clinical relevance Extubation with the cuff inflated removed more liquid contents from the trachea than extubation with the cuff deflated and may assist in the prevention of pulmonary aspiration when fluid is present in the proximal trachea. The technique did not remove all fluid so the potential for pulmonary damage remains.  相似文献   

5.
ObjectiveTo assess the effects of two sizes of silicone endotracheal tubes with internal diameter 26 mm (ETT26) and 30 mm (ETT30) inflated to minimum occlusive volume on tracheal and laryngeal mucosa of adult horses anesthetized for 2 hours with isoflurane.Study designProspective, randomized, blinded, crossover experimental study.AnimalsA total of eight healthy adult mares.MethodsUpper airway endoscopy and ultrasound measurements of internal tracheal diameter were performed the day before anesthesia. Horses were anesthetized and orotracheally intubated with ETT26 or ETT30. Ease of intubation was scored. The cuff was inflated in 10 mL increments to produce a seal. Final volume of air used and intracuff (IC) pressure (measured by pressure transducer) were recorded. At the end of anesthesia, a manometer was used to measure IC pressure and these measurements compared against measurements from the pressure transducer. Laryngeal and tracheal mucosa were assessed via endoscopy and assigned a score 0–3 before anesthesia, and at 2 and 24 hours following extubation.ResultsData are from seven horses because one horse with laryngeal hemiplegia was excluded. Mean tracheal ultrasound measurement was 3.5 ± 0.4 cm. No significant differences were noted between endotracheal tube sizes for intubation score, IC pressures, inflation volumes or tracheal or laryngeal injury scores at any time point. IC pressure measured by manometer was slightly higher than that by transducer (+1.0 ± 2.8 mmHg).Conclusions and clinical relevanceResults identified no clear advantage of one endotracheal tube size over the other in the population of horses studied, when endotracheal intubation is properly applied and IC pressure is carefully monitored. However, given that ETT26 was associated with the highest observed IC pressures and the only observed incidents of tracheal circumferential erythema, the larger ETT30 may be the better choice in most cases where tracheal size is sufficient.  相似文献   

6.
Endotracheal intubation is an essential component of general anaesthesia in horses to facilitate delivery of inhalation anaesthetic agent and oxygen, artificial ventilation, and prevent pulmonary aspiration of blood or gastric reflux. Experimental studies have identified a high incidence of tracheal mucosal injury after intubation resulting from direct trauma or local ischaemia from the pressure of the inflated cuff. Recommendations to minimise injury include gentle intubation, disconnection from the anaesthesia machine when moving the horse, and monitoring the endotracheal tube cuff pressure. New studies are needed to evaluate trachea and cuff pressure interactions under current practice conditions, including specialised ventilation modalities such as positive end‐expiratory pressure and continuous airway pressure.  相似文献   

7.
Nine adult horses were anesthetized for a nonsurvival abdominal adhesion study. Horses were randomly assigned into two groups to receive endotracheal tube cuff pressures of either 80 cm H2O (Group P80) or 120 cm H2O (Group P120). After intubation (Bivona 30 mm ID), anesthesia was maintained with isoflurane. Horses were ventilated 10 times per minute with a suitable inspiratory pressure to maintain Pe ′CO2 in the 35–40 mm Hg (4.7–6.0 kPa) range. Cuff pressure was continuously monitored with a pressure transducer (TruWave, Baxter) calibrated to the atmospheric pressure and maintained at a constant pressure. Twenty‐five millilitres of methylene blue dye in saline were instilled proximal to the cuff over 5 minutes. The horses were euthanized 123 ± 23 minutes later (mean ± SD). Immediately, the trachea was opened distal to the tip of the endotracheal tube, and the mucosa was observed for evidence of dye leaking past the cuff. The cervical trachea was resected and the lumen exposed by a ventral longitudinal incision. Biopsies (1–2 rings) were obtained at mid‐cuff level and distal to the tip of the endotracheal tube, and placed in formalin for later histologic examinations (H&E stain). Methylene blue stain was not observed distal to the endotracheal tube cuff in any horse. Visual examination of the tracheal mucosa revealed hyperemic or hemorrhagic lesions at the level of cuff contact both ventrally and dorsally. Histologic changes included epithelium damage, submucosal neutrophil infiltrates, and acute submucosal hemorrhages. P80 horses had none or focal to multifocal lesions on the ventral and dorsal aspects of the rings. P120 horses had multifocal to diffuse lesions on all aspects (dorsal, ventral, and lateral). We concluded that the endotracheal tube cuff produced a seal sufficient to prevent leakage at both pressures. Tracheal damages on gross and microscopic examinations were more severe and occurred more frequently at the higher cuff pressure.  相似文献   

8.
OBJECTIVE: To describe the use of intraluminal tracheal stenting in 3 cats with either benign or malignant tracheal obstruction. STUDY DESIGN: Retrospective clinical study. ANIMALS: Three client-owned cats. METHODS: Medical records were reviewed and information regarding signalment, clinical signs, physical examination findings, diagnostic tests performed, treatment, outcome and follow-up were retrieved. Intraluminal tracheal stent placement was performed as previously described in the literature. RESULTS: Three cats received intraluminal tracheal stents for the treatment of tracheal obstruction due to 3 different underlying causes: stricture secondary to traumatic endotracheal intubation, stricture secondary to a previous tracheotomy, and neoplasia. Self-expanding metallic stents of varying sizes were placed, and all cats recovered uneventfully from the procedures. The cat with tracheal neoplasia was euthanized because of pulmonary metastatic disease 6 weeks post-stent placement. The two cats with tracheal obstructions secondary to benign strictures are currently 39 months and 32 weeks post-stent placement, respectively. No complications were noted during the post-stent period in any of the 3 cats. CONCLUSIONS: Intraluminal tracheal stenting was easily, safely, and rapidly performed without complications and resulted in immediate improvement in clinical signs in all three cases. None of the cats in this study developed significant stent-associated complications during the study period. CLINICAL RELEVANCE: Intraluminal tracheal stenting has the potential to be a viable option for the treatment of tracheal obstruction in cats and perhaps for similar disease processes in other veterinary patients.  相似文献   

9.
Access to the respiratory tract of an anaesthetised animal is a vital line of life. An endotracheal tube ensures a secure airway that will allow the delivery of anaesthesia and facilitates mechanical ventilation. The case report by Miller and Auckburally (2020) described in this issue highlights the potential complications associated with endotracheal intubation. Intubation using a 30 mm ID endotracheal tube in the average sized horse (500 kg) has been documented to have a high rate of tracheal injury. The manufacturing specifications of endotracheal tubes may contribute to the incidence of tracheal injury. Further research is needed to help minimise the morbidity and potential mortality associated with this anaesthetic procedure.  相似文献   

10.

Objectives

To determine the endotracheal tube cuff pressure produced with two inflation techniques, in two brands of endotracheal tube in cats. To determine the inspiratory pressure which produces an audible leak when the intracuff pressure is 30 cmH2O.

Study design

Prospective, clinical, randomized study.

Animals

A total of 40 client-owned healthy adult cats.

Methods

Following induction of anaesthesia, endotracheal intubation was performed with a Parker Flex-Tip PFLP (Parker; n = 20) or Flexicare VentiSeal (Flexicare; n = 20) endotracheal tube. For each cat, the endotracheal tube cuff was inflated using two methods, minimum occlusive volume (MOV) and pilot balloon palpation (PBP). Intracuff pressure was recorded. Cuff pressure was then set at 30 cmH2O and the pressure within the breathing system when a manual breath first caused an audible leak was measured.

Results

PBP pressure was lower for Parker (36 ± 13 cmH2O) compared with Flexicare (45 ± 13 cmH2O, p = 0.048). MOV pressure was not different between tube types (56 ± 28 versus 66 ± 25 cmH2O for Parker and Flexicare, respectively, p = 0.247). MOV produced a higher pressure than PBP for Parker (56 ± 28 versus 36 ± 13 cmH2O, p = 0.001) and Flexicare (66 ± 25 versus 45 ± 13 cmH2O, p = 0.007). When intracuff pressure was set at 30 cmH2O, 95% of cats did not develop an audible leak until the inspiratory pressure was greater than 10 and 12 cmH2O for Parker and Flexicare tubes, respectively.

Conclusions

PBP produced lower cuff pressures than MOV, although both techniques produced a cuff pressure above that at which mucosal blood flow is believed to be restricted. A cuff pressure of 30 cmH2O may be sufficient to prevent audible leak in most cats if respiratory pressures are kept at 10–12 cmH2O or below.

Clinical relevance

To ensure a safe endotracheal tube cuff pressure, use of a specifically designed pressure gauge is recommended.  相似文献   

11.
CASE DESCRIPTION: Acute pulmonary hemorrhage developed during isoflurane anesthesia in 2 Himalayan cats undergoing routine dental cleaning and prophylaxis. CLINICAL FINDINGS: The cats were siblings and lived together. In both cats, results of pre-operative physical examinations and laboratory testing were unremarkable. Blood pressure and oxygen saturation were within reference ranges throughout the dental procedure. Approximately 15 to 20 minutes after administration of isoflurane was begun, frothy blood was noticed within the endotracheal tube. Blood was suctioned from the endotracheal tube, and the cats were allowed to recover from anesthesia. TREATMENT AND OUTCOME: 1 cat initially responded to supportive care but developed a second episode of spontaneous pulmonary hemorrhage approximately 30 hours later and died. The other cat responded to supportive care and was discharged after 4 days, but its condition deteriorated, and the cat died 10 days later. Subsequently, it was discovered that the home was severely contaminated with mold as a result of storm damage that had occurred approximately 7 months previously. Retrospective analysis of banked serum from the cats revealed satratoxin G, a biomarker for Stachybotrys chartarum, commonly referred to as "toxic black mold." CLINICAL RELEVANCE: Findings highlight the potential risk of acute pulmonary hemorrhage in animals living in an environment contaminated with mold following flood damage.  相似文献   

12.
Objective To evaluate the endotracheal tube cuff pressure achieved by four different inflation methods. Study design Prospective clinical study. Animals Eighty client owned dogs. Methods After anaesthesia induction, endotracheal intubation was performed using plastic or silicone tubes. A clinician unaware of tube type inflated the cuff by simple digital palpation (method A), thereafter the cuff was deflated and inflated again by a second clinician who tried to reproduce a previously learned cuff pressure of between 19 and 24 mmHg (method B). During method C the cuff was inflated to the minimum occlusive volume at an airway pressure of 20 cm H2O, and in method D the cuff was incrementally deflated until an audible air leak could be heard from the oral cavity at an airway pressure of 25 cm H2O. For all the methods, an operator recorded the actual cuff pressure obtained using a manometer. Heart rate, respiratory rate and mean arterial pressure were monitored throughout the procedure. Results The mean inflation pressure for plastic tubes was 56 ± 28 mmHg for method A, 20 ± 9 mmHg for method B, 35 ± 32 mmHg for method C and 46 ± 39 mmHg for method D. Pressures using silicone tubes were significantly higher than for plastic tubes, the mean registered pressures being 79 ± 39, 33 ± 16, 77 ± 50 and 92 ± 56 mmHg for methods A, B, C and D. Conclusions and Clinical Relevance None of the methods evaluated in this study can be considered effective for inflating the endotracheal tube cuff to within the optimal range when using silicone tubes. Direct measurement of the cuff pressure with a manometer is therefore recommended.  相似文献   

13.
Tracheal diameter can be assessed from a thoracic radiograph, with assessment of tracheal diameter in dogs based on ratios between tracheal diameter and a skeletal measurement. Reference intervals are not, however, available for the cat. Tracheal narrowing may cause significant clinical problems, although tracheal hypoplasia in dogs may be clinically silent, and is rarely reported in cats (both mesati- and brachycephalic). The tracheal diameter and trachea:thoracic inlet and trachea:rib ratios were calculated for populations of domestic shorthair (DSH) (n?=?68) and Persian (n?=?40) cats. This gave reference intervals for radiographic tracheal measurements in these breeds. It is proposed that the tracheal diameter in a normal DSH cat should be 18% of the diameter of the thoracic inlet, and compared to 20% in Persian cats.  相似文献   

14.
OBJECTIVE: To develop and assess the survival of a microvascular cutaneous free flap based on the ventral branch of the deep circumflex iliac (DCI) artery and vein in cats. STUDY DESIGN: Experimental study. ANIMALS: Phase 1: 6 feline cadavers; Phase 2: 2 adult cats; Phase 3: 10 adult cats. METHODS: Phase 1: Selective angiographic study of the deep circumflex iliac artery was completed in 6 feline cadavers. After injection of the DCI artery with barium, high-detail radiographs were made of skin flaps harvested from the lateral flank and thigh region. The extent of the cutaneous angiosome was mapped with regard to the underlying anatomical landmarks. Phase 2: An island flap based on anatomic boundaries of the DCI angiosome derived from phase 1 of the study was elevated in 2 cats. Flaps were observed for 3 weeks for survival. Phase 3: Free skin flaps based on the DCI vessels were harvested in 10 cats and transferred to the dorsal interscapular region. Flaps were evaluated for 2 weeks for survival. Tissue samples were collected for histopathology, and angiograms of the flaps were completed. RESULTS: Phase 1: Angiograms revealed a large primary cutaneous angiosome of the DCI artery located over the lateral femoral region, which extended from the iliac crest to the level of the patella. Phase 2: All island flaps survived for 3 weeks. Phase 3: Six free flaps survived for 2 weeks, and 4 flaps failed completely. Failure of 1 flap occurred because of avulsion of the venous and arterial anastomosis postoperatively. Another cat had intraoperative hemorrhage, which resulted in anemia and hypovolemia and likely caused the flap to fail. The other 2 flaps that failed had poor perfusion intraoperatively and had the longest ischemia times. CONCLUSIONS: The cutaneous DCI free flap in cats may be clinically useful in reconstruction of large cutaneous wounds. The length of ischemia time for successful cutaneous free flap transfer in the cat may be shorter than in other species. CLINICAL RELEVANCE: Large wounds created by trauma or oncologic ablative surgery in cats could be reconstructed with cutaneous microvascular free flap. Additional studies assessing the critical ischemia time of cutaneous flaps in cats and evaluating the use of this flap clinically are needed.  相似文献   

15.
This paper reports five new cases of intrathoracic tracheal rupture in cats, and summarizes these cases in conjunction with 11 cases from the literature. Most cats had no obvious respiratory signs at the time of injury, and in half of them the tracheal rupture was the only injury. The interval from trauma to onset of dyspnoea ranged from 1 to 28 days (median 12.5 days). Radiographic findings include loss of continuity of the trachea, often with a gas-filled diverticulum present between separated tracheal rings. With careful attention to surgical technique and anaesthetic management the prognosis for these cats is excellent. All eight of the cats reported in the last 14 years having surgical correction survived and returned to normal. The surgical anatomy, approach and tracheal anastomosis technique is described and recommendations for anaesthetic management are made.  相似文献   

16.
Endotracheal tubes manufactured from red rubber and polyvinyl chloride (PVC) were compared, using radiographic techniques, in dog cadavers, under in vitro conditions and in anaesthetised dogs (in vivo study). All endotracheal tubes were radiographed in 'neutral' and flexed positions and the percentage reduction in the ventrodorsal radiographical diameter of the tube was calculated. The red rubber tubes kinked completely in 40 per cent of the cadavers, 75 per cent of the in vitro study and 40 per cent of anaesthetised dogs. The PVC tubes kinked completely in only one case (in vivo study). However, these tubes had a mean reduction in diameter of 15 per cent in the dog cadaver study, 19 per cent in the in vitro study and 26 per cent in the in vivo study. During procedures in which the trachea is intubated and the atlanto-occipital joint of the patient must be flexed, PVC endotracheal tubes may be less prone to kinking than red rubber tubes.  相似文献   

17.
ObjectiveTo compare ultrasonography with computed tomography (CT) for assessment of tracheal diameter as a feasibility study for endotracheal tube selection.Study designProspective study.AnimalsA total of nine Beagle dogs with a median (interquartile range) weight of 7.4 (7.2–7.7) kg.MethodsTracheal diameter measurements were obtained at two locations: 1 cm proximal to caudal border of the cricoid cartilage (sublaryngeal; SL) and dorsal to above cranial border of the manubrium (thoracic inlet; TI). For CT, dogs were anesthetized with propofol and sevoflurane, in sternal recumbency, and measurements obtained after controlled ventilation–induced apnea and the endotracheal tube cuff was deflated. Transverse diameter, right and left 45° oblique diameters were measured. For ultrasonography, unsedated dogs were standing with slight neck extension, and images obtained in ventrodorsal, 45° right and left oblique ways after expiration. Diameters between the tracheal lumen mucosal borders were measured. The degree of agreement between the tracheal diameters measured at SL and TI locations with CT (TDCT-SL and TDCT-TI) and ultrasonography (TDUS-SL and TDUS-TI) was verified using the Bland-Altman method.ResultsThe agreement between the measurements obtained with CT and ultrasonography was revealed by Bland-Altman analyses, although ultrasonography tended to slightly underestimate the tracheal diameter.Conclusions and clinical relevanceUltrasonography can be applied for tracheal diameter measurement. Although further studies are required, an endotracheal tube selection method, using ultrasonography, could be proposed.  相似文献   

18.
A peri-carinal tracheal laceration was produced in a 11-year-old cat during tracheal intubation. Before reconstructive surgery began, the leak was bypassed with an endobronchial tube positioned using endoscopy and direct vision. However, single-lung ventilation could not be sustained because the tube became dislodged and could not be repositioned. Consequently, surgery was completed with periods of intermittent apnoea interspersed with manually controlled hyperventilation. Cardiovascular variables were stable during anaesthesia and no signs of hypoxia were detected. The difficulties in maintaining endobronchial tube position resulted from the animal's small size relative to the dimensions of the endotracheal tube.  相似文献   

19.
ObjectiveTo describe the sonoanatomy of the abdominal wall in live cats and to compare the distribution pattern of two versus three ultrasound-guided transversus abdominis plane (TAP) injections using clinically applicable volumes of lidocaine–dye solution in cat cadavers.Study designProspective anatomical study.AnimalsA total of eight client-owned healthy cats and eight cat cadavers.MethodsUltrasound anatomy of the abdominal wall, landmarks and sites for needle access were determined in live cats. Ultrasound-guided TAP injections were performed in eight thawed cat cadavers. Volumes of 0.25 or 0.16 mL kg?1 per point of a lidocaine–dye solution were injected using either two [subcostal and preiliac (SP)] or three [subcostal, retrocostal and preiliac (SRP)] injection points, respectively. Each cadaver was then dissected to determine the injectate distribution and the number of thoracolumbar nerves stained with each approach. The target nerves were defined as the ventromedial branches of the thoracic nerves 10 (T10), T11, T12, T13 and lumbar nerves 1 (L1) and L2.ResultsSonoanatomy was consistent with anatomy upon dissection and the TAP was identified in all cadavers. A total of 16 subcostal, 16 preiliac and nine retrocostal TAP injections were performed. The overall staining success rate of the target nerves was 66.7% and 92.6% for the SP and SPR approaches, respectively (p = 0.02). The ventromedial branches of T10, T11, T12, T13, L1 and L2 were stained in 57.1%, 100.0%, 85.7%, 28.6%, 42.9% and 85.7%, and in 66.7%, 100.0%, 100.0%, 100.0%, 88.9% and 100.0% of the cases with the SP and SRP approaches, respectively.Conclusions and clinical relevanceThe SRP approach allowed a broader distribution around the target nerves, whereas a staining gap was observed at T13 and L1 with the SP approach. Further studies are necessary to investigate the analgesic effect of these approaches in a clinical setting.  相似文献   

20.
Laryngotracheal injury associated with nasotracheal intubation in the horse   总被引：2，自引：0，他引：2  
Laryngotracheal damage following short-term nasotracheal intubation was studied in 7 healthy horses. A flexible fiberoptic endoscope was used to examine the upper respiratory tract of each horse before nasal intubation with a cuffed silicone endotracheal tube and again at 1 hour, 24 hours, and 48 hours after extubation. Any abnormalities still evident at 48 hours were evaluated at 7 days after extubation. Mucosal damage involved the nasal meatus (5 of 7 horses), the arytenoid cartilages (5 of 7 horses), the trachea (5 of 7 horses), the dorsal pharyngeal recess (4 of 7 horses), the vocal folds (3 of 7 horses), and the entrance to the guttural pouch (3 of 7 horses). Laryngeal injury was attributable to tube pressure on the arytenoid cartilages and vocal folds. Tracheal damage appeared to be a function of pressure exerted by the inflated cuff on the tracheal mucosa.  相似文献   

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