Tracheal rupture following general anaesthesia in a horse
Authors: Miller C., Auckburally A.
Journal: Equine Veterinary Education
Summary
# Editorial Summary: Tracheal Rupture Following General Anaesthesia A Dutch Warmblood underwent routine surgical excision of a sarcoid tumour on the distal pinna but suffered iatrogenic tracheal trauma during recovery from general anaesthesia when the endotracheal tube cuff was inadvertently left partially inflated during extubation. Subcutaneous emphysema along the neck became apparent 24 hours postoperatively, prompting tracheoscopic examination which revealed a 5 cm dorsal tracheal tear and abnormal flattening of the tracheal lumen. Despite the significant nature of the injury, conservative management alone proved sufficient for complete healing with no subsequent respiratory compromise. This case highlights a critical technical detail often overlooked in anaesthetic protocols: the importance of fully deflating the endotracheal tube cuff before withdrawal, as even partial inflation can generate sufficient pressure gradients to rupture the tracheal mucosa and submucosa, particularly during patient movement or if awakening stimulates laryngeal resistance. Practitioners should reinforce this basic safeguard in recovery protocols and maintain a high index of suspicion for tracheal injury when subcutaneous emphysema develops in the immediate postoperative period, as early detection via tracheoscopy may allow intervention before severe stenosis or infection develops.
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Practical Takeaways
- •Always ensure the endotracheal tube cuff is fully deflated before extubation to prevent tracheal trauma
- •Monitor for subcutaneous emphysema in the 24 hours following general anaesthesia, particularly if difficult recovery or unusual movement occurred
- •Even significant tracheal tears (5 cm) can heal well with conservative management; do not assume respiratory compromise is inevitable
Key Findings
- •Extubation with partially inflated endotracheal tube cuff caused a 5 cm dorsal tracheal tear in a Dutch Warmblood horse
- •Subcutaneous emphysema along the neck developed within 24 hours post-operatively
- •Symptomatic treatment resulted in complete healing with no residual respiratory complications