Traumatic perforation of the trachea in two horses caused by orotracheal intubation.
Authors: Saulez M N, Dzikiti B, Voigt A
Journal: The Veterinary record
Summary
# Editorial Summary: Traumatic tracheal perforation during orotracheal intubation Tracheal perforation represents a rare but serious anaesthetic complication, yet its aetiology and prevention strategies remain poorly documented in equine surgical practice. Saulez and colleagues reported two cases of iatrogenic tracheal perforation occurring amongst 348 horses undergoing gastrointestinal surgery under general anaesthesia, representing an incidence of approximately 0.6%. The first case resulted from excessive traction on the endotracheal tube when anaesthetic equipment was repositioned ahead of the horse during recovery movement, whilst the second perforation likely occurred during the intubation procedure itself. These cases highlight the mechanical vulnerability of the equine trachea during positioning and movement, particularly when tube tension is not carefully controlled—a risk that warrants deliberate attention to equipment placement, tube securing protocols, and controlled patient handling throughout induction, surgical positioning, and recovery phases. Practitioners should consider securing tubes with adequate slack, maintaining equipment proximity to the horse's head, and ensuring smooth coordinated movement between anaesthetist and handlers to minimise tractional forces that could compromise tracheal integrity.
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Practical Takeaways
- •Secure endotracheal tubes carefully during horse movement and ensure anaesthetic equipment moves in coordination with the patient to prevent traction injuries
- •Exercise caution during intubation to avoid traumatic perforation of the trachea
- •Monitor for signs of tracheal compromise post-operatively, as perforation is a potential but preventable complication of general anaesthesia
Key Findings
- •2 of 348 horses (0.57%) undergoing gastrointestinal surgery developed tracheal perforations from endotracheal tubes
- •Tracheal damage occurred from excessive tube traction when anaesthetic equipment was repositioned during patient movement
- •Tracheal injury also occurred during the intubation procedure itself in one case