Anaesthetic management of a surgical tracheal rupture in a cat

The aim of the study was to show the management of a tracheal rupture in a cat from the diagnosis to the surgical treatment. A 2 years client‐owned spayed female cat, was presented to the veterinary hospital for dyspnoea and anorexia. Lateral chest X‐ray view was taken as first emergency diagnostic procedure. A tracheal lesion was identified above the base of the heart. A differential diagnosis was made amongst tracheal mass, tracheal malformation and tracheal traumatic rupture. The cat was sedated with dexmedetomidine 2 mcg/kg and methadone 0.5 mg/kg intramuscularly and induced intravenously with a combination of ketamine and propofol (ketofol 1:1). Then 0.1 ml/kg of lidocaine 2% was used to desensitize the larynx. The cat did not revealed any respiratory problems after induction, also without endotracheal tube. Airway endoscopy was performed and it revealed a membranous web‐like concentric stenosis without cartilage involvment, at this point the endoscopic probe could not proceed further. The cat was then intubated and maintained with isoflurane in oxygen. A computed tomography scan of the neck and thorax was performed, which revealed a tracheal rupture at the thoracic level. Lateral thoracotomy was planned for the day after. Next day the cat was induced intravenously with ketofol 2 mg/kg and it did not show any respiratory abnormality during induction. A 6 points (T2‐T7) paravetrebral intercostal nerve block by electrolocation was performed using 0.3% ropivacaine. Anaesthesia was maintained with sevoflurane in 100 % oxygen and pressure mode mechanical ventilation was started with a preset peak airway pressure of 10 cm H2O, a respiratory rate of 25 breaths per minute and a PEEP of 4 cm H2O. Fentanyl 2‐5 mcg/kg/h was administrated to improve analgesia. Upon entry into the chest, there was an extensive tracheal mucosal bulla inflating during inspiration time. The endotracheal tube balloon was deflated to allow a better visualization of the mucosa. The mucosal bulla was then resected and a second sterile endotracheal tube was passed through the surgical incision. The breathing system was then connected to the new endotracheal tube. At the end of the surgical reconstruction, this tube was removed and the orotracheal tube was advanced over the tracheal lesion and mucosal suture performed. At the end of the surgery mechanical ventilation passed from controlled to assisted mode and the sevoflurane administration was suspended. The cat was positioned in sternal recumbency and 40 ml of air were aspirated from the right hemithorax. The recovery was uneventful. The diagnosis of traumatic tracheal rupture of this clinical case was complicated. The intact tracheal mucosa was essential for the spontaneous ventilation of this patient. A good work team members in different disciplines (diagnostic, surgery and anaesthesia) was fundamental to plan the several steps to approach this pathology leading to an excellent outcome.