Introduction
This clinical case study describes the highly unusual situation where a horse was not able to be extubated without the aid of a tracheostomy assisted extubation. A similar case study has been described in the dog where extubation was assisted via a tracheostomy (Grzywa & Barker, 2022). It is interesting to note that the majority of similar case reports describe the use of either silicone (Romano & Portela, 2020; Sanchis Mora & Seymour, 2011) or red rubber tubes (Grzywa & Barker, 2022). There was one report in a cat where a reused polyvinyl chloride tube was difficult to remove and required the instillation of extra lubrication around the ET cuff (Norgate & Jimenez, 2017). The cuff in this instance was bunched-up thus increasing the effective outer diameter of the ET tube. Could the wider cuff profile of high-volume, low-pressure polyvinyl chloride endotracheal tubes encourage people to use smaller tubes? This is something I have observed in several university clinical practices however it is hard to estimate how it influences general veterinary practice.
This clinical case study not only describes the situation associated with the ET tube becoming lodged in the trachea but also how the authors achieved the successful removal of the ET tube. Both aspects have clinical relevance to practitioners of anaesthesia. Some of the clinically pertinent aspects of this case study will be discussed in further detail below, followed by clinical recommendations.