Table 11.

Airway management options

Airway options	Advantages	Disadvantages
Endotracheal tube (ETT) cuffed Two types of cuff are available: Low-volume high-pressure High-volume low-pressure	Provides a secure airway No leakage of oxygen or inhalant anesthetic agents when the cuff is correctly inflated Prevents aspiration < Allows mechanical ventilation Inexpensive Placement can be confirmed by visualization of the ETT between the arytenoids	Requires skill to place atraumatically Requires a deeper plane of anesthesia for placement than a supraglottic airway device (SGAD) Traumatic intubation leads to laryngeal damage Overinflation of the cuff can lead to tracheal damage, such as necrosis or tearing. This is a greater risk with high-volume cuffs because of the greater dimensions of the inflated cuff May result in pharyngeal/laryngeal discomfort or stridor
ETT uncuffed	Provides a patent airway Reduced risk of tracheal tears Placement can be confirmed by visualization of the ETT between the arytenoids	Does not protect from aspiration Inhalant anesthetic agents and oxygen can leak around the outside of the tube* Leaks occur during manual or mechanical ventilation* May provide inadequate tidal volume during assisted ventilation
Supraglottic airway device (SGAD) (v-gel; Docsinnovent)	Can be placed with cat in a more superficial plane of < anesthesia than an ETT < Can be placed faster than an ETT and with fewer attempts < Less pharyngeal/laryngeal discomfort or stridor after removal < Higher food intake after use compared with an ETT Mechanical ventilation possible < Does not enter the trachea; therefore, avoids tracheal irritation May be better tolerated for repeated anesthesia (eg, successive days)	May take up too much room for oral procedures Easily dislodged with changes in patient position Correct placement cannot be confirmed by visualization Mechanical ventilation possible, but has only been tested up to 16 cmH2O Higher initial cost but designed as a multi-use device
Face mask Masks that conform to the cat’s face (Figure 16a) and with removable rubber seals (Figure 16b) are available	Ideal for preoxygenation < Can be used to administer oxygen and inhalant < anesthetic agents during anesthesia < Can be used to provide oxygen during procedural < sedation Can be used in an emergency to provide assisted < ventilation Suitable for providing oxygen during short procedures not requiring additional inhalant agent (eg, castration under injectable anesthesia)	Does not protect the airway from aspiration Airway obstruction can occur with neck flexion Leakage of oxygen and inhalant anesthetic agents* Assisted or mechanical ventilation will result in gastric distension If too large, rebreathing occurs
Nothing	No cost < < <	No means of protecting the airway No ability to provide oxygen or inhalant anesthetics No ability to support ventilation

Note: The ability to monitor end-tidal CO2 allows verification that ETTs and SGADs are correctly placed

^*Waste anesthetic gases pose a potential hazard to personnel