Intubation in Swine: What Recumbency to Choose?

SIMPLE SUMMARY: Whether a pig should be placed on its back or sternum to facilitate endotracheal intubation is currently not known and a subject of debate. Enrolling participants with different clinical anaesthesia backgrounds, we aimed at assessing which recumbency (dorsal versus sternal) is advantageous, and if operator experience can influence the results. Using objective and subjective outcomes, we found that sternal recumbency is advantageous if compared to dorsal, but that this is true only for operators lacking experience in anaesthetising animals. Experts’ confidence in intubating various animal species with different techniques probably minimized the influence of recumbency. ABSTRACT: Endotracheal intubation (ETI) is challenging in pigs. We compared the number of attempts and time to perform ETI, and the subjective perception of ease, while the animal was positioned in dorsal (DR) or sternal (SR) recumbency, as well as assessed whether operator experience influences the outcome. Participants were divided into three groups: undergraduates (ST; veterinary students), graduates (GR; veterinarians without specific anaesthesia training) and experts (EX; veterinary anaesthesia intern/resident and diplomate of the European College of Veterinary Anaesthesia and Analgesia). Each participant intubated one freshly euthanised pig in DR and ST. Number of attempts and time to correctly perform ETI, number of oesophageal intubations and answers to Likert-scale questions on larynx visualization and ease of endotracheal tube introduction and advancement were recorded. Thirty-three participants were enrolled (15 ST, 10 GR and 8 EX). Less attempts (p = 0.002) and time (p = 0.002) to correctly perform ETI were needed in SR for the ST group. In 21/119 and 5/48 ETI attempts, oesophageal intubation was performed in DR and SR, respectively. Larynx visualization (p < 0.001) and endotracheal tube introduction (p < 0.001) were perceived as easier in SR for the ST group. No difference between recumbencies was found in perceived ease to advance the endotracheal tube. For inexperienced operators, intubation in SR can be recommended.