Laryngeal xylocaine causing post-op problems in cats

Re: Laryngeal xylocaine causing post-op problems in cats

Anthony Todd — Wed, 29 Sep 2010 09:18:37 GMT

[quote user="Utlendigur"]I tried that aswell[/quote]

I found it worked well with a really really painful throat when nothing else worked, got to sleep at least [and waked up, well, as much as I ever do these days]

Re: Laryngeal xylocaine causing post-op problems in cats

Ariel Korber — Wed, 29 Sep 2010 04:02:31 GMT

http://bja.oxfordjournals.org/content/70/1/113.3.extract

Re: Laryngeal xylocaine causing post-op problems in cats

Ariel Korber — Wed, 29 Sep 2010 03:58:33 GMT

[quote user="Vikki Halliday"]Are there any members who have read any papers on this who could provide a link?[/quote]

Vet Rec., Vol. 130, Issue 26, -b June 27, 1992

Use of Xylocaine pump spray in cats

PM Taylor

Re: Laryngeal xylocaine causing post-op problems in cats

Martin Atkinson — Fri, 10 Sep 2010 14:47:28 GMT

[quote user="svn"]

Why not just wait a mere 30 seconds before intubating, therefore hypothetically eliminating any risk of laryngospasm, and reducing the risk of irritation and inflammation?

[/quote]

Because I would rather induce a laryngospasm than try and dig the vomitus out of the cats trachea because the stupid owner thought it wasn't fair to deprive the cat of its breakfast.

Re: Laryngeal xylocaine causing post-op problems in cats

Edward Jones — Fri, 10 Sep 2010 09:58:39 GMT

Of course to wait is better, but to say that if you don't wait you might as well not use any at all isn't entirely true.

Re: Laryngeal xylocaine causing post-op problems in cats

svn — Thu, 09 Sep 2010 22:57:17 GMT

[quote user="i am ed"]

I find that even a minimal wait is better than not using any local anaesthetic at all.

Seems to me that the local anaesthetic isn't just to aid intubation, but also to help with peri/post-op laryngeal oedema/irritation/etc.

[/quote]

OK, granted the only teaching I have had on the subject has been with respect to intubation.........

But as I said earlier I have seen vets seemingly induce laryngospasm by intubating before the intubeaze has had time to work.. surely that has the potential to cause enough irritation for post op larangeal inflammation.

Why not just wait a mere 30 seconds before intubating, therefore hypothetically eliminating any risk of laryngospasm, and reducing the risk of irritation and inflammation?

Your nurses will thank you for it!

Re: Laryngeal xylocaine causing post-op problems in cats

Vikki Halliday LLB — Thu, 09 Sep 2010 22:19:32 GMT

[quote user="Martin Atkinson"]

I also squirt lignocaine down the tube when I intubate them prior to insertion and blow it down, sometimes it blows back onto my tongue or ear and I can confirm they go numb fairly quickly.

[/quote]

Hmm, COSHH not your fave subject then?

Re: Laryngeal xylocaine causing post-op problems in cats

Edward Jones — Thu, 09 Sep 2010 20:38:59 GMT

I find that even a minimal wait is better than not using any local anaesthetic at all.

Seems to me that the local anaesthetic isn't just to aid intubation, but also to help with peri/post-op laryngeal oedema/irritation/etc.

Re: Laryngeal xylocaine causing post-op problems in cats

svn — Thu, 09 Sep 2010 20:32:36 GMT

[quote user="Martin Atkinson"]

I have to admit to being of the squirt and tube asap brigade

[/quote]

Apologies Martin for taking this snippet of your post, possibly out of context, but from what I have learnt (and again I stress I'm not a vet - couldn't resist joining in though ), why bother spraying at all if you are not going to give the product time to work properly?

Re: Laryngeal xylocaine causing post-op problems in cats

Martin Atkinson — Thu, 09 Sep 2010 19:22:04 GMT

[quote user="Kate Dawes"]

We are considering changing to lignocaine squirted through a syringe until intubeaze available again. This may well be a dim question but those of you using it this way are you using lignocaine with or without adrenaline?

[/quote]

I've always been taught to use lignocaine without adrenaline. We have used lignocaine in the syringe technique for years because its cheaper than Intubeaze - what would the cascade have to say about that now? My nurses super-glue the needle on the syringe to prevent blast-off and cut it blunt with ring cutters. I have to admit to being of the squirt and tube asap brigade as I'm scared of them vomiting and inhaling (had one do it once) but never had any issues after the first few seconds of coughing as a result. As I use the 'blind intubation - listen for breathing' technique to tube rabbits I also squirt lignocaine down the tube when I intubate them prior to insertion and blow it down, sometimes it blows back onto my tongue or ear and I can confirm they go numb fairly quickly.

Re: Laryngeal xylocaine causing post-op problems in cats

Rob Loxley — Thu, 09 Sep 2010 16:03:20 GMT

[quote user="Vikki Halliday"]Are there any members who have read any papers on this who could provide a link?[/quote]

Letter from Polly Taylor in BJA Vol 70 issue 1.

http://bja.oxfordjournals.org/content/70/1/113.3.extract

Re: Laryngeal xylocaine causing post-op problems in cats

Mark Holmes — Wed, 08 Sep 2010 10:06:28 GMT

Just ordering lignocaine myself and having checked the intubeze bottle that is straight lignocaine (or lidocaine if you want to be flamin American about it all) 20mg/ml solution no adrenalin so I guess I will order it without.

Re: Laryngeal xylocaine causing post-op problems in cats

Kate Dawes — Wed, 08 Sep 2010 08:42:46 GMT

Have not changed the way I intubate, have always waited at least a minute, so the problems we've noted in the last few weeks aren't down to that. Interestingly the BSAVA formulary states that "the CFC propellant used in aerosol preparations (Xylocaine spray) is alleged to have caused laryngeal oedema in cats" so there must be something in it.

Re: Laryngeal xylocaine causing post-op problems in cats

Evelyn Barbour-Hill — Wed, 08 Sep 2010 01:14:09 GMT

[quote user="svn"]As an SVN I was taught 30-90 secs before attempting to intubate. A slow IV bolus of propofol should give you 2-5 mins of ga without gas, so plenty of time to spray, wait, then intubate![/quote]

That's right.

Re: Laryngeal xylocaine causing post-op problems in cats

svn — Wed, 08 Sep 2010 00:06:31 GMT

As an SVN I was taught 30-90 secs before attempting to intubate. A slow IV bolus of propofol should give you 2-5 mins of ga without gas, so plenty of time to spray, wait, then intubate!

I know I'm not a QVN, or even an auxillary nurse at the moment, but I have seen horrendous larygospasm with the 'squirt, intubate immediatley' method, leading to intermittant resps, and a generally 'not nice' ga.

Our practice policy at the moment, is intubeaze, squirt, wait, then tube, but according to the VN's on the shop floor, our vets are a lil bit tube happy, and try to intubate straight away - even the partners do this apparently - *sigh*

Of course the partners don't admit that in meetings!

Re: Laryngeal xylocaine causing post-op problems in cats

Kirsten Simpson — Wed, 08 Sep 2010 00:02:20 GMT

I agree completely. My mission in life is to make my millions *cough aye right cough* making a new dispenser for Intubeze that actually works and means you don't waste half of it!

Re: Laryngeal xylocaine causing post-op problems in cats

Charlotte Marshall — Tue, 07 Sep 2010 23:39:49 GMT

I haven't used xylocaine in cats but I have actually had a case of oedema in a cat due to intubeaze. I wasn't trying to intubate either just checking for any signs of a fb so it wasn't due to trying to tube too early. Then had to place a tube until the cat stopped trying to drown in it's own saliva!

Re: Laryngeal xylocaine causing post-op problems in cats

Bob Russell — Mon, 06 Sep 2010 15:14:16 GMT

Many years ago xylocaine spray was used routinely in veterinary practice. It was manufactured I think by a company called Astra pharmaceuticals. It was reformulated (again from memory) to stop it destroying the ozone layer. It came in a dark blue spray with a brilliant long nozzle.

There were a series of serious problems reported in cats (not sure precisely what) and the manufacturers wrote to practices saying that the new formulation was unsuitable for cats and should not be used.

Intubese replaced it and has been a bane of my life since. How many products are designed to stop working when 1/3rd of the contents are still present?!!!

Re: Laryngeal xylocaine causing post-op problems in cats

Simon Neuhoff — Mon, 06 Sep 2010 13:47:54 GMT

Also curious to know whether these are genuine reactions or not. I see the odd "gurgly" (good desrciptive word!) cat following ga - using Intubeaze! So I'm not sure how much is down to individual reactions to the ET tube, dry oxygen gas, length of GA etc.

Re: Laryngeal xylocaine causing post-op problems in cats

Vikki Halliday LLB — Sun, 05 Sep 2010 21:32:38 GMT

I am interested to hear if there are genuine cases of laryngeal oedema, as when I heard Intubeze was out of stock I ordered Xylocaine spray, but a recent communication has persuaded me not to use it due to the potential complications.

I am however concerned that these reports are not verified and potentially leading to use of a drug not licenced by that route, in preference to one licenced for that route but not in that species.

Are there any members who have read any papers on this who could provide a link?

Re: Laryngeal xylocaine causing post-op problems in cats

Utlendigur — Sun, 05 Sep 2010 20:12:44 GMT

I had heard it was about 30 seconds

[quote user="bob lehner"]

In the interests of clinical research I have sprayed Intubeaze onto my own tongue and it actually takes quite a while to go numb.

[/quote]

I tried that aswell (in the interests of trying to stop coughing over clients every few seconds when I had a bad cold so I could get through the rest of the surgery). I found it worked within a few seconds - but made bugger all difference to the cough, just made it even harder to talk

Re: Laryngeal xylocaine causing post-op problems in cats

bob lehner — Sun, 05 Sep 2010 20:04:21 GMT

[quote user="Matthew Scotter"]Reason for this is quite simple in that the only other local anaesthetic we have is procaine (for cattle) and it has a long time of onset compared to prilocaine.[/quote]

I do wonder about how long one should wait after spraying with Intubeaze, or whatever, before attempting to intubate a cat. I think many vets give a squirt of spray onto the larynx and then more or less intubate straight away. In the interests of clinical research I have sprayed Intubeaze onto my own tongue and it actually takes quite a while to go numb. Perhaps some of the laryngeal oedema probs seen are actually the result of attempts to intubate a larynx that is not relaxed ? I do find after Propofol induction in cats there is often a long period where the laryngeal opening remains tightly closed - whereas after Dom/Torb/Ket (I know derided by some) the larynx is always beautifully relaxed and open.

Re: Laryngeal xylocaine causing post-op problems in cats

Louise6732 — Sun, 05 Sep 2010 19:50:02 GMT

We're using lignocaine in a 1ml syringe with an IV cathether (stylet removed!) on the end. It will likely prove slightly expensive re. excess cathether use, but we're getting rid of catheters no one likes to use at the minute! I'm cleaning them with spirit on cotton wool after each use at the moment, disposing of when we have a very suspicious/nasty looking mouth.

Re: Laryngeal xylocaine causing post-op problems in cats

ms1083 — Sun, 05 Sep 2010 19:17:40 GMT

Interesting to hear about potential xylocaine problems, didn't know about them. I am currently using "citanest" (prilocaine) and finding it very effective, about 0.1ml on each half of the larynx. Reason for this is quite simple in that the only other local anaesthetic we have is procaine (for cattle) and it has a long time of onset compared to prilocaine. Actually we have viles of lidocaine which I tend to use for infusions/dental nerve blocks - would this be better?

Our head nurse suggested using insulin syringe but if you bend the needle a few tims it snapps off leaving a very narrow & blunt syringe tip which is brilliant at aiming the spray onto the larynx without any risk of sharps in the airway.

Re: Laryngeal xylocaine causing post-op problems in cats

Kate Dawes — Sun, 05 Sep 2010 19:02:16 GMT

Interesting to hear - we've been using xylocaine for the last month or so since we haven't been able to get intubease, and there have been 2 cases in the last couple of weeks that have had post op complications. One was an elderly cat that had a dental and presented ~36hrs later with quite severe respiratory distress and increased urt noise. Apparently coughed up a load of mucus and then was much better, back to normal a day or two later. Another was a 6mth old cat spay - did seem to react more than usual when the xylocaine was sprayed initially, then post op v gurgly sounding resp noise (sorry for the non-technical description), that was definitely upper rather than lower respiratory on auscultation - would fit with laryngeal oedema. She was hospitalised overnight and was pretty much back to normal the next day. I thought these were just coincidence, but maybe not............

In my last practice we used to use lignocaine squirted through a syringe. The insulin syringe is definitely a good idea - I did almost lose a needle down a cat's throat once.......................