Inhalational anesthesia is becoming the main method of anesthetising reptiles for prolonged procedures and as described above offers many benefits. These are enhanced still further if the reptile is intubated allowing the anesthetic to be delivered in a controlled manner.
The glottis, which acts as the entrance to the trachea, is relatively rostral in many species. It is kept closed at rest, so the anesthetist must wait for inspiration to occur to allow intubation. Reptiles produce little or no saliva when not eating, so blockage of the endotracheal tube is uncommon.
In Serpentes, the glottis sits rostrally on the floor of the mouth caudal to the tongue sheath. Intubation may be performed consciously if necessary, as reptiles do not have a cough reflex. The mouth is opened with a wooden or plastic tongue depressor and the endotracheal tube inserted during inspiration. Alternatively, an induction agent may be given and then intubation performed.
In Chelonia, the glottis sits caudally at the base of the tongue. The trachea is very short and the endotracheal tube should only be inserted a few centimetres otherwise there is a risk one or other bronchus will be intubated, leading to only one lung receiving the anesthetic. As mentioned above, an induction agent such as ketamine or propofol is advised for Chelonia prior to intubation due to breath-holding and difficulty in extracting the head from the shell.
Sauria vary depending on the species, most having just a glottis guarding the entrance to the trachea. However, some species possess vocal folds, e.g. geckos. Some may be intubated consciously, but most are better induced with an injectable agent or following mask or chamber induction. Some species may be too small for intubation.
Crocodylia have a basihyal fold which acts like an epiglottis and needs to be depressed prior to intubation. These species, due to the risk associated with handling them, require some form of chemical restraint prior to intubation.
Intermittent positive pressure ventilation
If intubation is performed fully conscious, anesthesia may be induced, even in breath-holding species, by using positive pressure ventilation, in a matter of 5-10 min. This does have some advantages as avoiding injectable induction agents leads to rapid postoperative recovery.
Many, if not all species of reptile require positive pressure ventilation during the course of an anesthetic. Chelonia for example are frequently placed in dorsal recumbency during intracoelomic surgery (the absence of a diaphragm leads to one body cavity – the coelomic cavity). As they have no diaphragm and the lungs are situated dorsally, the weight of the digestive contents pressing on the lungs will reduce inspiration and lead to hypoxia. In addition, movement of the chelonian’s limbs induces most of the normal inspiratory effort: this should be abolished during anesthesia! Furthermore, if a neuromuscular blocking agent such as succinylcholine has been used, positive pressure ventilation may be needed due to the potential for respiratory muscle paralysis.
The aims of intermittent positive pressure ventilation (IPPV) are to just inflate the lungs for an adequately oxygenated state to be maintained and for the animal to remain anesthetised. Most reptiles require 4-8 breaths a minute, with inflation pressures of no more than 10-15 cmH2O (7-11 mmHg). A ventilator unit is useful, but with experience, manual ventilation of the patient with enough pressure to just inflate the lungs and no more, can be achieved. A rough guide is to inflate the first two fifths of the reptile’s body at each cycle.
Anaesthetic breathing systems
For species less than 5 kg a non-rebreathing system with oxygen flow at twice the minute volume (which approximates to 300-500 ml / kg / min for most species) is suggested. Ayres T-pieces, modified Bain circuits or Mapleson C circuits may all be used.