To obtain the best possible results, surgeons performing translational research experiments should be proficient at intubation and vascular line placement. This paper describes the techniques used by the Toronto Organ Preservation Laboratory to perform these procedures.
Translational surgical research models in swine are crucial for developing safe preclinical protocols. However, the success of the experimental surgeries does not solely rely on the research team’s surgical skills; perioperative care and management procedures, like intubation, central venous line, and arterial line placement, are necessary and of the utmost importance for favorable experiment results. As it is uncommon for research teams to have anesthesiologists or any other staff other than the surgical team, the surgical team involved in translational research must acquire and/or develop the skills to perform the perioperative care. The purpose of this paper is to show the techniques of intubation, central venous catheter, and arterial line placement used and perfected at the Toronto Organ Preservation Laboratory over the last 10 years, to be used as a reference for future researchers joining either this team or any other lab performing translational research protocols in swine and/or abdominal transplantation.
Swine experimental models are often used in studying human diseases because of their similar anatomical and physiological properties. These models are crucial in the development of safe pre-clinical protocols, but they are also subject to legal and ethical restrictions1. The use of swine for research must be done under the best possible conditions to avoid unnecessary loss of animals and suffering due to anesthesia complications unrelated to the research project.
Pre-operative techniques and skills such as intubation, central venous line placement, and arterial line placement are essential for achieving successful and reproducible results.
Every animal undergoing general anesthesia for a surgical procedure must be intubated to maintain an open airway, allowing assisted ventilation and avoiding broncho aspiration2. The most common positions for intubation in swine are dorsal, lateral, and sternal recumbency3,4. Sternal recumbency tends to be easier for personnel trained in human intubation3, which is the case at this research facility.
Good vascular access is essential for the administration of fluids, medications, and sampling during and after surgery. The use of vasopressors is common during abdominal transplant surgeries due to the hemodynamic instability resulting from the ischemia-reperfusion injury. Infusing vasopressors through a peripheral line can cause local tissue injury due to the vasoconstrictive effects5. A central venous line placement allows for infusing large amounts of fluids and vasoppresors. We prefer a guidewire-assisted percutaneous technique for central line placement since it minimizes damage to the soft tissue and vessels6.
Hemodynamic stability of the animal during surgery is required, and blood pressure is the parameter most typically monitored for this purpose7. An arterial line allows for a continuous blood pressure measurement, which is more accurate than traditional non-invasive measurement8 as non-invasive techniques underestimate values during hypertension and overestimate them during hypotension7,8. An accurate reading of blood pressure during these experiments is fundamental to be able to control the amount of fluids and vasopressors that must be administered to the pig.
The Toronto Organ Preservation Laboratory has been using porcine models for more than 10 years and has standardized these procedures throughout the years with excellent outcomes. Although other approaches can be found in the literature for the same procedures, the goal of this paper is to present the techniques developed and perfected over the years at our facility.
Every research center must create its own protocols and guidelines for translational research models; however, some basic rules are to be followed to guarantee successful results.
First, the pig must be submitted to a physical examination as soon as it arrives at the housing facility. A total of 5-7 days of conditioning is necessary before the procedure to reduce stress levels and allow the pig to recover the weight lost during transportation3. It is important to note t…
The authors have nothing to disclose.
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0.9% Sodium Chloride Irrigation, USP | Baxter | JF7124 | Saline |
Angiocath 16 GA 1.88 , 1.7 x 48 mm | BD | 381157 | |
Atropine sulfate (8 mg/20 mL – 0.4 mg/mL) | West-Ward | 17733 | 20 mL vial |
Cook TPN Single Lumen Cathether Set | Cook medical | G08132 | with 10 Fr peel away introducer set |
Hickman 9.6 F single-lumen CV cathether | Bard | 600560 | |
Laryngoscope | Heine | ||
Midazolam (5 mg/mL) | Sandoz | 46237968 | 10 mL vial |
Miller blade 4 | Heine | 185 mm blade length | |
Narketan (Ketamine – 100 mg/mL) | Vetoquinal | 8-00223 | 50 mL vial |
Nasal tracheal tube cuffed 7.0 mm I.D. | Covidien | 86450 | |
Optixcare eye lube for dogs and cats | Aventix | 5914304 | 20 g |
Percutaneous Sheath introducer set with integral hemostasis valve/side port for use -7.5 Fr. Catheters | Arrow | SI-09880 | 8.5 Fr, 10 cm, 0.035 inch dia. Spring wire guide |
Universal Electrosurgical Pad: Split with cord | 3M | 9165 | |
Valleylab Rocker Switch Pencil Holster | Covidien | E2515H | |
Xylocaine 10% Spray | AstraZeneca | 73050036 | lidocaine (10 mg/metered dose) |
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