Idea Exchange: Prevent aspiration during dentals without table tilting

Table tilting is a common practice during veterinary dental procedures to help prevent the aspiration of fluid and debris. Unfortunately, the possible dangers of tilting an anesthetized patient head downward include gastroesophageal reflux that could lead to esophageal ulceration, scarring, and stricture and cardiopulmonary compromise that may result from abdominal organ pressure on the diaphragm, thus potentially reducing lung expansion and increasing respiratory effort and cardiac stress.

In addition to placing a cuffed endotracheal tube, packing the posterior oral cavity with gauze, and using suction to prevent aspiration, I have found that the best method for ensuring adequate drainage during dental procedures is to fold several towels into squares, place these towels into layered piles, and then place the patient's abdomen and thorax on top of the towel piles, allowing the patient's neck and head to drop off the piles at a gentle downward angle. This downward slope of the head avoids fluid accumulation in the oral cavity and also avoids the dangers of whole body slanting or table tilting during anesthetic procedures.

Sharon Andersen, PhD (physiology), veterinary assistant

Monterey, Calif.