This work was supported by grants from the Instituto de Salud Carlos III [PFIS2017-0224], &#34;Beca Ruza&#34; from the Sociedad Espa&#241;ola de Cuidados Intensivos Pedi&#225;tricos and the Vanderbilt Medical Scholars Program.
The sponsors were not involved in the collection, analysis, or interpretation of the data.
We would like to thank Isabel Salas for the help provided within the animal laboratory and the Mr. Carles F&#225;brega and Ms. Gemma Fernandez-Asensio from the Audio-Visual Techincal Team from Sant Joan de D&#233;u Hospital for their technical support with the video recording and production.

The intubation procedure outlined below was approved by the Barcelona University Institutional Animal Care and Use Committee (CEEA 180/19)
1. Experimental preparation
<ol>
	<li>Obtain the following materials: 2 mm diameter polyvinyl chloride (PVC) endotracheal tube, 6 French (Fr) polyurethane feeding tube, flat and wide tip dissection forceps and sterile lubricant (Figure 1).</li>
	<li>During the intubation and surgery processes, maintain sterile conditions.</li>
</ol>
2. Anesthesia
<ol>
	<li>Anesthetize the animal with 5 mg/kg xylazine and 25 mg/kg ketamine applied together intramuscularly in the vastus lateralis of the femoral quadriceps. Alpha-2 agonists such as dexmedetomidine can also be used instead of xylazine.</li>
	<li>Allow 3-5 minutes for the medication to reach effect.</li>
	<li>Readminister the same dose until deep anesthesia is achieved (negative pedal, palpebral and corneal reflexes). Ideally, the rabbit will maintain spontaneous breathing until intubation.</li>
</ol>
3. Endotracheal intubation
<ol>
	<li>Place the rabbit on a thermal blanket at 37 &#176;C. Place the animal in dorsal recumbency with the head in hyperextension. Align the head as straight and midline as possible. A four-centimeter roll made of sterile gauze placed in the dorsal region of the neck may be helpful to achieve at least 45&#176; of extension (Figure 2).</li>
	<li>Use flat and wide tip dissection forceps to open the oral cavity approximately one centimeter wide. Use forceps with a blunt and wide end to avoid mouth trauma.</li>
	<li>Measure the distance between mouth and the region of stomach (first rib). Introduce a lubricated 6 French (Fr) polyurethane gastric tube to the pre-measured mark (Figure 3-4).</li>
	<li>Move the feeding tube to the left and fix with adhesive tape to the surgical field.</li>
	<li>Introduce the 2 mm diameter PVC endotracheal tube, covered with sterile lubricant to the 3 cm mark.
	<ol>
		<li>If there are any difficulties in advancing the tube, move it completely and reattempt until a smooth glide is achieved. The risk of trauma to the larynx and epiglottis is significant with multiple intubation attempts. Fix the tube with adhesive tape to the surgical field (Figure 5-6).</li>
	</ol>
	</li>
	<li>Connect the endotracheal tube to the ventilator with following settings: Tidal volume - 10 mL/kg; respiratory rate: 40 breaths/min; FiO2 100%, PEEP 6.</li>
	<li>Confirm the correct position of the tube by the detection of CO2 in exhaled air (ETCO2), direct visualization of thoracic expansion and fogging of the tube. Monitoring of the animal by pulse oximetry and lung auscultation can also be helpful (Figure 7).</li>
	<li>At the conclusion of the experiment, use a standardized euthanasia protocol that consists of intravenous administration of pentobarbital 120-240 mg/kg. Repeat doses until breath cessation, reflex absence and asystole are acheived. 
	NOTE: In the surgical experiments, the animal is alive during the ventilation process and finally is euthanized.</li>
</ol>

<ol>
	<li>Gilroy, B. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endotracheal+intubation+of+rabbits+and+rodents.">Endotracheal intubation of rabbits and rodents.</a> Journal of the American Veterinary Medical Association. 179 (11), 1295 (1981).</li><li>Graham, J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Common+procedures+in+rabbits.">Common procedures in rabbits.</a> The Veterinary Clinics of North America. Exotic Animal Practice. 9 (2), 367-388 (2006).</li><li>Fick, T. E., Schalm, S. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=A+simple+technique+for+endotracheal+intubation+in+rabbits.">A simple technique for endotracheal intubation in rabbits.</a> Laboratory Animals. 21 (3), 265-266 (1987).</li><li>Conlon, K. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Atraumatic+endotracheal+intubation+in+small+rabbits.">Atraumatic endotracheal intubation in small rabbits.</a> Laboratory Animal Science. 40 (2), 221-222 (1990).</li><li>Johnson, D. H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endoscopic+intubation+of+exotic+companion+mammals.">Endoscopic intubation of exotic companion mammals.</a> The Veterinary Clinics of North America. Exotic Animal Practice. 13 (2), 273-289 (2010).</li><li>Falc&#227;o, S. C., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Technique+of+blind+tracheal+intubation+in+rabbits+(Oryctolagus+cuniculi)+supported+by+previous+maneuver+of+esophageal+cannulization.">Technique of blind tracheal intubation in rabbits (Oryctolagus cuniculi) supported by previous maneuver of esophageal cannulization.</a> Acta Cirurgica Brasileira. 26 (5), 352-356 (2011).</li><li>Miura, H., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endotracheal+intubation+in+rabbits.">Endotracheal intubation in rabbits.</a> The Japanese Journal of Veterinary Anesthesiology. 19 (1), 25-29 (2012).</li><li>Thompson, K. L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Endotracheal+Intubation+of+Rabbits+Using+a+Polypropylene+Guide+Catheter.">Endotracheal Intubation of Rabbits Using a Polypropylene Guide Catheter.</a> Journal of Visualized Experiments. (129), (2017).</li><li>Comolli, J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Comparison+of+endoscopic+endotracheal+intubation+and+the+v-gel+supraglottic+airway+device+for+spontaneously+ventilating+New+Zealand+white+rabbits+undergoing+ovariohysterectomy.">Comparison of endoscopic endotracheal intubation and the v-gel supraglottic airway device for spontaneously ventilating New Zealand white rabbits undergoing ovariohysterectomy.</a> Veterinary Record. , 1-8 (2020).</li><li>Hua, S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+of+different+ventilation+strategies+on+lung+injury+in+newborn+rabbits.">Effects of different ventilation strategies on lung injury in newborn rabbits.</a> Pediatric Pulmonology. 47 (11), 1103-1112 (2012).</li><li>Kitchen, M. J., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+role+of+lung+inflation+and+sodium+transport+in+airway+liquid+clearance+during+lung+aeration+in+newborn+rabbits.">The role of lung inflation and sodium transport in airway liquid clearance during lung aeration in newborn rabbits.</a> Pediatric Research. 73 (4-1), 443-449 (2012).</li><li>Boon, M. S., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tubeless+tracheotomy+for+survival+airway+surgery+in+the+leporine+model.">Tubeless tracheotomy for survival airway surgery in the leporine model.</a> The Laryngoscope. 125 (3), 680-684 (2015).</li><li>Dion, G. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Morbidity+and+mortality+associated+with+preclinical+tracheostomy+models.">Morbidity and mortality associated with preclinical tracheostomy models.</a> The Laryngoscope. 128 (2), 68-71 (2018).</li><li>Phaneuf, L. R., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Tracheal+injury+after+endotracheal+intubation+and+anesthesia+in+rabbits.">Tracheal injury after endotracheal intubation and anesthesia in rabbits.</a> Journal of the American Association for Laboratory Animal Science. 45 (6), 67-72 (2006).</li></ol>

The authors have nothing to disclose.

Rabbits are widely used in animal experimentation due to their availability, high reproduction rate with short intergenerational times, and easy handling2. In our center, we use 5-7-day old New Zealand rabbits (Oryctolagus cuniculus) as a neonatal model to study the neurologic repercussions of extracorporeal surgery on the developing brain. As a result, we utilize procedures that require deep anesthesia and must use endotracheal intubation for periods of time up to an hour.
In the adult rabbit, several airway management techniques have been described, usually in a surgical context. When we tried to extrapolate these techniques to the rabbit kits, several problems arose. The rabbits weigh between 110 and 210 grams and have a maximum mouth opening range of 1 cm. These characteristics make direct visualization of the larynx difficult and it is complicated to find endoscopic material small enough. Another option described in the literature is to place an otoscope in the oral cavity and use it as a guide to introduce the PVC tube7. In newborn rabbits, both the presence of the tongue and the small size of the mouth make direct visualization of the glottis difficult. In addition, there are no supraglottic devices of adequate dimensions for newborns.
Due to the circumstances mentioned above, there are two fundamental mechanisms to secure the airway of the very small rabbit: tracheostomy and blind intubation. Tracheostomy is an invasive approach that has been used in both adult and newborn rabbits10, 12. It has the advantage of direct tracheal visualization, allowing the proceduralist to identify the exact location of the endotracheal tube. However, there is a high risk of mechanical complications and infection of the incision area, in addition to a decreased rate of survival of the animals once the procedures are completed13. Endoscopic/fiberoptic intubation is a method that would allow for direct visualization without surgery5. Another option to prevent laryngeal trauma is the use of a tight-fitting face mask, which has some additional drawbacks such as suboptimal ventilation and gastric distension.
In the laboratory, blind intubation is used to manage newborn rabbit airways. This method has been described in the adult rabbit as a feasible technique with high success index6. In the initial experiments, we tried to perform this technique without occlusion of the digestive tract. The result was a high rate of introduction of the endotracheal tube into the esophagus. With the insertion of the gastric tube prior to intubation, however, successful intubation was achieved in 90% of cases. Regarding the size of the endotracheal tube, we initially tried to use peripheral venous catheters up to 14 gauge in diameter, observing difficulties in both insertion (greater rigidity) and ventilation (diameter too small and difficulty connecting to the ventilator). In our experience, the use of 2 mm internal diameter endotracheal tubes introduced to a depth no more than 3 cm has been the most effective in ventilating small rabbits, shown by correct gasometric and ETCO2 values. While intubation in adult rabbits generally requires hyperextension of the head to essentially a 90&#176; angle to the horizontal surface of the table, we were able to perform the procedure with only a mild head extension.
One of the important elements to be considered when performing this procedure is the friable nature of the newborn rabbit trachea. Keeping this is mind, we introduce the pre-lubricated tube slowly and carefully to avoid tracheal perforation. We recommend not inserting the tube further than 3 cm, as this was found to be the optimal length during practice attempts, and halting the intubation if the proceduralist encounters any resistance; in this situation, it is preferable to remove the tube and start over. We experienced one case of likely tracheal perforation in the smallest animal in the cohort.
The main limitation of this technique is the difficulty in detecting the correct position of the endotracheal tube once introduced. In our experience, the advancement of the device without resistance, the detection of appropriate ETCO2, the fogging of the tube and visualization of thoracic expansion during ventilation, as well as the maintenance of vital signs have been sufficient to corroborate the suitability of the procedure in all cases. In some of the experimental subjects, arterial gasometries were performed during ventilation showing adequate levels of carbon dioxide and oxygen concentration. In addition, though histopathology analysis was not performed, previously published literature has described mucosal injury to the trachea in the absence of clinical changes secondary to intubation14.
In conclusion, the model of intubation in newborn rabbits we have described is a rapid technique that uses basic supplies and allows for effective ventilation. We believe this technique can be incorporated in the armamentarium of airway management of neonatal rabbits.

The peculiar anatomy of the rabbit&#39;s respiratory system makes endotracheal intubation complicated. The oral cavity is deep and narrow with a limited range of mouth opening and a relatively large tongue, making direct visualization of the larynx difficult even with the use of a laryngoscope1,2. Furthermore, intubation of the newborn rabbit, which is 10-20 times smaller than the adult, is even more of a challenging procedure. In addition to these anatomical characteristics, rabbits are prone to laryngospasm secondary to manipulation of the airway.
Several intubation techniques have been described in the literature, such as laryngoscope tracheal intubation, blind intubation, otoscope intubation, retrograde intubation, endoscope intubation, tracheostomy and supraglottic device ventilation3,4,5,6,7,8,9. All these techniques have been carried out successfully in adult rabbits; however, there are few publications regarding advanced airway management in the newborn rabbit10. One study describes performing tracheostomies in animals of this age to assess breathing mechanics and lung volumes, though this is an aggressive and irreversible technique11. This method for endotracheal intubation has proven to be an effective and low-cost method of airway management in newborn rabbits.

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>2 mm diameter Polyvinyl Chloride (PVC) endotracheal tube</td>
			<td>Vygon</td>
			<td>520.20</td>
			<td></td>
		</tr>
		<tr>
			<td>6 French polyurethane feeding tube</td>
			<td>Vygon</td>
			<td>310.06</td>
			<td></td>
		</tr>
		<tr>
			<td>Anesthesia (Ketamine and Xylazine)</td>
			<td></td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Multiparameter monitor Intellivue MP5</td>
			<td>Phillips</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Plain and wide tip dissection forceps</td>
			<td>LensforVision</td>
			<td>AK005</td>
			<td></td>
		</tr>
		<tr>
			<td>Sterile lubricant (Silkospray)</td>
			<td>Rush</td>
			<td></td>
			<td></td>
		</tr>
		<tr>
			<td>Ventilator Servo 900c</td>
			<td>Maquet</td>
			<td></td>
			<td></td>
		</tr>
	</tbody>
</table>

blind endotracheal intubation in neonatal rabbits

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical characteristics, which is further complicated in the case of the newborn. Of the different methods of advanced airway management, endotracheal intubation is less aggressive than tracheostomy, and is more feasible than supraglottic management given the lack of supraglottic devices of such a small size. As direct glottis visualization is very difficult in animals this size, this blind intubation model is presented as an effective alternative, especially for experiments requiring prolonged anesthesia. Using this method, we performed blind intubations with a 90% success rate.

In the laboratory, this technique is carried out by medical personnel with experience in experimentation with New Zealand rabbits and expertise in pediatric airway management. The procedure has been performed by one investigator in 10 animals with a global success rate of 90%. Previously, another researcher had practiced optimizing both the position of the animal and the correct tube fixation length. None of the animals were intubated in esophagus. Only one attempt (10%) failed due to the extremely small size of the animal (Table 1). Once blind intubation has been practiced, success is achieved on the first attempt in most cases, even if the procedure is performed by personnel not previously trained in rabbit airway management. We achieved a 100% intubation success rate in one or two attempts in animals weighing equal to or greater than 120 g.
<img alt="Figure 1" class="xfigimg" src="/files/ftp_upload/61874/61874fig01.jpg" /> 
Figure 1: Materials needed for the experiment: Dissection forceps, feeding tube, endotracheal tube, sterile lubricant. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig01large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 2" class="xfigimg" src="/files/ftp_upload/61874/61874fig02.jpg" /> 
Figure 2: Position of the animal before intubation: Dorsal recumbency and mild hyperextension. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig02large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 3" class="xfigimg" src="/files/ftp_upload/61874/61874fig03.jpg" /> 
Figure 3: Mouth opening with dissection forceps. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig03large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 4" class="xfigimg" src="/files/ftp_upload/61874/61874fig04.jpg" /> 
Figure 4: The feeding tube is introduced into the stomach. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig04large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 5" class="xfigimg" src="/files/ftp_upload/61874/61874fig05.jpg" /> 
Figure 5-6: The endotracheal tube is introduced 3 cm blindly and fixed, along with the feeding tube, to the surgical field. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig05large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 6" class="xfigimg" src="/files/ftp_upload/61874/61874fig06.jpg" /> 
Figure 6: The fixed endotracheal tube and feeding tube. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig06large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<img alt="Figure 7" class="xfigimg" src="/files/ftp_upload/61874/61874fig07.jpg" /> 
Figure 7: The animal is connected to the ventilator. <a href="https://www-jove-com.remotexs.ntu.edu.sg/files/ftp_upload/61874/61874fig07large.jpg" target="_blank">Please click here to view a larger version of this figure.</a>
<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>ANIMAL NUMBER</td>
			<td>WEIGHT (g)</td>
			<td>SUCCESS</td>
			<td>ATTEMPTS</td>
			<td>DEATH</td>
		</tr>
		<tr>
			<td>1</td>
			<td>150</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>2</td>
			<td>125</td>
			<td>+</td>
			<td>2</td>
			<td>-</td>
		</tr>
		<tr>
			<td>3</td>
			<td>180</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>4</td>
			<td>210</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>5</td>
			<td>120</td>
			<td>+</td>
			<td>2</td>
			<td>-</td>
		</tr>
		<tr>
			<td>6</td>
			<td>140</td>
			<td>+</td>
			<td>2</td>
			<td>-</td>
		</tr>
		<tr>
			<td>7</td>
			<td>200</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>8</td>
			<td>190</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>9</td>
			<td>180</td>
			<td>+</td>
			<td>1</td>
			<td>-</td>
		</tr>
		<tr>
			<td>10</td>
			<td>110</td>
			<td>-</td>
			<td>3</td>
			<td>+</td>
		</tr>
		<tr>
			<td>TOTAL</td>
			<td>160.5</td>
			<td>90%</td>
			<td>1.5</td>
			<td>10%</td>
		</tr>
	</tbody>
</table>
Table 1: Animal sample features and endotracheal intubation attempts.

Watch this Scientific Journal Video about Blind Endotracheal Intubation in Neonatal Rabbits at JoVE.com

Blind Endotracheal Intubation in Neonatal Rabbits

We describe a technique of endotracheal intubation in newborn rabbits after esophageal catheterization with a gastric tube.

The newborn rabbit is a useful animal model for various pathologies and procedures. Airway management of the rabbit is complex due to its anatomical ...

blind-endotracheal-intubation-in-neonatal-rabbits

Nanyang Technological University

Research

JoVE Journal

Medicine

5.2K Views.  Hospital Sant Joan de Déu, Institut de Recerca Sant Joan de Déu. We describe a technique of endotracheal intubation in newborn rabbits after esophageal catheterization with a gastric tube.

Video: Blind Endotracheal Intubation in Neonatal Rabbits

Guidelines for Elective Pediatric Fiberoptic Intubation

Fiberoptic intubation in pediatric patients is often required especially in difficult airways of syndromic patients i.e. Pierre Robin Syndrome. Small babies will desaturate very quickly if ventilation is interrupted mainly to high metabolic rate. We describe guidelines to perform a safe fiberoptic intubation while maintaining spontaneous breathing throughout the procedure. Steps requiring the use of propofol pump, fentanyl, glycopyrrolate, red rubber catheter, metal insuflation hook, afrin, lubricant and lidocaine spray are shown.

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Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

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Endotracheal Intubation in Mice via Direct Laryngoscopy Using an Otoscope

We have developed a simple, reliable, and relatively inexpensive method for endotracheal intubation in mice via direct laryngoscopy using an otoscope with a 2.0 mm speculum. This technique is atraumatic and can be used for repeated measurements in chronic experiments. We find it superior to tracheostomy or previously reported nonsurgical techniques.

Mice, both wildtype and transgenic, are the principal mammalian model in biomedical research currently. Intubation and mechanical ventilation are ...

Development of an Audio-based Virtual Gaming Environment to Assist with Navigation Skills in the Blind

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio based cues and set within the context of a video game metaphor, users gather relevant spatial information regarding a building's layout. This allows the user to develop an accurate spatial cognitive map of a large-scale three-dimensional space that can be manipulated for the purposes of a real indoor navigation task. After game play, participants are then assessed on their ability to navigate within the target physical building represented in the game. Preliminary results suggest that early blind users were able to acquire relevant information regarding the spatial layout of a previously unfamiliar building as indexed by their performance on a series of navigation tasks. These tasks included path finding through the virtual and physical building, as well as a series of drop off tasks. We find that the immersive and highly interactive nature of the AbES software appears to greatly engage the blind user to actively explore the virtual environment. Applications of this approach may extend to larger populations of visually impaired individuals.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind.

Audio-based Environment Simulator (AbES) is virtual environment software designed to improve real world navigation skills in the blind. Using only audio ...

A Simple Method of Mouse Lung Intubation

A simple procedure to intubate mice for pulmonary function measurements would have several advantages in longitudinal studies with limited numbers or expensive animal. One of the reasons that this is not done more routinely is that it is relatively difficult, despite there being several published studies that describe ways to achieve it. In this paper we demonstrate a procedure that eliminates one of the major hurdles associated with this intubation, that of visualizing the trachea during the entire time of intubation. The approach uses a 0.5 mm fiberoptic light source that serves as an introducer to direct the intubation cannula into the mouse trachea. We show that it is possible to use this procedure to measure lung mechanics in individual mice over a time course of at least several weeks. The technique can be set up with relatively little expense and expertise, and it can be routinely accomplished with relatively little training. This should make it possible for any laboratory to routinely carry out this intubation, thereby allowing longitudinal studies in individual mice, thereby minimizing the number of mice needed and increasing the statistical power by using each mouse as its own control.

This paper describes a striaghforward and efficient method of intubating mice for pulmonary function measurements or pulmonary instillation, that allows the mice to recover and be studied at later times. The procedure involves an inexpensive fiberoptic light source that directly illuminates the trachea.

A  simple procedure to intubate mice for pulmonary function measurements would  have several advantages in longitudinal studies with limited numbers or  ...

Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular disease is the development of ischemia. In severe cases, patients can develop critical limb ischemia in which they experience constant pain and an increased risk of limb amputation. Current therapies for peripheral ischemia include bypass surgery or percutaneous interventions such as angioplasty with stenting or atherectomy to restore blood flow. However, these treatments often fail to the continued progression of vascular disease or restenosis or are contraindicated due to the overall poor health of the patient. A promising potential approach to treat peripheral ischemia involves the induction of therapeutic neovascularization to allow the patient to develop collateral vasculature. This newly formed network alleviates peripheral ischemia by restoring perfusion to the affected area. The most frequently employed preclinical model for peripheral ischemia utilizes the creation of hind limb ischemia in healthy rabbits through femoral artery ligation. In the past, however, there has been a strong disconnect between the success of preclinical studies and the failure of clinical trials regarding treatments for peripheral ischemia. Healthy animals typically have robust vascular regeneration in response to surgically induced ischemia, in contrast to the reduced vascularity and regeneration in patients with chronic peripheral ischemia. Here, we describe an optimized animal model for peripheral ischemia in rabbits that includes hyperlipidemia and diabetes. This model has reduced collateral formation and blood pressure recovery in comparison to a model with a higher cholesterol diet. Thus, the model may provide better correlation with human patients with compromised angiogenesis from the common co-morbidities that accompany peripheral vascular disease.

We describe a surgical procedure used to induce peripheral ischemia in rabbits with hyperlipidemia and diabetes. This surgery acts as a preclinical model for conditions experienced in peripheral artery disease in patients. Angiography is also described as a means to measure the extent of introduced ischemia and recovery of perfusion.

Peripheral vascular disease is a widespread clinical problem that affects millions of patients worldwide. A major consequence of peripheral vascular ...

Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic step. Despite advances in our understanding of DED, significant knowledge gaps remain. Advances are limited in part due to the lack of informative animal models. The authors recently reported on a method of DED induced by injecting all orbital lacrimal gland (LG) tissues with the lectin concanavalin A. Here, we report a novel model of aqueous-deficient DED based on the surgical resection of all orbital LG (dacryoadenectomy) tissues. Both methods use rabbits because of their similarity to human eyes in terms of the size and structure of the ocular surface. One week after removal of the nictitating membrane, the orbital superior LG was surgically removed under anesthesia, followed by removal of the palpebral superior LG, and finally removal of the inferior LG. Dacryoadenectomy induced severe DED, evidenced by a marked reduction in the tear break up time test and the Schirmer&#39;s tear test, and significantly increased tear osmolarity and rose bengal staining. Dacryoadenectomy-induced DED lasted at least eight weeks. There were no complications and animals tolerated the procedure well. The technique can be mastered relatively easily by those with adequate surgical experience and appreciation of the relevant rabbit anatomy. Since this model recapitulates the features of human aqueous-deficient DED, it is suitable for studies of ocular surface homeostasis, DED, and candidate therapeutics.

A novel approach is presented to induce chronic dry eye disease in rabbits by surgically removing all orbital lacrimal glands. This method, distinct from those previously reported, produces a stable, reproducible model of aqueous deficient dry eye well suited to study tear physiology and pathophysiology and ocular therapeutics.

Dry eye disease (DED) is a complex disease with multiple etiologies and variable symptoms, having ocular surface inflammation as its key pathophysiologic ...

Repeated Orotracheal Intubation in Mice

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ventral neck for direct confirmation of cannula placement in the trachea. The relative difficulty or the tissue trauma induced to the subject by such procedures can be an impediment to an investigator&#8217;s ability to perform longitudinal studies. This article illustrates a technique in which physical manipulation of the mouse following the use of a depilatory to remove hair from the ventral neck permits transcutaneous visualization of the trachea for orotracheal intubation regardless of degree of skin pigmentation. This method is innocuous to the subject and easily achieved with a limited understanding of murine anatomy. This refined approach facilitates repeated intubation, which may be necessary for monitoring progression of disease or instillation of treatments. Using this method may result in a reduction of the number of animals and technical skill required to measure lung function in mouse models of respiratory disease.

The goal of this article is to describe a refined method of intubation of the laboratory mouse. The method is noninvasive and, therefore, ideal for studies that require serial monitoring of respiratory function and/or instillation of treatments into the lung.

The literature describes several methods for mouse intubation that either require visualization of the glottis through the oral cavity or incision in the ...

A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight infants, with high mortality and unclear pathogenesis. The cause of NEC may be related to inflammatory immune regulatory system abnormalities. An NEC animal model is an indispensable tool for NEC disease immune research. NEC animal models usually use C57BL/6J neonatal mice; BALB/c neonatal mice are rarely used. Related studies have shown that when mice are infected, Th2 cell differentiation is predominant in BALB/c mice compared to C57BL/6J mice. Studies have suggested that the occurrence and development of NEC are associated with an increase in T helper type 2 (Th2) cells and are generally accompanied by infection. Therefore, this study used neonatal BALB/c mice to induce an NEC model with similar clinical characteristics and intestinal pathological changes as those observed in children with NEC. Further study is warranted to determine whether this animal model could be used to study Th2 cell responses in NEC.

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight infants, with high mortality and unclear pathogenesis. The cause of NEC may be related to inflammatory immune regulatory system abnormalities. An NEC animal model is an indispensable tool for NEC disease immune research. NEC animal models usually use C57BL/6J neonatal mice; BALB/c neonatal mice are rarely used. Related studies have shown that when mice are infected, Th2 cell differentiation is predominant in BALB/c mice compared to C57BL/6J mice. Studies have suggested that the occurrence and development of NEC are associated with an increase in T helper type 2 (Th2) cells and are generally accompanied by infection. Therefore, this study used neonatal BALB/c mice to induce an NEC model with similar clinical characteristics and intestinal pathological changes as those observed in children with NEC. Further study is warranted to determine whether this animal model could be used to study Th2 cell responses in NEC.

Necrotizing enterocolitis (NEC) is the most severe gastrointestinal (GI) disease that often occurs in premature infants, especially very low birth weight ...

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway or high ventilation pressures. Endotracheal intubation is a challenging skill,&#160;requiring a minimum number of successful endotracheal intubations to achieve a high success rate under optimal conditions, which is often unachievable for non-anaesthesiology researchers. Due to the specific porcine airway anatomy, a difficult airway can usually be assumed. The impossibility of establishing a secure airway can result in injury, adverse events, or death of the laboratory animal. Using a prospective, randomized, controlled evaluation approach, it has been shown that fiberoptic-assisted endotracheal intubation takes longer but has a higher first-pass success rate than conventional intubation without causing clinically relevant drops in oxygen saturation. This model presents a standardized regimen for endoscopically guided endotracheal intubation, providing a secured airway, especially for researchers who are inexperienced in the technique of endotracheal intubation via direct laryngoscopy. This procedure is expected to minimize animal suffering and unnecessary animal losses.

The use of pigs in research has increased in recent years. Nevertheless, pigs are characterized by difficult airway anatomy. By demonstrating how to perform endoscopically guided endotracheal intubation, the present protocol aims to further increase laboratory animals' safety to avoid animal suffering and unnecessary death.

Endotracheal intubation is often a basic requirement for translational research in porcine models for various interventions that require a secured airway ...

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

Necrotizing enterocolitis (NEC) is a devastating disease affecting preterm infants, characterized by intestinal inflammation and necrosis. Enteroids have recently emerged as a promising system to model gastrointestinal pathologies. However, currently utilized methods for enteroid manipulation either lack access to the apical surface of the epithelium (three-dimensional [3D]) or are time-consuming and resource-intensive (two-dimensional [2D] monolayers). These methods often require additional steps, such as microinjection, for the model to become physiologically translatable. Here, we describe a physiologically relevant and inexpensive protocol for studying NEC in vitro by reversing enteroid polarity, resulting in the apical surface facing outward (apical-out). An immunofluorescent staining protocol to examine enteroid barrier integrity and junctional protein expression following exposure to tumor necrosis factor-alpha (TNF-&#945;) or lipopolysaccharide (LPS) under normoxic or hypoxic conditions is also provided. The viability of 3D apical-out enteroids exposed to normoxic or hypoxic LPS or TNF-&#945; for 24 h is also evaluated. Enteroids exposed to either LPS or TNF-&#945;, in combination with hypoxia, exhibited disruption of epithelial architecture, a loss of adherens junction protein expression, and a reduction in cell viability. This protocol describes a new apical-out NEC-in-a-dish model which presents a physiologically relevant and cost-effective platform to identify potential epithelial targets for NEC therapies and study the preterm intestinal response to therapeutics.

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis

This protocol describes an apical-out necrotizing enterocolitis (NEC)-in-a-dish model utilizing small intestinal enteroids with reversed polarity, allowing access to the apical surface. We provide an immunofluorescent staining protocol to detect NEC-related epithelial disruption and a method to determine the viability of apical-out enteroids subjected to the NEC-in-a-dish protocol.

Necrotizing enterocolitis (NEC) is a devastating disease affecting preterm infants, characterized by intestinal inflammation and necrosis. Enteroids have ...

Blind Endotracheal Intubation in Neonatal Rabbits

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Preclinical Model of Hind Limb Ischemia in Diabetic Rabbits

Establishment of a Severe Dry Eye Model Using Complete Dacryoadenectomy in Rabbits

Repeated Orotracheal Intubation in Mice

A Neonatal BALB/c Mouse Model of Necrotizing Enterocolitis

Endotracheal Intubation Using a Flexible Intubation Endoscope as a Standardized Model for Safe Airway Management in Swine

In Vitro Apical-Out Enteroid Model of Necrotizing Enterocolitis