Overview of a peer reviewed article from the April 2015 edition of Clinicians Brief.

1. Appeared in the April 2015 issue of Clinicians Brief
By: Jonathan Miller, DVM, MS, DACVS
Kristi Gannon, DVM, DACVECC

2. What should I consider before
anesthesia and surgical
correction of canine patients
with brachycephalic airway
syndrome?

3.  Breeds such as English bulldogs and pugs are at an
increased risk for air-way related complications in the
peri-operative period
 Death attributable to respiratory disease is the number
one killer of bulldogs
 Various types of airflow obstruction in brachycephalic
breeds

4. Identification of high risk patients
 In depth history- previous anesthesia complications,
exercise and heat intolerance, coughing, sleep apnea,
cyanosis, vomiting, regurgitation, prevalence of GI
disease (gastritis)
 Reduce overexcitement
 Obesity
 Age

5. Patient assessment
 Thorough physical exam and auscultation of the heart
and lungs
 Preoperative thoracic radiographs
- dorsoventral positioning to avoid airway collapse and patient
struggling
- obtain lateral radiographs quickly and return patients to lateral
- monitor for cyanosis and administer oxygen if needed

6. Premedication & Anesthesia
Induction
 The use of anticholinergics must be considered
carefully.
- Pros: increased heart rate, decreased airway
secretions, bronchodilation, reduced saliva
production.
- Cons: tachyarrythmias, decreased myocardial
perfusion, reduced GI mobility, and decreased
esophogeal sphincter pressure allowing for potential
reflux and esophagitis.

7. Premedication & Anesthesia
Induction
 Consideration prokinetics (metaclopramide,
cisapride) as well as antiemtics.
 Avoid nausea-inducing sedatives in the mu-opiod
family (morphine, hydromorphone, oxymorphone)
 Safer choices for premedication are buprenorphine,
butorphanol, or methadone.
 Use of acepromazine, dexmedetomidine, diazepam, or
midazolam for further sedation

8. Premedication & Anesthesia
Induction
 Preoxygenate for at least 3 minutes to reduce hypoxia
 Induce with propofol or ketamine along with
diazepam or midazolam

9. Postoperative Management
 Endotracheal tube should be left in place as long as the
patient will tolerate it
 Administering additional sedative or analgesic drugs
may help facilitate a smooth extubation
 Patient should be positioned in sternal recumbency
with the tongue pulled rostrally
 One-on-one care with an experienced technician

10. Postoperative Management
 Monitor with a pulse oximeter if possible
 Following extubation patient should be monitored for
signs of dyspnea (increased respiratory rate and effort,
stridor)
 Frequently monitor body temperature
 Respiratory rate and effort should be monitored every
hour