Minimising Risk of Anaesthesia in Brachycepalic Dogs

Anaesthesia and airway management in brachycepalic patients can be very challenging and a source of concern to vets and owners.

Due to the presence of BOAS and the high risk of gastro oesophageal reflux, these patients are at high risk of complications, particularly during induction and recovery. The most common complications relate to airway obstruction and aspiration. Often, although they are stable, they can decompensate rapidly when stressed or when sedative drugs are given. Risks of anaesthesia can be reduced by preparation, close monitoring of the patient and following these simple steps.

• Reduce hospitalisation time prior to anaesthetic to reduce stress.
• Pre-medicate. Use drugs appropriate to the patient, however a low dose of ACP (0.01mg/kg) combined with an opiate is often a good combination.
• Always place and intravenous catheter.
• Give omeprazole 1mg IV at induction or orally at least 4 hours before induction. This reduces the risk of reflux during anaesthesia.
• Pre-oxygenate for 3-4 minutes if tolerated to reduce hypoxia on induction.
• Have laryngoscope and multiple ET tubes available, particularly smaller than expected due to tracheal hypoplasia.
• Intubate in sternal with head up to reduce risk of reflux and aspiration.
• Lubricate eyes due to high risk of corneal ulcers.
• Care with recovery. Recover in sternal, head raised, neck extended and tongue pulled out.
• Maintain ET tube as long as is tolerated.
• Close observation is essential during recovery.
• Have induction agent, laryngoscope and ET tubes with the patient in case reintubation required.
• Monitor carefully during recovery, sedate if required to stop panting and prevent hyperthermia. Avoid opiates in the post-operative period unless the patient is painful as they will predispose to panting.
• Keep post anaesthesia time in the hospital to a minimum once you are confident the patient is completely recovered.