It is not possible to assess the airways – other than the nares, in a conscious dog. A complete assessment of brachycephalic dogs prior to surgery is essential for attaining the best possible outcome and also in order to give the animal’s owners the most accurate prognosis.
Prior to surgery we recommend the following assessment be undertaken:
Pedigree – record of the dog’s pedigree is essential for information gathering purposes.
History – a thorough clinical history including diet, previous and current illness and medications.
Physical examination – include auscultation of the sinuses, larynx, pharynx as well as the thorax.
Neurological examination – essential due to the high incidence of hemivertebrae and encephalopathies.
Haematology / biochemistry / blood gasses – biochemical and haematological analysis prior to anaesthesia is essential prior to any anaesthetic induction.
Ophthalmological examination – brachycephalic dogs have many eye issues
Musculoskeletal examination – many orthopaedic conditions are commonly seen in brachycephalic dogs – in particular medial patella luxation and hip dysplasia.
Imaging minimum database is thoracic radiology however assessment by whole body CT is our preferred imaging modality
Once all data is available a veterinarian can develop an assessment of the risk of brachycephalic surgery and have a discussion with the owner of the dog about these risks so that informed consent may be obtained.
Anaesthetic and Surgical Considerations of Brachycephalic Dogs
As previously advised, it is our preference to undertake definitive corrective procedures at the same time as assessment and examination under anaesthesia. Otherwise, anaesthetic recovery in a dog with compromised airways may be problematic. Screening blood testing – biochemistry and haematology are strongly recommended. An IV catheter is always placed. In healthy animals we use a pre-med of - Methadone – 0.2-0.3 mg/kg and Medotomidine 3-5 µg/kg.
Patients are pre-oxygenated for 10 minutes prior to induction of anaesthesia – we find this simple step significantly improves outcomes.
Induction at Veterinary Specialist Services is by Alfaxalone – 1-2mg/kg – to effect.
Following assessment of the upper airways and chonae animals are intubated with a cuffed endotracheal tube and anaesthesia is maintained with Isoflurane 1-2% and Oxygen.
The most common surgical procedures undertaken (in order of procedure) are:
Resection of the soft palate
Resection of oedematous laryngeal ventricles
Removal of tonsils
It is essential to note that each animal is an individual and not all animals require all procedures while some require alternate surgical options.
Removal of nasal turbinates is never performed at the time of initial surgery.
The animal must be closely monitored for the next 24-48 hours. At Veterinary Specialist Services / Animal Emergency Services we have a dedicated nurse cage side AT ALL TIMES. In my opinion it is negligent to leave an animal unattended in the 24 hours following BAS surgery.
Once surgery is completed and other BAS associated problems have been treated 1-2 folded swabs are soaked in 20mld Mannitol per swap and a dose of bupivacaine which is attached to a string or tie and placed in the oropharynx.
Extubation Our preference is to leave the dog intubated for as long as possible. We like the dog to be awake and even standing before extubation.
Nasal Oxygen We recover all dogs on nasal oxygen. Recently however we have been using paediatric nasal prongs with great success.
Medication Antibiotics – only used on the basis of culture and sensitivity
Analgesia Methadone (duration of activity 4-6 hours) is used as part of the pre-med then as required based on pain scoring
Dyspnoea / increased effort As dogs recover – if they start to develop mild dyspnoea and increased effort we use some or all of the following medications:
Medetomidine – this drug has been game changer for us at VSS. We have been using micro doses of medetomidine for the past 5 years. We dilute the 1mg/ml from the bottle with saline to make it 100mg/ml – 1 in 10 dilution.
Adrenaline - Adrenaline is administered by nebulizer – 0.4 mg with 5mls NaCl for a 10kg animal Nebulise with saline every 4-6 hours
Trazadone Particularly in very anxious dogs starting at 2.5-5mg/kg every 6-8 hours – not used with Tramadol
Maropitant If nauseous – 1mg/kg once daily.
Omeprazole 1mg/kg every 12 hours PO – for 4-6 weeks post op depending on severity of GIT signs
Oral Bupivacaine lasts 4-5 hours. Once the animal is discharged oral opioids (Tramadol) are dispensed for 5-7 days – unless Trazadone is required in which case we use a Fentanyl patch. I avoid NSAID’s in these animals until they are eating.
Soft food is usually offered 12 hours after recovery. Owners are advised to avoid any hard food for 2-3 weeks.