of oral contents, provide oxygen supplementation and preserve pulmonary ventilation to avoid hypoxaemia.
The anaesthetic recovery period presents a high risk of upper airway obstruction after BOAS surgery due to postoperative inflammation, active haemorrhage and the presence of blood clots. Close patient monitoring and being prepared to intervene in the event of an emergency are vital.
Author note
This article was produced as part of the primary author ' s studies at the Royal Veterinary College( PGCertAVN Anaesthesia and Analgesia).
Assessment of learning
1. Why are brachycephalic breeds at increased risk during anaesthesia?
a) They have high blood pressure
Figure 5. A French Bulldog recovering from anaesthesia after tracheostomy tube placement. Oxygen supplementation is provided via the tracheostomy tube and haemoglobin oxygen saturation is continuously monitored using a pulse oximeter.
tube suctioning and cleaning is described in the literature to prevent blockage with secretions, and it is recommended to use a sterile technique when handling the tube to reduce the risk of infection [ 26 ].
The patient must be closely monitored for signs of infection, including swelling, discharge, reddened skin and fever. Nebulisation with 0.9 % saline and airway humidification every 4 – 8 hours is also recommended to prevent drying of the airway mucosa [ 26 ].
Conclusions
Brachycephalic breeds develop various health conditions secondary to their abnormal body shape; these represent anaesthetic considerations and a greater risk of complications when surgical intervention is required. A thorough pre-anaesthetic assessment and anaesthesia plan tailored to the individual patient, as well as structured communication with the team, will optimise patient care and anticipate possible complications.
ET intubation in these patients is expected to be challenging, due to excessive soft tissue in the naso-oral cavity and the narrow upper airway. Preoxygenation can increase the desaturation time, and the use of ET tube introducers might facilitate ET intubation. The major challenges while maintaining an adequate depth of anaesthesia with TIVA, and without an airway device in place, are to protect the airway against aspiration b) They often have upper airway obstruction due to abnormal head anatomy conformation
c) They have sensitive skin d) They have a low metabolic rate
2. What is / are the main concern( s) when anaesthetising a brachycephalic dog?
a) Risk of airway obstruction b) Risk of hyperthermia c) Bradycardia due to high vagal tone d) All of the above
3. Which of the following is recommended during induction of anaesthesia in a brachycephalic patient?
a) Preoxygenation b) Rapid administration of the induction agent
c) Keep the patient ' s head elevated to avoid aspiration, in case regurgitation occurs
d) Check the patient ' s temperature
1. b) They often have upper airway obstruction due to abnormal head anatomy conformation 2. d) All of the above 3. c) Keep the patient ' s head elevated to avoid aspiration, in case regurgitation occurs
Answers
30 Veterinary Nursing Journal