Plus-Hex CLINICAL
Learning outcomes
• To quantify veterinary nurses '( VNs ') confidence in monitoring dogs of brachycephalic and nonbrachycephalic breeds under general anaesthesia
• To identify the factors that are known to influence VNs ' confidence
• To identify and compile necessary modifications for enhancing anaesthestic protocols for brachycephalic dogs, and to develop strategies for their practical implementation
Introduction
Brachycephalic breeding
Brachycephaly can be described as‘ a shortened skull and muzzle’ [ 1 ]. This study primarily focuses on brachycephic dogs, which present with child-like features such as bulging eyes and large, round faces. This appearance, which is known as paedomorphism, is believed to accentuate maternal instincts and cause humans to be attracted to brachycephalic breeds [ 2 ].
The earliest discussions about the breeding of brachycephalic dogs date to the 19th century [ 3, 4 ]. Since 2013, the number of French bulldogs registered with the Kennel Club has increased rapidly to 54,075 [ 5 ]. However, not every dog is registered, so numbers may be under-recorded.
Between 2021 and 2023, the number of Kennel Club registrations decreased slightly. Numerous campaigns focused on changing the breeding of brachycephalic dogs, such as those by the British Veterinary Association and the Brachycephalic Working Group, aim to reduce the popularity of these breeds, and it could be argued that these campaigns are proving effective [ 6, 7 ].
Health concerns in brachycephalic animals
Abnormalities associated with brachycephaly include stenotic nares and an elongated soft palate, which commonly contribute to brachycephalic obstructive airway syndrome( BOAS) [ 8 ].
BOAS is also associated with gastrointestinal signs such as vomiting, dysphagia and gastro-oesophageal reflux( GOR), which need to be taken into account when these breeds undergo anaesthesia [ 9, 10 ].
Studies have suggested that GOR in brachycephalic patients can be reduced by the administration of omeprazole preoperatively [ 11 ]. However, preoperative time frames vary among these studies, making it difficult to draw firm conclusions from the results.
Issues with anaesthesia in brachycephalic breeds and existing protocols
Today, brachycephalic breeds pose a higher anaesthetic risk( 12 %) than non-brachycephalic breeds( 0.05 %), so anaesthetic protocols for these breeds must be revised accordingly [ 12 – 14 ]. Common perioperative complications include hypoventilation, hypercapnia and hypoxia [ 8, 15 ]. Studies have supported the use of preoxygenation of brachycephalic animals before undergoing anaesthesia; however, recommended preoxygenation times vary between 3 and 5 minutes [ 12, 16 ].
As the population of brachycephalic dogs rises, veterinary practices are seeing an increased number of caesarean sections, due to the narrow pelvises and large heads of these breeds. Reid et al. [ 17 ] examined anaesthetic protocols for caesarean sections, including the benefits of intravenous fluid therapy, preoxygenation and multiparameter monitoring. Similar protocols should be adapted to every brachycephalic patient as they pose a higher anaesthetic risk [ 12, 16 ].
Confidence levels among VNs
Different pathways into veterinary nursing could influence VNs ' confidence in their ability to perform in the role. Holt et al. [ 18 ] found that the most common pathway was the diploma route, which may provide more understanding of, and confidence in, animal handling [ 19 ]. Vivian et al. [ 20 ] state that newly qualified VNs often rated their confidence as low, suggesting a relationship between length of time qualified and confidence. Despite the existence of literature analysing this relationship, there are minimal discussions about the confidence of VNs in relation to the anaesthesia of brachycephalic patients, highlighting the importance of further research.
Monitoring equipment
The use of various types of monitoring equipment during anaesthesia depends on the availability of the equipment and VNs ' confidence in using it [ 21 ]. The Royal College of Veterinary Surgeons( RCVS) strongly advises that all practices possess a multiparameter monitor [ 22 ]. Richardson and McMillan [ 23 ] suggest that although practices generally possess a multiparameter monitor, VNs often prefer to use‘ hands-on’ monitoring techniques, either because the equipment is‘ faulty’ or due to a lack of confidence; however, it should be noted that this study represents only 1.1 % of the total population of UK VNs [ 23, 24 ].
Relevance of research
The aim of this study was to minimise the gap between research on anaesthesia in non-brachycephalic and brachycephalic breeds of dog. A mixed-methods
Volume 40( 3) • June 2025
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