Are VNs satisfied with their practice ' s existing anaesthetic protocols for brachycephalic animals?
Almost half of respondents suggested that they are satisfied with their practice ' s existing protocols for the anaesthesia of brachycephalic patients( 44 %), whereas 16 % selected‘ neutral’. A common reason for lack of satisfaction was that there were‘ not enough staff members to monitor brachycephalic patients postoperatively’.
Staff shortages cause increased stress levels, excessive workloads and compassion fatigue [ 51, 52 ]. Inevitably, this leads to poor attendance, job dissatisfaction and patient safety risks [ 53 ]. Staff shortages could explain why‘ not every member of staff preoxygenates patients’. Richardson and McMillan [ 23 ] concluded that different attitudes towards anaesthesia monitoring lead to poor teamwork, poor staff relationships and a lack of trust.
What do VNs want to change?
Preoxygenation was highlighted as something that should be added to protocols. Brachycephalic dogs often develop perioperative hypoxia [ 34 ]. McNally et al. [ 16 ] hypothesised that 3 minutes of preoxygenation increases the time taken to reach hypoxia, whereas Petruccione et al. [ 54 ] suggested 5 minutes. Evidently, there is no solid evidence regarding the‘ perfect’ preoxygenation time, so further research is required.
Owing to the brachycephalic facial anatomy, it is unlikely that a face mask will be tight-fitting when applied to these animals [ 55 ]. Masks can also create additional stress and delay control of the airway, which increases the risk of regurgitation [ 8 ]. Oxygen kennels may be preferred, but financial constraints limit their use [ 56 ].
The preoperative administration of omeprazole was also highlighted. Costa et al. [ 57 ] concluded that the occurrence of GOR was significantly reduced when omeprazole was administered preoperatively. However, their study required owners of brachycephalic pets to report any signs of regurgitation, which could have been dismissed as‘ normal for the breed’ [ 13 ].
As a consensus, the majority of practices either tailor their protocols for brachycephalic patients, or do not implement any changes. This is a common finding, as Campbell [ 58 ] revealed that 81 % of VNs surveyed stated that they adapted their usual anaesthetic protocols to suit bulldog breeds.
Ironically,‘ issues on recovery’ was a common finding when VNs were asked about their existing anaesthetic protocols. Arguably, if protocols specific to brachycephalic patients were implemented, fewer issues would occur.
Limitations
Some respondents did not fulfil the inclusion criteria or answer all the questions. As a consequence, the desired sample size was not reached, meaning that this study is under-representative of UK RVNs [ 59 ]. The length of the questionnaire might explain the lower than desired response rate [ 60 ]. Using different distribution methods, such as paper copies, could have increased the sample size. However, due to COVID-19, digital distribution was preferred. In addition, if participants were not interested in brachycephalic breeds or anaesthesia, they might have lost interest in completing the survey [ 29 ]. To avoid this possibility, the questionnaire was posted in a Facebook group focusing on brachycephalic breeds; however, this generated some bias since the members of this group possessed existing knowledge of, and interest in, these breeds.
If a similar study were to be repeated, it could include some‘ in practice’ scenarios to allow participants ' knowledge to be tested. This would reduce the risk of VNs relying on their own perceptions of confidence and would prevent over- or under-estimation.
Conclusions
Overall, this study found that most VNs are satisfied with the anaesthetic protocols they use, despite most practices adapting them to brachycephalic breeds, rather than using protocols developed specifically for them. Isoflurane and propofol are regularly chosen due to their cost and widespread availability. Moreover, the frequent recommendation to include preoxygenation in practice protocols, and the lack of confidence with ECG, match findings from similar studies, emphasising the importance of additional training for VNs in these areas.
When examining factors influencing confidence, the study found that newly qualified VNs expressed the least confidence. Previous studies had similar findings, suggesting that confidence increases with time and experience. Common themes relating to barriers to the improvement of anaesthetic protocols included finances and staff shortages, which have also been highlighted in previous studies. Veterinary businesses may need to address these issues to prevent staff burnout and reduce staff turnover.
This study has provided evidence to suggest that education regarding the anaesthesia of brachycephalic patients is increasing, and has laid the groundwork for future research. Additional research to gain more evidence to reduce the divided opinions about induction and anaesthetic agents could greatly influence future protocols and the anaesthesia experience for brachycephalic dogs. Once these issues have been addressed more thoroughly, it may be possible to comprehensively assess the efficiency of existing anaesthetic protocols for brachycephalic dogs.
38 Veterinary Nursing Journal