Plus-Hex CLINICAL
Introduction
Brachycephalic obstructive airway syndrome( BOAS) has become more commonplace due to the rise in ownership of brachycephalic breeds. It is caused by excessive soft tissue in the upper airway leading to anatomical abnormalities [ 1 ]. These abnormalities include stenotic nares, a hypoplastic trachea and an elongated soft palate [ 2 ]. Due to the constant trauma of the pharyngeal tissue being caught in the airway, secondary problems often occur and result in swelling of the airway, everted saccules and, in emergency cases, a completely collapsed larynx [ 1 ].
Certain breeds of dog are commonly affected by BOAS. These include:
• English bulldog
• Pug
• Boston terrier
• Pekingese
• French bulldog
• Cavalier King Charles spaniel.
Many owners of brachycephalic dogs are not initially aware that their pets are likely to develop this condition, so it is vital that veterinary professionals are able to educate owners and provide treatment for these patients.
The aim of this article is to provide a comprehensive overview of what is required of veterinary nurses( VNs) in surgical BOAS cases and what to watch for in the pre-, peri- and postoperative periods.
Clinical signs
Patients with BOAS will present with a variety of signs, such as exercise intolerance and syncope( Table 1 [ 2 ]).
Examination and diagnosis
Airway assessment can be carried out under light sedation, which should allow full visualisation of the airways without affecting the natural movement of the larynx. Based on the author ' s experience, if this is not possible due to the patient ' s demeanour, propofol can be used; this can cause respiratory suppression but will allow the veterinary surgeon( VS) to perform a full examination of the oral cavity without distressing the patient.
The use of propofol facilitates rapid induction and a stable plane of anaesthesia, permitting the VS to perform a brief airway assessment before intubation. If surgical intervention is deemed necessary, the team can then proceed with endotracheal( ET) intubation and prepare the patient for surgery.
A spay hook, laryngoscope and tongue depressor should be on hand to facilitate visualisation [ 3 ]. It is also vital to have oxygen( O 2
) and emergency intubation equipment ready, in case they are required. This includes:
• A selection of small-diameter ET tubes
• Laryngoscopes
• An ET tube stylet
• A dog urinary catheter and 2 ml syringe( to connect the catheter to the anaesthetic circuit if required)
• Tracheostomy tubes.
Pre-anaesthesia considerations
Weight loss
Where feasible, preoperative weight reduction should be encouraged, as it will greatly enhance the patient ' s respiratory function before surgical intervention and
Table 1. Clinical signs of brachycephalic obstructive airway syndrome [ 2 ].
Clinical sign Stertor Stridor Exercise intolerance Inability to breathe through the nose at rest Syncope Resting tachycardia and tachypnoea Polycythaemia Cyanosis Tendency to hyperthermia / heat stroke
Definition A snore-like sound while awake A high-pitched sound from inspiring through a narrow airway
Fainting High heart and respiratory rates High red blood cell count Blue tinge to skin due to poor circulation or inadequate oxygen
Volume 41( 3) • June 2026
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