8/31/2017
1
Sheilah Robertson Senior Medical Director Lap of Love Veterinary Hospice
ANESTHESIA FOR BRACHYCEPHALIC BREEDS Talking Points
Why are they so popular?
Welfare issues
Anesthesia risks
Anesthetic techniques
RANK BREED
1 LABRADOR RETRIEVER
2 GERMAN SHEPHERD
3 GOLDEN RETRIEVER
4 BULLDOG
5 BEAGLE
6 FRENCH BULLDOG
8/31/2017
2
Why are brachycephalic dogs so popular?
The (British / English) Bulldog
1800’s
Today
Breeding for Extremes
BULLDOG GERMAN SHEPHERD
Health issues
Breathing
Risk of heat stress*
Skin, Eyes
Aspiration pneumonia
Arthritis
Pulmonic Stenosis
>80% born by C-section
* Largest number of airline transport deaths
8/31/2017
3
Problems begin early
We can fix it.....
Weight loss
Soft palate
laryngeal saccules
Nares
Skin folds
Heart surgery
Screw tail
Keratitis
Epiphora
Dental disease
Dystocia
Skin infections
Facial dermatitis
Brachycephalic airway syndrome
8/31/2017
4
VARIABLE
mmHg
BD CONTROL
PaO2
PaCO2
PCV
SAP
MAP
DAP
86
36
48
178
123
95
100
33
44
153
108
83
Risks
Airway management
Regurgitation
Vomiting
Aspiration
Tracheal size
8/31/2017
6
Premedication Prokinetics
Metoclopramide Cisapride
?Sedation
Opioid
Butorphanol
Nalbuphine
Acepromazine
0.01-0.03 mg/kg
8/31/2017
8
Am J Vet Res 2009
Time to desaturation < 90%
Room air: 69 ± 10 seconds
Oxygen: 298 ± 42 seconds CaO2 = [1.34 x Hb x SaO2] + 0.003 x PaO2
Love & Kline
Altered pharmacokinetics
Reduced blood volume
Hypoventilation
Hypoxia
Cardiac work increased
Inflammatory response
Boveri et al
Medetomidine + butorphanol
PROPOFOL
NORMAL WEIGHT
2.24 ±0.53 mg/kg
OVERWEIGHT
1.83 ±0.36
8/31/2017
9
Induction
Propofol
+ midazolam or diazepam
Thompson & Rioja 2016
Panti et al 2016
Equipment
8/31/2017
12
Analgesia
NSAIDs (if no steroids used)
Local blocks
Locoregional blocks
Opioids
RECOVERY
12
3
4
5
8/31/2017
13
What breed is this?
Normal Affected NT
Courtesy of Dr. Bryden Stanley
NTUAS
https://cvm.msu.edu/