Risk of anesthesia-related complications in brachycephalic dogs

Abstract

OBJECTIVE To determine whether brachycephalic dogs were at greater risk of anesthesia-related complications than nonbrachycephalic dogs and identify other risk factors for such complications. DESIGN Retrospective cohort study. ANIMALS 223 client-owned brachycephalic dogs undergoing general anesthesia for routine surgery or diagnostic imaging during 2012 and 223 nonbrachycephalic client-owned dogs matched by surgical procedure and other characteristics. PROCEDURES Data were obtained from the medical records regarding dog signalment, clinical signs, anesthetic variables, surgery characteristics, and complications noted during or following anesthesia (prior to discharge from the hospital). Risk of complications was compared between brachycephalic and nonbrachycephalic dogs, controlling for other factors. RESULTS Perianesthetic (intra-anesthetic and postanesthetic) complications were recorded for 49.1% (n = 219) of all 446 dogs (49.8% [111/223] of brachycephalic and 48.4% [108/223] of nonbrachycephalic dogs), and postanesthetic complications were recorded for 8.7% (39/446; 13.9% [31/223] of brachycephalic and 3.6% [8/223] of nonbrachycephalic dogs). Factors associated with a higher perianesthetic complication rate included brachycephalic status and longer (vs shorter) duration of anesthesia; the risk of perianesthetic complications decreased with increasing body weight and with orthopedic or radiologic procedures (vs soft tissue procedures). Factors associated with a higher postanesthetic complication rate included brachycephalic status, increasing American Society of Anesthesiologists status, use of ketamine plus a benzodiazepine (vs propofol with or without lidocaine) for anesthetic induction, and invasive (vs noninvasive) procedures. CONCLUSIONS AND CLINICAL RELEVANCE Controlling for other factors, brachycephalic dogs undergoing routine surgery or imaging were at higher risk of peri- and postanesthetic complications than nonbrachycephalic dogs. Careful monitoring is recommended for brachycephalic dogs in the perianesthetic period.

Development and validation of a brachycephalic risk (BRisk) score to predict the risk of complications in dogs presenting for surgical treatment of brachycephalic obstructive airway syndrome

“…French bulldogs have been found to have functional airway obstruction indices similar to English bulldogs, with a higher incidence of stenotic nares . Although multiple planned procedures have not been previously identified as a risk factor in brachycephalic dogs, prolonged anesthetic time, which is highly correlated with multiple procedures, has been identified as a risk factor for postanesthetic complications in brachycephalics . Obese dogs are reported to be 1.9‐fold more likely than dogs with normal body condition to show signs of BOAS, and severity of respiratory noise has been found to correlate with degree of airway function compromise …”

“…BRisk, brachycephalic risk brachycephalic dogs, prolonged anesthetic time, which is highly correlated with multiple procedures, has been identified as a risk factor for postanesthetic complications in brachycephalics. 8,19 Obese dogs are reported to be 1.9-fold more likely than dogs with normal body condition to show signs of BOAS, 20 and severity of respiratory noise has been found to correlate with degree of airway function compromise. 21 Our findings regarding associations between history of previous airway surgery, admission rectal temperature, and risk of negative outcome have not been previously identified.…”

Evaluation of Endotracheal Tube Cuff Pressure and the Use of Three Cuff Inflation Syringe Devices in Dogs

“…We also found the dogs that did not require ETT cuff inflation had a three times higher proportion of brachycephalic breeds than the dogs that required ETT cuff inflation (24.6% vs. 8.6%). Brachycephalic breed dogs are prone to have airway anatomical abnormalities including hypoplastic trachea (27,35). Dogs with hypoplastic trachea have narrowed tracheal diameters along the entire trachea due to the small tracheal cartilage (cshaped) with overlapped ends (36,37).…”

Biomechanical properties of canine staphylectomies closed with barbed or smooth suture

“…23 After surgery in dogs, staphylectomy incisions are subjected to tension and other forces associated with swallowing, barking, and turbulent, multidirectional airflow that may occur in brachycephalic dogs at recovery. [14][15][16][17][18][19][20][21][22][23][24][25] In this study, staphylectomies were tested under tension until failure to determine the mechanical strength or performance of the constructs. We therefore created a suture-tissue construct incorporating a Steinmann pin to facilitate evaluation in a universal testing device.…”

“…20 Death may result from airway obstruction, regurgitation and aspiration pneumonia, or failure to recover from anesthesia. [1][2][3][13][14][15][16][17][18][19][20] Although the clinical implications of many staphylectomy complications are recognized, the incidence and implications of dehiscence are unknown. Second-look endoscopy and repeat oral examination are rarely performed to assess healing after staphylectomy but are recommended in dogs that become dyspneic after surgery.…”