What is Brachycephalic?
Brachycephalic is a scientific term to describe dogs and cats with shortened noses. Common brachycephalic breeds that we often see include Bulldogs, Pugs, Shih-tzus, Cavalier King Charles Spaniels and Persian cats. These animals are very cute, and make amazing companions, but come with some differences in their anatomy. They have flatter faces and much shorter noses than other breeds, however the amount of tissue and skin they have remains unchanged, just compacted into a smaller space. This causes those wrinkly faces we know and love, but sadly that extra tissue is also present around their airway, which can lead to difficulty breathing.
Why is this a problem?
Because of a condition called brachycephalic obstructive airway syndrome (BOAS). This condition relates to difficulty breathing (or dyspnoea) caused by airway obstruction. The abnormal airway anatomy found in these breeds interferes with the inflow and outflow of air into the respiratory system. This problematic anatomy may include:
- Stenotic nares (narrow nostrils)
- Elongated soft palate (the soft palate is the soft tissue at the back of the throat; this extra tissue may block the entrance to the airway)
- Everted laryngeal saccules (these small saccules just inside the larynx may also block the airway)
- Hypoplastic trachea (where the trachea, or windpipe, is more narrow than normal)
- Laryngeal collapse (Chronic stress placed on the cartilage of the airway may cause it to weaken and collapse)
- These can cause the following clinical signs:
- Dyspnoea (difficulty breathing)
- Exercise intolerance (getting tired quickly or having to stop and rest on walks)
- Snoring/Stertorous breathing sounds – those snuffly sounds!
- Collapse/Syncope – in severe cases
- Cyanosis – a blue tinge to the gums and tongue – this is an emergency!
- Regurgitation/Reflux
- Increased strain on the heart
All brachycephalic breeds will have BOAS to a certain extent, though some animals are more affected than others.
So how do we ensure our anaesthetic is as safe as possible?
Our brachycephalic animals are unique and should be treated as such! Before any anaesthetic, your animal will have a full vet check to ensure they are fit to undergo the procedure. This also may include blood tests to ensure that your animal is healthy on the inside, as well as chest xrays to assess the health of their lungs and heart (which can be impacted by this disease) if deemed necessary.
Most of the extra precautions required in brachycephalic patients relate to the maintenance of the airway. Therefore, we prefer using either a very light sedation if possible, or better still a full anaesthetic where a tube is placed down the trachea. This allows us to deliver oxygen straight to the patient and ensure their airway stays open throughout the procedure. Before any sedation or anaesthetic on a brachycephalic patient, we will give them oxygen via a mask to ensure they are as oxygenated as possible before they are sleepy. They will also have this oxygen via a mask again as they wake up.
Brachycephalic patients have a high risk of respiratory obstruction following extubation (when we take the tube out) due to excessive soft tissue at the back of their throats. We will always extubate our brachycephalic patients as late as possible, so that they are awake enough to maintain their own airway. Once awake we place the patient in the kennel with its neck stretched and tongue pulled out of the mouth to minimize the risk of obstruction. At all times your animal will have a catheter (IV) in place – IV access is important incase the patient needs to be re-anaesthetised and re-intubated. The cage will be comfy with lots of padding but small enough so that they can’t run around too much as they must rest.
Stress can be a problem for these little guys as it can cause their body temperature to rise. This is because they may not be able to get enough air in when they are worried. Our job includes making sure they have enough pain relief and sedation to be comfortable, both before and after their anaesthetic, and to monitor their temperature closely.
Our fantastic team of vets and nurses will be monitoring your pets’ vital signs throughout the entire day, which includes their oxygen levels and their breathing. Medications we may administer to keep your pet comfortable may include steroids, to reduce any swelling in the throat, and anti-emetics, as these animals are prone to regurgitating and reflux. These animals also may have big bulgy eyes, so we routinely administer eye lubricant throughout the day to ensure their eyes don’t get too dry and sore.
How can we fix brachycephalic obstructive airway syndrome?
Surgery is the treatment of choice for this problem. This will correct the anatomical abnormalities to a certain extent. The surgery may include widening the narrow nostrils, trimming the elongated soft palate and removing everted laryngeal saccules. Generally, the earlier we fix these problems, the better the outcome. Dr Josh, Dr Nicole and Dr Garreth can all perform these surgical corrections for your dog, and along with our super team of nurses, will ensure your dogs surgery and anaesthetic is as safe and successful as possible.
If you have a brachycephalic pet, please be sure to ask us to assess the extent of their airway compromise when you are next in to see us.