I am so proud to announce the official opening of BCU at VSS Jindalee. We have been working very hard on this, to ensure we can provide the best care to brachycephalic patients referred to Jindalee for a variety of conditions.
What is the BCU? - It is a dedicated team and facility, that aims to improve the care of brachycephalic patients coming through our hospital. We see brachycephalic patients for a variety of conditions - fractures, spinal disease, ophthalmic conditions, gastrointestinal conditions, advanced dental procedures and obstructive airway disease.
We aim to capture, for the referring vet and pet owner, as much information as possible when they visit our Jindalee branch. This potentially reduces the number of stressful visits for them to a specialist hospital. Our services have been specifically coordinated so we can facilitate this. For example, when a brachycephalic patient is anaesthetised, they receive an airway examination and an ophthalmic examination. These reports are sent back to the referring vet and a copy is given to the pet owner (the exception may be if they need an emergency anaesthetic).
Brachycephalic Anaesthetic Tips
Brachycephalic patients require careful consideration of pharmacology. Often a drug that mitigates one problem, leads to an additional problem. For example, we want to reduce pain and associated tachypnoea (which increases oxygen demand), however we want to avoid the cardiorespiratory depression we can see with opioids. We want to avoid stress, which increases regurgitation, however we don’t want to over-sedate and impede their ability to breathe or compensate. We want to avoid regurgitation, however some anti-emetics that reduce the risk will induce vomiting. As you can appreciate, Brachycephalic pharmacology is a fine balance and a careful, individualised consideration of drug doses is required. Part of our BCU team includes a Specialist Anaesthetist who helps us with our brachycephalic protocols.
A tip for French Bulldog anaesthesia – consider the use of Otrivin, which reduces swelling of nasal mucosa and may help breathing via the nose during recovery. You use around 0.2mls (or one squirt) per nostril. It lasts around 6-8 hours. And always pre-oxygenate brachycephalic patients for 5 minutes.
Brachycephalic Stress Reduction
These strategies, combined with lower doses of drugs, is the safest option. These are my recommendations, if they can be facilitated.
1 – Try to perform surgery as early in the day as possible. I make every effort for a brachycephalic patient to be early in the list. Given they have a 4.3x higher chance of a post-operative complication, I want to maximise the time I myself am available during the day, after their specific procedure.
2 – Little things that reduce stress can go a long way, for example; applying emla cream prior to catheterisation, taking things very slowly in a quiet room with dim lighting and nurse cuddles (we are lucky enough in BCU to have one-on-one nursing care for brachycephalic patient recovery).
3 – Owner-assisted recovery. Research has indicated, that having the owner present during recovery of a brachycephalic dog from airway surgery can reduce the risk of complications in recovery. Exclusively at the Jindalee hospital, we have been allowing owners to sit with their pet during recovery from airway surgery (pictured!). Personally, I love the fact we can allow owners to be with their pet in recovery and appreciate I am lucky we have a dedicated space that allows this.
Brachycephalic Dental Conditions
A lot of brachycephalic dogs really don’t appreciate the veterinary dentist 🤣Sometimes, this is with good reason. It can lead to them pulling their tongue caudally, which puts further pressure on their soft palate and nasopharynx making it difficult for them to breathe. In the very worst instances, the stress of a dental examination could tip the patient into respiratory distress or lead to aspiration pneumonia.However the catch 22 is that they are prone to a variety of dental conditions! These include; malocclusion, overcrowding and retained teeth which can progress to dentigerous cysts.Therefore, at BCU, if they are having elective surgery we photograph their teeth and send the referring vet these pictures. If they are having airway surgery, we also compare these photographs to our CT image, to ensure that all teeth seen on skull CT, have erupted into the mouth. Training on brachycephalic dentistry and identification of dental issues, was provided to us by Specialist Dentist Dr Bec Tucker from Advanced Animal Dentistry (part of our Jindalee BCU team).
Brachycephalic Ophthalmic Conditions
Brachycephalic dogs are prone to a wide variety of ocular surface diseases.
Brachycephalic patients that come via our ophthalmic service are obviously also part of BCU. Patients anaesthetised for elective ophthalmic procedures receive an airway examination by a surgeon (that's where I come in! yay). The owner and referring veterinarian are given a report.
Vice versa, for elective airway surgery, a brachycephalic patient will receive an ophthalmic exam and report (something that is not easy in the awake brachycephalic!)
What ophthalmic conditions are brachycephalic dogs prone to?
Abnormally prominent eyes that are insufficiently protected by their eyelids (lagophthalmos)
• Increased incidence of hairs contacting the cornea from nasal fold trichiasis (normal hairs orientated towards the eye), medial canthal entropion (lids rolling in), and hairy caruncles
(hair growing from conjunctiva at the medial canthus)
• Persistently overexposed cornea from macroblepharon (oversized opening between the upper and lower eyelids)
• Increased risk of traumatic proptosis (eyeball prolapse out of the eye socket getting trapped in front of the eyelids)
• Distichiasis and ectopic cilia (extra lashes implanted in the wrong location and causing direct trauma to the cornea)
• Reduced corneal innervation and sensitivity which reduces blinking, tear production and impedes corneal healing
• Prolapsed gland (cherry eye)and folded cartilage of the third eyelids
At VSS Jindalee we have not one, but two specialist ophthalmologists. - Dr Vicki Liddle and Dr Johana Premont.
Brachycephalic Dogs and Internal Medicine
Brachycephalic dogs are very prone to gastrointestinal disease. One of my favourite phrases as it pertains to these breeds is ‘aerodigestive disease’. This is because it encompasses the very important link between gastrointestinal disease and obstructive airway syndrome.
Brachycephalic dogs are prone to a variety of primary gastrointestinal issues (IBD, hiatal hernia and greater cross-sectional area of the hiatus, esophageal dysmotility, pyloric hypertrophy, pyloric stenosis, redundant esophageal tissue to name a few!). Importantly, chronic subatmospheric (sucking) pressure creates a negative gradient such that food is encouraged/’sucked’ in a cranial direction. This increases further their propensity to regurgitate, and this exacerbates the airway disease due to acidic contents constantly bathing the airways. Summary – GI disease makes the airways worse, and airway disease makes the GI disease worse. It can be a vicious cycle.
Treatment often involves treating the airway disease, however careful consideration both pre and post-operatively of the GI disease is extremely important in these patients. Typically, for a regurgitating patient, I will treat with a couple of weeks of gastroprotectants to settle this first before embarking on airway surgery. Secondly, although airway surgery can help reduce regurgitation, it sometimes doesn’t resolve it to a level that is consistent with a good quality of life. Therefore, careful follow-up is recommended and ideally a team of specialties that work together i.e. Internal medicine and Surgery (one of the core premises of BCU is a team working together for these patients). If regurgitation does not resolve, there is a lot more that can help that dog.
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