Welcome everybody to May's issue of The Veterinary Nurse. This month has seen me present numerous lectures on respiratory patients, with the big focus being on brachycephalic breeds. I feel that the veterinary industry is truly pushing forwards to raise public awareness about the impact that conformational changes have on these animals. As a profession we no longer tolerate the use of brachycephalic breeds in advertising, but the sad fact is that the general public may never realise this.
I begin to wonder whether we need to have brachycephalic champions within practice. This could entirely be veterinary surgeons or nurses who own, or have previously owned, brachycephalic breeds; I personally had a rescue Bullmastiff - would this place me in the position of being the best person to advise owners regarding the issues they are likely to encounter owning one of these patients? Should we be encouraging owners to opt for surgery sooner rather than later? We know there are primary components as to why this group of animals have airway system changes, which include stenotic nares, elongated soft palates and hypoplastic tracheas. These abnormalities are further complicated by secondary changes such as everted laryngeal saccules, laryngeal collapse and everted tonsils; all of which reduce further the airway diameter and contribute to worsening respiratory compromise and clinical signs. As we see an increase in popularity of these breeds, we see them present more regularly for anaesthesia, which poses further problems. How many of us have time, or the staff, to offer one to one patient care, which I, personally, feel these patients require? Sedation of these patients will result in excessive relaxation of upper airway muscles, potentially worsening airway obstruction. If these patients are left unobserved, it could result in patient death.
All of this goes before the other issues related to anaesthesia including a potentially difficult intubation on induction, and the risk of regurgitation on induction and recovery, and the risk of airway obstruction during recovery. Personally, I continue to monitor these patients into the recovery period in the same way I did while under anaesthesia, which could include blood pressure monitoring and the use of ECGs. Pulse oximetry is useful in these patients during the recovery period, as it's an early indicatory of hypoxaemia. I recover brachycephalic breeds with the same dose of induction agent as was required for induction of anaesthesia, along with a range of endotracheal tubes. We frequently have patients that we have to make several attempts at recovering, so having everything at hand, including suction, can help reduce the stress associated with these situations. Recovery areas also need to be planned, although we want to avoid hypothermia, we don't want these patients getting too hot, or we risk getting into the vicious cycle of getting warm, panting, worsening the upper airway obstruction, decreasing the respiratory air flow, resulting in dynamic airway collapse and worsening oedema; all resulting in further panting. These really are patients where we need to plan for the worst, which will allow us to achieve the best!
On that happy note! Enjoy this month's issue. Happy reading and learning!