1) RECOMMENDATIONS
a) General Approach
i) Manage airway compromise issues
(1) Often have:
(a) Hypoplastic trachea
(b) Elongated soft palate
(c) Decreased chest wall compliance and low tidal volumes
ii) Gain rapid control over airway
iii) Plan for smooth, rapid recovery
(1) Plan thorough patient monitoring during recovery phase
iv) Expect increased vagal tone in these patients
b) Pre-anesthetic Medications
i) Avoid heavy sedation
(1) Use reversible drugs
ii) Pre-oxygenate if not overly stressful
iii) Brachycephilcs may have generally higher vagal tone
(1) Many will premedicate with an anticholinergic especially if a mu
opioid is used
c) Induction
i) Gain rapid control
over airway
(1) Ket/val
(2) Etomidate
(3) Thiopental
(4) Propofol
ii) Consider Lidocaine bolus (1mg/lb Dog & Cat) post-induction
agent to facilitate intubation, avoid vagal stimulation, and minimize
induction agent requirement
d) Maintenance
i) Sevoflurane or Isoflurane for more rapid patient recovery
e) Support
i) Routine anesthetic support
2) PRECAUTIONS
a) Pre-anesthetic Medications
i) Avoid heavy sedation
(1) Use reversible agents
ii) Pre-oxygenate if not overly stressful
b) Induction
i) Expect to use a much smaller endotracheal tube
(1) Carefully select a wide variety of sizes
(a) Have 2 tubes smaller than what you estimate to be the right size
ii) Gain rapid control of airway at induction
c) Maintenance
i) Be ready to assist ventilation
d) Support
i) As needed
e) Recovery
i) Maintain oxygen delivery prior to extubation to buy more time to
re-establish the airway
ii) Have additional induction agent at recovery in the event that
obstruction occurs and reintubation is needed
iii) Avoid overly aggressive stimulation that might trigger initial
swallowing, only to be followed by a relapse into unconsciousness when
stimulation is removed
(1) Sternal recumbancy may be the best position for recovery of
brachycephalic breeds |
