Veterinary Anesthesia & Analgesia Support Group
Practical Information for the Compassionate Veterinary Practitioner
line decor
line decor
  Brachecephalic Management Basics
  Dr. Bob Stein
  December, 2004


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



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

    Page References:
    Return to top of page
    Questions or problems regarding this web site should be directed to DRSTEIN@VASG.ORG .
Copyright © 2003 ASAH. All rights reserved.
Last modified: April 6, 2011 .