Post-operative monitoring, especially keeping the patient very calm, is extremely important when performing brachycephalic airway surgery.
Look to recover these patients in a quiet area, however a nurse cage-side is essential in the recovery period. Avoid stress and consider low doses of sedatives to keep them calm, for example medetomidine at low doses IV. Supplemental oxygen may be required. If significant airway distress occurs whilst the patient is oxygenated and calm, they may require endotracheal intubation while the swelling resolves or a temporary tracheostomy.
Treating gastro-intestinal signs medical improves the prognosis with brachycephalic airway syndrome.
Medical management primarily focuses on reduction in gastric acid secretion (consider omeprazole 1mg/kg BID) but may also include increasing the rate of gastric emptying with drugs such as cisapride, dietary management and antacid therapy in dogs with overt digestive clinical signs e.g regurgitation or vomiting.
You should aim to address as many factors as possible when performing brachycephalic airway surgery.
Some factors to address include aberrant nasal turbinates, everted laryngeal saccules, laryngeal collapse, elongated soft palate, everted tonsils, and stenotic nares.
Maropitant, omeprazole and medetomidine can all be useful medications to consider pre-operatively on the day of airway surgery.
Medetomidine can be a useful addition to the premedication at low doses of around 3-5ug/kg. Again, keeping the patient calm is a priority. Maropitant given subcutaneously on the morning of surgery is thought to help by reducing the risk of regurgitation post-operatively. Omeprazole is recommended by some surgeons a few days prior to surgery to reduce gastric acid secretion. This is then generally continued on the day of surgery and post-operatively for a few weeks. This may be more important in dogs showing concurrent gastro-intestinal signs.
To learn more about these surgical techniques, treatment plans, and post-operative care – join the VetPrac Fix The Face: Brachycephalic And Ear Surgery Workshop September 13th – 15th.
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