Stephanie Krein, DVM, &

Complications ANESTHESIOLOGY Lois A. Wetmore, DVM, ScD, DACVA

Tufts University
Peer Reviewed

Breed-specific
Anesthesia

Genetic differences and

C
ertain breed differences can lead to greater risks
for airway obstruction, increased responsiveness to
anatomic factors can anesthetic drugs, and delayed recovery, all of which Safe and
can result in increased anesthesia-related morbidity and successful
contribute to variability mortality. Individual genetic variability can trigger unex- sedation and
pected and adverse responses to anesthetic drugs, which
and complications during need to be identified by good recordkeeping and consis-
anesthesia can
tent patient monitoring. Although genetic differences are be performed
anesthetic events. typically held responsible for prolonged recoveries and in any breed of
increased drug responsiveness, true genetic sensitivity has dog or cat with
been demonstrated in only a handful of breeds, including
the greyhound and the collie. proper preoper-
ative workup
Because many canine breeds can suffer from cardiac and appropriate
disease, both acquired and congenital, it is important
patient
to know which patients are likely to be affected before
the anesthetic protocol is planned. If cardiac disease is monitoring.
For breed-specific anesthesia at suspected, a full cardiac workup with a veterinary cardi-
a glance, see the Checklist on
ologist is recommended.
page 20.
CoNtiNues

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Complications CONTINUED

BRACHYCEPHALIC BREEDS SIGHTHOUNDS

Brachycephalic breeds have anatomic considerations that Most breeds do not
may affect anesthetic outcome. Most brachycephalic breeds have true sensitivities
suffer from brachycephalic airway syndrome (BAS), which is to anesthestics,
characterized by stenotic nares, elongated soft palate, everted although sighthounds
laryngeal saccules, and hypoplastic trachea. (particularly the grey-
hound) do have
Affected dogs have narrower upper genetic factors that
airways than do dogs with normal cause them to metab-
anatomic features.1-3 Because in olize drugs differently. Therefore, before designing an anes-
brachycephalic breeds additional thetic protocol, examination findings and blood work results
airway contraction can occur with need to be evaluated. Sighthounds have a higher packed cell
stress (ie, increased respiratory volume and lower serum albumin concentration than do
effort, turbulent flow), clinicians mixed breeds.2,3 Sighthounds also should be evaluated for
need to be prepared for possible cardiac abnormalities (eg, dilated cardiomyopathy).
upper airway obstruction. Further-
more, brachycephalic dogs must be monitored closely after Because sighthounds are high-energy animals, they may expe-
premedication, throughout anesthesia and the postoperative rience high levels of hospitalization stress. Acepromazine is
period, and after extubation. An oxygen source and endotra- recommended for preventing stress in healthy sighthounds,
cheal tube should be readily available. but some individuals may be more sensitive to its sedative
effects, so a lower dose (0.02–0.03 mg/kg) is advised.4,5 In
Many brachycephalic dogs respond well to acepromazine addition, sighthounds metabolize drugs more slowly as com-
in conjunction with an opioid; however, the sedative dose pared with the average dog. Thiobarbiturates should be
should be half of that used for nonbrachycephalic dogs. Full avoided and other induction agents (eg, propofol, ketamine,
mu-opioid agonists can be used but because they may cause etomidate) used instead.1-3 Of note, propofol is metabolized
excessive respiratory depression, a reversal agent should be more slowly in these dogs because of reduced hepatic enzy-
available. Dexmedetomidine should be avoided because of matic activity, which may result in slower recovery.4,6,7
the presence of high vagal tone in these breeds. Anticholin-
ergics, such as glycopyrrolate, may be used to decrease airway Sighthounds have a low percentage of body fat (17%) com-
secretions and counteract high vagal tone. pared with the average dog (35%),6 which leaves them at risk
for hypothermia during anesthetic procedures.2,3,6 Therefore, it
Preoxygenation is recommended before dogs with BAS are is important to use hot water blankets and forced-air warmers
induced.2-4 Propofol or a similar short-acting drug should be during the perioperative period.
used for induction and intubation should be completed as
rapidly as possible. Mask inductions should be avoided,3,4
and smaller endotracheal tubes should be used.
Boxers of UK Lineage
Because brachycephalic breeds tend toward obesity, controlled On rare occasions, individual
or mechanical ventilation is often necessary. Most problems variability can result in a sub-
associated with mechanical ventilation occur during induc- population within a breed
tion and recovery, so monitoring is particularly important. that responds differently to
anesthetics. An example can
Extubation should be postponed until the patient is bright, be seen in boxers from the
alert, swallowing—even chewing on the endotracheal tube.4 UK. In this subpopulation,
If extubation is attempted while the patient is sedated and acepromazine often causes
groggy from anesthesia, there is increased risk for upper severe bradycardia, hypoten-
airway obstruction. If upper airway obstruction occurs, the sion, and collapse, so a
patient should be reintubated. reduced dose of acepro-
mazine (0.01–0.025 mg/kg) is recommended.2,4
Brachycephalic cats should be handled with care from pre- Because there are no published reports describing simi-
medication to recovery and treated in a manner similar to dogs. lar effects in US-bred boxers, standard doses of acepro-
mazine are typically routine in the US subpopulation.
BAs = brachycephalic airway syndrome

1 ...........................................................................................................................................................................NAVC Clinician’s Brief / March 2012 / Complications

HERDING BREEDS TOY BREEDS
The effect of certain anesthetic Because of their size,
drugs on herding dogs (eg, toy breeds can present
collie, border collie, Australian unique challenges.
shepherd, Shetland sheepdog) Obtaining an accurate
is somewhat controversial. weight and using the
However, these breeds have a appropriate dose of
high prevalence (eg, up to 75% anesthetic drug are
in collies in the United States) essential. Monitoring
for genetic mutation in the during surgery likewise is important. In small
ABCB1 (formerly MDR1) patients, Doppler blood pressure measurement
gene.8,9 ABCB1 encodes has been more accurate than oscillometric mon-
P-glycoprotein, an adenosine itoring; in addition, it provides an auditory
triphosphate–driven pump sound to monitor heart rate and rhythm.
that is an integral component
of the blood–brain barrier and Toy breeds have a greater body surface area– GIANT BREEDS
provides protection from toxic to–body mass ratio and higher metabolic rate, Giant breeds often respond profoundly
drug accumulation in body flu- which can lead to lower body temperatures and to normal therapeutic doses of seda-
ids, such as cerebrospinal fluid hypoglycemia.1 It is important to support nor- tives, such as acepromazine. In this
(CSF).10 In the collie and mal body temperature during anesthesia, moni- patient population, it is important to
other herding breeds, this tor blood glucose levels, and apply adequate either reduce the dose of acepromazine
genetic mutation results in a supplementation as indicated.3 (0.01–0.025 mg/kg) or calculate the
defective pump that allows a dose based on lean body mass or surface
select group of drugs to accu- area and not the actual body weight.2,3
mulate within the brain.
Acepromazine and opioids,
particularly butorphanol,9 are
DOBERMAN PINSCHER
members of this drug group,
Genetic variation is also noted in Doberman pinschers. In addition
and their accumulation in CSF
to a predilection for developing dilated cardiomyopathy, these dogs
may cause marked sedation
can have von Willebrand disease, which impairs normal clotting. It
and respiratory depression.
is important to evaluate the coagulation status of these patients
When using these agents in
before surgery.
susceptible breeds, the dose
should be decreased by 25%
If von Willebrand disease is suspected, desmopressin (also known
and patients closely monitored
as DDAVP) given before surgery promotes von Willebrand factor
for side effects.5,9
secretion from endothelial storage sites.3

In this patient population, the use of NSAIDs is somewhat controversial and other anal-
gesic options should be explored. If NSAIDs must be administered, preference should
be given to cyclooxygenase (COX)-2–selective drugs.

CLOSING REMARKS
Although it is important to be aware of breed-related anesthetic differences, the primary
consideration is the individual patient and tailoring the anesthetic protocol accordingly.
With proper perioperative workup and appropriate patient monitoring, safe and successful
sedation and anesthesia can be performed in any breed of dog or cat. Patient monitoring
should begin with premedication and end only after the patient has been extubated and is
normothermic, stable, and alert.
CoNtiNues

See Aids & Resources, back page, for references & suggested reading.
CsF = cerebrospinal fluid, CoX = cyclooxygenase

Complications / NAVC Clinician’s Brief / March 2012 ...........................................................................................................................................................................1

Complications
CHECKLIST
Classification
BRACHYCEPHALIC BREEDS
(eg, bulldog, pug, Boston terrier,
boxer, Cavalier King Charles
spaniel, Pekingese)
SIGHTHOUNDS (eg, greyhound,
whippet, Italian greyhound,
Afghan hound, Borzoi, Irish
wolfhound, Saluki)
HERDING BREEDS (eg, collie,
Shetland sheepdog, Australian
shepherd, border collie)
TOY BREEDS (eg, shih tzu,
Pomeranian, Chihuahua,
Pekingese, Brussels griffon, toy
fox terrier, Affenpinscher)
GIANT BREEDS (eg, Newfound-
land, Great Pyrenees, Saint
Bernard)
DOBERMAN PINSCHER
BOXER of UK lineage only
CsF = cerebrospinal fluid, CoX = cyclooxygenase
20 ...........................................................................................................................................................................NAVC Clinician’s Brief / March 2012 / Complications
CONTINUED
Anesthesia-Related Problems by Breed
Problem Checklist of Actions
Brachycephalic airway syndrome; increased ❏ Avoid excessive sedation
respiratory effort; potential for upper air- ❏ Avoid α2-agonists
way obstruction ❏ Administer acepromazine at half dose
❏ Preoxygenate
❏ Use short-acting induction agent
❏ Use appropriately sized endotracheal tubes
❏ Extubate after patient is sitting up, vigorously
chewing, bright, alert
Delayed metabolism, increased responsive- ❏ Use low-dose acepromazine (0.02–0.03 mg/kg)
ness to acepromazine; possible delayed ❏ Administer propofol slowly, only to effect
recovery from propofol; lower body fat ❏ Avoid thiopental & barbiturates
percentage; hypothermia; high-stress ❏ Avoid patient contact with cold tables
hyperthermia ❏ Use forced-air warmers, hot water blankets as
needed
❏ Treat stress/pain-induced hyperthermia with
anxiolytics, whole-body cooling, analgesics
ABCB1 mutation causes defect in P-glyco- ❏ Reduce butorphanol dose by 25%
protein pump, resulting in accumulation of ❏ Reduce acepromazine dose by 25%
certain drugs in CSF, followed by excessive ❏ Monitor carefully after sedation
sedation/respiratory depression Note: Morphine not proven P-glycoprotein substrate, but
dose may need to be reduced
Hypothermia from large body surface area ❏ Use forced-air warmers, hot water blankets, warm IV
relative to body size; difficulty monitoring; fluids, warm fluid bags around breathing tubes as
hypoglycemia needed
❏ Avoid patient contact with cold tables
❏ Perform intraoperative Doppler imaging, along with
routine monitoring (ECG, pulse oximetry, temperature)
❏ Monitor blood glucose concentration; supplement as
needed
Profound response to sedatives ❏ Administer acepromazine or α2-agonists at half dose
❏ Dose IM drugs based on lean body mass
Predilection for dilated cardiomyopathy, ❏ Evaluate coagulation status
von Willebrand disease ❏ If von Willebrand disease suspected, administer
desmopressin
Note: NSAID use controversial (if necessary, give COX-2–
selective drug)
Acepromazine-induced vagal response; ❏ Reduce acepromazine dose (0.01–0.025 mg/kg); avoid
marked hypotension, bradycardia; boxer α2-agonists
cardiomyopathy ❏ Use anticholinergic drug with acepromazine unless
heart disease present
❏ Give IV fluids, supportive care