Small Animals
Risk of anesthesia-related complications
in brachycephalic dogs
Michaela Gruenheid dvm
Turi K. Aarnes dvm, ms
Mary A. McLoughlin dvm, ms
Elaine M. Simpson dvm
Dimitria A. Mathys msph, vmd
Dixie F. Mollenkopf ms
Thomas E. Wittum phd
From the Departments of Veterinary Clinical Sciences
(Gruenheid, Aarnes, McLoughlin, Simpson) and Veteri-
nary Preventive Medicine (Mathys, Mollenkopf, Wittum),
College of Veterinary Medicine, The Ohio State Univer-
sity, Columbus, OH, 43210. Dr. Simpson’s present address
is Animal Medical Center of Chicago, 1618 W Diversey,
Chicago, IL 60614.
Address correspondence to Dr. Aarnes (aarnes.1@
osu.edu).
B rachycephalic airway syndrome in dogs is char-
acterized by anatomic abnormalities that include
stenotic nares, aberrant nasal conchae, elongated soft
palate, everted laryngeal saccules, laryngeal collapse,
hypoplastic trachea of various severities, and bronchi-
al collapse; the syndrome also often causes upper air-
way obstruction.1–7 Clinical signs associated with these
abnormalities can include various degrees of dyspnea,
snoring, stridor, exercise intolerance, regurgitation,
vomiting, cyanosis, syncope, and collapse. In a survey,8
91% of owners of brachycephalic dogs reported that
their dogs had stridor while sleeping, 100% reported
ABBREVIATIONS
ASA American Society of Anesthesiologists
CI Confidence interval
VPC Ventricular premature contraction
JAVMA • Vol 253 • No. 3 • August 1, 2018
OBJECTIVE
To determine whether brachycephalic dogs were at greater risk of anesthe-
sia-related complications than nonbrachycephalic dogs and identify other
risk factors for such complications.
DESIGN
Retrospective cohort study.
ANIMALS
223 client-owned brachycephalic dogs undergoing general anesthesia for rou-
tine surgery or diagnostic imaging during 2012 and 223 nonbrachycephalic
client-owned dogs matched by surgical procedure and other characteristics.
PROCEDURES
Data were obtained from the medical records regarding dog signalment,
clinical signs, anesthetic variables, surgery characteristics, and complica-
tions noted during or following anesthesia (prior to discharge from the
hospital). Risk of complications was compared between brachycephalic and
nonbrachycephalic dogs, controlling for other factors.
RESULTS
Perianesthetic (intra-anesthetic and postanesthetic) complications were
recorded for 49.1% (n = 219) of all 446 dogs (49.8% [111/223] of brachyce-
phalic and 48.4% [108/223] of nonbrachycephalic dogs), and postanesthetic
complications were recorded for 8.7% (39/446; 13.9% [31/223] of brachy-
cephalic and 3.6% [8/223] of nonbrachycephalic dogs). Factors associated
with a higher perianesthetic complication rate included brachycephalic sta-
tus and longer (vs shorter) duration of anesthesia; the risk of perianesthetic
complications decreased with increasing body weight and with orthopedic
or radiologic procedures (vs soft tissue procedures). Factors associated
with a higher postanesthetic complication rate included brachycephalic sta-
tus, increasing American Society of Anesthesiologists status, use of ket-
amine plus a benzodiazepine (vs propofol with or without lidocaine) for
anesthetic induction, and invasive (vs noninvasive) procedures.
CONCLUSIONS AND CLINICAL RELEVANCE
Controlling for other factors, brachycephalic dogs undergoing routine sur-
gery or imaging were at higher risk of peri- and postanesthetic complica-
tions than nonbrachycephalic dogs. Careful monitoring is recommended
for brachycephalic dogs in the perianesthetic period. ( J Am Vet Med Assoc
2018;253:301–306)
stridor during exercise, and 68% reported an increase
in inspiratory effort during exercise.
Arterial blood gas results for mesocephalic or doli-
chocephalic dogs have been compared with those of
brachycephalic dogs, revealing that the overall Paco2
was significantly higher (mean ± SD, 40.2 ± 3.3 mm Hg
for brachycephalic dogs and 33.0 ± 2.1 mm Hg for non-
brachycephalic dogs) and Pao2 was significantly lower
(76.8 ± 15.2 mm Hg for brachycephalic dogs and 94.0
± 12.6 mm Hg for nonbrachycephalic dogs) in brachy-
cephalic dogs.9 In addition, English Bulldogs, a brachy-
cephalic breed, can have prolonged periods of arterial
oxygen saturation < 90% during sleep.10
Brachycephalic airway syndrome may also pre-
dispose affected dogs to vomiting and regurgitation,
which may lead to aspiration pneumonia. Severity of
gastrointestinal signs is associated with severity of re-
301
 Small Animals
spiratory signs such as stertor, exercise intolerance,
and cyanosis in French Bulldogs, another brachyce-
phalic breed.11
Given the aforementioned anatomic abnormali-
ties and clinical signs, anesthesia is believed to pose a
greater risk to brachycephalic versus other dog breeds
owing to airway blockage and decreased oxygenation.
Common practice is to leave brachycephalic dogs in-
tubated for as long as possible following anesthesia be-
cause of these concerns.12 To the authors’ knowledge,
no studies have been conducted to evaluate whether
brachycephalic dogs are more prone than nonbrachy-
cephalic dogs to develop perianesthetic complications
during routine surgeries. The purposes of the study
reported here were to determine whether brachyce-
phalic dog breeds were more likely to develop peri-
anesthetic complications than nonbrachycephalic
breeds and to identify other risk factors for complica-
tions. Our hypothesis was that brachycephalic dogs
would be at a higher risk of perianesthetic complica-
tions than nonbrachycephalic dogs.
Materials and Methods
Animals
Medical records of The Ohio State University Vet-
erinary Medical Center were electronically searched
to identify brachycephalic dogs (exposed cohort) and
nonbrachycephalic dogs (unexposed cohort) that had
undergone general anesthesia for routine surgery or
advanced imaging between January 1, 2012, and De-
cember 31, 2012. Dogs were included if they had been
assigned an ASA status between I and III prior to sur-
gery. Dogs were excluded if they had been assigned
an ASA status of IV or V, had undergone emergency
surgery, or underwent only radiation therapy.
Once all eligible brachycephalic dogs had been
identified, 1 eligible nonbrachycephalic dog was se-
lected to match each included brachycephalic dog
on the basis of surgical procedure performed or, if no
exact procedure match was available, on the basis of
similar procedure invasiveness. As a second, third, and
fourth priority, dogs were also matched by age, body
weight, and sex, respectively, whenever possible.
Data collection
Information was obtained from the medical re-
cords regarding dog breed, age, sex, and body weight;
surgical procedure performed; ASA status; drugs ad-
ministered throughout the procedure (ie, specific
sedatives, opioids, induction anesthetic agents, main-
tenance agent, and additional drugs); whether epi-
sodes of hypotension (systolic arterial blood pressure <
80 mm Hg or mean arterial blood pressure < 60 mm
Hg) and bradycardia (heart rate < 60 beats/min) were
recorded, the duration of each episode, and the na-
ture of interventions performed; and whether hypo-
thermia (rectal or esophageal temperature < 35.6°C
[96.1°F]) was recorded. Information regarding re-
corded peri- and postanesthetic complications such
as hypertension, vomiting or regurgitation, VPCs, and
302 JAVMA • Vol 253 • No. 3 • August 1, 2018
dysphoria was also obtained, as were durations of an-
esthesia, surgery, and positive-pressure ventilation (if
provided). The postanesthetic period was defined as
the time from discontinuation of inhalant anesthetic
to discharge from the hospital. Information regarding
postanesthetic complications was also obtained from
discharge instructions.
Procedures were grouped in 3 broad categories:
noninvasive, minimally invasive, and invasive. Non-
invasive procedures included imaging (CT or MRI),
dental hygiene procedures, wound management, and
endoscopy. Minimally invasive procedures included
ophthalmic surgeries, orthopedic surgeries, ovariohys-
terectomy and orchiectomy, mass removal surgeries,
tail or digit amputations, and cardiological coiling or
ballooning. Invasive procedures included intra-abdom-
inal surgeries other than ovariohysterectomy, such as
portosystemic shunt ligation, exploratory celiotomy,
and gastrointestinal biopsy; neurologic surgeries (eg,
ventral slot or hemilaminectomy procedures); and up-
per airway surgeries, such as arytenoid lateralization
and procedures to correct brachycephalic airway syn-
drome. Procedures were also categorized by respon-
sible hospital service (ie, orthopedic, soft tissue, den-
tistry, ophthalmology, radiology, or multiple services).
Statistical analysis
Logistic regression was performed by use of
statistical softwarea to compare the odds of 3 out-
comes—intra-anesthetic, postanesthetic, and peri-
anesthetic (both intra-anesthetic and postanesthetic)
complications—between brachycephalic and non-
brachycephalic dogs, controlling for other factors.
A forward-selection model building approach was
used to select from the variables brachycephalic sta-
tus; procedure invasiveness; dog age, sex, and body
weight; attending hospital service; ASA status; type
of administered sedative, opioid, induction agent,
and maintenance agent; duration of anesthesia; and
presence of hypothermia during anesthesia (yes or
no). Any variable with a univariable model P value of
≤ 0.20 was considered in the multivariable analysis.
Hypotension and bradycardia were classified as
anesthetic complications, and in the multivariable
model for postanesthetic complications, hypoten-
sion and bradycardia were included as independent
variables. If multiple anesthesia procedures were
performed for a single patient, only 1 procedure was
included for analysis to avoid correlated data. Coef-
ficients in the final multivariable models for each of
the 3 outcomes were exponentiated to generate ORs.
The null hypothesis that the OR was equal to 1 was
tested by computation of the likelihood ratio χ2 statis-
tic. Odds ratios for which the 95% CI excluded 1 were
considered significant.
Results
Animals
A total of 486 (243 brachycephalic and 243 non-
brachycephalic) dogs were considered for inclusion
 Small Animals

in the study. Twenty (8.2%) dogs in each group were intact females were approximately twice as likely to
excluded because they had undergone ≥ 2 proce- have an intra-anesthetic complication as were castrat-
dures requiring anesthesia during 2012, leaving 223 ed males. The odds of a complication decreased by
dogs in each group. Thirteen brachycephalic dog 2.0% for every 1-kg (2.2-lb) increase in body weight
breeds were represented, including Boxer (n = 45), (OR = 0.98). Dogs treated by the orthopedic service
English Bulldog (41), Shih Tzu (31), Pug (29), Boston were 44.0% less likely to have a complication than
Terrier (21), Mastiff (15), French Bulldog (14), Ameri- were those treated by the soft tissue or dentistry ser-
can Bulldog (10), Chinese Shar-Pei (5), Lhasa Apso vices (OR = 0.56).
(5), Brussels Griffon (3), Pekingese (2), and Dogue de Factors identified through multivariable modeling
Bordeaux (2). as significantly associated with perianesthetic (intra-
anesthetic and postanesthetic) complications included
Outcomes brachycephalic status, body weight, duration of anes-
Perianesthetic (intra- and postanesthetic) compli- thesia, and attending hospital service (Table 2). In
cations were recorded for 49.1% (n = 219) of all 446 this model, brachycephalic dogs were approximately
dogs, intra-anesthetic complications for 40.4% (180), twice as likely to have a perianesthetic complication
and postanesthetic complications for 8.7% (39). as were nonbrachycephalic dogs (OR = 2.06). For each
These complications were recorded for 49.8% (n = 30-minute increase in the duration of anesthesia, the
111), 49.3% (110), and 13.9% (31) of the 223 brachy- odds of a perianesthetic complication increased by
cephalic dogs, respectively, and 48.4% (108), 48.9% 18.0% (OR = 1.18). Dogs treated by the orthopedic or
(109), and 3.6% (8) of the 223 nonbrachycephalic radiology services were less likely to have a complica-
dogs, respectively. tion than those treated by the soft tissue service. The
The most common postanesthetic complication
was aspiration pneumonia, which was recorded for 9
(4.0%) brachycephalic dogs and no nonbrachycephal- Table 1—Results of multivariable logistic regression modeling
ic dogs. Other complications included regurgitation to identify factors associated with intra-anesthetic complications
(7 [3.1%] brachycephalic dogs); dysphoria (1 [0.4%] in dogs undergoing routine surgery or advanced imaging (n =
brachycephalic and 4 [1.8%] nonbrachycephalic 446; 223 brachycephalic and 223 nonbrachycephalic dogs).
dogs); prolonged recovery (3 [1.3%] brachycephalic Factor OR (95% CI) P value
and 3 [1.3%] nonbrachycephalic dogs); stertorous Brachycephalic (vs nonbrachycephalic) 1.57 (1.05–2.34) 0.03
breathing (3 [1.8%] brachycephalic and 1 [0.4%] non- Body weight (kg) 0.98 (0.97–0.99) 0.01
brachycephalic dogs); death (2 [0.9%] brachycephalic Anesthetic duration (every 30 min) 1.01 (1.00–1.01) 0.003
Reproductive status
dogs); vomiting, anemia requiring blood transfusion, Castrated male 1.00 Referent
cranial or facial edema, hematuria or urinary tract Sexually intact female 2.1 (0.02–4.32) 0.04
infection, or inappetence (1 [0.4%] brachycephalic Spayed female 0.89 (0.02–4.32) 0.63
dog each); and VPCs (1 [0.4%] nonbrachycephalic Sexually intact male 1.20 (0.67–2.15) 0.54
Attending hospital service
dog). Of the 9 dogs with aspiration pneumonia, 4 had Soft tissue or dentistry 1.00 Referent
thoracic radiography performed prior to anesthesia Orthopedics 0.56 (0.32–0.98) 0.04
with no radiographic or clinical signs of aspiration Ophthalmology 0.86 (0.47–1.59) 0.64
pneumonia detected. Four dogs had radiography Radiology 0.60 (0.31–1.16) 0.13
Multiple services 0.58 (0.15–2.15) 0.41
performed only after the anesthetic event. One dog
had aspiration pneumonia diagnosed on the basis of Associations were considered significant when the 95% CI for a
thoracic radiographic findings before the anesthetic given OR excluded 1. An OR > 1 indicates an increased risk of the out-
event. Postoperative thoracic radiographs were ob- come relative to the risk in the referent group, and OR < 1 indicates
tained for this dog 24 hours after surgery, revealing a decreased risk.
worsening of the aspiration pneumonia.

Factors associated with outcome Table 2—Results of multivariable logistic regression modeling
No associations with any evaluated outcome to identify factors associated with perianesthetic (intra-anesthetic
were identified for sedatives, opioids, hypothermia, and postanesthetic) complications in the dogs of Table 1.
or anesthetic maintenance agents used or dog age. Factor OR (95% CI) P value
Factors identified through multivariable modeling as Brachycephalic (vs nonbrachycephalic) 2.06 (1.38–3.07) < 0.001
significantly associated with intra-anesthetic compli- Body weight (kg) 0.98 (0.97–1.00) 0.01
cations included brachycephalic status, body weight, Anesthetic duration (per 30-min interval) 1.18 (1.04–1.33) 0.01
Attending hospital service
duration of anesthesia, reproductive status, and at- Soft tissue 1.00 Referent
tending hospital service (Table 1). In this model, Dentistry 0.62 (0.22–1.72) 0.36
brachycephalic dogs were 1.57 times as likely to have Orthopedics 0.49 (0.03–0.86) 0.01
an intra-anesthetic complication as were nonbrachy- Ophthalmology 0.65 (0.35–1.21) 0.18
Radiology 0.45 (0.23–0.87) 0.03
cephalic dogs. For each 30-minute increase in dura- Multiple services 1.04 (0.25–4.35) 0.96
tion of anesthesia, the odds of an intra-anesthetic
complication increased by 0.6% (OR = 1.01). Sexually See Table 1 for key.

JAVMA • Vol 253 • No. 3 • August 1, 2018 303

 Small Animals
Table 3—Results of multivariable logistic regression modeling
to identify factors associated with postanesthetic complications
in the dogs of Table 1.
Factor OR (95% CI) P value
Brachycephalic (vs nonbrachycephalic) 4.33 (1.85–10.15) 0.001
ASA status in the airway.12 This negative pressure can then cause
I 1.00 Referent
II 2.59 (0.99–6.70) 0.05
III 3.79 (1.32–1.08) 0.01
Type of surgery negative-pressure pulmonary edema. In addition, the
Noninvasive 1.00 Referent
Minimally invasive 0.99 (0.33–2.90) 0.99
Invasive 5.21 (1.88–14.50) 0.002
Type of anesthetic induction agent used
Propofol with or without lidocaine 1.00 Referent
Propofol plus ketamine 1.31 (0.41–4.19) 0.65
Ketamine plus benzodiazepine 4.45 (1.50–13.12) 0.007
Other induction agent 2.08 (0.21–20.75) 0.53
See Table 1 for key.
odds of a perioperative complication decreased by 2%
with every 1-kg increase in body weight (OR = 0.98).
Factors identified through multivariable modeling
as significantly associated with postanesthetic compli-
cations included brachycephalic status, ASA status, inva-
siveness of surgery, and anesthetic induction agent used
(Table 3). Brachycephalic dogs had approximately 4
times the odds of a postanesthetic complication relative
to nonbrachycephalic dogs (OR = 4.33). The odds of
postanesthetic complication increased with increasing
ASA status. Dogs that underwent an invasive procedure
were approximately 5 times as likely to have a postan-
esthetic complications as were dogs that underwent a
noninvasive procedure (OR = 5.21). In addition, use of
ketamine plus a benzodiazepine for anesthetic induc-
tion was approximately 4 times as likely to be followed
by a postanesthetic complication as use of propofol
with or without lidocaine (OR = 4.45).
Discussion
Brachycephalic dogs are commonly brought to
the authors’ hospital for surgery to treat brachyce-
phalic airway syndrome. Brachycephalic dogs are
also referred for routine surgeries because veterinar-
ians and owners presume that a brachycephalic dog
is at a higher risk of adverse outcomes from anesthe-
sia, although this has never been conclusively dem-
onstrated. A survey13 of owners of dogs with severe
brachycephaly revealed that following brachycephal-
ic airway surgery, dogs had fewer life-threatening
respiratory-related events in their home environment
than before surgery. Such events included choking
fits, which decreased in incidence from 60% to 5%,
and collapse, which decreased in incidence from 27%
to 3%. However, only 7 dogs included in that study13
had a history of brachycephalic airway surgery.
Respiratory distress due to upper airway obstruc-
tion and overheating due to dysfunctional thermoregu-
lation are among the most life-threatening circumstanc-
es for brachycephalic dogs, and these factors account
304 JAVMA • Vol 253 • No. 3 • August 1, 2018
for much of the deterioration in their quality of life.8
These signs are also a concern for brachycephalic dogs
in a hospital setting. Pain or fear-induced tachypnea,
with a consequent increase in work of breathing, can
lead to a substantial increase in negative pressure with-
or exacerbate airway collapse or obstruction, and inef-
fective ventilation can soon lead to hypoxia and even
high prevalence of gastrointestinal signs (mostly vom-
iting and regurgitation) in brachycephalic dogs, includ-
ing but not limited to gastroesophageal reflux, distal
esophagitis, and diffuse pyloric hyperplasia, may lead
to a higher risk of possible aspiration than the risk for
dogs without these signs.11 Therefore, brachycephalic
dogs will often receive gastroprotectants, antinausea
medications, and prokinetics in the perianesthetic pe-
riod to reduce the risk of regurgitation and aspiration
pneumonia.
Withholding of food for 24 hours and sedative
administration prior to anesthesia have been pro-
posed to reduce the risk of regurgitation and aspira-
tion pneumonia in brachycephalic dogs.14 In addition,
prophylactic gastrointestinal medication administra-
tion (proton-pump inhibitors, prokinetics, antinau-
sea medications) to brachycephalic dogs undergoing
upper airway surgery may be helpful in prevent-
ing complications like aspiration pneumonia.11 One
study15 showed improvement of gastrointestinal signs
without complete resolution after brachycephalic air-
way surgery. Another study16 revealed improvement
of gastrointestinal signs after brachycephalic airway
surgery; however, medical management of gastroin-
testinal signs had no significant long-term effect, and
improvement was achieved with surgery alone. A 24-
hour food withholding period prior to anesthesia was
not beneficial in that study.16
Brachycephalic dogs were at a higher risk than
nonbrachycephalic dogs of developing complications
in the perianesthetic period in the present study, but
even more so in the postanesthetic period specifi-
cally. Brachycephalic conformation was significantly
associated with outcome in all 3 models, with the
greatest association observed for complications dur-
ing the postanesthetic period. Brachycephalic dogs
are likely at a higher risk of complications following
rather than during anesthesia because respiratory ob-
struction can occur after extubation.
Death was the most severe complication in the
present study, and this as well as other types of peri-
anesthetic complications appeared more common
in brachycephalic dogs than in nonbrachycephalic
dogs. Dysphoria and VPCs were the only 2 complica-
tions that were more common in nonbrachycephalic
dogs. In general, brachycephalic dogs are prone to
a higher resting vagal tone than nonbrachycephalic
dogs and therefore more prone to sinus bradycardia,17
which should put them at a lower risk for VPCs.
Anesthetized brachycephalic dogs should remain
intubated until they are awake,12 which helps to im-

prove breathing because the airway is kept open. In
the authors’ experience, endotracheal tubes are well
tolerated by most brachycephalic dogs, even when
dogs are fairly awake following anesthesia. Brachyce-
phalic dogs with airway obstruction had significantly
shorter expiratory-to-inspiratory ratios than control
dogs in another study,18 which further supports the
Hoareau hypothesis of a high resistance to flow on
inspiration. Thus, increasing the oxygen flow by pro-
viding an adequate airway opening with the endotra-
cheal tube decreases respiratory effort.
Invasive (vs noninvasive) procedures were asso-
ciated with increased risk of postanesthetic compli-
cations in the study reported here. Our data suggest-
ed a higher rate of complications in brachycephalic
dogs during the intra-anesthetic and perianesthetic
periods with increasing duration of anesthesia. Pro-
longed surgery is significantly related to complica-
tion rates in humans.19 In a previous study20 involving
anesthetized cats and dogs, procedure duration and
type of anesthetic induction and maintenance agents
used were associated with anesthetic-related death.
Sexually intact females were at higher risk of
intra-anesthetic complications than males in the pres-
ent study; however, the reason for this remains un-
clear. To the authors’ knowledge, this finding has not
been reported previously.
Although many dogs were included in the present
study, the design was observational in nature and not
a randomized controlled trial. It would be worthwhile
to investigate whether specific anesthetic agents may
minimize the odds of perianesthetic complications in
brachycephalic dogs. In addition, information on oth-
er potential risk or protective factors, such as body
condition score, was unavailable. Therefore, although
an association was identified between body weight
and intra- or perianesthetic complications, it remains
unknown whether this association could have been
attributable to body condition or to breed size. Fur-
ther investigation is warranted into the potential asso-
ciation between body condition score and anesthetic-
related complications in brachycephalic dogs.
Invasive procedures and higher ASA status, to-
gether with brachycephalic dog breed, accounted for
higher risks of a broad range of postanesthetic com-
plications in the study reported here. At the time of
our study, we were unaware of any reported studies
regarding associations between perianesthetic com-
plications and procedure invasiveness in brachyce-
phalic dogs. Noninvasive procedures included those
such as CT or MRI, whereas invasive procedures in-
cluded exploratory celiotomy or gastrointestinal sur-
gery, which can lead to blood loss or functional ileus.
The duration of postoperative ileus was briefer with
less invasive procedures (eg, laparoscopic cholecys-
tectomy) than with more invasive procedures (eg,
open cholecystectomy) in a previous study21 involv-
ing humans.
High ASA status has also been associated with
a higher risk of death in dogs and cats.22 We inten-
tionally excluded dogs with an ASA status ≥ IV from
JAVMA • Vol 253 • No. 3 • August 1, 2018
Small Animals
the present study to decrease the impact of systemic
abnormalities on outcome, and this choice may have
accounted for the finding that the ASA status had a
lower OR for postanesthetic complications than the
brachycephalic breed. Despite the exclusion of dogs
with a high ASA status and dogs that underwent
emergency procedures, both deaths observed in our
study involved brachycephalic and not nonbrachyce-
phalic dogs. One brachycephalic dog died of cardiac
arrest during anesthetic induction with propofol and
had been anesthetized for intravitreal gentamycin
injection. The other brachycephalic dog died 4 days
after undergoing a Billroth II procedure; this patient
stopped breathing during morning treatments and
then had cardiac arrest.
In general, brachycephalic dogs were often clas-
sified as ASA status II for no other reason than the
brachycephaly. Although care was taken to ensure
that most nonbrachycephalic dogs had the same or
worse ASA status as their matched brachycephalic
counterpart, the odds of developing complications
remained higher for brachycephalic dogs.
We also found that dogs that received ketamine
and a benzodiazepine as anesthetic induction agents
were at higher risk of postanesthetic complications
than dogs for which propofol with or without lido-
caine was used. This finding was unexpected given
that both ketamine and benzodiazepines cause mini-
mal to no respiratory depression23 and are considered
appropriate for dogs with airway disease or dysfunc-
tion. The induction and recovery phases of anesthesia
for brachycephalic dogs can be dangerous, but the
maintenance phase is generally straightforward be-
cause the laryngeal opening is protected by an endo-
tracheal tube.12
Brachycephalic dogs were 1.57 times as likely to
have intra-anesthetic complications and 4.33 times as
likely to have postanesthetic complications as were
nonbrachycephalic dogs in the present study. The eti-
ology of perianesthetic complications is likely multi-
factorial, and additional studies should be performed
to identify anesthetic practices that reduce the risk of
perianesthetic complications in brachycephalic dogs.
Acknowledgments
Presented in abstract form at the American College of Veteri-
nary Surgeons Surgery Summit, Indianapolis, Ind, October 2017.
The authors thank Kathleen Bailey, Heather Cruea, Theresa
Hand, Gladys Karpa, Mary Beth Morrow, Amanda Spires, Robyn
Victorine, and Dan Wallon for data collection and patient care.
Footnotes
a. Stata, version 13, StataCorp LP, College Station, Tex.
References
1. Trader R. Nose operation. J Am Vet Med Assoc 1949;114:210–211.
2. Oechtering TH, Oechtering GU, Nöller C. Structural charac-
teristics of the nose in brachycephalic dog breeds analysed
by computed tomography. Tierarztl Prax 2007;35:177–187.
3. Farquharson J, Smith KW. Resection of the soft palate in the
dog. J Am Vet Med Assoc 1942;100:427–430.
305
 Small Animals

4. Leonard HC. Eversion of the lateral ventricles in dogs; five
cases. J Am Vet Med Assoc 1957;131:83–84.
5. Leonard HC. Collapse of the larynx and adjacent structures
in the dog. J Am Vet Med Assoc 1960;137:360–363.
6. Suter PF, Colgrove DJ, Ewing GO. Congenital hypoplasia
of the canine trachea. J Am Anim Hosp Assoc 1972;8:120–
127.
7. De Lorenzi D, Bertoncello D, Drigo M. Bronchial abnormali-
ties found in a consecutive series of 40 brachycephalic dogs.
J Am Vet Med Assoc 2009;235:835–840.
8. Roedler FS, Pohl S, Oechtering GU. How does severe brachy-
cephaly affect dog’s lives? Results of a structured preopera-
tive owner questionnaire. Vet J 2013;198:606–610.
9. Hoareau GL, Jourdan G, Mellema M, et al. Evaluation of ar-
terial blood gases and arterial blood pressures in brachyce-
phalic dogs. J Vet Intern Med 2012;26:897–904.
10. Hendricks JC, Kline LR, Kovalski RJ, et al. The English Bull-
dog: a natural model of sleep-disordered breathing. J Appl
Physiol 1987;63:1344–1350.
11. Poncet CM, Dupre GP, Freiche VG, et al. Prevalence of gastro-
intestinal tract lesions in 73 brachycephalic dogs with upper
respiratory syndrome. J Small Anim Pract 2005;46:273–279.
12. Grubb T. Anesthesia for patients with respiratory disease
and/or airway compromise. Top Companion Anim Med
2010;25:120–132.
13. Pohl S, Roedler FS, Oechtering GU. How does multilevel up-
per airway surgery influence the lives of dogs with severe
brachycephaly? Results of a structured pre- and postopera-
tive owner questionnaire. Vet J 2016;210:39–45.
14. Hendricks JC. Brachycephalic airway syndrome. Vet Clin
North Am Small Anim Pract 1992;22:1145–1153.
15. Haimel G, Dupre GP. Brachycephalic airway syndrome:
a comparative study between Pugs and French Bulldogs.
J Small Anim Pract 2015;56:714–719.
16. Poncet CM, Dupre GP, Freiche VG, et al. Long-term results
of upper respiratory syndrome surgery and gastrointesti-
nal tract medical management in 51 brachycephalic dogs.
J Small Anim Pract 2006;47:137–142.
17. Doxey S, Boswood A. Differences between breeds of dog in a
measure of heart rate variability. Vet Rec 2004;154:713–717.
18. Bernaerts F, Talavera J, Leemans J, et al. Description of original en-
doscopic findings and respiratory functional assessment using baro-
metric whole-body plethysmography in dogs suffering from brachy-
cephalic airway obstruction syndrome. Vet J 2010;183:95–102.
19. Kroenke K, Lawrence VA, Theroux JF, et al. Operative risk
in patients with severe obstructive pulmonary disease. Arch
Intern Med 1992;152:967–971.
20. Brodbelt D. Perioperative mortality in small animal anaesthe-
sia. Vet J 2009;182:152–161.
21. Schippers E, Ottinger AP, Anurov M, et al. Intestinale motil-
ität nach laparoskopischer vs. konventioneller cholezystekto-
mie. Langenbecks Arch Chir 1992;377:14–18.
22. Bille C, Auvigne V, Libermann S, et al. Risk of anaesthetic
mortality in dogs and cats: an observational cohort study of
3546 cases. Vet Anaesth Analg 2012;39:59–68.
23. Haskins SC, Farver TB, Patz JD. Cardiovascular changes in
dogs given diazepam and diazepam-ketamine. Am J Vet Res
1986;47:795–798.

From this month’s AJVR

Evaluation of the thermal antinociceptive effects and pharmacokinetics

of hydromorphone hydrochloride after intramuscular administration
to cockatiels (Nymphicus hollandicus)
Emma L. Houck et al

OBJECTIVE
To evaluate the thermal antinociceptive effects and pharmacokinetics of hydromorphone hydro-
chloride after IM administration to cockatiels (Nymphicus hollandicus). August 2018
ANIMALS
16 healthy adult cockatiels.
See the midmonth
PROCEDURES
During the first of 2 study phases, each cockatiel received each of 4 treatments (hydromorphone issues of JAVMA
at doses of 0.1, 0.3, and 0.6 mg/kg and saline [0.9% NaCl] solution [0.33 mL/kg; control], IM), with for the expanded
a 14-day interval between treatments. For each bird, foot withdrawal in response to a thermal
stimulus was determined following assignment of an agitation-sedation score at predetermined table of contents
times before and for 6 hours after each treatment. During the second phase, a subset of 12 birds
received hydromorphone (0.6 mg/kg, IM), and blood samples were collected at predetermined
for the AJVR
times for 9 hours after drug administration. Plasma hydromorphone concentration was deter- or log on to
mined by liquid chromatography–mass spectrometry. Noncompartmental analysis of sparse data
was used to calculate pharmacokinetic parameters. avmajournals.avma.org
RESULTS for access
Thermal withdrawal response did not differ among the 4 treatment groups at any time. Agitation- to all the abstracts.
sedation scores following administration of the 0.3- and 0.6-mg/kg doses of hydromorphone dif-
fered significantly from those for the treatment with saline solution and suggested the drug had
a sedative effect. Plasma hydromorphone concentrations were > 1 ng/mL for 3 to 6 hours after
drug administration in all birds.
CONCLUSIONS AND CLINICAL RELEVANCE
Results indicated that IM administration of hydromorphone at the evaluated doses did not in-
crease the thermal withdrawal threshold of cockatiels despite plasma drug concentrations consid-
ered therapeutic for other species. Further research is necessary to evaluate the analgesic effects
of hydromorphone in cockatiels. (Am J Vet Res 2018;79:820–826)

306 JAVMA • Vol 253 • No. 3 • August 1, 2018