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Filipas MC, Owen L, Adami C. A retrospective observational cohort study on the postoperative respiratory complications and their risk factors in brachycephalic dogs undergoing BOAS surgery: 199 cases (2019-2021). J Small Anim Pract 2024; 65:329-337. [PMID: 38413137 DOI: 10.1111/jsap.13707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Revised: 01/11/2024] [Accepted: 01/17/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVES To observe the occurrence of postanaesthetic respiratory complications and to determine their prevalence and risk factors in dogs undergoing brachycephalic obstructive airway syndrome surgery. MATERIALS AND METHODS Data from 199 clinical records were retrospectively analysed. Univariable logistic regression followed by multivariable logistic regression was used to identify associations between the dependent variables (set as the postoperative respiratory complications observed in the study dogs) and various independent covariates. The quality of model-fit was assessed using the likelihood ratio test. P≤0.05 was considered statistically significant. RESULTS Four postoperative respiratory complications were observed: hypoxaemia (n=10/199; 5%), dyspnoea requiring tracheal re-intubation (n=13/199, 7%), dyspnoea requiring tracheostomy (n=10/199, 5%) and aspiration pneumonia (n=12/199, 6%). Univariable logistic regression showed an association between postoperative aspiration pneumonia and increasing body condition score and American Society of Anaesthesiology classification; however, when these covariates were evaluated in the multivariable model significance was not maintained. Risk factors for tracheostomy were preoperative and postoperative aspiration pneumonia (odds ratio: 9.52, 95% confidence interval: 1.56 to 57.93) and increasing brachycephalic obstructive airway syndrome grade (odds ratio: 4.65, 95% confidence interval: 0.79 to 27.50). CLINICAL SIGNIFICANCE High brachycephalic obstructive airway syndrome grade and aspiration pneumonia, either developing peri-operatively or as pre-existing condition, may represent risk factors for postoperative tracheostomy. Preoperative diagnosis of aspiration pneumonia may further increase the risk of postoperative complications.
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Affiliation(s)
- M C Filipas
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - L Owen
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
| | - C Adami
- Department of Veterinary Medicine, University of Cambridge, Madingley Road, Cambridge, CB3 OES, UK
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Lai GP, Grimes JA, Wallace ML, Schmiedt CW, Savage MY. Anatomic characterization of the location of the esophageal ostium relative to the rima glottidis on CT in adult Labrador Retrievers. Am J Vet Res 2021; 82:975-980. [PMID: 34714769 DOI: 10.2460/ajvr.20.11.0201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To characterize the anatomic location of the esophageal ostium relative to the rima glottidis in adult Labrador Retrievers with the use of CT. ANIMALS 98 CT scans of 75 adult Labrador Retrievers. PROCEDURES A search of the medical records database identified records of Labrador Retrievers that underwent CT of the head and neck between January 1, 2015, and December 31, 2018. Evaluators, blinded to each other's results, reviewed CT images and measured esophageal area at the level of the rima glottidis. For each dog, the left esophageal percentage (LEP) was calculated as the esophageal area left of the rima glottidis midline divided by the overall esophageal area at that level. Variables (age, sex, patient position, intubation status, and maxillary support during CT) were evaluated for association with LEP. The CT images of dogs that had multiple scans were assessed for within-patient variance. RESULTS Mean LEP was 56.2 ± 18.1% for all dogs. Only right lateral recumbency was significantly associated with LEP, with a lower LEP for dogs positioned in right lateral recumbency (42.4 ± 12.7%), compared with left lateral (63.0 ± 7.4%) or sternal (57.3 ± 18.8%) recumbency. No association was detected between LEP and other variables assessed. Eleven dogs had multiple CT scans; within-patient variance for LEP was ± 26.6%. CONCLUSIONS AND CLINICAL RELEVANCE Results indicated that, although most dogs had an LEP > 50%, the esophageal ostium was fairly centrally located in most dogs and may be more mobile than previously thought. Additional research is warranted to assess this mobility and whether the esophageal ostium location, relative to the larynx, affects the incidence of aspiration pneumonia in dogs undergoing surgical treatment for geriatric-onset laryngeal paralysis and polyneuropathy.
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Affiliation(s)
- Grace P Lai
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Janet A Grimes
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Mandy L Wallace
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
| | - Chad W Schmiedt
- From the Department of Small Animal Medicine and Surgery, College of Veterinary Medicine, University of Georgia, Athens, GA 30602
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Jones CT, Fransson BA. Evaluation of the effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux in dogs. J Am Vet Med Assoc 2020; 255:437-445. [PMID: 31355727 DOI: 10.2460/javma.255.4.437] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE To investigate the prophylactic effectiveness of preoperative administration of maropitant citrate and metoclopramide hydrochloride in preventing postoperative clinical gastroesophageal reflux (GER) in dogs and to identify risk factors for clinical postoperative GER in dogs. ANIMALS 93 client-owned dogs undergoing surgery at the Washington State University Veterinary Teaching Hospital between March 2016 and February 2017. PROCEDURES Dogs were randomly assigned to either the intervention group (preoperatively received maropitant and metoclopramide) or the control group (did not preoperatively receive maropitant and metoclopramide). After surgery, all dogs were recovered and monitored, and occurrences of GER were noted. The prophylactic effectiveness of maropitant and metoclopramide was evaluated, and univariate and multivariate logistic regression analyses were performed to identify variables associated with postoperative clinical GER in dogs. RESULTS No meaningful difference in the incidence of clinical GER during the postoperative period was detected between the control and intervention groups. Results indicated that variables associated with significantly increased odds of postoperative clinical GER included the male sex (OR, 9.2; 95% confidence interval [CI], 1.26 to 195.0), an overweight BCS (OR, 12.3; 95% CI, 2.1 to 135.1), gastrointestinal surgery (OR, 30.5; 95% CI, 3.0 to 786.9), and requirement for a dexmedetomidine constant rate infusion after surgery (OR, 9.6; 95% CI, 1.3 to 212.5). CONCLUSIONS AND CLINICAL RELEVANCE Findings indicated that incidence of clinical GER during the postoperative period was not lower for dogs that received preoperative prophylactic administration of metoclopramide and maropitant, compared with incidence dogs that did not receive the prophylactic treatment. Further research is required into alternative measures to prevent postoperative clinical GER in dogs.
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Lindsay B, Cook D, Wetzel JM, Siess S, Moses P. Brachycephalic airway syndrome: management of post-operative respiratory complications in 248 dogs. Aust Vet J 2020; 98:173-180. [PMID: 32037517 DOI: 10.1111/avj.12926] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 11/28/2022]
Abstract
OBJECTIVE As ownership of brachycephalic dog breeds rises, the surgical correction of components of brachycephalic airway syndrome (BAS) is increasingly recommended by veterinarians. This study's objective was to describe the incidence of, and strategies for the management of post-operative respiratory complications in brachycephalic dogs undergoing surgical correction of one or more components of BAS. METHODS Medical records of 248 brachycephalic dogs treated surgically for BAS were retrospectively reviewed for demographic information, procedures performed, post-operative complications and treatment implemented, hospitalisation time, and necessity for further surgery. RESULTS Pugs, Cavalier King Charles Spaniels and British Bulldogs were the most commonly encountered breeds. Dogs which experienced a complication were significantly older (mean was 5.5 years, compared with 4.1 years [P < 0.01]). Fifty-eight dogs (23.4%) had complications which included: dyspnoea managed with supplemental oxygen alone (7.3%, n = 18), dyspnoea requiring anaesthesia and re-intubation (8.9%, n = 22), dyspnoea necessitating treatment with a temporary tracheostomy (8.9%, n = 22), aspiration pneumonia (4%, n = 10), and respiratory or cardiac arrest (2.4%, n = 6). Five of the 22 dogs requiring anaesthesia and re-intubation deteriorated 12 or more hours after post-surgical anaesthetic recovery. The overall mortality rate in this study was 2.4% (n = 6). Age, concurrent airway pathology, and emergency presentation significantly predicted post-operative complications. CONCLUSION Our data show the importance of close monitoring for a minimum of 24 h following surgery by an experienced veterinarian or veterinary technician. Surgical intervention for BAS symptomatic dogs should be considered at an earlier age as an elective procedure, to reduce the risk of post-operative complications.
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Affiliation(s)
- B Lindsay
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - D Cook
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - J-M Wetzel
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - S Siess
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
| | - P Moses
- Department of Neurology, Veterinary Specialist Services, Underwood, Queensland, 4119, Australia
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Sample SJ, Stilin A, Binversie EE, Baker LA, Hardie RJ. Late-onset laryngeal paralysis: Owner perception of quality of life and cause of death. Vet Med Sci 2020; 6:306-313. [PMID: 31981469 PMCID: PMC7397904 DOI: 10.1002/vms3.240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Revised: 10/10/2019] [Accepted: 01/05/2020] [Indexed: 01/13/2023] Open
Abstract
Background Late‐onset laryngeal paralysis (LoLP) is an idiopathic disease of older dogs, and is common in the Labrador Retriever. Owner perspective of how LoLP affects their pet's quality of life (QOL), the degree to which LoLP is perceived to be a life‐limiting disease, and how a glottic opening procedure affects these perceptions is not known. Objectives (a) To determine owner's perception of late‐onset laryngeal paralysis (LoLP) with respect to their dog's QOL; (b) To determine whether LoLP is considered by owners to be a life‐limiting disease; (c) To evaluate whether a glottic opening procedure altered QOL and perceived cause of death in affected dogs. Methods Owners of Labrador Retrievers with LoLP completed a questionnaire. Questions were asked pertaining to a dog's LoLP, including clinical progression and perception of cause of death, and whether a glottic opening procedure was undertaken. Owners also completed a pet‐owner administered QOL survey. Results Seventy‐six owners participated. Overall, 94% of owners felt their dog's LoLP affected QOL, and 47% of owners felt LoLP was a large contributing factor in their dog's death. Dogs that underwent a glottic opening procedure were reported to have a better QOL, and the contribution of LoLP towards their death was less than dogs that did not have surgery. Conclusion Owners of Labrador Retrievers with LoLP perceive LoLP to be a life‐limiting disease that negatively impacts their dog's QOL. Arytenoid lateralization surgery had a positive impact on QOL in affected dogs.
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Affiliation(s)
- Susannah J Sample
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Allison Stilin
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Emily E Binversie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Lauren A Baker
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Robert J Hardie
- Department of Surgical Sciences, School of Veterinary Medicine, University of Wisconsin-Madison, Madison, WI, USA
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Abstract
Laryngeal diseases are manifested by obstructive breathing patterns reflecting functional or mechanical upper airway obstruction. Laryngeal paralysis is the most common disease of the larynx. Diagnosis requires close attention to anesthetic plane and coordination of respiratory effort with laryngeal motion. Surgical arytenoid lateralization improves clinical signs and quality of life in dogs; however, aspiration pneumonia is a recognized complication, and generalized neuropathy can progress. Laryngeal collapse can result from any cause of chronic upper airway obstruction but is most often associated with brachycephalic obstructive airway syndrome. Although uncommon, laryngeal neoplasia has a guarded to grave prognosis regardless of treatment.
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Affiliation(s)
- Catriona M MacPhail
- Small Animal Surgery, Department of Clinical Sciences, Colorado State University, 1601 Campus Delivery, Fort Collins, CO 80523-160, USA.
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Ogden J, Ovbey D, Saile K. Effects of preoperative cisapride on postoperative aspiration pneumonia in dogs with laryngeal paralysis. J Small Anim Pract 2018; 60:183-190. [DOI: 10.1111/jsap.12940] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 07/13/2018] [Accepted: 07/29/2018] [Indexed: 11/28/2022]
Affiliation(s)
- J. Ogden
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania 15237 USA
| | - D. Ovbey
- Southeast Veterinary Anesthesia Services; Charleston South Carolina 29416 USA
| | - K. Saile
- Pittsburgh Veterinary Specialty and Emergency Center; Pittsburgh Pennsylvania 15237 USA
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Brown MB, Dugat DR, Lyon SD, Nafe LA, Payton ME, Peakheart SK, Salazar RS. Comparison of methohexital and propofol as induction agents for evaluation of laryngeal function in healthy dogs. Vet Surg 2018; 48:70-78. [PMID: 30367699 PMCID: PMC6587481 DOI: 10.1111/vsu.13110] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Revised: 07/02/2018] [Accepted: 09/03/2018] [Indexed: 11/28/2022]
Abstract
Objective To determine the influence of propofol or methohexital, with and without doxapram, on the examination of laryngeal function in dogs. Study design Experimental study. Animals Forty healthy dogs randomly assigned to 4 groups: propofol with saline (n = 10), propofol with doxapram (n = 10), methohexital with saline (n = 10), or methohexital with doxapram (n = 10). Methods Propofol and methohexital were administered to effect. Investigators examined laryngeal function (initial) simultaneously with video laryngoscopy. Doxapram or saline was administered, and laryngeal function was reevaluated (second). Laryngeal motion, quality of laryngeal exposure, and the degree of swallowing, laryngospasm, and jaw tone were scored at each evaluation. Adverse events were recorded. Initial and second videos were evaluated by a masked observer, and still images obtained from both evaluations were evaluated for change in rima glottidis size by 2 masked observers. Results Administration of doxapram and saline was delayed with propofol (P = .001). Laryngeal function did not differ between dogs receiving propofol or methohexital, irrespective of doxapram administration. Doxapram improved breathing scores in both groups (P < .001). Jaw tone increased with propofol during the second evaluation (P = .049). Swallowing was more prevalent at initial examination (P = .020). Methohexital resulted in an increased heart rate (P < .001) compared with propofol. Twenty‐five percent of dogs receiving methohexital developed seizure‐like activity (n = 5/20). Conclusion Evaluation of laryngeal function did not differ between healthy dogs anesthetized with propofol or methohexital. Methohexital provided shorter examination times with less jaw tone but was associated with adverse events. Clinical significance This study provides evidence to recommend propofol over methohexital as an induction agent for laryngeal function examination.
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Affiliation(s)
- Mikala B Brown
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Danielle R Dugat
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Shane D Lyon
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Laura A Nafe
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Mark E Payton
- Department of Statistics, Oklahoma State University, Stillwater, Oklahoma
| | - Sarah K Peakheart
- Department of Veterinary Clinical Sciences, Oklahoma State University, Stillwater, Oklahoma
| | - Rebecca S Salazar
- Blue Pearl Veterinary Emergency and Specialty Hospital, Spring, Texas
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