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130 Brachycephalic Airway Syndrome

• Pharyngeal collapse
○ No treatment currently available
VetBooks.ir ○ New treatments are being explored, such
• Caudal aberrant nasal turbinates
as laser ablation of aberrant turbinates.
Chronic Treatment
Treatment of underlying GI disease may
improve outcome. Surgical correction of hiatal
hernia may be necessary if medical management
does not improve clinical signs (p. 468).
Nutrition/Diet
Maintain lean body weight (p. 1077).
Behavior/Exercise A B
• Patients should avoid hot environments BRACHYCEPHALIC AIRWAY SYNDROME A, French bulldog with severe stenotic nares. B, Sedated
because they have limited ability for airway examination of an English bulldog; note that the soft palate extends and obscures the larynx.
thermoregulation.
• Avoid strenuous exercise, especially during
warm weather.
Possible Complications after 2 years of age has been shown to have Technician Tips
• Hyperthermia worse prognosis. • Hospitalized patients with BAS require
• Noncardiogenic pulmonary edema (pp. 27 • Presence of laryngeal collapse associated with intensive preoperative and postoperative
and 836) a worse prognosis due to limited surgical care and constant monitoring. Respiratory
○ Can cause persistence of hypoxemia and corrections obstruction is a potential problem at any
cyanosis even after obstruction has been time. Technicians caring for these patients
corrected PEARLS & CONSIDERATIONS perioperatively should be familiar with and
• Aspiration pneumonia comfortable performing:
• Oronasal reflux if excessive shortening of Comments ○ Orotracheal intubation in a brachycephalic
soft palate • Early decision and surgical correction may dog
○ Do not excise rostral to the caudal pole reduce the secondary clinical signs caused ○ Oxygen administration
of the tonsillar crypt. by chronic negative inspiratory pressure. ○ Tracheostomy care
• Upper airway obstruction secondary to Correction at the time of early neuter is
inflammation often ideal. Client Education
○ Be prepared to perform temporary tra- • Severe dyspnea should be treated with seda- • Discuss breed-associated heritability of
cheostomy in cases of soft palate resection tion and oxygen therapy; may need endo- brachycephalic conditions.
or laryngeal sacculectomy (p. 1166). tracheal intubation • Syndrome is progressive and may cause
• Use caution with sedation in brachycephalic clinical signs later in life. Clients should limit
Recommended Monitoring patients, who may be predisposed to upper activities that exacerbate clinical signs and
• Postoperative monitoring should minimally airway obstruction. If sedation is necessary, should avoid obesity, high ambient tempera-
include respiratory rate and effort, oxygen- oxygen supplementation is necessary to tures, and stress.
ation, mucous membrane color, mentation, prevent hypoxemia. • Early surgical intervention may result in best
and evidence of regurgitation/vomiting. • Endotracheal tube should be sized smaller long-term outcome.
• Monitor for recurrence of clinical signs, than expected for patient size.
which may indicate progression of or • Identification of features such as pharyngeal SUGGESTED READING
degeneration of upper airway disease (laryn- collapse and caudal aberrant turbinates may Dupré G, et al: Brachycephalic syndrome. Vet Clin
geal collapse, pharyngeal collapse). Additional help to better elucidate prognosis. North Am Small Anim Pract 46:691-707, 2016.
sedated airway exam may show excessive
granulation tissue on soft palate or inap- Prevention AUTHOR: Jacob A. Rubin DVM, DACVS
EDITOR: Elizabeth A. Swanson DVM, MS, DACVS
propriate resection. BAS is a genetically inherited disease.
Until such a time as public perceptions
PROGNOSIS & OUTCOME of extreme flat faces in certain breeds are
undesirable, breeding practices are unlikely to
• Prognosis depends on secondary effects of the change.
chronic negative airway pressure. Correction

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