Implementation of a standard perioperative protocol reduces postoperative respiratory distress events in dogs undergoing surgical correction of brachycephalic obstructive airway syndrome.

Objective: To determine whether a standardized perioperative protocol for patients undergoing brachycephalic obstructive airway syndrome (BOAS) surgery reduces the incidence of regurgitation, aspiration pneumonia, and respiratory distress in the postoperative period.

Methods: The records of client-owned dogs referred to the Texas A&M University Small Animal Teaching Hospital for surgical correction of BOAS over 4 years (February 2019 to June 2023) were retrospectively reviewed. A perioperative protocol for patients undergoing surgical correction of BOAS was implemented in June 2021, which included preoperative cisapride and antacid administration, minimizing opioid use, and a slow recovery with nebulization of hypertonic saline. Patient factors, perioperative treatments administered, and complications identified in hospital were recorded and compared between pre- and postprotocol groups.

Results: The pre- and postprotocol groups included 42 and 47 dogs, respectively. A significant reduction in postoperative respiratory distress events was identified after protocol implementation (postprotocol, n = 6 [12.77%]; preprotocol, 15 [35.71%]). Postoperative regurgitation (preprotocol, n = 15 [35.71%]; postprotocol, 23 [48.94%]) and aspiration pneumonia events (preprotocol, 4 [9.52%]; postprotocol, 3 [6.38%]) did not differ significantly between groups. More dogs enrolled after protocol implementation experienced historical regurgitation prior to BOAS surgery (postprotocol, n = 31 [65.96%]; preprotocol, 18 [42.86%]).

Conclusions: Standardized protocol implementation reduced postoperative respiratory distress events, but not postoperative regurgitation nor aspiration pneumonia events, in patients undergoing BOAS surgery at our institution. Prospective studies are required to further assess these findings.

Clinical relevance: Veterinarians performing surgery in BOAS patients should consider implementation of a protocol to proactively minimize complications in the postoperative period.