Jan. 4, 2021

Peri-operative management of brachycephalic dogs, with Dr Bronwyn Fullagar and Dr Mark Tenenbaum.

Peri-operative management of brachycephalic dogs, with Dr Bronwyn Fullagar and Dr Mark Tenenbaum.
Apple Podcasts podcast player icon Spotify podcast player icon RSS Feed podcast player icon
Apple Podcasts podcast player icon Spotify podcast player icon RSS Feed podcast player icon
Season 1

We wanted to share one of the episodes from our clinical series of podcasts to give you an idea what they are about. This one is from a series we did on brachycephalic obstructed airway syndrome (BOAS) with specialist surgeon Dr Bronwyn Fullagar and Dr Mark Tenenbaum, a GP vet who works in a practice that has a strong focus on brachycephalics. Regardless how you feel about bulldogs and all their flat faced friends - the reality is that you WILL have to deal with them. This episode is from our surgery series, but don’t be put off if you’re not the surgeon who’ll be doing upper airway surgery. There’s a lot of value here for any vet around a general approach to dealing with the brachys in hospital: from safe handling and sedating, all the way to waking them up and managing them post-op for any surgical procedure, not just airway surgery. If you want to hear part 1, 3 and 4 of the BOAS series to learn more about the pathophys of BOAS, how to decide which ones need surgery, how to assess them for surgery, what can go wrong, how to actually DO the surgery, and much much more, and if you want access to summarised show notes that you can refer back to later, then we’d love you to check out the vet vault clinical at https://vvn.supercast.tech. Enjoy!

It's pretty easy for these guys to silently abstract and die and and you wouldn't even notice if you didn't have somebody actually in that room heat, like actually watching the patient really actively, then they'll die pretty quickly.And I would say that they would die within five minutes.
Hi, I'm Hubert.This is Gerardo.And I'm dr.Bronwyn falaka, I'm a specialist small animal surgeon based in the Canadian rocky mountains.And you are listening to the vet V clinical podcast, Hello.
Vit Walters welcome back and happy New Year.We wanted to share one of the episodes with you from our clinical series of podcasts to give you an idea what they are about.This one is from a series we did on brachycephalic obstructed, Airway syndrome.IE squishy-face dogs, who can't breathe with specialist surgeon, dr.
Brown run.Full Agra and dr.Mark Tenenbaum, who is a GP vet who works in the practice that has a strong focus on helping brachycephalic, regardless, how you feel about And they flat-faced friends, the reality is that you will have to deal with them.This episode is from a surgery series but don't be put off.
If you're not, the surgeon will be doing upper Airway surgery.There is a lot of value here for any of it around General approaches to dealing with the brackets.In hospital from Safe, Handling and sedating all the way to waking them up and managing them post up for any surgical procedure, not just Airway surgery if you want to hear.
But one three and four of the boa series to learn more about the better.If it's of boas, how to decide, which ones need surgery?How to assess them for surgery, what can go wrong?How to actually do the surgery and much much more and if you want access to the summarized show notes that you can refer back to later, then we'd love you to check out the vet for clinical at VV n dot, super Cast Tech.
That's a v VN, 4 VH V Network or click the link in our show notes, okay, over to doctors Bronwyn and Mark enjoy.Last time we talked about - Felix and the Airways and how we make our decisions around surgery with them.
But today I want to zoom out a little bit and look at how we manage brackets.If Alex in hospital whether it is for Airway surgery or any other surgery.Really, what were talk about the risk for these guys and how do we ramanujan that?So I want to kick off with the first thing is when during that process from the moment you admit a bulldog in hospital to win, it's healed and everything's fine again.
When are they going to die?What else one of the periods that we worry about most, if things are gonna go wrong, what are the highest of experience?Brian, where are they?Is there research on it to?What'd you guys find in practice?Yeah, I think there's two major risk periods.One of them is is having a bulldog or brachycephalic, dog.
Who's stressed in the hospital.So, this is a dog that is, you know, come in and either been admitted or being brought into the treatment area for anything, really?Anything from a nail trim to an x-ray to a, just a regular physical exam.It's quite common for brachycephalic patients to become increasingly stressed.
Then unlike me Joseph, A like dogs or regular face dogs when these dogs become stressed, they become a lot of them need to breathe through their mouth.And so they start panting and as they pant, they generate lots of negative pressure in their upper Airway and that leads to edema and swelling and collapse of the upper Airway and then pretty rapidly can progress through the upper respiratory.
Ian or complete respiratory failure, and it can happen surprisingly fast.And so I think a one big thing is identifying a brachycephalic dog, that's getting a little stressed or anxious in the hospital and immediately dealing with that.So in some cases, it can be as simple as.
Let's just take this dog back to the owner, put them in a cool exam room and let them settle down for a minute.And in other cases it might be sedating.That patient putting them in a quiet space.Providing a little bit of oxygen than trying to reverse this cycle of Airway inflammation and Airway obstruction.So, I think that applies to really any brachiocephalic patient in the hospital and that's not, just, that's not just post up, that's even pre-op.
No, that's pre-op.I mean, fortunately, it hasn't specifically happened to me, but there certainly have been cases where a dog comes in for something completely unrelated, you know, an x-ray of their knee, or even a blood collection or a nail trim, or something like that.
And it's been a hot day and the dogs had a car trip and before, you know it, especially if people who are less experienced and With Bulldogs, are handling the patient and they don't see the warning signs.These patients can can even die in the worst cases from a really simple procedure, just because of this cycle of Airway inflammation and stress.
So that's kind of one risk period that doesn't necessarily have anything to do with surgery.And then, I think the second risk periods are the perioperative, period.So, immediately, preoperatively at the time when you sedated your patient?But you haven't yet intubated them.That's a time when brachycephalic dogs, if they're heavily sedated aren't able to maintain.
Maintain active opening of there are a pharynx, so a lot of these dogs in order to breathe, usually have to actively contract.The muscles of their are referring to keep their airway open.And as soon as we sedate them though, that area, relaxes and they can obstruct and silently, go into respiratory arrest, many of them also regurgitate.
So they can regurgitate and develop aspiration pneumonia.Before you've had a chance to intubate them.And then saying goes for the post-operative period.Hopefully, everyone's fairly familiar with waking up brachycephalic dogs, tremendous.She'll want them to be quiet, not stressed.Intubated for as long as possible preferably until they're up and almost walking around the room with their endotracheal tube in and then being closely monitored for Airway swelling, and and aspiration, and having equipment and staff on standby for these patients in the ICU or in the hospital.
So endotracheal tubes and induction agent and a living your scope right by their kennel.So that if somebody does notice that they're having difficulty breathing, it can be immediately addressed in an instant Okay.Cool.Mark.Have you guys had problems of you see the stuff go wrong or almost go wrong?
Yeah certainly I think all those points are the risk periods that are brahmins mentioned and I think for us the one we most keeping a real close eye on is the post-operative and the initial post operative, it's when they're waking up is their stress and I think of a dog wakes up, they've already got some Airway information from the surgery and all I need to be distressed start breathing a bit, start freaking out and that's killing just clothes.
Over that it weighs for us.That's probably our highest risk period where we really keep a close eye.We've got a much closer eye on them and ready to jump in.If we need to interesting, you talk about the stress prone in an emergency, we'd often see that dogs?
The brackets come in for a mild head Strokes or not talking about the actual boil he'd struck, but just when they start getting upper respiratory distress on a hot day and they start swelling closed from that that they do and then you treat them and it's flowers in and they find in their wake up from because most of them need to be knocked out when they come in to intubate, while you settle things down and they go really well and then an hour or two while you're waiting for the owner.
The bloody things, get stressed in the cage again and start panting because they stressed and you can hear them, go from normal Panic to and they go Blue.So let's chase really does get them.So we know these things go wrong, do you?Well, obviously the well most bull dog owners will break is fairly owners are pretty aware of the risks, as well.
Albert, do you handle the client differently in terms of how you prep them for the surgery?Mark I'm going to go with you straight away.You have different consent forms and things like that.How do you set things up with them?Yeah.So certainly the biggest thing here is the chat beforehand which yes, we do have a tweak to conform that basically says yet.
Go ahead with whatever needs to be done because you know, we only know what we're dealing with once we actually in there, having a look.So we have consent forms that right up exactly what they own as a comforter with us doing or not doing.And we also so have a consent form about the need for intranasal oxygen.The trach tube, or we described as high-risk care, which comes into your see, our eyes and which we'll discuss and things about managing them postoperatively, which so we discussed that but the main thing apart from a consent form, is the free admit discussion or when we talk to him first a bit of that bow is in.
We taught the risks and we also have percentages which we like to give them in the general stats in.Australia's to Specialists anywhere from dogs at 8:00.Should I jump until 10 years?Of age is 17, percent will need intranasal oxygen for the first 24 to 48 hours.
After bowel surgery 7% will need to track your smiie tube.And one in 200, don't make it through the surgery, we don't love it and fake it with completely serious.And we say that if your dog doesn't attract you not only does it change the outcome, but it's expensive.
Yeah.And the price goes up and they need sometimes emergency care.And I think that having that discussion, From beforehand, which is a half-hour discussion.Yeah.Then when it comes to the consent form, the like, oh yeah, I know that this, yeah, gotcha.We don't specifically have a different consent form at our practice for brachycephaly dogs, although we've considered it and and the avma here in North America recently suggested that.
But suddenly have a really Frank discussion with owners about perioperative risks and complications and and what exactly will be involved with their pet.We always keep brachycephalic dogs in hospital for at least one night after Surgery.So they have 24-hour monitoring and nursing care.
And I always explain to owners that the risk isn't over once the surgery is over, you know, they've got this sort of at least 24 hour if not a little bit longer period where they might be at risk of upper respiratory abstraction or aspiration pneumonia, you know, there's so much information.Now on the Internet, it's unusual for an owner of one of these breeds to never have heard that.
Anesthesia is you know most of them understand and understand each other is more risky and their dog even if they don't understand why.So it's yeah it's almost the opposite.You almost need to be able to Assure them that we can do that because most of them, actually right there skater having procedures done, cause all I've heard is for dogs, going to die in this and anesthetic.
Yeah.Right.We talked about this dress earlier and how you manage them and keep them Calm before and after we'll start with you, and then we'll ask, Mark, the same thing.Have you guys got any protocols?And it's a day, should Protocols are obviously trying to keep them in a calm environment.I want to say that goes without saying but chemically how do you keep them happy and Hospital?
Yeah suddenly so we do a couple of things we Tend to always operate.Our break is for like patients first thing in the morning if possible.So if I have an upper Airway surgery to do, I want that surgery to be done early in the day?So that one, the patient isn't sitting in the hospital stressing before they get their pre-med and to, we've got a full team in the ICU, ready and waiting for that patient to come downstairs.
And then I'll be in the building for the rest of the day, ready to do a temporary tracheostomy if needed.So everything's set up for that dog.To if anything happens we're all here and ready for it and you know it The middle of the night or anything like that in terms of drugs and medications that can be helpful if dogs come in for their initial appointment and there are particularly stressed little dog, then I'll often send home some trazodone anti-anxiety medication, with their owner and advised the owner to give that one hour before they come to the clinic in the morning, we've also got trazodone in the hospital so we can give them that.
You know, it is an oral medication the day of surgery, but I don't think that increases the risk of, you know, aspiration is patient.It's probably more important for them to be calm.I've heard of As using in conjunction with trazodone, some Gabapentin, as well as like a little cocktail for stressed break, his family dogs, and it does work quite nicely.
So you want to have a dog that's sitting in their kennel waiting for surgery.That's breathing calmly that you hopefully minimal, respiratory noise.And the patient is sort of resting in their kennel.I guess, I usually avoid giving heavy sedative medication until we're all ready to start with the procedure.So I avoid giving, you know, Dex mitama, Dean, for example, until we're all ready and waiting to be monitoring that Can't really closely because I don't want to happen is for that dog to get really sedate and then close up their way.
Yeah, of course.Yeah.But what about you guys have?You got any recipes?Yeah, and that was actually has Bowman with the chassis.Don't you give it a few days leading up to the surgery?Or do you just give it that morning if the dog is stressed at home?
Then we can give it at home as well but otherwise usually instead to give trazodone sort of an hour before an anticipated stressful event so it's not a drug that needs to build up in the system.Over a number of days to be effective.I think it in a clinic.Pretty similar.We used our pre-meds mediterrenean and methadone and we use half dose mediterrenean that would normally use.
So, we go a bit lighter on that.And we also use either mm sarinya as well beforehand, because of the potential for regurge or things like that.You just want one or the other or do you combine them.We used to use sarinya but now more using met amide, and we also sometimes Time to send them home with medified.
We used to which we don't anymore, you low SEC or and that result.It depends on the history of the dog and the history of regurgitation things like that.Where did you stop using them in Brazil?You know, we weren't really getting a big difference for the post-op trigger, but maybe bomb would have more.
Yeah.Ideas on that.Yeah.So it depends a little bit on each end of individual patient, but I always use prophylactic GI protective medication.In any brachycephalic dogs, having any kind of surgery in the dogs.Were regurgitating, fairly frequently prior to surgery.
I'll start treating them with medical management.So usually Omeprazole and, and sometimes also medical or mad at home for five days prior to surgery.So I'm a all it's a proton pump inhibitor.So it will reduce the amount of acidity of the stomach.
It won't prevent regurgitation by any sort of physical means, but if the dogs do reflux, it's less likely to cause esophagitis, whereas metoclopramide will Of Titan that lower esophageal sphincter and hopefully prevent regurgitation.And then preoperatively I'll treat them with injectable, remembers all which in the North America is called Pinto Brasil, in the immediate preoperative, period, and marah potential Serenity at the same time.
And then sometimes, if they've been a frequent regurgitator, will treat them with the metoclopramide CRI.So medical information as a pretty short duration of action.So it's more effective if you can give it as a CRA and then to go home, usually I will send these dogs home.With an F is all and or medical and provide tablets depending on how much regurgitation they've had.
But yeah I think even the dogs that are not clinically regurgitating a lot at home.We just know that the bulldog in the breakfast felt like population has a higher risk of reflux and aspiration just as a general rule it makes sense to me to use it.I had a yes into talk once my medicine specialist who said the dealt with a fair amount of esophageal strictures and burns both any surgery and we're not talking break it.
If Alex, he's talking about any dog and he says, they are such a nightmare to deal with his to the point is, is that if he ever had to go back into general practice, he would put every single dog that's going to have surgery on to the maples.I'll look for something a day or two before and stay on it for five years afterwards just in case, they have a really good Mark.
I want to go back to the mid, am in that.You guys use is that as soon as they walk in the door.No, no, it's not a soon.Again, as Brahman said, we also try and do especially the high-risk boas in the morning.Yeah.But we Pre-med them when we're ready.
So this is not to keep them calm in the cage or something else.Is that the actual premedication he's had four hours, post up, we do and I'll have to get you the dosages as well.For this is a Mediterranean Sea RI which kinda to keep them again more for the high-risk ones or where the concern that they're going to stress out.
And so we put them on a CRA afterwards and sometimes now we're actually preemptively using the CRI.But after get that does because it in My Mind Made It.Do it in.Is it bombs an animal out?But that's obviously at this, the standard I'm going to do a major procedure does, how how cooked other.
They're just nice and chill.Are they still sitting up or they're just lying gummy sleeping?Or what do they look like on that CRA that you guys use?You know, they're the prettiest alert reactive and we taper it and it's not a long-term thing.It's just the initial very hour or two hours after surgery that we want to make sure that they're recovering appropriately, but they're not yet.
Not bombed.And is it just met Am Lord?Put anything else in there.There's there are a few I didn't, I suppose there aren't opioids anyway for pain control and imagine.Yeah, we just use judgment, and I guess many time it has pain is a pain relief on board as well.So has, you know, what it out to.
We also have whether we're using some, we use steroids, and we use medicham so nonsteroidals, supposed up early for these dogs.Yeah, that's a good question.Steroids versus non-steroidals, Brandon, is there a preference for you?Yeah.So I'll routinely give the brachycephalic patients that are having Airway surgery.
Three and anti-inflammatory dose of dexamethasone and induction as well.So Point 1 mg per kg IV and that sort of a prophylactic because it reduces the inflammation and the swelling and edema of the upper Airway and reduces the incidence of the dogs, having an upper respiratory obstruction and I think that's fairly common in the specialty world.
At least to give our prophylactic steroid anti-inflammatory.It's less for a pain relief and more to reduce swelling.And then because I've given that single dose of dexamethasone I'm not going to give a nonsteroidal anti-inflammatory to those dogs.Yeah.Perhaps if I had a really, you know, a dog where I done a way surgery that that wasn't super clinical and there was minimal swelling and the dog had also had some sort of other procedure and there was no history of regurgitation, maybe I would use NSAIDs.
I'm not straddles, but usually I'll give the dogs.At least 24 hours after surgery before.I'll start non-steroidal anti-inflammatories at all.Just in case in that post operative period, we need to give steroidal anti-inflammatories.I never send the dogs home.I'm with with prednisone or a steroid, as a pain relief medication, if they've had a steroid, I'll send them home.
If it's a really small dog with oral buprenorphine, which can be absorbed transmitted cozily or Gabapentin, or you can use acetaminophen or paracetamol or combinations of that medication as well.It's obviously off label, but it can be used for post-operative pain relief in dogs that cannot happen in said, I also just wanted to, I can tell you guys to what we use for our pre-med.
So we use our North America more commonly X-Men etomidate, which is very similar in action to met etomidate small potent.So, the dose that we would use would be IV.It's a pre-med and then, generally, we use a lot of hydromorphone, which is not as common in Australia for because it's the most commonly available and most cost-effective opioid, pain relief, but Hydromorphone has a tends to make it can make dogs vomit, and it tends to make dogs pant.
And so what I'll tend to do is give the dam Tama Dean induce with propofol or I'll fax alone.And then once the patient has had their Airway exam and their intubated at that point, give them their Hydromorphone.So as to avoid a patient or you're trying to do an upper Airway exam and they're either panting a lot or worst case vomiting.
So what kind of delay the opioid until the patient's intubated, that's a good idea, but I don't know what you use.Margaret methadone's of one of our most common and that can make the bent like crazy.So it's a good idea to hold that off.Yeah.Methadone has a less incidents of vomiting which is nice.
And then you have a post-op pain relief, depending on the patient, we might use methadone or buprenorphine IV while they're in the hospital, and again, avoiding Hydromorphone and Fentanyl.Just because of the, the panting and incrementals case for Ilyas, and the regurgitation potential, it's not to put them on a desk man.
Am I doing CRI?I might use a micro dose of dam.Medina's, they're waking up if they're having a little bit of a anxious anxious episode.So, I, that would be sort of half to 1 microgram per kilogram of decimated Tandy.And Ali low dose, just another find that takes the edge off, and then treat them either with intermittent X-Men, trauma, team, low-dose acepromazine, or once they're able to swallow and have a little bit of foods and trazodone again, but I think I would rather have these patients be alert sitting up in their kennel, looking around swallowing because that enables them to control their own Airway and use their own muscles to keep their airway open.
I think if they're to sedate that's when you can run into problems.So it's this very fine line between having the patient.Not stress but also not completely.Because one thing I would mention with brachycephalic dogs and alpha-2 Agonist like Reddit AMA, Dino decks mitama Dean is that Becky's tend to have really high vagal tone to begin with and so they can have, you know, pretty profound bradycardia associated with altitudes and so just being aware of that and monitoring it for it and then being prepared to reverse it or use glyco as needed, right?
So, enough down and and anesthetic maintenance, there's anything different there compared to other patients.That you reserve for the racket of Felix was.I just a standard knock down, any debates and ISO or whatever you're using, I think if I'm doing only an airway surgery.So the anesthesia times going to be quite quite short, I'll use profile rather than Al facts alone.
And this, this may be just an anecdotal experience of mine and not sure if other people have felt this.But I find that dogs that had a really short anesthesia with all facts alone when they're waking up.And they're waking up from our facts alone as opposed to waking up from isoflurane, if it's been a longer and a Asia.
They can be quite panty and have a period of quite profound dysphoria and that's not what I want.And I break his if I like patients.I'll use propofol because I feel like their recovery is smoother.That may just be my own anecdotal evidence.There's no both of them are safe.How short is short if like how quick is this edgy?
Like 20 minutes half an hour okay?Okay.Yeah.I mean the patient is still going on to isoflurane they're still being intubated in the Run ISO and oxygen, but or for example, if you know, we're doing it upper Airway.And, but we may not do surgery.We're just looking at the airway and then waking up for patient.Then that would be a pretty quick as well.
I do we'll talk about this.I guess when it comes bit about a bit the procedure itself burner with our head surgeon, I think the laryngeal sack feels if they're inverted remove them before intubating so that can just change a bit about maintaining almost on an IV and aesthetic that short period of time.
It's a quick procedure that part but that kind of is a bit of a iteration to your standard one because and that's on the assumption that you Doing both Judy, quick getaway exam and correct appropriately but if it's got a good laryngeal circles and you are removing them that kind of tweaks the protocol a little bit but otherwise pretty stuck standard.
Yeah, I do remove, either the laryngeal Cycles with the patient excavated.I think I've kept got into the habit of doing them second in line in the procedure after the soft palate because I find that in some patients.By the time you've done your upper Airway exam.Maybe the patient has been breathing great because I've just had some induction agent or They're mildly cyanotic, or their Spirit, to is not the greatest, I like to just get them intubated, get them on oxygen, you know, improve their ventilation and then do the soft palate.
So I found a nice period of time, breathing oxygen, and then top them up with some induction agent, remove the shackles and then reintubate them and then the endotracheal tube places and pressure on the region where the Cycles have been exercised and helps to control some of the Hemorrhage and then go on and do the Nares after that.
And then obviously excavate them slowly.I think the other thing from an anesthetic monitoring standpoint in bracket cephalic Dogs that have had about Isis that they're resting in title, CO2 is much higher than a normal dog.So they've been living life, some of them with an end-tidal CO2, on a daily basis of 50 millimeters of mercury, for example.
And so don't be surprised if your back is a phallic patient.Under anesthesia is ticking along nicely with kind of a higher than normal end tidal CO2.We usually try and keep dogs around 40 to 45 millimeters of mercury, but some of your brackets are felt like, patients.It'll be hard to At their CO2 lower just because they've equilibrated and you may find that it takes a higher level of an tidal CO2 to stimulate them to breathe.
Most dogs have a respiratory drive is primarily from the end title CO2, but in brachycephalic patients expect to kind of stimulate them to breathe as you're waking them up.So as you saying that if they're not, if they've got a bit of post induction apnea or they're just not breathing not to stress as much.
As long as you need that entitle a bit higher to stimulate the breathing is that.Yeah.You may need to as your if your patient has stopped breathing, while they're under anesthesia and you've been ventilating them, it may take a little bit longer and you may need to let that in Tidal CO2 get a little higher than then you would be comfortable with in a non brachycephalic patient in order to stimulate their respiratory Center.
To get them breathing.Again if things have weird physiological responses to actually getting room air into their lungs, their actually normal about the boxers like what the hell's happening, what's all this oxygen?Yeah right.
That poster period the well, first of all the setup and obviously brand-new working Specialist Clinic.So I presume you're going to have a full 24-hour team in most of the hospitals, they taken care of him.If you're in a clinic, what might have?Let's ask it this way.Mike, what's your setup of these guys?
Do they do they always stay 24 hours, post up.Do you have to have 24-hour monitoring to do this safely at all?Yeah, good question.Bomb on you and I guess at clinics will differ on this and we're not a Clinic again, we see a lot of young or 12 month old dogs.
If we have healthy dogs, come in and have a pretty straightforward Boaz procedure where they don't have any concerns their home that afternoon.If it's a, let's say, the dog near the trach tube post.Then again, it really depends on the dog business owners is a lot of factors that come into play.
But obviously, if it's high risk and we have five minutes down the road in Emergency Center.Okay cool.And we have a relationship with which they offer what we call babysits, which can vary from a babysitter's literally just keeping an eye on it all the way upwards.
So, you know, knowing what to look for.Knowing what's a concern?What's not a concerned having them five minutes next to an emergency.This should things go wrong.We think sometimes and from a, you can comment on this is especially high stress dogs.That have need a trach tube.
Yes.Kevin austral gets us have our eyes on them but sometimes the hospital environment can stretch them out.It's So we find getting them home early and we usually send them home.We had the owner in the room with them, seeing them for a few hours before we take them home, just to see how they go with it.And we think actually that reduces risk.
And sometimes that can reduce the dogs need to be in the hospital for longer because they're at home, they're comfortable in their environment.And again, that's all on the assumption that everyone's knows that they're doing, everyone's comfortable the dogs comfortable, a lot of things and even took off, but that's our person, but we don't have a 24-hour.
We don't routinely recommend it, and Less cases are appropriate for, why'd you have of easy availability, 24 hours that I think that's the ticket exact try to imagine if you're a small country practice and he's not 24 hours and there's no emergency saying that.Should you be sure to be doing these probably probably send them somewhere where they could again be watched potentially overnight.
Hmm.Yeah, I think again, we see slightly from populations.I think it's totally feasible.That, you know, otherwise, healthy young dog with very mild clinical science that has surgery at Finish the surgery at 10 a.m. could conceivably go home at 6:00 p.m. and and be fine.No, providing that they haven't had any post-operative issues, I can completely see that that could be reasonable.
If they've had a very straightforward procedure, I think the majority of cases that I see at least a fairly clinical by the time they've come to me and so I don't think I've ever sent one home the day of surgery, mainly because we do have 24-hour Hospital monitoring and every surgery.Patient in a hospital stays overnight for intravenous pain relief and post-op monitoring.
One thing I would say about having these It's in your ICU or in your hospital is that they need to be in the post-operative period somewhere where they're easily visible.So, it's pretty easy for these guys to silently obstruct and die.And, and you wouldn't even notice if you didn't have somebody actually in that room.
Keep like actually watching the, the patient really actively and it's very, it's very tragic.When that happens.So I think having them in a kennel that's easily seen from the computer station.For example, is really important.I if a patient needs a tracheostomy tube, I I would say as a absolute rule that I would never send the patient home with a tracheostomy tube in place.
I think by default.If they've had to have a trick to place, then their upper respiratory tract is probably if not completely obstructed at very high risk of being completely obstructed.And so if that trach tube slips or becomes blocked, the patient is going to their respiratory tract, is going to abstract and they'll die pretty quickly.
And I would say that they would die within five minutes so you don't have, you know, if that's if that happens you don't have five minutes to get them to the The Emergency Center and I think unless the owners are themselves, veterinarians, it's very difficult.I don't think owners should be attempting to replace a tracheostomy tube.That's fallen out or become blocked or anything like that.
And so I guess I would say that if your patient has had that kind of a complication post-op, then my strong advice would be that patient.Should go to the 24-hour Center for for overnight monitoring.Okay, so we missing anything and then first time period, from either of you, any other inputs or anything, but I think we've covered it pretty well.
It was the this something.And I think one question I had for you Mark and was when when do you feed these patients postoperatively are at what point in the post-war period.You tell owners that they should feed them and what do you feed them?
Yeah.Usually we, the next day, will feed.That nice depends on the level of interests, but slowly really small amounts and we go soft food.So that could be whether that's like chunks of meat or whether that's canned food, obviously having Airway work done is going to have that information, so we don't always say not dry food, nothing harder.
It's going to be abrasive but we usually don't want about Burns.Going to have both that's going to allow nothing to go down and scratch where the stitches we're doing.
What's been done?But yeah we try and feed them pretty soon.Assuming they want to eat and then by 10 to 40 days afterwards, this video check up a tender for 10 days.It's the first checkup at that stage assume he's doing well, they transition back onto the normal.Dry food.Eru similar to that.
Are you different?Yeah, yeah, pretty similar.I tend to hold off Foods until the morning after surgery and then I'll put on the treatment sheet that I would like to feed them myself.So I'll hand feed them.Just a couple of meatballs.So we form soft foods, important, and also soft food that can be easily.
Swapped Followed whole as a bolus.So the goal is to not have food getting stuck on the stitches.So rather than giving them a bowl full of soft food, I'll put the soft food into kind of meatball and you want to be watching the dog to swallowing carefully, it just to make sure that they are swallowing and separating their breathing from their from their swallowing that first meal.
And then after that yeah, feeding frequent small meals of meatballs.And I'll ask the owners to hand-feed them for the first couple of days in that same way and then switch to a soft foods through a week or two.And Back to the normal food, but I think what you want to avoid is wanting after surgery with, you're probably quite hungry, Bulldog, giving them a huge plate of food kit or animals or any sort of food that they said of stick their head in to and choker aspirate, because they are trying to work out how those pharyngeal muscles and swallowing is is coordinated again.
So I love that, I love the little meatballs.I can also imagine if you're always the one feeding them that there's dogs Must Love Doctor Brown River, they they coming from.The tickets are like hey it's me fool girl.I think.Yeah these well that I just want to see.Yeah, I just want to see them swallow.
Make sure that everything's everything looks good.Makes you sleep better.Yeah, exactly.It's so reassuring.Yeah, and I was gonna say, I think ghosts, in that post up here, we more and more in finding that the first week.A lot of them do have.If any that could increase in there be some regurgitation or, you know, a bit here, then the first week, but usually, it's by 10 to 14 days.
First up, especially with a snoring sometimes a bit louder and we always talk about with our owners that expect a little bit more snoring expect because it's those expectations that you said, if they think my dog, the next day is going to be silent and no regurgitation.They start regurgitating five times a day and snoring.
Well, they're going to be concerned.So it's setting those expectations and we find that the still kind of regurg you more sometimes just because you've got stitches in there.You've got their information but usually the tender 14 a mark but they're like the first week was rough and that's where they start to see the benefits and they actually We start to see and then usually between that two week to three month course, that was when they start to exercise them.
So, usually most people said I haven't exercised yet and then we kind of get an idea of the benefits in the exercise tolerance noise kind of area.Okay.Is that us think we're done?There was great.That's super super insightful.I love that.There's a lot of advice there for the little Fuller, referring great.
Even if you're not the one doing the surgery setting these up, right?And then wrapping him up nicely fits perfect.And then for the next episode we will talk about the Little bit more about the actual details of surgery.What it's done.Just so everybody has a better understanding of what actually happens when you're in there and also talking about how to assess t-there's predatory track for surgery.
If you're not the surgeon, getting this checked out and deciding whether you should send them off and on, hopefully everybody enjoyed that and we'll join you next time.Thanks again.Brian.And Mark.Thanks very much.You know, those conversations that you have at conferences, back in the days, when we still had big bed conferences, when people are chatting to the lectures and asking questions, and you hear things like, this isn't really in the books.
But here's what I think, it's in those kinds of conversations that the best nuggets of wisdom appear, the nitty-gritty of real-life details that you can only get from here's and years of experience.And it's exactly those kinds of conversations that we try to emulate on the vet V clinical podcast, we don't want Has we want to hear about the challenges?
The tips, the stuff UPS there.This is how I do it.Go to VV n dot super cast dot tick to join in the conversation.

Dr Bronwyn Fullagar

Dr Mark Tenenbaum