Surgical management of brachycephalic obstructive airway syndrome: An update on options and outcomes

Dogs with a brachycephalic conformation often experience a collection of abnormalities related to their craniofacial conformation, which can lead to a variety of clinical signs such as stertor, exercise intolerance, respiratory distress, and gastrointestinal signs such as regurgitation, among others. This collection of abnormalities is termed brachycephalic obstructive airway syndrome (BOAS). With the rise in popularity of several brachycephalic breeds, veterinarians and veterinary surgery specialists are seeing these dogs with increasing frequency for surgical and medical treatment of these clinical signs, leading to an increased interest in developing surgical techniques for dogs with BOAS and evaluating objective methods of determining outcome after surgery. Advances in anesthetic management including standardized protocols and use of local nerve blocks to decrease opiate use may decrease postoperative complications. A variety of new or modified surgical techniques to manage hyperplastic soft palate and stenotic nares, among other BOAS components, have been developed and studied in recent years. Newer studies have also focused on risk factors for development of major complications in the postoperative period and on objective measurements that may help determine which patients will receive the most benefit from BOAS surgery. In this review, the newest studies focused on updates in anesthetic management, surgical techniques, and postoperative care will be discussed. Additionally, updated information on complication rates and outcomes for dogs undergoing surgical management of BOAS will be included.