The Value of a Truly Thorough History in Brachycephalic Patients (in honour of Scipio)

In brachycephalic patients, the importance of taking a detailed and structured history cannot be overstated. A comprehensive history not only guides my expectations of what I will find on airway examination, but it also helps me predict how the patient is likely to recover—from airway surgery specifically, and from anaesthesia and surgery in general.

Beyond airway assessment, a good history provides insight into how stressed the patient is likely to be when hospitalised. This has a direct impact on peri-anaesthetic management.

In many cases, I will send a patient home with trazodone to be administered on the morning of the procedure so that they arrive calmer and easier to handle for IV catheter placement and premedication.

To ensure consistency, I use a structured template in ezyVet, broken down into Airway, Gastrointestinal, Swallowing, Sleep, Neurological, Stress, and Other Medical Conditions. Below is the template in full.

Brachycephalic History Template

Airway – Noise and Exercise Tolerance

• Any snoring?

• Airway noise at rest or with exercise?

• Any episodes of cyanosis or collapse?

• Any coughing (i.e. possible aspiration)?

• Exercise tolerance: How long can the dog walk in summer? In winter?

• Recovery time after exercise estimate?

• Any pale colour noted during exercise or at rest?

• Worst episode to date?

Gastrointestinal Signs

• Any regurgitation or evidence of “silent reflux”?(Neck extension, lip smacking, gulping, hard swallowing, coughing at night, hacking/gagging with exercise)

• Any vomiting?

• Usual diet and feeding schedule?

Swallowing

• Hypersalivation with or without exercise (this can indicate difficulty exercising and swallowing at the same time)?

• Any difficulty eating: choking, gagging, coughing, or breathing trouble while feeding?

Sleep

• Do they need a specific position (elevated, seated) to sleep?

• Sudden waking? Choking during sleep?

• Do they sleep with their mouth open?

• Does the owner feel they are excessively sleepy in the daytime (subjective, however sometimes owner has another dog to compare to)?

Neurological

• Any toe scuffing, knuckling, or other neurologic signs?

Stress Levels

• Are they anxious away from the owner?

• Anything that helps reduce their anxiety e.g. special toy, not touching feet etc?

Other Medical Conditions / Current Medications

• (Free-text)

A detailed history also helps identify patients who may benefit from additional peri-anaesthetic support.

For patients with underlying GI disease

• Omeprazole 1 mg/kg BID for a few days prior to surgery.

  • Owners are instructed to discontinue if vomiting occurs.

• If signs are more severe:

  • Metoclopramide 0.5 mg/kg BID as well for a few days before the procedure may be added.

To reduce hospital-associated stress

• Trazodone 5–10 mg/kg, administered 30 minutes before leaving home for the hospital.

Reducing stress in these patients is more than a comfort measure—it directly improves safety by smoothing catheter placement, facilitating cooperative handling, and reducing airway effort during the pre-anaesthetic period.

I hope this helps!

Abs x