Surgical Consent Form

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Introduction

Brachycephalic obstructive airway syndrome (BOAS) is a combination of upper airway abnormalities that can cause partial obstruction to a dog's airway. Breeds affected include: shorter nosed dogs such as English Bulldogs, French Bulldogs, Pugs, Boston Terriers, and many other breeds. The short nose and face in proportion to body size can cause problems for these breeds at times. The potential negative impact of heat, exercise, and stress (including veterinary hospital visits) cannot be overemphasized.

BOAS generally involves multiple anatomic abnormalities

Elongated Soft Palate: The soft palate is the soft tissue that lies behind the hard palate on the roof of the mouth in front of the opening of the airway. When the soft palate is too long, it can block movement of air into the trachea or “windpipe” resulting in increased noise and respiratory distress.

Stenotic Nares: The term "stenotic nares" refers to a narrow opening of the entry to the nasal passage. When a dog's nostrils are narrow or collapse inward during breathing, airflow is decreased, forcing patients to breathe through the mouth.

Laryngeal collapse: Over time, the laryngeal cartilages that hold open the entrance to the trachea (windpipe) can weaken and collapse as a result of increased resistance of airflow and increased effort to breathe. There are three stages to laryngeal collapse. Stage I (everted laryngeal saccules) is present in most brachycephalic dogs but can progress to the more advanced stages II or III, where the cartilage can fold onto itself preventing movement of air into the trachea. Your dog's risk of complications increases with increasing stages of laryngeal collapse.

Additional complicating factors can include: hypoplastic (underdeveloped) trachea, epiglottic retroversion (additional cartilage will intermittently block part of the airway entrance), laryngeal dysfunction (the airway does not properly open), nasopharyngeal stenosis (narrowing of the back of nasal passages), macroglossia (enlarged tongue), hiatal hernia or other alterations in gastrointestinal anatomy, and regurgitation. Generally, the severity and type of abnormalities present are not determined until a complete airway evaluation is performed immediately prior to anesthesia.

Sedation and Anesthesia

While sedation and anesthesia are commonly performed in brachycephalic breeds, these procedures are not without risk. In addition to the standard preanesthetic and surgical checklist, additional presurgical precautions are taken with brachycephalic breeds, and may include prolonged fasting, medications to reduce risk of aspiration, additional sedation, additional vascular access and possible transfer to a 24-hour veterinary hospital for recovery in the intensive care unit for respiratory monitoring.

Brachycephalic Consent Form

Brachycephalic dogs are considered a high-risk population for hospitalization, anesthesia and/or surgery. Risk factors that can affect outcome include:

English or French Bulldogs
Previous airway surgery
Additional surgical procedures under the same anesthetic event as BOAS correction
Overweight body condition
Respiratory distress at the time of admission to the hospital
Elevated body temperature at the time of admission to the hospital
Difficulty eating including gagging, vomiting, and regurgitation

I grant permission for the Patient to undergo general anesthesia / sedation / hospitalization.*

I have read and understand.

I am aware that the Patient likely has Brachycephalic Obstructive Airway Syndrome (BOAS), and I am aware that BOAS increases the risk of complications associated with sedation and anesthesia.*

I have read and understand.

I am aware that if the Patient undergoes sedation and general anesthesia, the potential complications include partial or complete airway obstruction during recovery and regurgitation / vomiting, which can lead to aspiration pneumonia and respiratory distress.*

I have read and understand.

I am aware that anesthetizing or sedating brachycephalic breeds for any reason can lead to the development of significant complications. In rare circumstances, these complications include the possible need to transfer the Patient to a 24-hour care veterinary hospital, prolonged hospitalization in the intensive care unit, and temporary tracheostomy tube placement. In extremely rare cases, anesthesia and sedation can result in death. These complications and further aftercare are not covered within the original estimate for surgery, and would be at my own expense.*

I have read and understand.

I have been informed by my Attending Veterinarian regrading the potential complications associated with BOAS.*

I have read and understand.

Client Signature (patient owner or party responsible)*

*** You must use your mouse or touchpad to WRITE your full signature here. Simply clicking in the box does not authorize Jewel Veterinary Surgery LLC to provide surgical services. ***

Please verify that you are human*

Informed Consent for Brachycephalic Breeds