Veterinary Vertex
Veterinary Vertex is a weekly podcast that takes you behind the scenes of the clinical and research discoveries published in the Journal of the American Veterinary Medical Association (JAVMA) and the American Journal of Veterinary Research (AJVR). Tune in to learn about cutting-edge veterinary research and gain in-depth insights you won’t find anywhere else. Come away with knowledge you can put to use in your own practice – along with a healthy dose of inspiration to remind you what you love about veterinary medicine.
Veterinary Vertex
Breathing Easier: How Standard Perioperative Protocols are Changing Brachycephalic Surgery
Breathing new life into brachycephalic airway surgery practices, this eye-opening conversation with Drs. Vanna Dickerson and Mason Hill reveals how implementing standardized protocols can dramatically reduce post-operative complications in our flat-faced canine companions.
The surge in popularity of brachycephalic breeds like French Bulldogs has brought increased attention to the challenges these dogs face during surgical procedures. Through collaborative efforts between surgery, anesthesia, and critical care specialists at Texas A&M University, the team developed a comprehensive perioperative management strategy that's making a real difference in patient outcomes. Their research demonstrated significant improvements in respiratory distress events, though dogs with pre-existing regurgitation issues remain a high-risk population requiring special consideration.
What makes this episode particularly valuable for veterinary professionals is the practical approach to implementation. Rather than complex interventions, the team created an accessible one-page protocol guide that practices can adapt to their specific environments. As Dr. Dickerson emphasizes, "The surgery isn't the hard part—it's managing the perioperative period that can go wrong." For dog owners, this research offers both reassurance about improving surgical outcomes and practical guidance about what questions to ask their veterinarians before procedures.
Whether you're a surgeon, general practitioner, or a devoted brachycephalic breed owner, this episode provides crucial insights that could potentially save lives.
JAVMA article: https://doi.org/10.2460/javma.24.09.0598
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Sarah Wright:This is Veterinary Vertex, a podcast of the AVMA Journals. In this episode we chat about how the implementation of a standard perioperative protocol reduces postoperative respiratory distress events in dogs undergoing surgical correction of brachycephalic obstructive airway syndrome, with our guests Vanna Dickerson and Mason Hill.
Lisa Fortier:Welcome listeners. I'm Editor-in-Chief Lisa Fortier, and I'm joined by Associate Editor Sarah Wright. Thank you so much for taking the time to be with us here today.
Vanna Dickerson:Yeah, thank you for having us.
Mason Hill:Yes, thank you.
Sarah Wright:All right, let's dive right in. So, Vanna, your JAVMA article discusses how the implementation of a standard perioperative protocol reduces postoperative respiratory distress events in dogs undergoing surgical correction of brachycephalic obstructive airway syndrome. Please share with our listeners the background on this article.
Vanna Dickerson:Yeah. So, I think you know, as veterinarians we're all very well aware of how popular these brachycephalic breeds are becoming. I've been in the veterinary field since early 2000s and even I can just massively see how much more frequently we're seeing them. And I think, especially as surgeons, maybe we see even more of them to address their airways, and along with that we know how scary kind of the complications in the perioperative period can be. So we, shortly after I arrived at Texas A&M, had a group meeting between our surgery, anesthesia and critical care teams where we all sat down kind of reviewed available literature, and that's sort of where the protocol that we evaluated in this study was born.
Sarah Wright:Yeah, like you said, I think they're definitely very popular as pets and we chatted about this before we started the podcast, but your article is super popular on social media, reaching over 77,000 different people, which is incredible, so a very important topic. I remember talking to some UGA surgeons too and they were talking about, like, the Bulldog Special for the embrace of hallux surgeries there, so definitely something worth investigating.
Vanna Dickerson:Yeah, yeah, for sure.
Sarah Wright:So, Vanna. What are the important take-home messages from this JAVMA article?
Vanna Dickerson:Yeah, so I think you know we made a lot of changes in how we manage these patients pre and post-operatively in our study. And you know, of course, because we made so many changes all at once, it is one of the limitations, right, we don't know what. You know what actually made the most difference. But I think for me, I think the biggest takeaway is just this is another study sort of pointing to you really do need to treat these dogs a little bit differently than maybe our doliosophallic counterparts in the perioperative period, and that's true, I think, whether or not we're performing airway surgery. So I think it's just another kind of piece of the puzzle to me that shows we really kind of have to think differently with these guys.
Lisa Fortier:Yeah, before their. What did you call it? Surgence in popularity or something like that? It used to be the Dobermans we were worried about. Nobody really talks about Dobermans anymore in their surgical risk. It's all relative, I guess.
Vanna Dickerson:Yeah, yeah.
Lisa Fortier:Mason, what sparked your interest in brachycephalic obstructive airway syndrome?
Mason Hill:Yeah, so similar to what Vanna said. You know, especially when I was at A&M and still true here up at Ohio State, Brachycephalic dogs constitute a large proportion of the dogs that we see on soft tissue surgery, for airway surgery, but also we see them throughout the hospital on our orthopedic service for musculoskeletal abnormalities and our neurology service related to intervertebral disc disease, and the scope of this paper was very much focusing on their perioperative outcomes related to upper airway surgery, but certainly both the question of should we be considering implementing protocols similar to this, you know, whenever they come into the hospital because we can see them have these respiratory distress events or regurgitation aspiration, whether they're with us or with other services. So, you know that was kind of our starting place. And the you know.
Mason Hill:Next thing, as Vanna alluded to as well, was that the complications that these patients do experience when they're here seem to be more frequent but also more severe, and they can be both financially and emotionally devastating for families. And so researchers at Tufts University, originally a few years back, implemented a protocol similar to the one that we implemented. That really sparked an interest in the team at Texas A&M, because they were able to reduce regurgitation events in their patient population, and so specialists across multiple disciplinaries came together and made this protocol, and I, as a student and then as an intern, was in a unique position to help evaluate its impact on our patients.
Lisa Fortier:Fantastic. Vanna talked a little bit earlier about some of the take-home messages, and yet many, many things were investigated at the same time. So for you, what were some of the very surprising things from this research article that you found?
Mason Hill:Yeah, you know, I don't know if it'll necessarily be surprising, but I think a major point of interest for us was that in our post-protocol groups the group of patients dogs that were enrolled after protocol implementation and when we evaluated their historical findings, they had an increased incidence of regurgitation compared to those dogs enrolled prior to protocol implementation.
Mason Hill:When we were evaluating our results, we ultimately did not find a significant difference in the outcomes of regurgitation and aspiration in this post-protocol group. And so the question became then well, was it related to the protocol or was it more related to the fact that these patients historically regurgitated more and again? Kind of makes the point that's kind of straightforward that well, regurgitation pre-op may beget regurgitation in a peri-op and post-operative period for these patients. You know, multiple studies have identified this as a problem, though to my knowledge, at least at this point, this hasn't been evaluated prospectively. But I think it certainly makes us have to wonder. You know, not only do we need to be treating our brachycephalic patients, especially because we know that they're in increased risk, but this specific group of brachycephalics that has historic regurgitation, I think is going to need additional evaluation and care moving forward.
Lisa Fortier:Off a completely beaten path. Do either one of you think that the popularity in these breeds will go down now that a giant Schnauzer finally won the best in show at Westminster?
Vanna Dickerson:Uh?
Vanna Dickerson:you know, maybe I don't know. I feel like they're especially the Frenchies. I mean, they're stinking cute man and they're the perfect size to be in lots of different households. So I don't know.
Lisa Fortier:Yeah, very true. How about you, Mason? What do you predict?
Mason Hill:Yeah, I agree with Vanna, I'm not entirely sure, you know. I just hope you know, when folks invest in these dogs because they are precious and they are perfect family members, and that you know they're just aware that they can come with some increased chance and risk for complications related to their airway and otherwise, so I think us, you know, as a veterinary profession, just doing our best to educate our clientele and let them know what can occur is really really important moving forward.
Lisa Fortier:I like what you said, and otherwise it's not just anesthetic complications, it's, and otherwise.
Sarah Wright:Yeah, funny enough, the soft tissue surgeon from my rotating internship owned a Frenchie. I remember learning that and I was like huh before you know, so did not expect that. So, Mason, you did talk about some areas of future research, such as looking at like regurgitation events, but are there any other areas for next steps for research in this topic?
Mason Hill:Yeah, I know I really did allude to my kind of next point here, which is that I think us really evaluating this population of brachycephalic patients that have historical regurgitation, how we can impact that, moving forward, looking at prospective studies, really wanting to evaluate for me how the use of prokinetics maybe receiving them more long-term prior to hospitalization and PPIs, would be really beneficial, just because in a lot of our patients their prokinetic administration and kind of medical management strategy was initiated very close to time of hospitalization, and so I just wonder, if we prolong that, could we potentially benefit them? But I think there is a breadth of research that remains to be done, looking at these patients as a whole.
Sarah Wright:Well, we look forward to hopefully seeing a manuscript about that in the future. So, AI is definitely a really hot topic and we actually have a AI supplemental issue coming out in AJVR in March about AI and veterinary medicine. So, Mason, do you see a role for AI in this area of research?
Mason Hill:Yeah, I think you know important for me to mention is that I have not yet myself delved super far into the utility of AI, but I'm really excited that were really embracing it as a field and think that it will be very impactful for us. Areas where I think it can be beneficial especially on the conversation of looking at these patient populations that regurgitation m of multi-institute this study evaluating these patients and using AI to help assimilate that information and help develop the protocol that could impact these patients.
Mason Hill:And that's kind of my general thought and I didn't know if you had anything you wanted to add to that
Vanna Dickerson:and I do wonder one of my colleagues here just recently published, I think, in veterinary surgery, a paper where they're trying to look at could we remotely grade how severe brachycephalic airways are? You know, in the UK there's a bigger push to maybe work a little bit harder to sort of breed for better kind of more health sustainingsustaining traits in these dogs. And I mean I wonder if we ever get to a point. Could we train AI to listen to how severe stutter is and maybe combine it with things like the Brisk score that's been published to help us quickly identify which patients are more at risk?
Sarah Wright:Yeah, it's a super cool question. We're actually going to be going back and looking at all the answers and combining everything for some future research topics, so it's pretty cool. And for those of you just joining us, we're discussing how the implementation of a standard perioperative protocol reduces postoperative respiratory distress events in dogs undergoing surgical correction of brachycephalic obstructive airway syndrome.
Lisa Fortier:With our guests Vanna and Mason correction of brachycephalic obstructive airway syndrome with our guests Vanna and Mason. Vanna, you described how you designed this protocol with a multi-team approach and then you had to implement it and do the research and write the manuscript and get it across the finish line. How did your previous training prepare you to get all that done? It's hard to get from the concept to get everybody on board and really finish it. I think that would be really interesting to hear what you have, the advice you have to give to other authors.
Vanna Dickerson:Yeah, I mean I was fortunate. You know Mason is, you know, one of those vet students as many of them are that are just incredibly eager to help with things like this. So a big help was having her be so excited about the topic and really taking it head on. But you know, sarah, you mentioned UGA earlier. I was there for actually 10 years through vet school and then I did do a research fellowship and my residency there.
Vanna Dickerson:So you know, I think for this topic specifically had a ton of exposure to what we called the bulldog special there, but just brachycephalic, you know, dogs in general, and we did during my residency, also publish an article looking at a different way of doing their rhinoplasties, which it's interesting to me.
Vanna Dickerson:I don't even do them that way anymore and I think it just speaks to how quickly this, you know field is changing. But you know, in terms of getting this published and through the finish line, you know we're fortunate here, I think, to have a collaborative enough environment for everyone to be very excited about trying something new and seeing if it can help our patients. So I think that was kind of step one here is just getting everyone excited about it, getting everyone on board. And then, since we looked at it retrospectively, then a lot of the work really was on Dear Sweet Mason, who made a very large spreadsheet and helped us to get through it, and we did make sure to have, you know, authors from all different kind of specialties on this article as well, just to make sure we were kind of encompassing everyone's thoughts.
Sarah Wright:I think it's really cool how collaborative everyone's being on this topic. We actually my husband and I were watching the Illinois basketball game the other weekend and they actually had a commercial for the vet school, but the focus was on Heidi Phillips and her like break-cephalic research as far as like self-dischiever surgery goes.
Vanna Dickerson:So I was like we had kind of a little special group that talked just about these brachycephalic dogs and kind of you know, what could we be doing in research in the future?
Sarah Wright:So so our next set of questions is going to be very important for our listeners. Vanna, what is one piece of information the veterinarian should know about the surgical correction of brachycephalic obstructive airway syndrome?
Vanna Dickerson:Yeah, I mean. So I tell my veterinary students all the time that the surgery is not the hard part of managing these dogs, especially if you're speaking, you know specifically about airway surgery. It really is that perioperative crap that can go wrong and making sure that you can handle it. So I mean, I really think it's important for every practice if you're going to be seeing these patients and certainly if you're going to be anesthetizing them, to try to figure out what's going to work for you.
Vanna Dickerson:We did put our here when we instituted this protocol. Dr Ito, one of the anesthesiologists on it, helped makea really pretty kind of one pager that we could just put up in the hospital, make it really easy for everybody to see and use as sort of a checklist. So and that's available as a supplementary material on the article. So I think people maybe reference that but kind of try to develop what protocol is going to make the most sense for you with what drugs you have in your practice, how much monitoring you have and maybe these higher risk dogs that do already have a history of a lot of regurg and things like that, you know, even though the surgery is not that bad, you know, maybe those are dogs you refer, just because of the potential need for really heavy aftercare.
Sarah Wright:On the other side of the relationship. What's one thing that clients should know about this topic?
Vanna Dickerson:Yeah. So you know, even though we talk about a lot of scary things that can happen with these surgeries, I do still think that in most cases the benefits veterinarian about hey, you know how much experience do you have anesthetizing these dogs? What is the plan if something goes wrong? Are we five hours away from the nearest emergency clinic? Or, you know, do you have someone overnight that can help watch my pet as they recover? But I do still think, even though there are scary things that can happen, it is uncommon. Mortality rates actually both pre and post protocol in our study were less than 10 percent. So they usually still make it through it.
Lisa Fortier:It just sometimes is a little bit of a rocky road, exceptionally well summarized. As we wind down, we like to ask a little more of a fun question. So, mason, for you, what is the oldest or the most interesting item on your desk or in your desk drawer?
Mason Hill:We have a very large 1980s Rolodex on our desk at home to keep contact information for friends and such. I have no idea of where it came from, but it is a unique staple to the house now.
Lisa Fortier:Very cool Because everything's in my phone. If I lose that, I'm in big trouble. Right, it's an old school back, Vanna. This one usually dates people, but what was the first concert you attended?
Vanna Dickerson:Yeah, so the first one that I can remember, being kind of big, that I went to was Weezer actually, and it was so much fun. And actually this question made me think about how I need to start going to more concerts, where did you go see them In Atlanta?
Lisa Fortier:Okay, yep, wow, do you want to answer that too, Mason, you look a lot younger than the rest.
Mason Hill:Well, maybe not Sarah, but I grew up listening to a lot of like red dirt, Texas country, probably no like big, big names, but they're fantastic. So if that's something that interests y'all, I implore you to dig in. But very cool Good times.
Sarah Wright:Yeah, it's a fun question. We haven't asked that one in a while, so I was happy to bring that one back. Thank you, Vanna and Mason. We really appreciate you spending your time with us today, and also for contributing your research to JAVMA. Yeah, thanks again for having us.
Mason Hill:Yeah, thank you all so much.
Sarah Wright:And to our listeners. You can read Vanna and Mason's article on JAVMA. I'm Sarah Wright with Lisa Fortier. Be on the lookout for next week's episode and don't forget to leave us a rating and review on Apple Podcasts or whatever platform you listen to.
