Anaesthesia for Bulldog

C-section
Amanda Lian, Henry Fan
Case History/Signalment

A 6 year old 20kg heavily pregnant English Bulldog has been straining non-productively for 2 hours,
and requires anaesthesia for caesarean section.
 Considerations
Physiological changes in a Clinical implications Preventative action
pregnant dog

Respiratory: ● Higher oxygen requirements Pre-oxygenation before surgery is

Large uterus putting pressure on
diaphragm→ atelectasis → ↓ total
lung volume + ↓ functional residual
capacity (FRC)
● Reduced oxygen delivery → important
rapid Hb desaturation
● Higher risk of hypoxaemia on
induction due to less FRC
buffer
● Uptake of inhalational Vigilant attention to anaesthetic
anaesthetics more rapidly depth
achieved

Neurological: Increased sensitivity to anaesthetic Vigilant attention to anaesthetic

↑ progesterone and agents depth
beta-endorphin levels
 Considerations
Physiological changes in a
pregnant dog
Gastrointestinal:
● ↑ progesterone →↓ lower
oesophageal sphincter tone
● ↑ Abdominal Pa → ↑
intra-gastric Pa + delayed
gastric emptying
Cardiovascular:
● Increased CO
● Ureto-placental perfusion is
pressure dependant
Clinical implications
Higher risk of aspiration or
regurgitation
If CO not maintained, risk of
hypotension → hypoperfusion to
the foetus → foetal distress
Preventative action
Rapid sequence induction (RSI)
technique and protection of airway
Monitor blood pressure and give IV
fluids intraoperatively
Positioning - Avoid aortocaval
compression aka ‘Supine
hypotension’
 Considerations
Common brachycephalic breed Clinical implications Preventative action
problems

Tend to have higher vagal tone Parasympathetic effects such as Prepare anticholinergic drugs should
bradycardia, bronchoconstriction, and these effects become severe
excessive saliva formation

Elongated soft palate Difficult intubation Laryngoscope is essential

Hypoplastic trachea Wide variety tube size should be

selected
Aims

● Minimal stress on the bitch

● Provide insensibility to pain during surgery
● Provide immobility to facilitate surgery
○ Use lowest possible dose of injectable/inhalational anaesthetic agents, dosage
reduction by 30-60%
● Uncomplicated, rapid recovery
○ Preferable to use drugs with short duration of action or easily reversed
● Minimal foetal/maternal mortality
Pre-anaesthesia management and
(premedication)
In lateral recumbency:

1. Clip and prep pre-induction if tolerated

2. Place an IV catheter and attach to IV fluids (Hartmanns, 10 ml/kg/hr)
3. No premed at all or low dose ACP with pethidine
4. Pre-oxygenation 3 to 5 minutes by facemask if tolerated
Induction and maintenance

1. In sternal recumbency: RSI with propofol (3 mg/kg) and immediate cuffed ET intubation
2. Maintain with isoflurane and oxygen
3. Quick reprep (or clip and prep if not done before)
4. Midline local block with 50:50 bupivacaine and lidocaine
5. Shift into dorsal recumbency → incise and remove pups
(Neonatal Resuscitation)

● Prepare warm and dry box beforehand

● Removal of pharyngeal secretions: rub/wipe off, suction
● Rub with warm towel: prevention of hypothermia, tactile stimulation of respiration
● Jen Chung acupuncture point

Not breathing → ventilate by mask or intubate

Heart rate slow/weak/absent → chest compressions

“Drugs are rarely indicated in resuscitation of newborns. Bradycardia is usually the result of
hypoxemia or hypothermia”. Neonatal Resuscitation Guidelines
Perioperative and post-op analgesic plan

Once all pups are removed from uterus, give:

○ Methadone (buprenorphine less preferable)

○ One off injection of NSAID: carprofen or meloxicam
○ +/- Tramadol to go home: unlicensed
Recovery

1. Recover in sternal recumbency with head slightly elevated

2. Keep supplying oxygen and monitor SpO2 with pulse oximeter
3. Extubate only when the dog is awake and aware of the presence of the tube (ie.
swallows)
4. Prepare more ET tubes and induction agent in case of relapse back into an unconscious
state