Nebulization of epinephrine to reduce the severity of brachycephalic obstructive airway syndrome in dogs

Abstract

Objective: To determine the preoperative and postoperative effect of nebulized epinephrine on brachycephalic obstructive airway syndrome (BOAS) severity in dogs. Study design: Prospective clinical study. Sample population: Thirty-one client-owned pugs, French bulldogs, and English bulldogs with moderate to severe BOAS. Methods: Whole body barometric plethysmography was used to determine BOAS severity (BOAS index; 0%–100%) prior to and after nebulization with 0.05 mg/kg epinephrine diluted in 0.9% saline preoperatively. The same protocol was repeated postoperatively (within 24 hours of surgery). Results: Five dogs were excluded because they did not tolerate nebulization, and postoperative data were available for 13 dogs. Epinephrine nebulization resulted in a decreased BOAS index across all breeds of dog both before (9.6% [3.1% to −30.2%], n = 26) and after surgery (14.3% [0.9% to −24.3%], n = 13). The preoperative reduction in BOAS index was greater (17.3% [1.8% to −27.4%]) in dogs with a baseline BOAS index >70% (P =.006) and in pugs (16.9% [0.8% to −27.4%]) compared with French bulldogs (5.2% [3.1% to −30.2%], P =.03). Simple linear regression was used to identify a positive relationship between baseline BOAS index and reduction in BOAS index for pugs (n = 10, P =.001). Nausea was noted as a side effect in four dogs. Conclusion: Nebulized epinephrine reduced the BOAS index of dogs in this study. This effect was clinically significant in preoperative dogs with a BOAS index >70% and in dogs recovering from surgery. Clinical significance: This study provides evidence to support the use of nebulized epinephrine in the perioperative management of BOAS-affected dogs.