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Brachycephalic Obstructive Airway Syndrome (BOAS) affects many flat-faced breeds, impacting their breathing and overall well-being. In this blog, we’ll be diving into the key clinical signs, challenges, and management of BOAS patients. 

🔍 Understanding BOAS grading! 🐾

Patients with a flat, wide-shaped head are said to be brachycephalic (‘brachy’ meaning short, and ‘cephalic’, meaning head). The soft tissue in the nose and throat of some brachycephalic breeds may be excessive for the airways, partially obstructing the airway and making it difficult for them to breathe normally (causing heavy panting or noisy breathing). This condition is known as BOAS.

BOAS severity is assessed on a grading scale from mild to severe, helping guide treatment and management. Here’s a breakdown of the grading system!

🐶 Classic airway changes in the BOAS patient 🐱   

BOAS patients often experience structural airway abnormalities that make breathing difficult, including:

❤️‍🩹 Stenotic nares
❤️‍🩹 Elongated/thickened soft palate
❤️‍🩹 Everted laryngeal saccules
❤️‍🩹 Hypoplastic trachea
❤️‍🩹 Laryngeal collapse

Understanding these changes is key to managing and treating affected patients! 

Travelling with the BOAS patient 🚗🐶

Travel can be stressful for brachycephalic pets, but with the right approach, it doesn’t have to be! If possible, have the carers transport them, as this keeps them calmer. Keep travel time short, use air conditioning, and create a stress-free environment. If the patient is already in crisis, a pet ambulance may be necessary. These are equipped with oxygen and trained staff, and they can accommodate intubated patients.

How does the BOAS patient ✨ present ✨

Recognising the signs of BOAS patients is key, clinical signs include: 

🐾 Cyanosis
🐾 Unable to nose breathe at rest
🐾 Resting tachycardia
🐾 Syncope
🐾 Excessive noisy respiration (“pug snort”)
🐾 Resting tachypnoea
🐾 Prone to hyperthermia as panting is ineffective and difficult
🐾 Poor exercise tolerance

Nursing the BOAS patient ✨ pre-surgery ✨

Caring for BOAS patients before surgery requires a calm and controlled approach:

✅ Monitor for excessive panting
✅ Avoid covering the kennel unless evidently necessary, as this may worsen their anxiety
✅ Create a quiet, dim, and stress-free environment
✅ Keep them cool & hydrated
✅ Keep TPRs to a minimum
✅ Be mindful of any potential triggers that could cause excitement or over-arousal in their environment

Nursing the BOAS patient ✨ post-surgery ✨

Post-op care is crucial for BOAS patients to ensure a smooth recovery:

✅ Assign a dedicated nurse to sit with them if possible
✅ Have an emergency intubation tray prepared and keep ETT (endotracheal tube) in as long as possible
✅ Maintain a quiet, cool, and dim environment
✅ Always have a source of oxygen nearby in case needed and maintain SpO₂ between 95-100%
✅ If they regurgitate during surgery, keep them on an antiemetic CRI
✅ Feed soft, balled foods and and gradually transition them back to their regular diet as soon as possible

Close monitoring makes all the difference! 💙

Check out our animation on BOAS here, or if you are interested to find out more about our Soft Tissue and Anaesthesia + Analgesia Services, please click on the links! Be sure to follow us on Facebook and Instagram for regular patient stories.

Thanks for reading 🐾