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Posted On Jun 24, 2025

Updated On Oct 07, 2025

Complications Of Anesthesia In Brachycephalic Dogs

Anesthesia & Analgesia

We previously reported on the issue and complications of postoperative vomiting and regurgitation in dogs and we have also learned more about the incidence of this problem and other anesthetic risks in brachycephalic as compared to nonbrachycephalic dog breeds.

Upper airway obstruction is a frequent complication in many brachycephalic dog breeds due to the anatomic abnormalities seen in many of these animals including stenotic nares, elongated soft palate, hypoplastic trachea, etc. As such, a commonly held belief is that “squashed or smush-faced” dog breeds are at a higher risk for complications associated with anesthesia, as airway compromise is more likely to develop and result in decreased oxygenation of the patient.  

A study1 compared the anesthesia-related complications between brachycephalic dogs and non-brachycephalic breeds and found the following:

  • Perianesthetic (intra-anesthetic and postanesthetic) complication rates were roughly the same for both groups - nearly 50% of all dogs experienced at least one perianesthetic complication

  • Postanesthetic complication rates were significantly different between both groups:
    • 13% of brachycephalic dogs experienced postanesthetic complications compared  to only 3% of non-brachycephalic dogs
    • Aspiration pneumonia developed in 4% of brachycephalic dogs compared to none on the non-brachycephalic dogs
    • Death occured in 1% of brachycephalic dogs compared to none of the non-brachycephalic dogs


Multivariate analysis of all the data in that study concluded that brachycephalic dog breeds are approximately twice as likely to develop perianesthetic complications and four times more likely to develop postanesthetic complications compared to other dogs. The odds of a complication decreased 2% with every 1 kg increase in body weight of the dog.

Complications were most frequent during the induction and recovery phases of anesthesia for brachycephalic dogs (as compared to the maintenance phase of anesthesia). This is likely because during the maintenance phase of anesthesia the larynx is open and protected and respirations can be controlled. 

Brachycephalic dogs are generally at a greater risk for vomiting and regurgitation. If this occurs in the perianesthetic period, there is a greater risk of the dog developing aspiration pneumonia. Withholding food for 24 hours prior to anesthesia and the pre-op administration of gastroprotectants, antinausea medications, and prokinetics can be considered to minimize the likelihood of aspiration pneumonia. It's important to realize, however, that these measures are not always effective.

Complications in the intra- and post- anesthetic periods can generally be minimized through a variety of practices (standards of care) including the use of balanced anesthetic drug protocols and monitoring of patients including their heart rate and rhythm, respirations, core body temperature, and blood pressure. Additionally, it is common practice to keep brachycephalic dog breeds intubated as long as possible during anesthetic recovery to ensure a patent airway and minimize the likelihood of aspiration in the event of vomiting or regurgitation.

Owners of brachycephalic dogs are sometimes especially fearful of having their pet undergo anesthesia. While we understand that the risk for adverse events are greater in these dogs, these risks likely increase if compounded by other comorbidities. It's important for owners to understand that many problems can progress (e.g. dental disease). Rather than avoiding anesthesia, being proactive in caring for a problem early on (before it worsens) is preferred. Being healthier going into an anesthesia (for a dental prophylaxis or mass removal) instead of deferring a procedure until it worsens is a proactive step towards minimizing risks and complications. 

 

[1] Risk of anesthesia-related complications in brachycephalic dogs. JAVMA Vol 253(3), pp 301-306. https://doi.org/10.2460/javma.253.3.301