My French Bulldog Died Under Anesthesia
Hello Dr. Kraemer, I recently lost my 4-month-old French bulldog while she went in for a spay procedure. She went into cardiac arrest before being extubated.
They used telazol and isoflurane during her procedure. After my bulldog died, I was told these are very high-risk for French Bulldogs, but the vet could not tell me the reasons why these are high-risk.
Could you please explain this to me?
Answer for My French Bulldog Died Under Anesthesia During a Routine Spay Procedure
Dear Kasey, My deepest condolences.
I extend my heartfelt sympathies. It is widely known that bulldogs and French bulldogs are more prone to anesthetic-related deaths compared to many other breeds.
Unfortunately, in the past thirty years, I have frequently received calls from grieving families or emails like yours, sharing sad stories of undetermined bulldog anesthetic deaths.
This guide is based on my extensive experience with tens of thousands of bulldog anesthetic cases, including many complex cases referred by other hospitals.
I strongly recommend reading this post and related links before undergoing any elective anesthetic procedure.
If you have family and friends planning a procedure, please share the links with them and ensure they read them.
Fortunately, we can limit those incidents by adhering to a few critical “must-know, must-do” rules.
Answer for My French Bulldog Died Under Anesthesia CAN IT BE PREVENTED?
Many of these unfortunate incidents could be avoided.
Most veterinarians are skilled in spaying and neutering, as it is often the most routine surgery.
However, a considerable number of them may possess limited expertise in bulldogs and may not be fully aware of the specific anesthetic risks associated with this breed.
Listed below are potential root causes of seemingly “unexplainable” deaths of bulldogs related to sedative or anesthetic procedures, most of which could have been prevented.
- Heart Disease: (rare)
- Bulldog anesthetic death is rarely caused by heart disease
- Conducting proper pre-anesthesia exams and diagnostic screening tests can help prevent them
- Anesthetic Drugs: (probable)
- Drugs are a probable cause of accidental anesthetic death.
- Proper drug selection, customization, and specialized anesthetic protocols can help prevent them
- Anesthetic monitoring: (probable)
- Lack or inadequate monitoring is a probable cause of a preventable anesthetic death
- Prevention requires proper instrumentation, training, and experience.
- Veterinary team: (probable)
- The medical team’s lack of experience, training, and breed specialization is a probable cause of preventable anesthetic death
- Prevention requires breed specialization and experience.
- BOAS: (highly likely)
- Anesthetic death related to misdiagnosed and untreated BOAS is a highly likely cause of preventable anesthetic death
- Prevention requires a proper diagnosis and prioritizing BOAS repair before any anesthetic elective.
- Anesthetic Recovery: (most likely)
- Lack of knowledge, training, and expertise in recovering a bulldog from an anesthetic procedure is most likely the #1 cause of the bulldog’s unexplained anesthetic death.
- It is unfortunate and preventable in the majority of cases.
See below for vital information concerning this list:
BULLDOG AND FRENCH BULLDOG HEART DISEASE
While uncommon, young bulldogs may possess congenital heart defects specific to the breed, such as:
- Pulmonary Stenosis
- Aortic or Subarotic stenosis
Older bulldogs could have heart conditions linked to their advanced age; examples are:
- Heart Base Tumor
- DCM (dilatative cardiomyopathy)
These issues should have been detected through a thorough veterinary examinations and screening tests
SCREENING TESTS FOR HEART DISEASE
- General Exam
- Blood pressure
- Chest radiographs
Bulldog Anesthetic Drugs Formulation and Protocols
Anesthetic drugs include:
- Pre-Anesthesia drugs
- Induction drugs
- Pain control drugs
- Anti-vomiting drugs
- inhalation anesthetics (vapor)
Anesthesia instantly becomes a risk if:
- Certain critical drugs are not used
- Using the wrong drugs
- Using an incorrect mix
- Giving them at the wrong time
- Using improper dosages
At my hospital, I developed an Excel sheet with preset protocols, timings, and drug information. The simplified process only required the nurse to input the bulldog’s weight, and the sheet automatically calculated the remaining details.
BULLDOG ANESTHETIC DRUGS COMMON ERRORS:
Morphine: Due to its potential to induce vomiting, morphine is generally not recommended for bulldogs under anesthesia. Vomiting can lead to aspiration, a serious and potentially life-threatening condition.
- INDUCTION IV DRUGS:
Propofol: Can cause respiratory depression and apnea. It should be used carefully because bulldogs rely on active muscle effort to maintain their airway; even mild respiratory depression can turn into a critical event.
ANESTHETIC TEAM AND MONITORING
Inadequate monitoring and an inexperienced team, coupled with insufficient monitoring personnel and monitoring instrumentation, can result in tragic anesthetic and preventable outcomes, may it be during induction, the anesthetic event, or post-anesthesia recovery.
Bulldog Anesthetic Monitoring: COMMON ERRORS
Relying too heavily on monitoring instrumentation is not advisable. A balanced approach should be sought, where a trained anesthetic nurse and modern monitoring devices complement each other effectively.
Concerns arise from
- Inadequate emergency CPR preparation and protocols
- Insufficient heating
- Suboptimal pain control
- Inadequate perfusion (fluid replacement)
- Premature extubation
- Inadequate post-extubation monitoring
Addressing and rectifying these aspects is crucial for ensuring the safety and well-being of the patient during and after anesthesia administration.
INEXPERIENCE VETERINARY TEAM:
A veterinary surgeon’s inexperience may prolong the anesthetic procedure and increase the likelihood of critical errors.
Bulldog Specialist Tip
If you cannot locate a general practice bulldog specialist, it’s advisable to explore having the procedure done at a local surgical center. These centers typically feature on-site certified boarded surgeons and anesthesiologists, with many offering 24-hour care as well.
Shop for expertise instead of $
Bulldog Veterinary Team: COMMON ERRORS
The most common examples are
- Proceeding with sedation and anesthesia without intubation
- Mask only
- IV anesthetic only
- Not recognizing patient distress
- Scheduling anesthesia for an elective procedure on a bulldog with BOAS
Bulldog BOAS and Anesthesia
Another common mistake is proceeding with an elective routine procedure on a bulldog suffering from brachycephalic obstructive airway syndrome (BOAS) problems such as:
- Elongated Palate
- Stenotic Nares
- Everted Laryngeal Saccules
- Laryngeal Collapse
- Hypoplastic Trachea
Some of those BOAS cases might also experience underlying, undiagnosed aspiration pneumonia, which can further escalate the risks associated with anesthesia.
BULLDOG POST-ANESTHESIA ERRORS:
Regardless of the hospital’s official version, the most frequent cause of bulldog anesthetic-related deaths, in my opinion, is the recovery phase.
Most veterinarians lack a comprehensive understanding of the substantial distinctions involved in recovering a bulldog from anesthesia compared to other dog breeds.
They may be unaware of the breed’s unique requirements and vulnerabilities, often letting their guard down during the critical post-anesthetic phase.
This stands as the primary undisclosed factor contributing to anesthetic deaths in bulldogs, and ironically, it occurs after the procedure, often following extubation.
Answer for My French Bulldog Died Under Anesthesia Due to CARDIAC ARREST
Regrettably, due to the lack of crucial details, I am not able to tell you the underlying cause of death.
It’s important to note that attributing death to “cardiac arrest” may overlook the actual root cause (the heart arrest with every passing of life).
Presented below are vital safety guidelines for administering anesthesia to bulldogs. I hope that they will provide you and your family with some closure.
Equally important is my aspiration that these guidelines will prove beneficial to our bulldog community and serve as a preventive measure against any future unfortunate incidents.
This information can be shared and discussed with your vet before agreeing to any sedation or anesthetic procedure.
French Bulldog Died Under Anesthesia During a Spay Must Know #1: RISK-REWARD MERITS
Insist on anesthetic decision-making that considers risk and reward. Refuse to accept any anesthetic procedure that lacks substantial merit.
For instance, question the necessity of an anesthetic procedure solely aimed at enhancing the aesthetic appearance of your pet, such as a benign, slow-growing tumor on a senior bulldog.
French Bulldog Died Under Anesthesia During a Spay Must Know #2: SEDATION
I would steer clear of any sedation that does not include intubation (ensuring patent airways).
While this practice is routine and safe in other breeds, it poses a risk for bulldogs due to their abnormal airways and unique breathing “biomechanics” when under sedation.
Generally, I favor inhalation anesthetics over injectable ones. Inhalation anesthetics offer superior control and safety margins.
French Bulldog Died Under Anesthesia Must Know #3: MEDICAL TEAM
Bulldogs and French Bulldogs differ from other breeds. It’s crucial to find a veterinarian and veterinary team with experience in the specific medical idiosyncrasies of these breeds and their potential effects on anesthesia.
This video demonstrates some basic monitoring and patient care while under anesthesia.
- Body Heat: keeps the pet warm (hot-air red bag, blanket, heated table)
- IV Fluid Drip: keeps the pet perfused
- Trained Nurse: constant monitoring, flow chart recordings
- Monitoring Devices: high-end monitor devices and sensors
- ETT: endotracheal intubated
Bulldog Died Under Anesthesia Must Know #4: DIAGNOSTIC WORKUP
At our specialized Bulldog hospital, it is mandatory for all patients undergoing anesthesia to provide a pre-anesthesia diagnostic assessment. This assessment should encompass:
- Preoperative laboratory tests:
- urine analysis
- Electrocardiogram (ECG)
- Blood pressure measurements
- Radiographs, in some cases
Bulldog Elongated Soft Palate Chest Radiographs:
Furthermore, we require all bulldogs and French bulldogs scheduled for soft palate surgery, to have current chest and airway radiographs
Bulldog Died Under Anesthesia Must Know #5: AIRWAY DISEASE
If your bulldog displays signs of respiratory distress, such as stridor, before the anesthesia procedure, it is crucial to address these issues before proceeding.
Moreover, brachycephalic obstructive airway syndrome (BOAS) conditions, including stenotic nares and laryngeal airflow problems like an elongated soft palate, should take precedence over elective procedures like spaying and neutering.
The treatment and correction of these airway conditions should be undertaken either during or before the specified elective procedure.
Failing to prioritize these steps significantly increases the risk of a postoperative extubation catastrophe.
Bulldog Died Under Anesthesia Must Know #6: SPECIALIZED PROTOCOL
To mitigate various potential risks, I’ve created a specialized anesthetic protocol specifically designed for brachycephalic breeds like bulldogs.
This protocol considers their distinctive requirements and inherent challenges related to anesthesia.
- DRUGS: The ultimate drug mix and dosage are customized to the breed, breed age, breed size, and health status.
- TIMING: The correct timing to administer
- PERFUSION: Intravenous fluids for ideal perfusion
- ETT: Correct-size endotracheal tube
It’s crucial to ensure that your veterinarian is well-informed about the breed’s unique anesthesia needs.
Bulldog Died Under Anesthesia Must Know #7: PRE-OXYGENATION
Before induction, we administer 100% oxygen to all our bulldogs and French bulldogs as part of the pre-anesthesia protocol. This is done to enhance their ventilation, perfusion, and airway oxygen saturation, as illustrated in the accompanying photo.
In some cases, we also transport the patient to an oxygen cage or place a nasal oxygen tube after the anesthetic procedure ends.
Bulldog Died Under Anesthesia Must Know #8: MONITORING
We employ comprehensive anesthetic monitoring equipped with state-of-the-art devices.
- Pulse Oximeter (tissue oxygenation)
- Capnography (CO2 sensor)
- Blood Pressure Monitor
- Body Temperature Monitor
Additionally, I have introduced specialized training in anesthesia and recovery monitoring, which is mandatory for all nursing team members before they participate actively in anesthetic procedures.
Bulldog Anesthesia Safety Must Know #9: SEVOFLORAN vs. ISOFLORANE
For brachycephalic breeds like bulldogs, we exclusively employ sevoflurane for inhalation anesthesia, in contrast to the more commonly used isoflurane in most hospitals.
The heightened safety offered by sevoflurane justifies the additional expense.
Bulldog Anesthesia Safety Must Know #10: RECOVERY
The post-anesthesia period, known as the “recovery period,” is the most crucial phase.
Ironically, an inexperienced medical team often lets their guard down during that phase and prematurely pulls the ETT.
Unfortunately and tragically, the majority of “bulldog anesthetic deaths” occur in that phase, most of which could have been prevented
Various factors contribute to this, with premature extubation being the most prevalent.
Extubation in bulldogs necessitates precise timing and vigilant supervision. An improperly timed extubation can result in asphyxiation due to an obstructed airway resulting from:
- Thickened tongue
- Swollen elongated soft palate
- Edematous larynx
Emergency reintubation becomes a critical task in such circumstances, demanding swift action within seconds to provide the patient with a fighting chance for a successful recovery.
Additional compromising conditions that can exacerbate this emergency include
- lower airway problems (pulmonary edema)
- temperature regulation (under or overheating)
- heart irregularities (arrhythmias)
- reflux & vomiting
The combination of these factors creates a perfect storm that requires prompt and efficient management to address the complexities and ensure the well-being of the patient. Speed is of the essence in handling this multifaceted emergency scenario.
In our hospital, we have developed a tailored recovery protocol for bulldogs to ensure an optimal and safe recovery process.
Answer for My French Bulldog Died Under Anesthesia: SAFETY SUMMARY:
Every anesthetic procedure carries inherent risks, particularly in bulldogs and French bulldogs. However, these risks can be minimized through:
- Specialized training and protocols
- Diligent monitoring
Many veterinarians may lack extensive experience with these breeds and may not fully grasp the level of difficulty and expertise needed, especially in terms of sedation and anesthesia.
As the owner and caretaker, it is crucial to invest time, ask relevant questions, and conduct thorough research to ensure proper understanding and due diligence.
Bulldog Anesthesia Safety: OWNERS MUST DO
- Expertise Vs Price: Shop for the best medical team instead of the best price
- Risk-Reward: Decide if the procedure is worth the risk
- Intubation: The patient must be intubated
- BOAS: Must be repaired before an elective procedure
- Keep it as long as possible
- Ensures that a nurse remains with the patient for at least 15 minutes after extubation
To acquire further information, please visit my “prevent & treat” articles dedicated specifically to Bulldog and French bulldog anesthesia safety
My sincere condolences for your loss
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