Brachycephalic Consent Form

Introduction

This resource is intended to inform you of potential risks related to: anesthesia, hospitalization and sedation for pets with brachycephalic features. It also provides Animal Eye Care with relevant information regarding your pets health status. While not every risk listed may apply to your pet, these conditions are more prevalent in short nosed breeds; and may become more apparent or worsened due to: stress, travel, or medical care.

What Does "Brachycephalic" Mean?

The term "brachycephalic" refers to breeds (both cats and dogs) where the skull is shortened. Typically these individuals also have compressed, narrow airways. Breeds included in this designation are: Bulldogs (all), Shih Tzu, Chow Chows, Boston Terriers, Pugs, Persian cats, Exotic Shorthairs, Himalayan, Scottish Folds and many others.

Higher Risk for Brachycephalic Pets

Brachycephalic pets have unique challenges when receiving veterinary care, including breathing difficulties that can be worsened by sedation, anesthesia, or restraint. These conditions may result in inflammation, airway obstruction, inadequate oxygen intake, stomach content aspiration, increased body temperature, and, in severe cases, fatal complications. Environmental factors, stress, and travel can further heighten these risks. While surgical procedures may help correct airway issues, they do not completely eliminate them.

Pre-Procedure Assessment

Please answer the following questions to help us assess your pet’s condition:

Owner Name(Required)

Has your pet ever experienced difficulty breathing, loud snoring, intolerance to exercise, or episodes of collapse?(Required)

Yes

Has your pet ever suffered from gagging, vomiting, or regurgitation?(Required)

Yes

Has your pet been diagnosed with aspiration pneumonia?(Required)

Yes

Has your pet undergone corrective airway surgery?(Required)

Yes

Is your pet currently on steroid medication (e.g., prednisone) or a non-steroidal anti-inflammatory drug (NSAID) such as aspirin or Rimadyl?(Required)

Yes

Acknowledgment & Consent

Please read and initial the following statements to confirm your understanding of the risks involved:

I understand that my pet’s physical characteristics may increase risks associated with sedation, anesthesia, and hospitalization.(Required)

Please initial

I acknowledge that sedation and anesthesia may lead to complications such as breathing difficulties, aspiration pneumonia, airway blockages, and even death.(Required)

Please initial

I understand that emergency interventions, including airway intubation, may be necessary.(Required)

Please initial

I understand that my pet may have extended monitoring and care requirements while recovering from anesthesia and I agree to those costs associated.(Required)

Please initial

I confirm that I have had the opportunity to ask questions and discuss potential risks with the veterinary team.(Required)

Please initial

By signing below, I acknowledge that I have read and understood this information and consent to the necessary treatments for my pet.(Required)

Today's Date(Required)