Did you know that a brachycephalic dog with BOAS has a 433% higher anaesthetic risk than a dog with a normal nose?

Let me rephrase that: that Frenchie you’re spaying later this week is more than four times more likely to die on her surgery day than any of your other patients. 😳

Do we have your attention?!

Thanks mainly to the rising popularity of the French Bulldog, you’re probably anaesthetising these kinds of patients all the time.

So how do we reduce that risk? How do improve patient safety while decreeing your stress levels?!

At the Brachycephalic Care Unit, surgeon Dr Abbie Tipler and her team have polished brachycephalic anaesthesia down to a fine art, and in this episode, she shares all the gold.

From the days leading up to anaesthesia to selecting the safest mix of premed and anaesthesia agents, all the way to a calm, well-oxygenated recovery, this episode is the ultimate masterclass in brachycephalic anaesthesia.

Hit us up for the full show notes for this episode, as well as Dr Abbie’s brachycephalic pre-surgery history template, here.

This episode is one of more than 600 from our subscriber-only clinical podcasts. If you like this style of learning, where I dig for all the pro tips and updates from some of the best specialists in the world, then you’ll love our clinical feed. Go check it out at thevetvault.com

Oh, and if you’d like to join me in Japan in February or the Maldives in April for the most fun you’ll ever have at a vet conference - have a browse at vetsontour.com

Topics Covered:

Before the big day

• Structured history taking: airway, gastrointestinal, sleep, and anxiety indicators
• Understanding the link between upper airway obstruction and GI dysfunction
• Assessing regurgitation, silent reflux, and aspiration risk
• Pre-treatment protocols: omeprazole, metoclopramide, and diet adjustments
• Identifying when to delay elective procedures for optimisation
• Using C-reactive protein and radiographs to assess for aspiration pneumonia
• Managing anxiety pre-hospitalisation with trazodone

Plan for the day of surgery

• Fasting times and timing surgeries for optimal recovery monitoring
• Strategies for minimising stress in brachycephalic patients pre-op
• The role of early premedication and pain relief
• Drug choices: the “Goldilocks” approach to sedation
• Reducing regurgitation risk
• Your pre-op pro tips
• Extubation and recovery: positioning, monitoring, and oxygen weaning
• The impact of cage-side nursing and owner-assisted recovery

“If you can’t afford a pet, you shouldn’t own one.”

Ever said this line?

Once you’ve been on the receiving of someone’s anger about the cost of their vet bill, it’s an easy thought to have.

But it’s not the whole story, is it?

In this episode, I sit down with Dr. Paul Manktelow - a veterinary surgeon with 20+ years in UK animal charities and current Director of Veterinary Services at Blue Cross. Dr Paul shares lessons learned in not-for-profit vet care to help us untangle that tension between care, compassion, and commercial reality.

We cover:

• Trends from the front lines in the charity sector
• How “affordability” is shifting under rising cost of living
• Decision-making tools that balance optimal vs achievable care
• Business models that either enable or block access to care

• How vets can approach financial conversations with clarity, dignity, and trust

You’ll learn about:

💡 “Pragmatic care” as the antidote to chasing the mythical ‘gold standard’

💡 Cost-based vs value-based pricing models

💡How to think in tiers of care—and where the limits lie

Because behind every clinical decision is a human one.

Find out how we can help you build you in your vet career at thevetvault.com.

Check out our Advanced Surgery Podcast at ⁠⁠⁠⁠⁠⁠cutabove.supercast.com⁠⁠⁠⁠⁠⁠.

Get case support from our team of specialists in our ⁠⁠⁠⁠⁠⁠Specialist Support Space⁠⁠⁠⁠⁠⁠.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Join us in person for our epic adventure CE events at ⁠⁠⁠⁠Vets On Tour⁠⁠⁠⁠. (Next up: Japan snow conference!)

Topics and Time Stamps

03:11 Balancing Costs and Care in Veterinary Practice

06:45 Challenges and Changes in the Veterinary Profession

11:41 Client Expectations vs Financial Realities

16:32 The Impact of Economic Hardships on Pet Care

32:16 Blue Cross's Model

39:10 Individual Responsibility in Veterinary Practice

42:54 Getting Clear on Quality of Life and Prognosis

47:23 Cost-Based vs Value-Based Pricing Models

01:10:05 Pragmatic Care and Clinical Guidelines

01:16:54 The One Question

In episode 141, I shared my take on where AI fits into veterinary medicine - and where it might take us next.

But I’m no expert.

So I brought one in.

In this episode, I sit down with Rohan Relin , Silicon Valley software engineer and founder of ScribbleVet ,an AI tool built for vets. We unpack the promise and pitfalls of AI in clinical practice and try to figure out how you can use it without losing sleep (or your license).

What we cover:

• Why AI is not just a "smarter Google”- and why that matters
• The risky shortcuts vets are already taking (and how to avoid them)
• How to increase trust and accuracy when using AI
• Where innovation collides with privacy, data, and consent
• DIY AI vs purpose-built tools

If you're curious about AI but not sure what’s hype and what’s helpful, this one’s for you.

Come find out what W(asabi)TF Wednesday is all about at our Japan Snow Conference

Check out our podcast for business owners, and Dr Sam’s ‘How To Make A Hell Of a Profit And Still Go To Heaven’ workshop.

Join our community of Vet Vault Nerds to lift your clinical game and get your groove back with our up-to-date, easy-to-consume clinical episodes at ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠vvn.supercast.com⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠.

Get help with your tricky cases in our ⁠⁠⁠⁠⁠⁠⁠⁠Specialist Support Space.⁠⁠⁠⁠⁠⁠⁠⁠

V⁠⁠isit ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠thevetvault.com⁠⁠⁠⁠⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠for show notes and resources related to this episode.

⁠Subscribe to our weekly newsletter⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠here⁠⁠⁠⁠⁠⁠ ⁠for Hubert's favourite clinical and non-clinical learnings from the week.

Topics and Timestamps

04:39 What I got wrong about AI

08:19 How models “know” things — next‐word prediction & reasoning

15:00 Grounding AI responses using external tools / search

19:19 Scribble Vet features

38:12 Privacy, ownership, and AI liability

51:00 Rohan’s podcast and AI tool recommendations

54:00 Key misconceptions & Caveats