Seizure activity following atracurium continuous rate infusion in three mechanically ventilated juvenile dogs

Area of Science:

• Veterinary neurology
• Critical care medicine
• Pharmacology

Background:

• Mechanical ventilation (MV) is a critical intervention for respiratory failure in dogs.
• Atracurium, a neuromuscular blocking agent, is used to facilitate MV.
• The use of atracurium via continuous rate infusion (CRI) in veterinary patients undergoing prolonged MV has not been previously documented.

Observation:

• This case series describes three pediatric dogs (2-3 months old) requiring MV due to respiratory fatigue and hypoxemia.
• All dogs received atracurium as a continuous rate infusion (CRI) during their ventilation period.
• Seizure activity was observed in all three dogs within 24 hours following extubation from MV.

Findings:

• All three dogs successfully weaned from MV after atracurium CRI administration experienced new-onset seizures during their recovery.
• Anticonvulsant protocols were administered, and no seizures were documented after 48 hours post-discontinuation from MV.
• This represents the first clinical description of seizures in dogs following atracurium administration and its use in long-term MV.

Implications:

• The findings suggest a potential association between atracurium CRI and seizure activity in dogs recovering from mechanical ventilation.
• While causation is not proven, clinicians should exercise caution and implement appropriate monitoring when using atracurium for extended durations in ventilated canine patients.
• Further research is warranted to elucidate the potential mechanisms and confirm the association between atracurium and post-extubation seizures in dogs.