Utility of Rocuronium-Sugammadex Combination to Induce Apnea in Dogs Undergoing Stereotactic Radiation Therapy

Area of Science:

• Veterinary Medicine
• Radiation Oncology
• Anesthesiology

Background:

• Stereotactic radiation therapy (SRT) demands high precision due to steep dose gradients and small margins.
• Respiratory motion significantly challenges accurate tumor targeting in SRT.
• Minimizing patient motion is crucial for effective and safe SRT delivery.

Purpose of the Study:

• To evaluate the efficacy and safety of the rocuronium-sugammadex (ROC-SUG) combination for inducing apnea in dogs undergoing SRT.
• To assess the impact of rocuronium administration methods (bolus vs. constant rate infusion) on apnea duration and quality.
• To identify and characterize any adverse effects associated with ROC-SUG use during SRT.

Main Methods:

• A retrospective study analyzed 43 SRT treatments in 14 pet dogs using the ROC-SUG combination.
• Rocuronium was administered via initial bolus followed by constant rate infusion (CRI) or bolus alone.
• Apnea duration, quality, and adverse events (hypercapnia, bradycardia, hypotension) were recorded. Neuromuscular blockade reversal by sugammadex was also assessed.

Main Results:

• Rocuronium constant rate infusion (CRI) significantly improved apnea induction success (88%) compared to bolus alone (27%).
• Median apnea duration was 6 minutes, with a maximum of 7 minutes.
• Hypercapnia occurred in 79% of treatments, but significant bradycardia and hypotension were rare (2%) and rapidly reversible. Sugammadex ensured rapid reversal of neuromuscular blockade.

Conclusions:

• The ROC-SUG combination, particularly with ROC CRI, is an effective method for inducing apnea in dogs during SRT.
• This technique can mitigate respiratory motion artifacts, potentially enhancing treatment precision and safety.
• Further research with standardized protocols is recommended to confirm efficacy and safety.