Superior MAP-EtCO₂ Target Attainment with Rocuronium-Facilitated Controlled Ventilation in Geriatric Small Dogs: A...

Comparative evidence for integrated ventilation-neuromuscular blockade-reversal strategies is limited in geriatric small dogs. This single-center retrospective cohort included 288 dogs aged ≥12 years and weighing ≤7 kg undergoing orthopedic surgery or thoracolumbar hemilaminectomy. Initially planned strategies were spontaneous ventilation without neuromuscular blockade (A), controlled ventilation without blockade (B), rocuronium-controlled ventilation-sugammadex (C), vecuronium-controlled ventilation-sugammadex (D), or vecuronium-controlled ventilation-neostigmine-atropine (E). The primary outcome was the percentage of the entire primary physiologic window with concurrent mean arterial pressure ≥ 60 mmHg and end-tidal carbon dioxide 35-55 mmHg. Adjusted means were A 58.9%, B 59.3%, C 86.6%, D 74.0%, and E 67.8%. Group C exceeded A, B, and D by 27.7 (95% confidence interval, 26.3-29.2), 27.3 (25.9-28.8), and 12.7 (11.2-14.1) percentage points; B and A differed by 0.4 points (-0.8-1.6). Ventilator asynchrony occurred in 3.4% of C versus 73.2% of B. Adjusted mean times to normalized train-of-four ratio ≥ 0.90 were 1.41, 2.31, and 7.43 min in Groups C-E, respectively. Observed early respiratory and hard 48 h event risks were 3.4% and 1.7% in C, 40.7% and 18.6% in A, and 44.6% and 17.9% in B. The rocuronium-facilitated strategy was associated with superior concurrent target attainment; nonrandomized strategy selection precludes causal safety conclusions.