Superior MAP–EtCO2 Target Attainment with Rocuronium-Facilitated Controlled Ventilation in Geriatric Small Dogs: A Retrospective Cohort Study

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.