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

Objective: To describe patient recovery in dogs that had undergone mechanical ventilation (MV) and received atracurium as a continuous rate infusion (CRI).

Case series summary: Three dogs were treated with atracurium CRI while mechanically ventilated and were successfully weaned. All were pediatric patients (2-3 months old) ventilated due to respiratory fatigue and hypoxemia. All dogs experienced seizure activity in the initial 24 h following extubation and were treated with various anticonvulsant protocols; no patients experienced documented seizures after 48 h of discontinuation from MV.

New or unique information provided: All three successfully weaned dogs that had received an atracurium CRI experienced new onset seizures in their recovery from MV. Atracurium use in long-term MV has not been described previously, and seizures in dogs following atracurium administration has not been described in the clinical setting. Although causation cannot be proven in this case series, atracurium use should be carefully considered and be monitored appropriately when used for a prolonged duration.

Keywords: mechanical ventilation; neuromuscular blocker; neuromuscular blocking agents; positive pressure ventilation.