Sugammadex reversal of an accidental rocuronium overdose in a dog in the context of incivility in the workplace.

A 7-year-old, 10.6 kg female mixed-breed dog underwent anaesthesia for craniotomy to excise a brain mass. During anaesthetic preparation, repeated time pressure remarks resulted in rushed preparation and workflow disruption. Following anaesthetic premedication with methadone, general anaesthesia was induced with lidocaine, midazolam, and propofol, and maintained with propofol and remifentanil intravenous infusions. Rocuronium was given as a bolus (0.5 mg kg -1 IV) followed by continuous infusion at an intended rate of 0.2 mg kg -1 hour -1 . After 120 minutes of rocuronium constant rate infusion, a dose calculation error was identified resulting in a 60 fold rocuronium overdose per hour. The infusion was stopped and surgery continued for a further 100 minutes. Sugammadex (1 mg kg -1 IV) was given 390 minutes after the constant rate infusion of rocuronium was initiated (and 270 minutes after the infusion stopped), leading to return of spontaneous ventilation within one minute, without haemodynamic compromise. Tracheal extubation occurred uneventfully 60 minutes after injection of sugammadex. This report demonstrates that sugammadex can effectively reverse a large rocuronium overdose in dogs, providing a valuable rescue option in deep neuromuscular blockade. It also highlights the role of workplace incivility in contributing to medication error. The complex technical demands of veterinary anaesthesia, including medication preparation and delivery, are vulnerable to inadequate safety practices. Awareness of both pharmacological rescue strategies and the impact of incivility, alongside implementing standard operating procedures aimed at reducing medication error, are essential to improving patient outcomes in veterinary anaesthesia.