Should dosing of sugammadex in morbidly obese patients be ...
Should dosing of sugammadex in morbidly obese patients be based on ideal or corrected body weight? P VAN LANCKER, T. BOGAERT*, #, J. P. MULIER#, M DE KOCK*.
Department of anaesthesiology*: UCL St Luc Woluwe# : AZ St Jan Brugge.
Introduction
Sugammadex is a water-soluble molecule. Overdosing is possible when dosed on Total Body Weight in obese patients.
Methods
Morbidly obese patients scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomized into three groups : ideal body weight (IBW), IBW + 20% and IBW + 40%. (IBW = length (cm) – 110 (woman) or 100 (man).(1)) All patients received Rocuronium 0.6 mg/kg ideal body weight at induction and additional doses in order to keep response ≤ 1 at the adductor policis to a supra-maximal train of four (TOF) stimulation of the ulnar nerve using TOF guard accelerometry. At the end of surgery and when TOF responses ranged T1-T2, patients received sugammadex 2mg/kg IBW or corrected IBW. Primary endpoint was time from sugammadex injection to a TOF ratio of 0.9. Secondary end-points were the ability of getting into bed by themselves on arrival at the post anaesthetic care unit (PACU) within 5 minutes and Steward recovery score at arrival on PACU and 15, 30 and 45 minutes after arrival. One-way ANOVA statistical analysis was used with p < 0.05.
Results
75 Patients were included after written informed consent and approval of the hospital ethical committee. There was no difference in BMI between the study groups (43.7, 43.6, 44.9 kg/m2). All patients in the three groups were fully reversed after sugammadex administration with a T4/T1 ratio ≥ 0.9. There was a significant difference (p = 0.000) in time of decurarisation between the three groups (see graph). 52% of the patients in IBW group, 56% in IBW+20% and 68% in IBW+40% were able to get into bed by themselves at arrival in the PACU. The Steward recovery scores were not significantly different between the three groups.
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Discussion
Sorgenfrei (2) found at a dose of 2mg/kg a median reversal time for Rocuronium-induced blockade of 78 seconds in non-obese patients. In our study, we observed longer reversal times in the first two study groups, with significant difference between the groups. The neuromuscular blockade was fully reversed in all 75 patients.
Conclusion
Morbidly obese patients can be reversed from rocuronium-induced neuromuscular blockade at T1-T2 level with sugammadex dosed at 2 mg/kg IBW. At 2 mg/kg IBW+40% the shortest time of 109 seconds was achieved coming close to 78 seconds what was described for TBW.
References
1. Broca P. P., Mémoires d’anthropologie. Paris, 1871/1877.
2. Sorgenfrei I. F., et al., ANESTHESIOLOGY, 104, 667-74, 2006
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