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Actual versus ideal body weight dosing of sugammadex in morbidly obese patients offers faster reversal of rocuronium- or vecuronium-induced deep or moderate neuromuscular block: a randomized clinical trial.


ABSTRACT:

Background

This randomized, double-blind trial evaluated sugammadex-mediated recovery time from rocuronium- or vecuronium-induced moderate (M-) or deep (D-) neuromuscular block in morbidly obese adults dosed by actual (ABW) or ideal body weight (IBW).

Methods

Adults with BMI ?40?kg/m2 were randomized to 1 of 5 groups: M-neuromuscular block, sugammadex 2?mg/kg ABW; M-neuromuscular block, sugammadex 2?mg/kg IBW; M-neuromuscular block, neostigmine 5?mg, and glycopyrrolate 1?mg; D-neuromuscular block, sugammadex 4?mg/kg ABW; or D-neuromuscular block, sugammadex 4?mg/kg IBW. Supramaximal train of four (TOF) stimulation of the ulnar nerve (TOF-watch SX®) monitored recovery. Primary endpoint was time to TOF ratio???0.9 for ABW and IBW groups pooled across neuromuscular blocking agent (NMBA)/blocking depth, analyzed by log-rank test stratified for agent and depth. Prespecified safety outcomes included treatment-emergent bradycardia, tachycardia, and other arrhythmias, and adjudicated hypersensitivity and anaphylaxis.

Results

Of 207 patients randomized, 188 received treatment (28% male, BMI 47?±?5.1?kg/m2, age 48?±?13?years). Recovery was 1.5?min faster with ABW vs IBW dosing. The sugammadex 2?mg/kg groups recovered 9-fold faster [time 0.11-fold, 95% CI 0.08 to 0.14] than the neostigmine group. ABW (5.3%) and IBW (2.7%) groups had similar incidences of recovery time?>?10?min (95% CI of difference: -?4.8 to 11.0%); 84% for neostigmine group. Re-curarization occurred in one patient each in the 2?mg/kg IBW and neostigmine groups. Prespecified safety outcomes occurred with similar incidences.

Conclusions

ABW-based sugammadex dosing yields faster reversal without re-curarization, supporting ABW-based sugammadex dosing in the morbidly obese, irrespective of the depth of neuromuscular block or NMBA used.

Trial registration

Registered on November 17, 2017, at ClinicalTrials.gov under number NCT03346070 .

SUBMITTER: Horrow JC 

PROVIDER: S-EPMC7913453 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Publications

Actual versus ideal body weight dosing of sugammadex in morbidly obese patients offers faster reversal of rocuronium- or vecuronium-induced deep or moderate neuromuscular block: a randomized clinical trial.

Horrow Jay C JC   Li Wen W   Blobner Manfred M   Lombard John J   Speek Marcel M   DeAngelis Matthew M   Herring W Joseph WJ  

BMC anesthesiology 20210227 1


<h4>Background</h4>This randomized, double-blind trial evaluated sugammadex-mediated recovery time from rocuronium- or vecuronium-induced moderate (M-) or deep (D-) neuromuscular block in morbidly obese adults dosed by actual (ABW) or ideal body weight (IBW).<h4>Methods</h4>Adults with BMI ≥40 kg/m<sup>2</sup> were randomized to 1 of 5 groups: M-neuromuscular block, sugammadex 2 mg/kg ABW; M-neuromuscular block, sugammadex 2 mg/kg IBW; M-neuromuscular block, neostigmine 5 mg, and glycopyrrolate  ...[more]

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