Sugammadex Ideal Body Weight Dose Adjusted by Level of Neuromuscular Blockade in Laparoscopic Bariatric Surgery Full Text
Llaurado S et al. – A sugammadex dose calculated according to ideal body weight (IBW) is insufficient for reversing both deep and moderate blockades in morbidly obese patients.Methods
- Prospective observational study of consecutive patients scheduled for laparoscopic bariatric surgery.
- To reverse a deep blockade (2 or fewer posttetanic twitches), a dose of sugammadex of 4mg/kg ideal body weight (IBW) was followed by a second dose of 2mg/kg IBW if the TOFR was less than 0.9 after 3min.
- To reverse a moderate blockade (reappearance of the second twitch in the TOF), a 2mg/kg IBW dose of sugammadex was followed by a second dose of 2mg/kg IBW if the TOFR was less than 0.9 after 2min.
- Sugammadex effectiveness was reflected by the time required to obtain a TOFr of 0.9 or more.
- A total of 120 patients were included.
- The blockade was deep at the end of surgery in 43 and moderate in 77.
- The median times (range) to TOFR of 0.9 or more were 167 (20–460)seconds and 113 (28–300)seconds in deep and moderate blockades, respectively (P<0.05).
- The percentage of patients requiring a second dose of sugammadex were larger after deep blockades (39.5% [n=17] vs. 23.4% [n=18] after moderate blockades); the difference was not significant.