Efficacy and safety of sugammadex doses calculated on the basis of corrected body weight and total body weight for the reversal of deep neuromuscular blockade in morbidly obese patients

Abstract

Objective We investigated the efficacy and safety of sugammadex doses calculated using corrected body weight (CBW) for reversing deep rocuronium-induced neuromuscular blockade (NMB) in morbidly obese patients undergoing laparoscopic bariatric surgery. Methods One hundred and twenty-five morbidly obese patients were randomly assigned to three groups: (1) a CBW group, n = 50; (2) a total body weight (TBW) group, n = 50; and (3) a control group, n = 25. Deep NMB was maintained using a continuous infusion of rocuronium. At the reappearance of 1 to 2 post-tetanic counts (PTCs), 4 mg/kg sugammadex, calculated using CBW or TBW, were administered. Results All the participants in the CBW and TBW groups recovered to a train-of-four (TOF) ratio of 0.9 within 5 minutes. The recovery times from the start of sugammadex administration to a TOF ratio of 0.9 were 2.2 ± 0.7 and 2.0 ± 0.7 minutes in the CBW and TBW groups, respectively. Thus, a sugammadex dose calculated using CBW was not inferior to that calculated using TBW for the reversal of rocuronium-induced deep NMB in morbidly obese patients. Conclusion A dose of 4 mg/kg of sugammadex calculated using CBW is efficient and safe for the reversal of deep NMB after a continuous infusion of rocuronium in morbidly obese patients. Clinical Trial Registration Number ChiCTR1900028652 (Chinese Clinical Trial Registry, www.chictr.org.cn )

Appropriate dosing of sugammadex for reversal of rocuronium-/vecuronium-induced muscle relaxation in morbidly obese patients: a meta-analysis of randomized controlled trials

“… 13 – 16 Four trials reported a comparison between TBW and CBW, calculated as IBW + 0.4 × (TBW–IBW), as the dosing scalar. 13 – 15 , 17 One trial also included a group of patients receiving no reversal agent and another trial included a group in which IBW + 0.2 × (TBW–IBW) had been used as the dosing scalar; the patients from these groups were not incorporated into the pooled analysis. 13 , 17 The mean ± SD age was 40.82 ± 10.71 years.…”

“…According to the descriptions of the RoB 2 tool, three of five (60%) studies had a low risk of bias in all five domains (see supplementary materials, Figure 1 ). 14 , 16 , 17 In the other two studies, some concerns of bias arose from domain 1 (randomization) and/or domain 4 (measurement of outcome). 13 , 15 No domain in any study was considered to have a high risk of bias.…”

“…The final analysis included 444 patients with morbid obesity from five RCTs. [13][14][15][16][17] The characteristics of the five RCTs are summarized in Table 1. [13][14][15][16][17] Four trials reported a comparison between TBW and IBW as the dosing scalar.…”

“…[13][14][15][16][17] The characteristics of the five RCTs are summarized in Table 1. [13][14][15][16][17] Four trials reported a comparison between TBW and IBW as the dosing scalar. [13][14][15][16] Four trials reported a comparison between TBW and CBW, calculated as IBW þ 0.4 Â (TBW-IBW), as the dosing scalar.…”

“…[13][14][15]17 One trial also included a group of patients receiving no reversal agent and another trial included a group in which IBW þ 0.2 Â (TBW-IBW) had been used as the dosing scalar; the patients from these groups were not incorporated into the pooled analysis. 13,17 The mean AE SD age was 40.82 AE 10.71 years. According to the descriptions of the RoB 2 tool, three of five (60%) studies had a low risk of bias in all five domains (see supplementary materials, Figure 1).…”