Sugammadex by ideal body weight versus 20% and 40% corrected weight in bariatric surgery – double-blind randomized clinical trial

Duarte, Nádia Maria da Conceição; Caetano, Ana Maria Menezes; Neto, Sílvio da Silva Caldas; Filho, Getúlio Rodrigues de Oliveira; Arouca, Gustavo de Oliveira; Campos, Josemberg Marins

doi:10.1016/j.bjane.2017.10.011

Cited by 4 publications

(5 citation statements)

References 25 publications

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“…The most common form of dose reduction used is based on the patient's IBW. Duarte et al 23 showed that the time taken for the TOF ratio to return to 0.9 was 225 AE 81 s after the administration of 2 mg/kg sugammadex according to IBW at the reappearance of the second twitch (T2), and they concluded that IBW can be used to calculate the sugammadex dose required to reverse moderate NMB in morbidly obese patients. Abd El-Rahman et al 22 compared the efficacy of sugammadex at doses of 1.5, 2, and 4 mg/ kg, calculated according to IBW, for the reversal of moderate rocuronium-induced NMB in laparoscopic bariatric surgery.…”

Section: Discussionmentioning

confidence: 99%

“…Duarte et al . 23 showed that the time taken for the TOF ratio to return to 0.9 was 225 ± 81 s after the administration of 2 mg/kg sugammadex according to IBW at the reappearance of the second twitch (T2), and they concluded that IBW can be used to calculate the sugammadex dose required to reverse moderate NMB in morbidly obese patients. Abd El-Rahman et al .…”

Section: Discussionmentioning

confidence: 99%

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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

et al. 2021

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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 )

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…10 Recent studies suggest a need for dosage prescription modification for these patients. 11 As the debate within ideal and real weight 12 for dose calculation is not defined, our protocol neglected this issue. For all sugammadex infusion, and especially for these particular patients, it is a legal obligation in most European countries to monitor sugammadex action.…”

Section: Discussionmentioning

confidence: 99%

“…The chosen population allowed us to analyse consistent data and to avoid possible confounding variables introduced by patients with extreme overweight, major renal insufficiency 9 or even dialysis 10 . Recent studies suggest a need for dosage prescription modification for these patients 11 . As the debate within ideal and real weight 12 for dose calculation is not defined, our protocol neglected this issue.…”

Section: Discussionmentioning

confidence: 99%

Earlier and lower dose administration of sugammadex

Duranteau¹,

Fernandez²,

Tuna³

et al. 2021

European Journal of Anaesthesiology

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BACKGROUND Sugammadex allows for rapid reversal of muscle relaxation after the use of rocuronium or vecuronium. The lowest recommended dose is 2 mg kg−1 intravenously when there are two twitches during the train-of-four stimulation. OBJECTIVE To study the efficacy and risks of a lower dose of sugammadex administered earlier. DESIGN Monocentric randomised controlled double-blind study. SETTING Academic hospital. PATIENTS Eighty patients were enrolled and randomised in 8 groups of 10 patients, 56 were finally evaluated. INTERVENTIONS Patients were distributed in two clusters constituting four groups each. In the first cluster, injections were administered after the return of one twitch with the train-of-four (TOF1). In the second cluster, injections were delivered after the return of two twitches with the TOF (TOF2). We created four groups in each cluster for different dosages: placebo, 0.5, 1 or 2 mg kg−1. MAIN OUTCOME MEASURES Time between the injection of sugammadex and full recovery (TOF ratio > 0.9) that is expressed in minutes. RESULTS Fifty-six successive patients were assessed between February and August 2018. The difference to TOF greater than 0.9 was not statistically significant between groups with the same dose administered at different times (F value = 0.001, P value = 0.975). There was a significant difference between groups with a different dosage administered at the same time (F ratio = 28.34; P value <0.0001). Concerning the time to TOF greater than 0.9 from the time point of TOF1, the timing of the dosages were statistically significant using log rank test (P < 0.0001). No patient presented a reparalysis. CONCLUSION No difference between injecting sugammadex at TOF1 or TOF2 was found regarding time to full recovery. Difference regarding sugammadex quantity was found and compatible with other studies. TRIAL REGISTRATION clinicaltrials.gov: ‘BRIDION_ERASME’, EudraCT: 2017-005074-19.

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“…These results are comparable to the results of the literature. But in the literature the dosage is calculated according to bodyweight, 19 IBW 20 or IBW + 40% 21 and not the CLBM. The effect of sugammadex is dose dependent.…”

Section: Discussionmentioning

confidence: 99%

Dosage of sugammadex according to the calculated lean body mass in obese female patients: time to reverse moderate neuromuscular blockade induced by rocuronium

Bougouma

Demeere

2019

Southern African Journal of Anaesthesia and Analgesia

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Background: Sugammadex is a selective relaxant binding agent for antagonism of prolonged rocuronium-induced neuromuscular blockade. The recommended dose is 2 mg/kg. Based on the pharmacological characteristics of sugammadex in obese patients, the calculated lean body mass (CLBM) should be used to determine the dose to reverse moderate neuromuscular blockade induced by rocuronium. Objective: A study was undertaken to prove that sugammadex can be used according to CLBM to reverse moderate neuromuscular blockade in obese female patients. Methods: This is a prospective, non-randomised, observational study. Sugammadex was used at the end of bariatric surgery on obese patients with a body mass index > 32 kg/m 2 . The dose was calculated according to the lean body mass. Muscle blockade was assessed using train-of-four monitoring. Results: Twenty women were included in this study. All patients were female and ASA 2. The age of patients ranged between 20 and 50 years with a mean age of 35.74 (±10) years. The mean CLBM was 50 kg. The mean time from administration of sugammadex to reverse neuromuscular blockade from two responses of TOF to T4/T1 > 90% was 167.25 seconds (2.8 minutes) (60-285 seconds). Conclusion: It is concluded that the calculated lean body mass can be used to calculate the dose of sugammadex for obese female patients to reverse moderate neuromuscular blockade induced by rocuronium.

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Sugammadex by ideal body weight versus 20% and 40% corrected weight in bariatric surgery – double-blind randomized clinical trial

Cited by 4 publications

References 25 publications

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

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

Earlier and lower dose administration of sugammadex

Dosage of sugammadex according to the calculated lean body mass in obese female patients: time to reverse moderate neuromuscular blockade induced by rocuronium

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