Key result
Sugammadex dosed at 2 mg/kg based on adjusted (141.85 s) or actual body weight (137.9 s) significantly reduced neuromuscular reversal time compared to ideal body weight (176.30 s).
Why the study?
The recommended sugammadex dose is 2 mg/kg, but calculating an appropriate dose for morbidly obese patients is problematic.
Does sugammadex dosed by adjusted or actual body weight reduce reversal time compared to ideal body weight dosing in morbidly obese patients undergoing bariatric surgery?
RCT (n=60)
No
Does sugammadex dosed by adjusted or actual body weight reduce reversal time compared to ideal body weight dosing in morbidly obese patients undergoing bariatric surgery?
Absolute Event Rate: 141.85% vs 176.3%
In morbidly obese patients, sugammadex dosed by adjusted body weight provides significantly faster reversal of neuromuscular blockade than ideal body weight, with no added benefit from using actual body weight.
May support adjusted or actual body weight dosing for faster reversal; leaves open larger randomized confirmation.
Background and objectives Sugammadex is a novel neuromuscular reversal drug. The recommended dose for sugammadex is 2 mg/kg. For morbidly obese patients, the calculation of an appropriate sugammadex dose is problematic. The aim of this study was to compare the reversal of rocuronium-induced neuromuscular blockade in morbidly obese patients using three doses of sugammadex; based on ideal body weight (IBW), adjusted body weight, and actual body weight. Patients and methods Sixty patients scheduled for laparoscopic bariatric surgery in Ain Shams University Hospital were enrolled into this prospective randomized study. At the end of the surgery, patients received sugammadex only when train of four response reached second twitch. According to their randomization, group A received sugammadex at a dose of 2 mg/kg for an IBW. Group B received sugammadex at a dose of 2 mg/kg for adjusted body weight, and group C received sugammadex, at a dose of 2 mg/kg for actual body weight. Time from administration of sugammadex to train of four ratio more than or equal to 0.9 was measured. Results Mean reversal time was 176.30±5.44 s in group A and decreased to 141.85±5.184 s in group B, and decreased again to 137.9±3.307 in group C. Pairwise comparisons between each of the two groups revealed that the decrease in reversal time from group A to group B, and from group A to group C were statistically significant. However, the decrease in reversal time from group B to group C was not statistically significant. Conclusion This study demonstrated that there was a statistically significant difference with respect to reversal time for sugammadex in morbidly obese patients, when given based on IBW versus adjusted body weight, and when given based on IBW versus actual body weight. However, there was no statistically significant difference with respect to reversal time for sugammadex, when given based on adjusted body weight versus actual body weight.
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Saleh et al. (2019) conducted an RCT in Morbid obesity requiring laparoscopic bariatric surgery (n=60). Sugammadex based on adjusted or actual body weight vs. Sugammadex based on ideal body weight was evaluated on Time from administration of sugammadex to train of four ratio more than or equal to 0.9. Sugammadex dosed at 2 mg/kg based on adjusted (141.85 s) or actual body weight (137.9 s) significantly reduced neuromuscular reversal time compared to ideal body weight (176.30 s).
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