Key result
In patients with high body fat percentage, rocuronium dosed by total body weight resulted in a significantly shorter onset time (91.9 ± 28.8 s) compared to normal patients or dosing by fat-free mass (p=0.003).
Why the study?
Pharmacodynamics in patients with high body fat percentage might be similar to those in obese patients, but the effects of rocuronium across different percent body fats required evaluation.
Does dosing rocuronium based on fat-free mass compared to total body weight improve pharmacodynamic profiles in patients with high body fat percentage?
RCT (n=54)
No
Does dosing rocuronium based on fat-free mass compared to total body weight improve pharmacodynamic profiles in patients with high body fat percentage?
In patients with high body fat percentage, dosing rocuronium based on fat-free mass provides a similar pharmacodynamic profile to normal patients, whereas dosing based on total body weight prolongs clinical and pharmacological duration.
Answers are grounded in this paper and cite their sources.
FFM-based rocuronium dosing yields normal pharmacodynamics in high-PBF patients; extends weight-adjusted guidance beyond obesity.
The pharmacodynamics in patients with high body fat percentage might be similar to those in obese patients. This randomised controlled clinical trial observed the effects of rocuronium in patients with different percent body fats (PBFs). Fifty‐four patients who underwent elective urological or pelvic surgery under general anaesthesia at Shanghai General Hospital were included in the present study; 51 patients were included for data analysis. Patients with normal PBF (<25%) were given a single dose of rocuronium calculated based on total body weight (N‐TBW, control group). Patients with a higher PBF (≥25%) were given a single dose of rocuronium calculated based on total body weight (H‐TBW). Patients with higher PBF and rocuronium were dosed based on fat‐free mass (H‐FFM). A train of four (TOF)‐Watch acceleromyography monitor was used to measure the effects of the rocuronium. H‐TBW (91.9 ± 28.8 s) had significantly shorter onset time than N‐TBW and H‐FFM (p = 0.003). H‐TBW had significantly longer clinical duration time and pharmacological duration time than the other groups (p = 0.000 and 0.000, respectively); the TOF ratio0.25–0.9 time was significantly different among the three groups (p = 0.005). There were no significant differences in the recovery time (p = 0.103) or recovery index (p = 0.159) among the three groups. The effects of rocuronium dosed based on FFM in patients with high PBFs are similar to those in normal patients. A single dose of rocuronium calculated based on TBW might shorten the onset time, prolong the clinical and pharmacological duration times, and prolong the recovery time.
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An et al. (2024) conducted an RCT in Elective urological or pelvic surgery (n=54). Rocuronium vs. Rocuronium calculated based on total body weight in patients with normal percent body fat (<25%) was evaluated on Onset time (p=0.003). In patients with high body fat percentage, rocuronium dosed by total body weight resulted in a significantly shorter onset time (91.9 ± 28.8 s) compared to normal patients or dosing by fat-free mass (p=0.003).
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