Sugammadex based on ideal, actual, or adjusted body weights for the reversal of neuromuscular blockade in patients undergoing laparoscopic bariatric surgery

Abstract

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.