Dosage of Sugammadex in morbidly obese patients

Abstract

Aim: The aim of the present study was to compare the doses of sugammadex based on ideal body weight, corrected body weight or actual body weight in terms of reversal of neuromuscular blockade and recovery of cognitive function. Material and Methods: Sixty morbidly obese patients scheduled for laparoscopic sleeve gastrectomy (LSG) were studied. Patients were randomly divided into three groups and received sugammadex according to IBW, CBW or ABW. BIS and acceleromyography were used in addition to routine monitoring. All patients received total intravenous anesthesia during the operation. Neuromuscular reversal times and cortical recovery times were recorded after administration of sugammadex for recovery from anesthesia. Results: Eye opening times were not statistically different between groups. The time to TOFR to 0.9, time to extubation was shortest in Group ABW and these times were longest in Group IBW. Cognitive recovery markers differed significantly among groups. The time to reach a BIS level above 80 was 160 s in Group ABW, 231 s in Group CBW and 290 s in Group IBW (p=0.024). Time to first verbal answer to questions and time to orientation were significantly longest in Group IBW and shortest in Group ABW. Among the three groups, none of the patients had a delayed discharge from PACU secondary to respiratory complications. Discussion: The ideal dosing regimen for administration of sugammadex to obese patients is still unclear. We suggest that TBW might be more appropriate for calculating sugammadex dose for safe and effective reversal of moderate rocuronium-induced neuromuscular block in morbidly obese patients.