Should dosing of rocuronium in obese patients be based on ideal or corrected body weight?
BACKGROUND
Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections.


METHODS
Fifty-one obese patients, with a median (range) body mass index of 44 (34-72) kg/m2, scheduled for laparoscopic gastric banding or gastric bypass under propofol-remifentanil anesthesia were randomized into three groups. The patients received rocuronium (0.6 mg/kg) based on IBW (IBW group, n = 17), IBW plus 20% of excess weight (corrected body weight [CBW]20% group, n = 17), or IBW plus 40% of excess weight (CBW40% group, n = 17). Propofol was administered as a bolus of 200 mg and an infusion at 5 mg x kg(-1) x h(-1) and remifentanil was administered at 1.0 microg x kg(-1) x min(-1), both according to CBW40%. Neuromuscular function was monitored with train-of-four nerve stimulation and acceleromyography. The primary end point was duration of action, defined as time to reappearance of the fourth twitch in train-of-four.


RESULTS
The median (range) duration of action was 32 (18-49), 38 (25-66), and 42 (24-66) min in the IBW, CBW20%, and CBW40% groups, respectively (P = 0.001 for comparison of the IBW and CBW40% group). There were no significant differences in onset time (85 vs 84 vs 80 s) or in intubation conditions 90 s after administration of rocuronium.


CONCLUSIONS
In obese patients undergoing gastric banding or gastric bypass, rocuronium dosed according to IBW provided a shorter duration of action without a significantly prolonged onset time or compromised conditions for tracheal intubation.
Meyhoff
Christian S
CS
Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark. christianmeyhoff@gmail.com
Lund
Jørgen
J
Jenstrup
Morten T
MT
Claudius
Casper
C
Sørensen
Anne M
AM
Viby-Mogensen
Jørgen
J
Rasmussen
Lars S
LS
D000328:Adult; D000732:Androstanols / Q000494:pharmacology*; D000762:Anesthesia Recovery Period; D018686:Anesthetics, Intravenous / Q000494:pharmacology; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology*; D005260:Female; D015390:Gastric Bypass; D006801:Humans; D008297:Male; D008875:Middle Aged; D003473:Neuromuscular Nondepolarizing Agents / Q000494:pharmacology; D009765:Obesity / Q000150:complications*; D010880:Piperidines / Q000494:pharmacology; D015742:Propofol / Q000494:pharmacology; D000077208:Remifentanil; D000077123:Rocuronium
D000732:Androstanols; D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D000077208:Remifentanil; D000077123:Rocuronium; D015742:Propofol