Randomized comparison of sugammadex and neostigmine for reversal of rocuronium-induced muscle relaxation in morbidly obese undergoing general anaesthesia.
BACKGROUND
Complete and fast recovery of neuromuscular function is very important in morbidly obese patients because of the possible influence of postoperative residual curarization (PORC) on respiratory function in the postoperative period. Recent reports underline incidences of the residual influence of neuromuscular blocking agents.


METHODS
Seventy morbidly obese (BMI >40 kg m(-2)) patients requiring general anaesthesia and receiving rocuronium for muscle relaxation were randomly assigned into two groups: at the end of the anaesthetic procedure, one group received sugammadex 2 mg kg(-1) of corrected body weight (Group SUG) and the other group received neostigmine 0.05 mg kg(-1) of CBW (Group NEO). At the end of surgery and when response reached a train-of-four (TOF) score of 2, patients received the study drugs. The neuromuscular function was recorded and time to achieve 90% of TOF (safe extubation) was measured. Patients were examined directly after arrival to the post-anaesthesia care unit (PACU) by a blinded investigator for the presence of PORC.


RESULTS
Thirty-five patients received sugammadex and 35 neostigmine. Mean dose of rocuronium was 87.9 vs 85.6 mg (P>0.05), mean time to 90% of TOF was 2.7 vs 9.6 min (P<0.05), and TOF at the PACU was 109.8% vs 85.5% (P<0.05) in Groups SUG and NEO, respectively.


CONCLUSIONS
Administration of sugammadex provides fast recovery of neuromuscular function and prevents PORC in the morbidly obese, however neostigmine does not.
Department of Anaesthesiology and Intensive Therapy, BarlickiUniversity Hospital, Medical University of Lodz, Poland. tomgaszyn@poczta.onet.pl
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Gaszynski
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Szewczyk
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Gaszynski
D000328:Adult; D000732:Androstanols / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D000762:Anesthesia Recovery Period; D000886:Anthropometry / Q000379:methods; D050110:Bariatric Surgery; D006801:Humans; D008875:Middle Aged; D008991:Monitoring, Physiologic / Q000379:methods; D009388:Neostigmine / Q000494:pharmacology*; D019148:Neuromuscular Blockade / Q000379:methods; D009469:Neuromuscular Junction / Q000187:drug effects / Q000503:physiopathology; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors* / Q000494:pharmacology; D009767:Obesity, Morbid / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies; D000077123:Rocuronium; D000077122:Sugammadex; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000494:pharmacology*
D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D009388:Neostigmine; D000077123:Rocuronium