title: Comparison of neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients.
abstract: OBJECTIVE
  Obese patients are more vulnerable to residual neuromuscular block (NMB) and its associated complications in the post-operative period. This study was carried out to compare neostigmine induced reversal of vecuronium in normal weight, overweight and obese female patients, objectively using neuromuscular (NM) monitoring.
  
  
  METHODS
  Twenty female patients each belonging to normal weight, overweight and obese, based on body mass index, requiring general anaesthesia were recruited for this prospective cross sectional study. NMB was induced with vecuronium (0.1 mg/kg) dose based on patient's real body weight (RBW) and monitored using acceleromyographic train of four (TOF). All patients received neostigmine 40 μg/kg and glycopyrrolate 10 μg/kg at 25% of spontaneous recovery of first twitch height (T1) of TOF (DUR 25%) and were allowed to recover to TOF ratio of 0.9. Statistical analysis was done using analysis of variance test.
  
  
  RESULTS
  Recovery of TOF ratio to 0.5 was comparable in all three groups. Recovery of TOF ratio to 0.7 was delayed in obese (9.82 ± 3.21 min) compared with normal weight group (7.50 ± 2.52 min). Recovery of TOF to 0.9 was significantly delayed in both overweight (12.18 ± 4.29 min) and obese patients (13.78 ± 4.30 min). DUR 25% was significantly longer in overweight (mean, standard deviation [range]; 30.10 [19-40 min]) and obese (28.8 [12-45 min]) compared with normal weight patients (22.75 [16-30 min]).
  
  
  CONCLUSIONS
  In overweight and obese patients, when vecuronium induction dose is based on RBW, neostigmine induced recovery of NMB is delayed in late phases (TOF 0.7-0.9), which may result in vulnerability for associated complications of incomplete recovery. Ensuring safe recovery thus requires objective NM monitoring.
authors.affiliation: Department of Anaesthesiology and Critical Care, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
authors.forename: Shilpa Bhimasen
authors.initials: SB
authors.lastname: Joshi
authors.affiliation: Department of Anaesthesiology and Critical Care, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
authors.forename: Ks Vasudeva
authors.initials: KV
authors.lastname: Upadhyaya
authors.affiliation: Department of Anaesthesiology and Critical Care, St John's Medical College and Hospital, Bengaluru, Karnataka, India.
authors.forename: M
authors.initials: M
authors.lastname: Manjuladevi
keywords: Neostigmine; neuromuscular monitoring; obesity; vecuronium bromide
references.citation: Anaesthesia. 2012 Sep;67(9):991-8
references.pmid: 22698066
references.citation: Anesth Analg. 2010 Jan 1;110(1):64-73
references.pmid: 19713265
references.citation: Br J Anaesth. 2000 Jul;85(1):91-108
references.pmid: 10927998
references.citation: Anesth Analg. 1992 Apr;74(4):515-8
references.pmid: 1348166
references.citation: Eur J Anaesthesiol. 1995 Nov;12(6):585-9
references.pmid: 8665881
references.citation: Anaesthesia. 2009 Mar;64 Suppl 1:10-21
references.pmid: 19222427
references.citation: J Clin Anesth. 2011 Nov;23(7):575-86
references.pmid: 22050805
references.citation: Anaesthesia. 2009 Mar;64 Suppl 1:82-9
references.pmid: 19222435
references.citation: Acta Anaesthesiol Scand. 1996 May;40(5):574-8
references.pmid: 8792887
references.citation: Anaesthesia. 2009 Mar;64 Suppl 1:22-30
references.pmid: 19222428
references.citation: Anesth Analg. 2010 Jul;111(1):120-8
references.pmid: 20442260
references.citation: Anesthesiology. 2009 Jun;110(6):1253-60
references.pmid: 19417617
references.citation: Br J Anaesth. 2009 Jul;103(1):115-29
references.pmid: 19468024
references.citation: Anesth Analg. 2010 Jul;111(1):129-40
references.pmid: 20442261
references.citation: Int Anesthesiol Clin. 2013 Summer;51(3):52-66
references.pmid: 23797645
references.citation: Anesthesiology. 1987 Apr;66(4):471-6
references.pmid: 3565812
references.citation: Can J Anaesth. 1996 Sep;43(9):932-8
references.pmid: 8874911
references.citation: Curr Anesthesiol Rep. 2013 Mar 1;3(1):10-17
references.pmid: 23525377
references.citation: Acta Anaesthesiol Scand. 1992 May;36(4):383-6
references.pmid: 1350697
references.citation: Ann Pharmacother. 2000 Sep;34(9):1066-9
references.pmid: 10981254
references.citation: Anesthesiology. 1986 Sep;65(3):286-91
references.pmid: 2875680
references.citation: Br J Anaesth. 1991 Apr;66(4):469-75
references.pmid: 2025474
references.citation: Anesthesiology. 1990 Sep;73(3):410-4
references.pmid: 1975484
references.citation: Anesth Analg. 1988 Dec;67(12):1149-53
references.pmid: 2904232
references.citation: Br J Anaesth. 1993 May;70(5):579-80
references.pmid: 8100440
references.citation: Br J Anaesth. 2006 Aug;97(2):160-3
references.pmid: 16782976
references.citation: Curr Opin Anaesthesiol. 2010 Aug;23(4):485-91
references.pmid: 20531173