title: Use of Sugammadex in Patients With Obesity: A Pooled Analysis.
abstract: A growing proportion of patients undergoing surgical procedures are obese, providing anesthesiologists with numerous challenges for patient management. The current pooled analysis evaluated recovery times following sugammadex reversal of neuromuscular blockade by body mass index (BMI) in general, and in particular, in patients with BMIs ≥30 kg/m (defined as obese) and <30 kg/m (defined as non-obese). Data were pooled from 27 trials evaluating recommended sugammadex doses for reversal of moderate [reappearance of the second twitch of the train-of-four (TOF); sugammadex 2 mg/kg] or deep (1-2 post-tetanic counts or 15 minutes after rocuronium; sugammadex 4 mg/kg) rocuronium- or vecuronium-induced neuromuscular blockade. All doses of sugammadex were administered based on actual body weight. The recovery time from sugammadex administration to a TOF ratio ≥0.9 was the primary efficacy variable in all individual studies and in the pooled analysis. This analysis comprised a total of 1418 adult patients treated with sugammadex; 267 (18.8%) of these patients had a BMI ≥30 kg/m. The average time to recovery of the TOF ratio to 0.9 was 1.9 minutes for rocuronium-induced blockade and 3.0 minutes for vecuronium-induced blockade. No clinically relevant correlation was observed between BMI and recovery time. The recommended sugammadex doses based on actual body weight provide rapid recovery from neuromuscular blockade in both obese and non-obese patients; no dose adjustments are required in the obese patient.
authors.affiliation: 1Department of Anesthesiology and Perioperative Medicine, University of Missouri, Columbia, MO; 2Formerly of Biostatistics and Research Decision Sciences, MSD, Oss, The Netherlands; and 3US Medical Affairs, Anesthesia, Merck Sharp & Dohme Corp., Whitehouse Station, NJ.
authors.forename: Terri G
authors.initials: TG
authors.lastname: Monk
authors.forename: Henk
authors.initials: H
authors.lastname: Rietbergen
authors.forename: Tiffany
authors.initials: T
authors.lastname: Woo
authors.forename: Hein
authors.initials: H
authors.lastname: Fennema
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000732:Androstanols / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D000762:Anesthesia Recovery Period; D015992:Body Mass Index; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D061886:Neuromuscular Monitoring; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000037:antagonists & inhibitors*; D009765:Obesity / Q000601:surgery*; D000077123:Rocuronium; D000077122:Sugammadex; D013514:Surgical Procedures, Operative / Q000009:adverse effects*; D013997:Time Factors; D014673:Vecuronium Bromide / Q000008:administration & dosage / Q000037:antagonists & inhibitors; D055815:Young Adult; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D014673:Vecuronium Bromide; D000077123:Rocuronium