title: Reversal of neuromuscular blockade by sugammadex in laparoscopic bariatric surgery: In support of dose reduction.
abstract: BACKGROUND
  Sugammadex is the first molecule able to antagonize steroidal muscle relaxants with few adverse effects. Doses are adjusted to body weight and the level of neuromuscular blockade. Sleeve gastrectomy is becoming a very popular form of bariatric surgery. It requires deep muscle relaxation followed by complete and rapid reversal to decrease postoperative and especially post-anaesthetic morbidity. Sugammadex is therefore particularly indicated in this setting. The objective of this study was to evaluate the deep neuromuscular blockade reversal time after administration of various doses of sugammadex (based on real weight or at lower doses). Secondary endpoints were the interval between the sugammadex injection and extubation and transfer from the operating room to the recovery room. We then investigated any complications observed in the recovery room.
  
  
  METHODS
  This pilot, prospective, observational, clinical practice evaluation study was conducted in the Amiens University Hospital. Neuromuscular blockade was induced by rocuronium. At the end of the operation, deep neuromuscular blockade was reversed by sugammadex at the dose of 4mg/kg.
  
  
  RESULTS
  Sixty-four patients were included: 31 patients received sugammadex at a dosage based on their real weight (RW) and 33 patients received a lower dose (based on ideal weight [IW]). For identical rocuronium doses calculated based on IBW, sugammadex doses were significantly lower in the IW group: 349 (± 65) mg versus 508 (± 75) mg (P<0.0001). Despite this dose reduction, neuromuscular blockade reversal took 115 (± 69) s in the IW group versus 87 (± 40) s in the RW group, but with no significant difference between the two groups (P=0.08). The intervals between injection of sugammadex and extubation (P=0.07) and transfer from the operating room to the recovery room (P=0.68) were also non-significantly longer in the IW group. The mean dose of sugammadex used by anaesthetists in the IW group was 4mg/kg of ideal weight increased by 35% to 50% (n=20; 351±34mg). No sugammadex adverse effects and no residual neuromuscular blockades were observed. Postoperative nausea and vomiting (PONV) was observed in 19.4% of patients in the real weight group versus 27.3% in the ideal weight group (P=NS).
  
  
  CONCLUSIONS
  Reversal of deep neuromuscular blockades by sugammadex in obese subjects can be performed at doses of 4mg/kg of ideal weight plus 35-50% with no clinical consequences and no accentuation of adverse effects.
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France. Electronic address: badaoui.rachid@chu-amiens.fr.
authors.forename: Rachid
authors.initials: R
authors.lastname: Badaoui
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Cabaret
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Youssef
authors.initials: Y
authors.lastname: Alami
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Elie
authors.initials: E
authors.lastname: Zogheib
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Ivan
authors.initials: I
authors.lastname: Popov
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Lorne
authors.affiliation: Pôle anesthésie-réanimation, centre hospitalier universitaire, place Victor-Pauchet, 80054 Amiens cedex 1, France.
authors.forename: Hervé
authors.initials: H
authors.lastname: Dupont
mesh_terms: D000328:Adult; D000732:Androstanols / Q000037:antagonists & inhibitors; D000762:Anesthesia Recovery Period; D050110:Bariatric Surgery / Q000379:methods*; D004305:Dose-Response Relationship, Drug; D023381:Endpoint Determination; D005260:Female; D005743:Gastrectomy / Q000379:methods; D006801:Humans; D056865:Ideal Body Weight; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019148:Neuromuscular Blockade / Q000379:methods*; D003473:Neuromuscular Nondepolarizing Agents / Q000037:antagonists & inhibitors; D010865:Pilot Projects; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D011446:Prospective Studies; D000077123:Rocuronium; D000077122:Sugammadex; D047408:gamma-Cyclodextrins / Q000008:administration & dosage*
chemical_list: D000732:Androstanols; D003473:Neuromuscular Nondepolarizing Agents; D047408:gamma-Cyclodextrins; D000077122:Sugammadex; D000077123:Rocuronium
keywords: Neuromuscular blockade; Obesity; Reversal; Rocuronium; Sleeve gastrectomy; Sugammadex