Does Rocuroinum Dose Adjusted Due to Lean Body Weight Provide Adequate Intubation Conditions?: A Prospective Observational Study

Duygu Demiroz, Yusuf Ziya Colak, Sumeyye Koc Iclek, Mehmet Ali Erdogan, Neslihan Altunkaya Yagci, Mahmut Durmus, Nurcın Gulhas, Duygu Demiroz, Yusuf Ziya Colak, Sumeyye Koc Iclek, Mehmet Ali Erdogan, Neslihan Altunkaya Yagci, Mahmut Durmus, Nurcın Gulhas

Abstract

Methods: This is a prospective, observational study. Patients between the ages of 18 and 65 with BMI of 18.5-34.9, who are expected to be under general anesthesia for less than 6 hours, were divided into 3 groups according to their BMI (Group 1 BMI = 18.5-24.9, Group 2 BMI = 25-29.9, Group 3 BMI = 30-34.9). These groups were randomly divided into 2 subgroups: Groups LBW; 1 LBW, 2 LBW, and 3 LBW were given rocuronium intubation dosages based on their LBW while control groups; 1K, 2K, and 3K were given 0.6 mg/kg rocuronium according to their total body weight. The data on the duration of action of rocuronium and its effects on the endotracheal intubation conditions were evaluated.

Results: In Group 1, T1 time was found to be significantly longer (p=0.001). Intubation score and the use of additional rocuronium dose were found to be significantly higher in Group 1 LBW than in Group 1K (p=0.001). In Group 1, an additional rocuronium dose was needed to achieve optimal intubation conditions for subgroup 1 LBW. Rocuronium duration of action was found to be significantly longer in control groups 2 and 3, that received TBW-based dosage.

Conclusion: In adult patients with a BMI of 18.5 and 24.9 BMI, we report optimal intubation conditions with the LBW-adjusted rocuronium dosage. This trial is registered with NCT05476952.

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Copyright © 2022 Duygu Demiroz et al.

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Flowchart.

References

    1. Al-Dorzi H. M., Al Harbi S. A., Arabi Y. M. Antibiotic therapy of pneumonia in the obese patient: dosing and delivery. Current Opinion in Infectious Diseases . 2014;7(2):165–173. doi: 10.1097/qco.0000000000000045.
    1. Barras M., Legg A. Drug dosing in obese adults. Australian Prescriber . 2017;40(5):189–193. doi: 10.18773/austprescr.2017.053.
    1. Hebbes C. P., Thompson J. P. Pharmacokinetics of anaesthetic drugs at extremes of body weight. BJA Education . 2018;18(12):364–370. doi: 10.1016/j.bjae.2018.09.001.
    1. Brull S. J., Kopman A. F. Current status of neuromuscular reversal and monitoring: challenges and opportunities. Anesthesiology . 2017;126(1):173–190. doi: 10.1097/aln.0000000000001409.
    1. Aytac I., Postaci A., Aytac B., et al. Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists. Brazilian Journal of Anesthesiology (English Edition) . 2016;66(1):55–62. doi: 10.1016/j.bjane.2012.06.011.
    1. .
    1. Vasold K. L., Parks A. C., Phelan D. M. L., Pontifex M. B., Pivarnik J. M. Reliability and validity of commercially available low-cost bioelectrical impedance analysis. International Journal of Sport Nutrition and Exercise Metabolism . 2019;29(4):406–410. doi: 10.1123/ijsnem.2018-0283.
    1. Weir C. B., Jan A. BMI Classification Percentile and Cut Off Points . Treasure Island, FL, USA: StatPearls Publishing; 2022.
    1. Brull S. J., Meistelman C., Gropper M. A., Miller R. D. Miller’s Anesthesia . 9th. New York, NY, USA: Elsevier; 2020. Pharmacology of neuromuscular blocking drugs; pp. 799–822.
    1. Erstad B. L., Barletta J. F. Dosing of neuromuscular blocking agents in patients with obesity: a narrative review. Anaesthesia & Intensive Care . 2021;49(2):98–104. doi: 10.1177/0310057x20968573.
    1. Cammu G. Residual neuromuscular blockade and postoperative pulmonary complications: what does the recent evidence demonstrate? Current Anesthesiology Reports . 2020;10(2):131–136. doi: 10.1007/s40140-020-00388-4.
    1. Sakızcı-Uyar B., Çelik S., Postacı A., et al. Comparison of the effect of rocuronium dosing based on corrected or lean body weight on rapid sequence induction and neuromuscular blockade duration in obese female patients. Saudi Medical Journal . 2016;37(1):60–65. doi: 10.15537/smj.2016.1.14099.
    1. Barclay K., Eggers K., Asai T. Low-dose rocuronium improves conditions for tracheal intubation after induction of anaesthesia with propofol and alfentanil. British Journal of Anaesthesia . 1997;78(1):92–94. doi: 10.1093/bja/78.1.92.
    1. Furuya T., Suzuki T., Kashiwai A., et al. The effects of age on maintenance of intense neuromuscular block with rocuronium. Acta Anaesthesiologica Scandinavica . 2012;56(2):236–239. doi: 10.1111/j.1399-6576.2011.02605.x.
    1. Davies E. A., O’Mahony M. S. Adverse drug reactions in special populations-the elderly. British Journal of Clinical Pharmacology . 2015;80(4):796–807. doi: 10.1111/bcp.12596.
    1. Fujimoto M., Tanahira C., Nishi M., Yamamoto T. In non-obese patients, duration of action of rocuronium is directly correlated with body mass index. Canadian Journal of Anaesthesia . 2013;60:552–556. doi: 10.1007/s12630-013-9914-x.
    1. Puhringer F. K., Khuenl-Brady K. S., Mitterschiffthaler G. Rocuronium bromide: time-course of action in underweight, normal weight, overweight and obese patients. European Journal of Anaesthesiology-Supplement . 1995;11:107–110.
    1. Leykin Y., Pellis T., Lucca M., Lomangino G., Marzano B., Gullo A. The pharmacodynamic effects of rocuronium when dosed according to real body weight or ideal body weight in morbidly obese patients. Anesthesia & Analgesia . 2004;99(4):1086–1089. doi: 10.1213/01.ane.0000120081.99080.c2.

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