Use Actual Body Weight for Sugammadex Dosing in Obese Patients

Sugammadex reverses rocuronium-induced paralysis and is widely used in Europe and Australia. Recommended dosage is based on actual body weight (ABW) rather than ideal body weight (IBW). To compare dosing strategies, researchers in Belgium randomized 100 morbidly obese patients (body-mass index, >40 kg/m²) undergoing elective bariatric surgery to one of four sugammadex dosing groups: IBW, IBW + 20%, IBW + 40%, or ABW. All patients received general anesthesia and 0.6 mg/kg of rocuronium for paralysis and then 2 mg/kg of sugammadex when partial neuromuscular recovery was noted.

Baseline patient characteristics (age, sex, body weight, fat mass) were similar among groups. Reversal times (time from injection of sugammadex to train of 4 ratio >0.9)…