Meyhoff Christian S, Lund Jørgen, Jenstrup Morten T, Claudius Casper, Sørensen Anne M, Viby-Mogensen Jørgen, Rasmussen Lars S
Department of Anaesthesia, Section 4231, Centre of Head and Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
Anesth Analg. 2009 Sep;109(3):787-92. doi: 10.1213/ane.0b013e3181b0826a.
Pharmacokinetic studies in obese patients suggest that dosing of rocuronium should be based on ideal body weight (IBW). This may, however, result in a prolonged onset time or compromised conditions for tracheal intubation. In this study, we compared onset time, conditions for tracheal intubation, and duration of action in obese patients when the intubation dose of rocuronium was based on three different weight corrections.
Fifty-one obese patients, with a median (range) body mass index of 44 (34-72) kg/m2, scheduled for laparoscopic gastric banding or gastric bypass under propofol-remifentanil anesthesia were randomized into three groups. The patients received rocuronium (0.6 mg/kg) based on IBW (IBW group, n = 17), IBW plus 20% of excess weight (corrected body weight [CBW]20% group, n = 17), or IBW plus 40% of excess weight (CBW40% group, n = 17). Propofol was administered as a bolus of 200 mg and an infusion at 5 mg x kg(-1) x h(-1) and remifentanil was administered at 1.0 microg x kg(-1) x min(-1), both according to CBW40%. Neuromuscular function was monitored with train-of-four nerve stimulation and acceleromyography. The primary end point was duration of action, defined as time to reappearance of the fourth twitch in train-of-four.
The median (range) duration of action was 32 (18-49), 38 (25-66), and 42 (24-66) min in the IBW, CBW20%, and CBW40% groups, respectively (P = 0.001 for comparison of the IBW and CBW40% group). There were no significant differences in onset time (85 vs 84 vs 80 s) or in intubation conditions 90 s after administration of rocuronium.
In obese patients undergoing gastric banding or gastric bypass, rocuronium dosed according to IBW provided a shorter duration of action without a significantly prolonged onset time or compromised conditions for tracheal intubation.
针对肥胖患者的药代动力学研究表明，罗库溴铵的给药剂量应基于理想体重（IBW）。然而，这可能会导致起效时间延长或气管插管条件不佳。在本研究中，我们比较了肥胖患者在罗库溴铵插管剂量基于三种不同体重校正方法时的起效时间、气管插管条件及作用持续时间。
51例肥胖患者，体重指数中位数（范围）为44（34 - 72）kg/m²，计划在丙泊酚-瑞芬太尼麻醉下行腹腔镜胃束带术或胃旁路手术，被随机分为三组。患者分别接受基于理想体重的罗库溴铵（0.6 mg/kg）（理想体重组，n = 17）、理想体重加20%超重体重的罗库溴铵（校正体重[CBW]20%组，n = 17）或理想体重加40%超重体重的罗库溴铵（CBW40%组，n = 17）。丙泊酚按200 mg静脉推注，随后以5 mg·kg⁻¹·h⁻¹输注，瑞芬太尼按1.0 μg·kg⁻¹·min⁻¹输注，均根据CBW40%计算。采用四个成串刺激和加速度肌电图监测神经肌肉功能。主要终点为作用持续时间，定义为四个成串刺激中第四个肌颤搐再次出现的时间。
理想体重组、CBW20%组和CBW40%组的作用持续时间中位数（范围）分别为32（18 - 49）分钟、38（25 - 66）分钟和42（24 - 66）分钟（理想体重组与CBW40%组比较，P = 0.001）。罗库溴铵给药后90秒时，起效时间（85秒 vs 84秒 vs 80秒）或插管条件无显著差异。
在接受胃束带术或胃旁路手术的肥胖患者中，根据理想体重给药的罗库溴铵作用持续时间较短，且起效时间无显著延长，气管插管条件也未受影响。
