Department of Anesthesiology, Reanimation and Pain Clinic, Hospital Universitari de Bellvitge, Universitat de Barcelona Health Campus, Barcelona, Spain.
Anesthesiology. 2012 Jul;117(1):93-8. doi: 10.1097/ALN.0b013e3182580409.
Bariatric surgery patients are at risk of perioperative airway collapse. Neuromuscular blockade should be fully reversed before tracheal extubation. The optimal dosage of the reversal agent sugammadex in the morbidly obese is still unknown. This study explored the sugammadex dose adjusted according to train-of-four ratio (TOFR).
Prospective observational study of consecutive patients scheduled for laparoscopic bariatric surgery. To reverse a deep blockade (2 or fewer posttetanic twitches), a dose of sugammadex of 4 mg/kg ideal body weight (IBW) was followed by a second dose of 2 mg/kg IBW if the TOFR was less than 0.9 after 3 min. To reverse a moderate blockade (reappearance of the second twitch in the TOF), a 2 mg/kg IBW dose of sugammadex was followed by a second dose of 2 mg/kg IBW if the TOFR was less than 0.9 after 2 min. Sugammadex effectiveness was reflected by the time required to obtain a TOFr of 0.9 or more.
A total of 120 patients were included. The blockade was deep at the end of surgery in 43 and moderate in 77. The median times (range) to TOFR of 0.9 or more were 167 (20-460) seconds and 113 (28-300) seconds in deep and moderate blockades, respectively (P < 0.05). The percentage of patients requiring a second dose of sugammadex were larger after deep blockades (39.5% [n = 17] vs. 23.4% [n = 18] after moderate blockades); the difference was not significant.
A sugammadex dose calculated according to IBW is insufficient for reversing both deep and moderate blockades in morbidly obese patients.
肥胖症患者在围手术期存在气道塌陷的风险。在气管拔管前，应充分逆转神经肌肉阻滞。目前尚不清楚肥胖患者使用罗库溴铵拮抗剂舒更葡糖的最佳剂量。本研究探讨了根据四成串（TOFR）比值调整舒更葡糖剂量。
对拟行腹腔镜减重手术的连续患者进行前瞻性观察研究。为逆转深度阻滞（强直刺激后仅有 2 个或更少的肌颤搐），给予理想体重（IBW）4 mg/kg 的舒更葡糖，若 3 分钟后 TOFR ＜ 0.9，则给予第二次 2 mg/kg IBW 的舒更葡糖。为逆转中度阻滞（TOF 中出现第二个肌颤搐），给予 IBW 2 mg/kg 的舒更葡糖，若 2 分钟后 TOFR ＜ 0.9，则给予第二次 2 mg/kg IBW 的舒更葡糖。舒更葡糖的有效性通过获得 TOFR 为 0.9 或更高所需的时间来反映。
共纳入 120 例患者。手术结束时，43 例患者的阻滞为深度，77 例患者为中度。TOFR 为 0.9 或更高的中位时间（范围）分别为 167（20-460）秒和 113（28-300）秒，深度阻滞和中度阻滞的差异有统计学意义（P＜0.05）。深度阻滞后需要第二次给予舒更葡糖的患者比例较大（39.5%[n=17] vs. 23.4%[n=18]中度阻滞，差异无统计学意义）。
在肥胖症患者中，根据 IBW 计算的舒更葡糖剂量不足以逆转深度和中度阻滞。
