Obesity, lean body mass, and Sugammadex dosing

Abstract

Recently, Merck issued a recommendation for sugammadex dosing for reversal of neuromuscular junction (NMJ) blockade.  Appropriately, the guideline assumes assessment of residual block using some form of nerve stimulator to assess any residual block. Less appropriate is the recommendation that dosing is based simply on the weight of the patient. With obesity an increasing global health issue, the question of drug dosing by weight is an increasing conundrum.   Drug dosing is always an approximation.  For the typically fast acting drugs that anesthesiologists employ, the key is to rapidly load the plasma and interstitial fluid volumes, so that drug bind in equilibrium with the plasma/interstitial volume concentration.  The paper by Bougouma and Demeere¹ attempts to achieve a rational approach to drug doing in the obese patients, specifically for sugammadex reversal of rocuronium.