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Does Rocuroinum Dose Adjusted Due to Lean Body Weight Provide Adequate Intubation Conditions?: A Prospective
Duygu Demiroz1, Yusuf Ziya Colak1, Sumeyye Koc Iclek1
1Inonu University, School of Medicine, Department of Anesthesiology and Reanimation, Malatya, Turkey.
Insights
Adjusting rocuronium dosage based on lean body weight (LBW) in patients with a normal BMI (18.5-24.9) improved intubation conditions. This approach ensures optimal endotracheal intubation with LBW-adjusted dosing, enhancing patient care.
Area of Science:
- Anesthesiology and Perioperative Medicine
- Pharmacology and Drug Dosing
- Clinical Trial Research
Background:
- Standard rocuronium dosing is based on total body weight (TBW), which may not be optimal for all patients, particularly those with varying body compositions.
- Accurate neuromuscular blockade is crucial for successful endotracheal intubation, impacting patient safety and surgical outcomes.
- Previous studies have not definitively established the optimal dosing strategy for rocuronium concerning lean body weight (LBW) across different BMI categories.
Purpose of the Study:
- To evaluate the efficacy of lean body weight (LBW)-adjusted rocuronium dosage versus total body weight (TBW)-based dosing for endotracheal intubation.
- To compare intubation conditions and duration of action of rocuronium between LBW-adjusted and TBW-based dosing groups across different BMI categories.
- To determine if LBW-adjusted dosing improves intubation success and reduces the need for additional neuromuscular blocking agents.
Main Methods:
- A prospective, observational study involving adult patients (18-65 years) with BMI 18.5-34.9, undergoing procedures <6 hours under general anesthesia.
- Patients were stratified by BMI into three groups (18.5-24.9, 25-29.9, 30-34.9) and further randomized into LBW-adjusted or TBW-based (0.6 mg/kg) rocuronium subgroups.
- Data collected included duration of action of rocuronium and assessment of endotracheal intubation conditions using standardized scores.
Main Results:
- In the normal BMI group (18.5-24.9), the LBW-adjusted rocuronium subgroup required additional doses more frequently and had a significantly longer T1 time compared to the TBW-based control group (p=0.001).
- Optimal intubation conditions were achieved with LBW-adjusted rocuronium dosage in the normal BMI group, indicating improved efficacy.
- Rocuronium's duration of action was significantly longer in the control groups (2 and 3) that received TBW-based dosing, suggesting potential for prolonged neuromuscular blockade in higher BMI categories.
Conclusions:
- Lean body weight-adjusted rocuronium dosage is effective in achieving optimal endotracheal intubation conditions in adult patients with a normal BMI (18.5-24.9).
- This study, registered as NCT05476952, provides evidence supporting individualized rocuronium dosing strategies based on lean body mass.
- Further research may be warranted to explore the implications of LBW-adjusted dosing in obese patient populations and its impact on recovery.
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.
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