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A Comment About Methodological Limitations on the Study by An et al
1Department of Anesthesiology and Reanimation, University of Health Sciences, Konya City Hospital, Konya, Turkey.
None:
The study by An et al. provides valuable insights into rocuronium pharmacodynamics in patients with high body fat percentages (PBF). However, the lack of normalisation for acceleromyographic train-of-four (TOF) ratios raises concerns about the validity of endpoints. Due to the acceleromygraph's inherent "inverse fade" artefact, non-normalised TOF ratios may mask clinically significant residual paralysis. For example, a reported TOF of 0.9 could correspond to a true ratio of 0.75 (assuming a baseline of 1.2), overestimating recovery. This methodological gap weakens the study's conclusion on fat-free mass-based dosing advantages in high-PBF patients. Future studies should adopt TOF normalisation or electromyography (EMG)-based monitoring to improve accuracy and patient safety. Addressing this limitation would strengthen the clinical applicability of individualised neuromuscular blocking strategies.
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