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Duration of the action of rocuronium in patients with BMI of less than 25

An observational study

Takahata, Osamu; Takahoko, Ken-ichi; Sasakawa, Tomoki; Inagaki, Yasuyoshi; Takahoko, Hiroyuki; Kunisawa, Takayuki

European Journal of Anaesthesiology (EJA): November 2018 - Volume 35 - Issue 11 - p 863–866
doi: 10.1097/EJA.0000000000000823
Neuromuscular blocking agents

BACKGROUND The duration of rocuronium in patients with BMI more than 30 kg m−2 is prolonged. Whether the reverse is true when BMI is less than 18.5 kg m−2 is unclear.

OBJECTIVE The objective of this study was to investigate whether a BMI less than 25 kg m−2 affects the duration of rocuronium in doses adjusted for actual body weight.

DESIGN A prospective, observational, single-centre study.

SETTING The operating room of a teaching hospital from 1 June 2008 to 30 June 2015.

PATIENTS Thirty patients with American Society of Anesthesiologists physical status I or II who were scheduled to undergo elective surgery (BMI < 25 kg m−2, aged 23 to 74 years) maintained by 0.7 minimum alveolar concentration sevoflurane and remifentanil.

MAIN OUTCOME MEASURES Repetitive train-of-four stimulation was applied and contractions of the adductor pollicis muscle were recorded. Duration of the initial dose of rocuronium (D1) was defined as the time from injection of rocuronium 0.6 mg kg−1 to return of first twitch height to 25% of the control. Duration of additional doses (D2) was the time from a supplement of 0.15 mg kg−1 rocuronium to return of first twitch height to 25% of the control. The relationship between D1 or D2 and BMI was examined using linear regression analysis.

RESULTS Linear regression analysis revealed a significant correlation between duration of initial dose and BMI (R2 = 0.246; P = 0.00531). A significant correlation between the duration of the additional dose and BMI was also found (R2 = 0.316; P = 0.00122).

CONCLUSION The lower the BMI, the shorter the duration of rocuronium at initial and additional doses determined by the actual body weight in adult patients with a BMI less than 25 kg m−2.

TRIAL REGISTRATION with registry number UMIN 00009337 and UMIN 000015407.

From the Department of Pain Clinic, Asahikawa-Kosei General Hospital, Asahikawa (OT), Department of Anesthesiology, National Hospital Organization Obihiro Hospital, Obihiro (K-iT), Department of Anesthesiology and Critical Care Medicine, Asahikawa Medical University, Asahikawa (TS,TK), Emergency Medical Center, Nayoro City General Hospital, Nayoro (YI) and Department of Anesthesiology, Engaru-Kosei General Hospital, Engaru, Japan (HT)

Correspondence to Dr Osamu Takahata, Department of Pain Clinic, Asahikawa-Kosei General Hospital, 1-24, Asahikawa 078-8211, Hokkaido, Japan E-mail:

Published online 2 May 2018

© 2018 European Society of Anaesthesiology