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BJA Advance Access originally published online on June 17, 2006
British Journal of Anaesthesia 2006 97(2):160-163; doi:10.1093/bja/ael142
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© The Board of Management and Trustees of the British Journal of Anaesthesia 2006. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients

T. Suzuki1,*, G. Masaki2 and S. Ogawa1

1 Department of Anaesthesiology, Surugadai Nihon University Hospital 1-8-13, Kanda-Surugadai, Chiyoda-Ku, Tokyo, 101-8309, Japan
2 Department of Anaesthesia Tokyo Rinkai Hospital, Tokyo, Japan

*Corresponding author: 3-24-3, Asagaya-Kita, Suginami-Ku, Tokyo 166-0001, Japan. E-mail: suzukit{at}cd5.so-net.ne.jp

Background. The purpose of this study was to compare neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients.

Methods. In total, 15 each of normal weight (18.5≤BMI<25), overweight (25≤BMI<30) and obese (BMI≥30) patients were enrolled. Anaesthesia was induced and maintained with fentanyl, propofol and nitrous oxide. Neuromuscular block was induced with vecuronium 0.1 mg kg–1 on the basis of the patient's real body weight (RBW) and was monitored using acceleromyographic train-of-four (TOF) of the adductor pollicis. All patients received neostigmine 0.04 mg kg–1 combined with atropine 0.02 mg kg–1 at 25% recovery of the first twitch (T1) of TOF and were allowed to recover to a TOF ratio of 0.9.

Results. The time from administration of vecuronium to spontaneous recovery of T1 to 25% of control was significantly longer in the obese [mean (SD, range); 68.4 (16.3, 39.8–110.8) min] and the overweight groups [49.3 (6.2, 39.8–60.8) min] as compared with the normal weight group [41.0 (9.0, 27.5–59.5) min]. The times for facilitated recovery with neostigmine to a TOF ratio of 0.7 did not differ among groups. However, the recovery to a TOF ratio of 0.9 in the obese [25.9 (6.7, 13.5–41.0) min] and the overweight groups [14.6 (7.7, 3.3–28.5) min] were significantly longer than that in the normal weight group [6.9 (2.0, 3.0–10.7) min].

Conclusions. Early reversal after neostigmine is prompt; however, recovery to a TOF ratio of 0.9 is slow in overweight and obese patients when vecuronium is dosed on the basis of the patient's RBW.


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