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BJA Advance Access published online on June 17, 2006
British Journal of Anaesthesia, 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
Accepted April 20, 2006

Clinical Investigation

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

T. Suzuki 1 *, G. Masaki 2, and S. Ogawa 1

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

* To whom correspondence should be addressed.
T. Suzuki, E-mail: suzukit{at}cd5.so-net.ne.jp


  Abstract

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.

Keywords: antagonists neuromuscular block, neostigmine; complications, obesity; neuromuscular block, vecuronium.
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