Sugammadex and Ideal Body Weight in Bariatric Surgery; The Debate Continues

摘要

I read with great interest the paper by Sanfilippo et al., evaluating the safety and efficacy of sugammadex administered on the basis of ideal body weight (IBW) to reverse neuro-muscular blockade (NMB) at the reappearance of second twitch during train-of-four (TOF) stimulation [1]. However, this study raises several issues that deserve comment.First, the authors chose a TOF ratio of 0.9 after sugammadex administration based on IBW as their primary end-point [1]. A TOF ratio of 0.9 may not indicate full recovery, as this ratio can be associated with impaired neuromuscu-lar transmission [2], inhibition of the hypoxic ventilatory response, and upper airway or pharyngeal dysfunction [3]. Based on acceleromyography studies, the current recommendation is that a TOF ratio greater than or equal to 1.0 should be used to confirm complete recovery from NMB [3].