Dosing of neuromuscular blocking agents in patients with obesity: A narrative review

Brian L. Erstad, Jeffrey F. Barletta

Research output: Contribution to journalReview articlepeer-review

Abstract

There is no consensus on which weight clinicians should use for weight-based dosing of neuromuscular blocking agents (NMBAs), as exemplified by differing or absent recommendations in clinical practice guidelines. The purpose of this paper is to review studies that evaluated various size descriptors for weight-based dosing of succinylcholine and non-depolarising NMBAs, and to provide recommendations for the descriptors of choice for the weight-based dosing of these agents in patients with obesity. All of the studies conducted to date involving depolarising and non-depolarising NMBAs in patients with obesity have assessed single doses or short-term infusions conducted in perioperative settings. Recognising that any final dosing regimen must take into account patient-specific considerations, the available evidence suggests that actual body weight is the size descriptor of choice for weight-based dosing of succinylcholine and that ideal body weight, or an adjusted (or lean) body weight, is the size descriptor of choice for weight-based dosing of non-depolarising NMBAs.

Original languageEnglish (US)
Pages (from-to)98-104
Number of pages7
JournalAnaesthesia and Intensive Care
Volume49
Issue number2
DOIs
StatePublished - Mar 2021

Keywords

  • Neuromuscular blocking agents
  • body weight
  • critical care
  • drug dosage calculations
  • neuromuscular depolarising agents
  • neuromuscular non-depolarising agents

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine
  • Anesthesiology and Pain Medicine

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