Tuesday, May 5, 2020

NMB and weight

Q: Which of the following Neuro-Muscular Blockade (NMB) should be dosed according to ideal body weight?

A) succinylcholine 
B) rocuronium 
C) vecuronium 
D) cisatracurium

Answer: C

Obesity always posses a dilemma to clinicians while dosing medications. In case of NMBs, it all depends on half-life, pharmacokinetics, pharmacodynamics, and route of elimination. As vecuronium has a prolonged duration of action, it should be given according to the ideal body weight. This tends to keep them effective without having long accumulation. Others can be given per actual body weight.

Cisatracurium has become a drug of choice in ICU as it has a relatively shorter half-life and gets spontaneous degradation at physiologic pH and temperature via Hofmann elimination in the serum.



1. Schwartz AE, Matteo RS, Ornstein E, et al. Pharmacokinetics and pharmacodynamics of vecuronium in the obese surgical patient. Anesth Analg 1992; 74:515. 

2. Suzuki T, Masaki G, Ogawa S. Neostigmine-induced reversal of vecuronium in normal weight, overweight and obese female patients. Br J Anaesth 2006; 97:160.

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