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Anesthesiology Research and Practice
Volume 2016 (2016), Article ID 3136895, 4 pages
http://dx.doi.org/10.1155/2016/3136895
Research Article

The Effect of Patient Weight and Provider Training and Experience on Dosing of Rocuronium

1Department of Anesthesiology, Jackson Memorial Hospital/University of Miami, Miami, FL 33136, USA
2Department of Health Sciences Research, Mayo Clinic, Rochester, MN 55905, USA

Received 31 December 2015; Revised 3 April 2016; Accepted 8 June 2016

Academic Editor: Ferenc Petak

Copyright © 2016 N. C. Godwin et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Introduction. Maintenance dosing of neuromuscular blocking agents is complex and varies with patient, procedure, and clinical situation. With this in mind, we sought to identify factors impacting the maintenance dosing of neuromuscular blockers as a step toward identifying best practice with respect to minimizing residual neuromuscular blockade. Methods. Cases utilizing rocuronium from July 1, 2010, to June 30, 2014, at the sponsoring institution were analyzed. Using a mixed model to account for repeated measures, patients were analyzed by dose and weight category as defined by the World Health Organization (eight categories ranging from very severely underweight to very severely obese) as well as by the administering provider’s level of experience. Results. The study included 12,671 patients with a mean age of 49.7 (SD 16.7). Increasing weight category and higher levels of provider experience were associated with higher doses for rocuronium. There were no differences in initial dose or in frequency of maintenance dosing by weight category after controlling for case length. Discussion. The two dosing patterns identified, higher doses for overweight patients and higher doses administered by experienced providers, are modifiable factors that could enhance patient safety.