Which of the following neuromuscular blocking agents is best dosed using total body weight in the morbidly obese population?

Morbidly obese patients have an increased concentration of plasma cholinesterase, hypothetically because of increased overall metabolic activity. In a 2006 study, doses of succinylcholine (1 mg/kg) were scaled on ideal body weight (IBW), lean body weight (LBW), and total body weight (TBW) in 45 morbidly obese patients. Time to maximal onset of neuromuscular block was the same in all groups, but maximal block was less in the IBW group (for which the intubating conditions were rated as “poor” in one third of the patients). The LBW group and the TBW groups had similar degrees of neuromuscular blockade, and intubation was equally successful in all 3 groups. The authors concluded that scaling the drug dose on TBW ensured maximal relaxation and...

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