A Comment About Methodological Limitations on the Study by An et al.
Clinical and Experimental Pharmacology and Physiology, cilt.52, sa.7, 2025 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Kısa Makale
- Cilt numarası: 52 Sayı: 7
- Basım Tarihi: 2025
- Doi Numarası: 10.1111/1440-1681.70047
- Dergi Adı: Clinical and Experimental Pharmacology and Physiology
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, BIOSIS, Chemical Abstracts Core, EMBASE
- Anahtar Kelimeler: acceleromyography, body fat percentage, perioperative complications, residual neuromuscular block, rocuronium, TOF normalisation
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
The study by An et al. provides valuable insights into rocuronium pharmacodynamics in patients with high body fat percentages (PBF). However, the lack of normalisation for acceleromyographic train-of-four (TOF) ratios raises concerns about the validity of endpoints. Due to the acceleromygraph's inherent “inverse fade” artefact, non-normalised TOF ratios may mask clinically significant residual paralysis. For example, a reported TOF of 0.9 could correspond to a true ratio of 0.75 (assuming a baseline of 1.2), overestimating recovery. This methodological gap weakens the study's conclusion on fat-free mass-based dosing advantages in high-PBF patients. Future studies should adopt TOF normalisation or electromyography (EMG)-based monitoring to improve accuracy and patient safety. Addressing this limitation would strengthen the clinical applicability of individualised neuromuscular blocking strategies.