Total intravenous anesthesia with midazolam, remifentanil, propofol and cisatracurium in morbid obesity

被引:22
作者
Alvarez, AO [1 ]
Cascardo, A [1 ]
Menendez, SA [1 ]
Capria, JJ [1 ]
Cordero, RA [1 ]
机构
[1] Arturo Onativia Hosp, Specialized Multidisciplinary Inst Obes Treatment, Buenos Aires, DF, Argentina
关键词
anesthesia; bariatric surgery; TIVA; remifentanil; midazolam; cisatracurium; rocuronium; propofol; morbid obesity; co-induction;
D O I
10.1381/096089200321629120
中图分类号
R61 [外科手术学];
学科分类号
摘要
Background: According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed. Methods: 10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases,Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated, Results: The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency. Conclusions: TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.
引用
收藏
页码:353 / 360
页数:8
相关论文
共 39 条
[1]   THE CARDIORESPIRATORY EFFECTS OF ICI-35 868 IN PATIENTS WITH VALVULAR HEART-DISEASE [J].
AUN, C ;
MAJOR, E .
ANAESTHESIA, 1984, 39 (11) :1096-1100
[2]  
BELDA J, VENTILACON MECANICA, P128
[3]   THE CLINICAL NEUROMUSCULAR PHARMACOLOGY OF 51W89 IN PATIENTS WITH RECEIVING NITROUS-OXIDE OPIOID BARBITURATE ANESTHESIA [J].
BELMONT, MR ;
LIEN, CA ;
QUESSY, S ;
ABOUDONIA, MM ;
ABALOS, A ;
EPPICH, L ;
SAVARESE, JJ .
ANESTHESIOLOGY, 1995, 82 (05) :1139-1145
[4]   HALOTHANE BIOTRANSFORMATION IN OBESE AND NON-OBESE PATIENTS [J].
BENTLEY, JB ;
VAUGHAN, RW ;
GANDOLFI, AJ ;
CORK, RC .
ANESTHESIOLOGY, 1982, 57 (02) :94-97
[5]  
BENTLEY JB, 1979, ANESTH ANALG, V58, P409
[6]   PANCURONIUM PRETREATMENT AND POST-SUCCINYLCHOLINE MYALGIAS [J].
BRODSKY, JB ;
BROCKUTNE, JG ;
SAMUELS, SI .
ANESTHESIOLOGY, 1979, 51 (03) :259-261
[7]  
Ceraso O L, 1969, Minerva Anestesiol, V35, P1111
[8]   HEMODYNAMIC-CHANGES DURING ANESTHESIA INDUCED AND MAINTAINED WITH PROPOFOL [J].
CLAEYS, MA ;
GEPTS, E ;
CAMU, F .
BRITISH JOURNAL OF ANAESTHESIA, 1988, 60 (01) :3-9
[9]  
COATES DP, 1985, POSTGRAD MED J, V61, P76
[10]  
COPER RA, 1993, ANESTHESIA, V48, P103