Neuromuscular effects of cisatracurium in morbidly obese patients

Obesity is associated with significant changes in body composition and function that may alter the pharmacodynamics and pharmacokinetics of various drugs. In this study, we investigated the neuromuscular effects of cisatracurium in morbidly obese as compared to control group of normal body weight patients. In the morbidly obese group [n = 20], corrected weight was used to calculate the drug doses. In the control group [n = 20], the dose was calculated on ideal body weight [IBW]. 0.15 mg/kg[-1] cisatracurium was administered as the neuromuscular blocker. Neuromuscular effects were recorded at T[0] [onset time], T[1] [appearance of first stimulus of TOF], T[25] [25% recovery of T[1]] and T[25-75] [time of T[25] to T[75], recovery time]. T[0] was determined as 177 +/- 23 s and 168 +/- 19 s in the morbidly obese, and control group, respectively. T[25] was determined as 46 +/- 7 min and 56 +/- 8 min, in the morbidly obese and control group, respectively [p<0.05]. T[25-75] was determined as 11 +/- 5 min and 14 +/- 6 min in the morbidly obese and control group, respectively [p<0.05]. Intubation conditions were determined as good in 13, excellent in 7 patients in the morbidly obese group, and as good in 4 and excellent in 16 patients in the control group [p<0.05]. As different neuromuscular effects of cisatracurium were detected, we conclude that neuromuscular agents must be monitored in the morbidly obese patients

Effect of pneumoperitoneum on the level of plasma potassium

The purpose of this study was to find out the impact of acute respiratory acidosis on serum potassium level during laparoscopy. The study was performed on ninety patients who underwent laparoscopic surgery. Ventilation parameters were kept constant throughout the study. Samples for assessment of blood gases were collected in the following sequence: before pneumoperitoneum, a the 20[th] minute of pneumoperitoneum, at the 60[th] minute of pneumoperitoneum, and after extubation. The systolic, diastolic pressures and heart rate were recorded simultaneously. Before pneumoperitoneum, heart rate, systolic and diastolic pressures were reduced according to baseline values. With the induction of pneumoperitoneum, both systolic and diastolic pressures returned to the baseline levels except the heart rate. There was a statistically significant increase in potassium level [Control: 3.49 mEq.L[-1], determined high level:3.75mEq.L[-1]]. Electrolytes, especially potassium, should be monitored during laparoscopy utilizing CO[2] pneumoperitoneum and when necessary, ventilatory parameters should be adjusted

Effect of sevoflurane, propofol and position changes on respiratory mechanics

This study was designed to investigate the effects of propofol, sevoflurane and position changes on respiratory mechanics. Forty patients scheduled for thyroid surgery were divided randomly into two groups; those receiving sevoflurane [group S] [n=20], and those receiving TIVA propofol [group P] [n=22]. Dynamic compliance [Cdyn], peak inspiratory pressure [PIP], and respiratory resistance [Rr] values were recorded with a VenTrak respiratory monitor [Novometrix Inc. USA] at three time instances. The first measurement was done immediately after the beginning of ventilation and before the inhalation agent was initiated [Induction]. Second measurement was done after 5 minutes of thyroid position [Thyroid] [ventilation with 1 MAC sevoflurane concentration or propofol infusion at the rate of 6 mg/kg/h].The third measurement was performed 5 minutes after end of surgery in the supine position [Supine] Blood gases were measured at the three time instances. Respiratory mechanics did not change in the P group [51 +/- 13, 46 +/- 11, 48 +/- 10 mL/cmH2O] at Induction, Thyroid and Supine positions]. In the S group, dynamic compliance measurements showed changes statistically significant in the supine position [52 +/- 6 mL/cmH2O]] when compared to Induction [47 +/- 9 mL/cmH2O] and Thyroid position [47 +/- 6 mL/cmH2O] measurements [p<0.05]. When the groups were compared with each other, there was no significant difference whatsoever at all periods [p>0.05]. this concluded that sevoflurane, propofol and position changes exhibit similar effects on respiratory mechanics and blood gases at described dose and concentration