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