Ideal versus corrected body weight for dosage of sugammadex in morbidly obese patients.

To date, the dosing of sugammadex is based on real body weight without taking fat content into account. We compared the reversal of profound rocuronium-induced neuromuscular blockade in morbidly obese patients using doses of sugammadex based on four different weight corrections. One hundred morbidly obese patients, scheduled for laparoscopic bariatric surgery under propofol-sufentanil anaesthesia, were randomly assigned four groups: ideal body weight; ideal body weight + 20%; ideal body weight + 40%; and real body weight. Patients received sugammadex 2 mg.kg(-1), when adductor pollicis monitoring showed two responses. The primary endpoint was full decurarisation. Secondary endpoints were the ability to get into bed independently on arrival to the post-anaesthetic care unit and clinical signs of residual paralysis. There was no residual paralysis in any patient. Morbidly obese patients can safely be decurarised from rocuronium-induced neuromuscular blockade T1-T2 with sugammadex dosed at 2 mg.kg(-1) ideal body weight + 40% (p < 0.0001).

The analgesic effect of preoperative administration of propacetamol, tenoxicam or a mixture of both in arthroscopic, outpatient knee surgery.

A prospective, randomized, double-blind, placebo-controlled, comparative study was undertaken to assess the efficacy of the preemptive use of propacetamol, tenoxicam or the combination of both in arthroscopic, outpatient surgery of the knee. One hundred patients aged 18 to 65 years, ASA 1-2, scheduled for arthroscopy were randomized to receive propacetamol 30 mg/kg i.v. (repeated after 6 hours), tenoxicam 0.5 mg/kg i.v. (max. 40 mg), the combination of both or placebo one hour prior to a standard anesthetic. There were no differences with regard to total dose opioid consumption, sedation scores and side effects in the four groups.

Systemic piroxicam as an adjunct to patient-controlled analgesia with alfentanil for postoperative pain relief.

In a double-blind, placebo-controlled study, the non-steroidal anti-inflammatory drug, piroxicam, in combination with alfentanil given in a patient-controlled analgesia system, was compared with alfentanil alone given by the same route for analgesic effect, side effects and acute phase reaction over a 4-day period following anterior cruciate ligament reconstruction of the knee. The patients receiving piroxicam had lower pain scores and consumed less alfentanil. There were no differences with regard to side effects between the two treatment groups, apart from significantly more sedation at 08.00 h on the first postoperative day in the non-piroxicam group. Piroxicam did not influence either the levels of interleukin-6 or the acute phase response to surgery.

Evaluation of morphine for patient controlled analgesia with the Infusor system after opiate-free locoregional anesthesia for osteotomy of the foot.

Efficacy and safety of a PCA protocol, without loading dose or background infusion, was investigated in 40 consenting patients after osteotomy of the foot. All patients had intrathecal lidocaine 5% 1.8 ml preoperatively. Postoperative pain relief was provided with morphine from a Baxter Travenol infusor with PC module. The morphine concentration was 2 mg/ml or 3 mg/ml. In order to reach the analgesic blood concentration as quickly as possible, the patients were instructed to start PCA from the very first moment pain occurred. The patients breathed room air. The nursing staff evaluated respiratory and cardiovascular parameters, pain and side effects. Although mean VAS scores were higher than 3 in the early postoperative phase, no supplementary analgesics were required. One patient had urine retention. One patient had a drop in blood pressure at the start of morphine, which was quickly restored with the administration of colloids. Oxygen saturations were lower (SpO2 < 95%) the first hours postoperatively, especially at the first assessment where no morphine was administered. Pain or relative hypovolaemia could be an explanation. Dry mouth and sleepiness were the most frequently reported side-effects, followed by dizziness, vomiting and nausea. Sweating and itching were less frequently reported. The occurrence of the side effects was the highest during the first postoperative day. We conclude that even when morphine is used in PCA without loading dose or background infusion after opiate-free locoregional analgesia, close monitoring is necessary for at least 5 hours.