Maintenance of anesthesia in morbidly obese patients using propofol with continuous BIS-monitoring: a comparison of propofol-remifentanil and propofol-epidural anesthesia
| Autor: | S, van Kralingen, E M W, van de Garde, E P A, van Dongen, J, Diepstraten, V H M, Deneer, B, van Ramshorst, C A J, Knibbe |
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| Rok vydání: | 2011 |
| Předmět: |
Adult
Anesthesia Epidural Male Dose-Response Relationship Drug Bariatric Surgery Blood Pressure Electroencephalography Middle Aged Obesity Morbid Cohort Studies Remifentanil Piperidines Heart Rate Monitoring Intraoperative Anesthesia Intravenous Humans Female Prospective Studies Infusions Intravenous Propofol Anesthetics Intravenous |
| Zdroj: | Acta anaesthesiologica Belgica. 62(2) |
| ISSN: | 0001-5164 |
| Popis: | Aim of this study was to evaluate maintenance of anesthesia using propofol with continuous Bispectral Index (BIS)-monitoring in morbidly obese patients receiving propofol-remifentanil and propofol-epidural anesthesia.In the first group in ten morbidly obese patients receiving remifentanil analgesia, a propofol infusion was started at 10 mg/kg/hr and modified by aiming at BIS values between 40-60 together with predefined hemodynamic parameters. In the second group, the propofol dose resulting from the first group was prospectively evaluated in a matched cohort of six morbidly obese patients receiving propofol-epidural analgesia aiming for the same BIS and hemodynamic parameters. In both groups, propofol concentration and infusion rates, BIS and hemodynamic values were collected.In the propofol-remifentanil group (Body Mass Index (BMI) 39-60 kg/m2), the mean propofol infusion rate that corresponded to the predefined BIS and hemodynamic parameters was 4.8 mg/kg/hr (SD 1.5). On this basis, a maintenance dose of 5 mg/kg/hr was started in the propofol-epidural group (BMI 38-58 kg/m2). In this second group, the mean propofol infusion rate that corresponded to predefined BIS and hemodynamic parameters was 5.0 mg/kg/hr (SD 0.6). Between the two groups, there was no difference in the propofol concentration-BIS relation.Using both BIS and hemodynamic parameters as an endpoint, a maintenance dose of propofol of 4-6 mg/kg/hr is proposed for maintenance of anesthesia in morbidly obese patients undergoing bariatric surgery either in combination with remifentanil or epidural analgesia. There was no difference in propofol concentration-BIS relation in morbidly obese patients receiving propofol-remifentanil or propofol-epidural anesthesia. |
| Databáze: | OpenAIRE |
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