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Early recovery characteristics are important for patients' safety and operating room turnover. Our aim was to compare fundamental methods for dosing remifentanil during morbid obesity surgeries: a manual infusion and a target-controlled infusion (TCI). Throughout study, patient's recovery time was tracked and compared between the groups.
Introduction: The population of overweighted patients is increasing dramatically, therefore physicians face them in their daily practice (1-2). There are many guidelines showing the dose counting methods of intravenous anesthetics, but none of them are perfectly good for morbidity obese patients (3). Early recovery characteristics are important for patients' safety and operating room turnover (4).
Aim: Our aim was to compare fundamental methods for dosing remifentanil during morbid obesity surgeries: a manual infusion and a target-controlled infusion (TCI). Throughout study, patient's recovery time was tracked and compared between the groups.
Methods: 31 patients were evaluated who underwent bariatric surgery in Hospital of Lithuanian University of Health Sciences. All of them had received sevoflurane/remifentanil anaesthesia. Remifentanil infusion was randomly assigned to a manual (control group) or to a TCI (case group) method. We had evaluated patients' hemodynamics (arterial blood pressure, heart rate, saturation), spontaneous breathing and airway reflexes recovery time, time of extubation, eye opening, recovery of orientation and start of the following oral command. Also we had registered concentrations of remifentanil in the blood (according to automatic infusion pump) while using TCI method.
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| Label | Type | Description | Intervention Names |
|---|---|---|---|
| Manual infusion (control) group | |||
| TCI (case) group |
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| Measure | Description | Time Frame |
|---|---|---|
| eye opening | The time of patient's respond after the end of remifentanyl infusion | up to 20 minutes |
| spontaneous breathing | The time of patient's respond after the end of remifentanyl infusion | up to 20 minutes |
| airway reflexes | The time of patient's respond after the end of remifentanyl infusion | up to 20 minutes |
| orientation | The time of patient's respond after the end of remifentanyl infusion | up to 20 minutes |
| oral command | The time of patient's respond after the end of remifentanyl infusion | 2,4,6,8,10,12,14,16,18,20 minutes |
| Measure | Description | Time Frame |
|---|---|---|
| Heart rate | Measure was started after the end of remifentanyl infusion | up to 20 minutes |
| Arterial blood pressure | Measure was started after the end of remifentanyl infusion |
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Inclusion Criteria:
Exclusion Criteria:
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Patients with morbid obesity who are hospitalised in Hospital of Lithuanian University of Health Sciences Kaunas Clinics for laparoscopic bariatric surgery.
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| Facility | Status | City | State | ZIP | Country | Contacts |
|---|---|---|---|---|---|---|
| Lithuanian University of Health Sciences | Kaunas | Lithuania |
| PubMed Identifier | Type | Citation | Retractions |
|---|---|---|---|
| 9813653 | Background | Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults--The Evidence Report. National Institutes of Health. Obes Res. 1998 Sep;6 Suppl 2:51S-209S. No abstract available. | |
| 11020136 | Background | Cheymol G. Effects of obesity on pharmacokinetics implications for drug therapy. Clin Pharmacokinet. 2000 Sep;39(3):215-31. doi: 10.2165/00003088-200039030-00004. |
| Label | URL |
|---|---|
| Cortrnez L I, Anderson B J. Current Opinion in Anaesthesiology 2018; 31(4):415-422. | View source |
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| ID | Term |
|---|---|
| D009767 | Obesity, Morbid |
| ID | Term |
|---|---|
| D009765 | Obesity |
| D050177 | Overweight |
| D044343 | Overnutrition |
| D009748 | Nutrition Disorders |
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| up to 20 minutes |
| Saturation | Measure was started to record after the end of remifentanyl infusion | up to 20 minutes |
| Remifentanyl dose | The amount of medication used during surgery | up to 20 minutes after surgery |
| 10927998 | Background | Adams JP, Murphy PG. Obesity in anaesthesia and intensive care. Br J Anaesth. 2000 Jul;85(1):91-108. doi: 10.1093/bja/85.1.91. No abstract available. |
| 8982900 | Background | Michelsen LG, Hug CC Jr. The pharmacokinetics of remifentanil. J Clin Anesth. 1996 Dec;8(8):679-82. doi: 10.1016/s0952-8180(96)00179-1. |
| 14970134 | Background | Egan TD, Kern SE, Muir KT, White J. Remifentanil by bolus injection: a safety, pharmacokinetic, pharmacodynamic, and age effect investigation in human volunteers. Br J Anaesth. 2004 Mar;92(3):335-43. doi: 10.1093/bja/aeh075. |
| Egan T D. Remyfentanil Pharmacocinetics and Pharmacodynamics. Clin. Pharmacokinet 1995; 29:80. | View source |
| Valstybinė vaistų kontrolės tarnyba. Remifentanil Kabi. | View source |
| D009750 |
| Nutritional and Metabolic Diseases |
| D001835 | Body Weight |
| D012816 | Signs and Symptoms |
| D013568 | Pathological Conditions, Signs and Symptoms |