الفهرس 
Pathophysiology of airway in morbidly obese patient
Rapid sequence induction of anaesthesia in morbidly obese patientsيوجد فقط 14 صفحة متاحة للعرض العام
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المستخلص
Summary and Conclusion
Over the past thirty years, there has been a sharp increase in rates of
obesity worldwide. The BMI is used in clinical practice to estimate the degree
of obesity: Obesity is defined as having a BMI ≥30 kg/m2. Morbid obesity,
defined as a BMI ≥40 kg/m2, can also be further classified into super obesity
(BMI 50 kg/m2) and super‐super obesity (BMI 60 kg/m2).
Surgical intervention in those patient population is considered high‐risk
but careful planning, preoperative risk assessment, adequate anaesthetic
management, and effective postoperative pain control will all help to reduce
the perioperative risk. Obesity is one of the major factors that contributes to the
risk of aspiration during anesthesia that needs effective rapid sequence
induction of anaesthesia to secure the patient’s airway smoothly and quickly.
Traditionally, suxamethonium had been the neuromuscular blocking drug
of choice in the rapid sequence induction because of its rapid onset of action
and relative short duration. The use of suxamethonium can, however, be
associated with many side effects including muscle pains, bradycardia,
hyperkalemia, and raised intra ocular pressure. It may also acts as a trigger for
malignant hyperthermia, so there have been many studies looking at the
equivalence of suxamethonium and nondepolarizing neuromuscular agents like
rocuronium and cisatracurium, with conflicting outcomes.
The aim of this study is to use a higher intubating dose of nondepolarizing
muscle relaxant like rocuronium and cisatracurium to fasten and facilitate the
intubation process.
This prospective randomized double blind study was carried out on 60
patients with ASA physical status II&III, aged 20-40 years, BMI 40-50 kg/m2 and scheduled for elective surgery. Patients were classified into two groups (30
patients in each group):
group (ROC): patients in this group received intubating dose of
rocuronium in a dose of 0.9 mg/kg I.V
group (CIS): patients in this group received intubating dose of
cisatracurium in a dose of 0.15 mg/kg.
We excluded patients if refused to participate in the research, had major
hepatic, renal, cardiovascular, pulmonary or neuromuscular diseases, pregnant
patients, supermorbidant obese patient with BMI <50kg/m2, known or
suspected allergy to used drugs or patients who should be offered awake
intubation.
Timing of intubation in seconds, intubation score (excellent, good, poor, or
inadequate), adverse events and hemodynamic variables before induction
(baseline), after induction and before injection of NMB, after injection of NMB
and before endotracheal intubation and just after intubation were assessed and
measured. The results were summarized, tabulated and statistically analyzed in
tables and figures.
Both groups were comparable as regard age, sex, body mass index, type of
surgery, the duration of operation and incidence of complications with
insignificant changes.
There was statistically significant decrease in the timing of intubation in
ROC group as compared to CIS group. However, there was statistically
insignificant difference in the intubation score among the two groups As regards hemodynamic variables, there was significant decrease in heart
rate and mean arterial blood pressure after the induction of anaesthesia as
compared to the baseline; Heart rate and mean arterial blood pressure changes
were comparable among the two groups.