Cysatracurium dosing in gynecological laparoscopic surgery in obese patients
https://doi.org/10.25207/1608-6228-2020-27-4-62-71
Abstract
Aim. Substantiation of cisatracurium dosing in routine gynaecological laparoscopic surgery in obese patients based on comparative development time and duration of the neuromuscular block.
Materials and methods. The assay included 24 women with class II-III obesity and routine laparoscopic gynaecological surgery divided into two cohorts. In cohort 1, cisatracurium was dosed at 0.15 mg/kg ideal body weight estimated with the Lorentz formula. In cohort 2, cisatracurium dosing was 0.15 mg/kg real body weight.
Results. Tracheal intubation and total operation doses of the relaxant were higher when rated for real body weight. Time between cysatracurium administration and maximal neuromuscular transmission inhibition was less in cohort 2, and recovery time of the first response to stimulation — in cohort 1. Neuromuscular block recovery time to 25% TOF count and the recovery index did not differ significantly between the cohorts.
Conclusion. Cysatracurium dosage rated for ideal body weight resulted in a better controlled course of the neuromuscular block, whilst rating for real body weight resulted in a dose-dependent increase of the duration of action and total consumption rate of the relaxant.
About the Authors
E. V. Polovnikov
State Regional Clinical Hospital of Novosibirsk
Russian Federation
Russian Federation
Evgenii V. Polovnikov — Physician (anaesthesiology and resuscitation), Anaesthesiology and Critical Care Unit
Nemirovicha-Danchenko str., 130, Novosibirsk, 630008
tel.: +7 (923) 233-79-05
N. L. Elizar’eva
State Regional Clinical Hospital of Novosibirsk; Novosibirsk State Medical University
Russian Federation
Russian Federation
Natalia L. Elizar’eva — Dr. Sci. (Med.), Assoc. Prof., Chair of Anaesthesiology and Resuscitation, Faculty of General Medicine
Nemirovicha-Danchenko str., 130, Novosibirsk, 630008
A. N. Kolosov
State Regional Clinical Hospital of Novosibirsk
Russian Federation
Russian Federation
Alexander N. Kolosov — Cand. Sci. (Med.), Head of the Anaesthesiology and Critical Care Unit
Nemirovicha-Danchenko str., 130, Novosibirsk, 630008
A. N. Shmakov
Novosibirsk State Medical University
Russian Federation
Russian Federation
Alexey N. Shmakov — Dr. Sci. (Med.), Prof., Chair of Anaesthesiology and Resuscitation, Faculty of General Medicine
Krasniy ave., 52, Novosibirsk, 630091
V. N. Kokhno
Novosibirsk State Medical University
Russian Federation
Russian Federation
Vladimir N. Kokhno — Dr. Sci. (Med.), Prof., Head of the Chair of Anaesthesiology and Resuscitation, Faculty of General Medicine
Krasniy ave., 52, Novosibirsk, 630091
E. M. Loktin
Novosibirsk State Medical University
Russian Federation
Russian Federation
Evgenii M. Loktin — Dr. Sci. (Med.), Prof., Chair of Anaesthesiology and Resuscitation, Faculty of General Medicine
Krasniy ave., 52, Novosibirsk, 630091
References
1. Zabolotskikh I.B., Lebedinskii K.M., Anisimov M.A., Gorobets E.S., Gritsan A.I., Musaeva T.S., et al. Perioperative management of patients with concomitant morbid obesity (second review). Clinical recommendations. Tol’yattinskii Meditsinskii Konsilium. 2016: 5–6; 38–56 (In Russ.).
2. Willis S., Bordelon G.J., Rana M.V. Perioperative Pharmacologic Considerations in Obesity. Anesthesiol. Clin. 2017; 35(2): 247–257. DOI: 10.1016/j.anclin.2017.01.010
3. Ingrande J., Lemmens H.J. Dose adjustment of anaesthetics in the morbidly obese. Br. J. Anaesth. 2010; 105(Suppl 1): i16–23. DOI: 10.1093/bja/aeq312
4. Pasechnik I.N., Skobelev E.I., Mescheryakov A.A., Rybintsev V.Yu., Mityagin G.I., Khrykov G.N. A Modern Trend: utmost Monitoring of anaesthetic Management drugs. Doctor.Ru. 2018; 151(7): 52–57 (In Russ., English abstract). DOI: 10.31550/1727-23782018-151-7-52-57
5. Bruintjes M.H., van Helden E.V., Braat A.E., Dahan A., Scheffer G.J., van Laarhoven C.J., Warlé M.C. Deep neuromuscular block to optimize surgical space conditions during laparoscopic surgery: a systematic review and meta-analysis. Br. J. Anaesth. 2017; 118(6): 834–842. DOI: 10.1093/bja/aex116
6. Dubois P.E., Putz L., Jamart J., Marotta M.L., Gourdin M., Donnez O. Deep neuromuscular block improves surgical conditions during laparoscopic hysterectomy: a randomised controlled trial. Eur. J. Anaesthesiol. 2014; 31(8): 430–436. DOI: 10.1097/EJA.0000000000000094
7. Aytac I., Postaci A., Aytac B., Sacan O., Alay G.H., Celik B., et al. Survey of postoperative residual curarization, acute respiratory events and approach of anesthesiologists. Braz. J. Anesthesiol. 2016; 66(1): 55–62. DOI: 10.1016/j.bjane.2012.06.011
8. Palsen S., Wu A., Beutler S.S., Gimlich R., Yang H.K., Urman R.D. Investigation of intraoperative dosing patterns of neuromuscular blocking agents. J. Clin. Monit. Comput. 2019; 33(3): 455–462. DOI: 10.1007/s10877018-0186-4
9. Saager L., Maiese E.M., Bash L.D., Meyer T.A., Minkowitz H., Groudine S., et al. Incidence, risk factors, and consequences of residual neuromuscular block in the United States: The prospective, observational, multicenter RECITE-US study. J. Clin. Anesth. 2018; 55: 33–41. DOI: 10.1016/j.jclinane.2018.12.042
10. Garbuzov E.Yu, Ovsyannikov G.A., Shcherbak S.G. The features of anesthesia in bariatric surgery. Vestnik Intensivnoi Terapii Imeni A.I. Saltanova. 2018; 2: 3135 (In Russ., English abstract). DOI: 10.21320/1818474X-2018-2-31-35
11. Bestaev G.G., Slepushkin V.D. To the question about factors influencing neuromuscular blockade. Vestnik Intensivnoi Terapii Imeni A.I. Saltanova. 2018: 2; 3639 (In Russ., English abstract). DOI: 10.21320/1818474X-2018-2-36-39
12. Neimark M.I., Kiselev R.V., Elisariev A.Yu. Anaesthetic aspects of improving conditions of endoscopic gastrectomy in patients with morbid obesity. Grekov’s Bulletin of Surgery. 2018; 177(4): 56–62 (In Russ., English abstract). DOI: 10.24884/0042-4625-2018-1774-56-62
13. Lipnitski A.I., Marochkov A.V. Comparative evaluation of cisatracurium and atracurium action as components of endotracheal anesthesia in laparoscopic surgeries. Novosti Khirurgii. 2015; 23(1): 91–96 (In Russ., English abstract).
14. Sottile P.D., Kiser T.H., Burnham E.L., Ho P.M., Allen R.R., Vandivier R.W., Moss M.; Colorado Pulmonary Outcomes Research Group (CPOR). An Observational Study of the Efficacy of Cisatracurium Compared with Vecuronium in Patients with or at Risk for Acute Respiratory Distress Syndrome. Am. J. Respir. Crit. Care. Med. 2018; 197(7): 897–904. DOI: 10.1164/rccm.201706-1132OC
15. Epshtein S.L. Perioperative anesthetic management of patients with morbid obesity. Meditsinskii Sovet. 2013; 5–6: 17–27 (In Russ.).
16. Li J.Y., Zou Q.R., Peng X.M. Pharmacokinetics of a cisatracurium dose according to fat-free mass for anesthesia induction in morbidly obese patients. Nan Fang Yi Ke Da Xue Xue Bao. 2016; 36(10): 1396–1400.
17. Geng Z., Wu X. Neuromuscular effects of cisatracurium besylate in obese patients. Zhonghua Yi Xue Za Zhi. 2014; 94(36): 2844–2846.
18. Leykin Y., Pellis T., Lucca M., Lomangino G., Marzano B., Gullo A. The effects of cisatracurium on morbidly obese women. Anesth. Analg. 2004; 99(4): 10901094. DOI: 10.1213/01.ANE.0000132781.62934.37
Review
For citations:
Polovnikov E.V., Elizar’eva N.L., Kolosov A.N., Shmakov A.N., Kokhno V.N., Loktin E.M. Cysatracurium dosing in gynecological laparoscopic surgery in obese patients. Kuban Scientific Medical Bulletin. 2020;27(4):62-71. (In Russ.) https://doi.org/10.25207/1608-6228-2020-27-4-62-71
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