Download presentation
Presentation is loading. Please wait.
Published byCathleen Baker Modified over 9 years ago
3
The Dose Of Succinylcholine in Morbid Obesity By Harry Lemmens & Jay Brodsky Anesthesia Dep. In Sanford University School of Medicine,Sanford, Claifornia. Puplished In Anesth & Analg J.2006.
4
The purpose of This Study is to determine The Appropriate dose of Succinylcholine in Morbidly Obese Patients. Objectives
5
The Study enrolled 45 Morbidly Obese Patients who were scheduled for Gastric Bypass surgery. Patients with predicted difficult intubation wrere excluded. Methods
6
In Randomized Double Blind Fashion, Patients were Assigned to One of three Study Groups. Methods
7
Group 1, Recived 1mg/kg for the Ideal Body weight. Group 2, Received 1mg/kg for the Lean Body weight. Group 3, Recived 1mg/kg for the Total Body weight. Methods
8
IBW was calculated using the formula IBW=22×H 2. LBW was estimated as 130%IBW Cont.. Methods
9
An accelerometer was taped to thumb of an immobilized arm and response to ulnar nerve stimulation of the adductor pollicis muscle was Recorded. Cont.. Methods
10
General Anesthesia was induced with fentanyl 3mcg/kg LBW, propofol 2.5 mg/kg LBW and the lung were ventilated Via Bag and Mask with 100% O 2. Cont.. Methods
11
Then, SCH doses were given in Identical filled 20 ml syringes for all study groups. Cont.. Methods
12
The Trachea was intubated when, after two consecutive stimuli, no further decrease in twitch height was observed. Cont.. Methods
13
Laryngoscopy conditions were scored to Excellent, good or poor, based on The Guidelines Of The Consensus Conference On Good Clinical Research Practice In Pharmacodynamic Studies of Neuromuscular Blocking Agents. Cont.. Methods
14
Laryngoscopy conditions were rated as Excellent, if laryngoscopy was easy with relaxed jaw and no resistance to the laryngoscopy blade,if the vocal cords were abducted and did not move,if there was no airway reaction and the patient did not move his limbs during intubation. Cont.. Methods
15
Laryngoscopy conditions were rated as Good, if the jaw was not fully relaxed and if there was slight resistance to the laryngoscopy blade,if vocal cords were not fully abducted or moving, if there was diaphragmatic movement<10s or if there was slight limb movement during intubation. Cont.. Methods
16
Laryngoscopy conditions were rated as Poor, If there was poor jaw relaxation or if there was active resistance to laryngoscopy, if the vocal cords were closed, if there was diaphragmatic movement >10s or if there was vigorous limb movement during intubation. Cont.. Methods
17
After intubation general anesthesia maintained with 50% nitrous oxide and isoflurane (0.8-1.2%) in oxygen. Cont.. Methods
18
The recovery from neuromuscular block was recorded for 20 min, during which,No further Muscle relaxant added. Cont.. Methods
19
The incidence and degree of fasciculation after SCH administration were recorded and scored as Absent, Mild or Gross Cont.. Methods
20
Each patient was interviewed postoperatively on Day1 to determine the incidence of Myalgias. Cont.. Methods
21
The three study groups were comparable with respect to Age, BMI and Gender. Results
22
Demographic Data Results group3group2group1 46±1044±941±10Age 165±7167±7166±8Height 122±18126±23128±20weight 45±645±546±7BMI 2-131-142-13 Gender(M,F)
23
There was No difference in the onset time of maximum neuromuscular blockade among groups, almost 90s.But the maximum block was significantly less in group1. Cont.. Results
24
The maximum block was significantly less in group 1. The recover intervals were significantly shorter in Groups 1 and 2. Cont.. Results
25
One third of patients in group 1 had poor intubating conditions. In contrast, None of patients in groups 2&3 had poor intubating condition. Cont.. Results
26
Intubating conditions Cont.. Results Group3Group2Group1 1374Excellent 246Good 045Poor
27
There were No differences in the incidence or degree of fasciculation among the three groups. Cont.. Results
28
Also, There were no difference in the incidence of non incisional pain on day 1 postoperatively. No patient in any group experienced moderate or severe nonincesional pain. Cont.. Results
29
For the average –weight adults, the usual dose of SCH 1mg/kg given on the basis of TBW. In Morbidly Obese patients TBW is much heavier than IBW. Discussion
30
It is Postulated that morbidly obese patients may have larger absolute SCH dose requirement than average-weight patients. Discussion
31
Because Level of Plasma pseudocholinesterase activity and volume of extracellular fluid determine the duration of action of SCH and Both factors are increased in Obesity. Cont.. Discussion
32
Jense et al. demonestrated that apnic morbidly obese patient will desaturate to hypoxemic levels in <3-4m Discussion
33
Benumof et al. Defined the time to 50% twitch recovery as the time to functional Recovery with regard to arterial hemoglobin desaturation risk. Discussion
34
Because, recovery to 50%twitch height in the smaller dose group did not occur before 5m, A dose of SCH based on IBW will provide less than Optimal intubating conditions without protecting from Hypoxemia if difficulty is encountered. Discussion
35
for morbidly obese patient intubation can be achieved by 1mg/kg based on (IBW,LBW or TBW), None of these dosing regimens will provide Both Adequate and safe conditions. Discussion
36
In Morbidly Obese Patient: For Complete neuromuscular paralysis and Predictable Laryngoscopy conditions, a larger dose of SCH (1mg/kg for TBW) is Recommended. Study Conclusion
37
The Dose Of Succinylcholine in Morbid Obesity By Harry Lemmens & Jay Brodsky Anesthesia Dep. In Sanford University School of Medicine,Sanford, Claifornia. Puplished In Anesth & Analg J.2006.
38
وصلى الله وسلم على نبينا محمد وعلى آله وصحبه أجمعين
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.