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Volatile rapid sequence induction in morbidly obese patients
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences.
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology. (Heart centre)
Umeå University, Faculty of Medicine, Department of Surgical and Perioperative Sciences, Anaesthesiology.
2011 (English)In: European Journal of Anaesthesiology, ISSN 0265-0215, E-ISSN 1365-2346, Vol. 28, no 11, 781-787 p.Article in journal (Refereed) Published
Abstract [en]

Background and objective: The interest in bariatric surgery is growing. Morbidly obese patients have an increased risk of hypoxia and decreased blood pressure during rapid sequence induction (RSI). Alternate RSI methods that provide cardiovascular and respiratory stability are required. With this in mind, we evaluated a method for volatile RSI in morbidly obese patients.

Design: Observational study.

Methods: Thirty-four patients with mean BMI 42.4 kg m(-2) undergoing bariatric surgery (morbidly obese group) and 22 patients with mean BMI 25.6 kg m(-2) as a control group were included in the study. Anaesthesia was induced with sevoflurane, propofol, suxamethonium and alfentanil, designed to avoid respiratory and haemodynamic adverse events and to minimise depressing effect on the brain respiratory centre under ongoing RSI. Peripheral oxygen saturation (SpO(2)) and mean arterial blood pressure were registered before and after endotracheal intubation. In addition, two time periods were measured during RSI: spontaneous breathing time (SBT) and apnoea time.

Results: We found no significant differences between the groups. No periods of desaturation were detected. SpO(2) was 100% before and after endotracheal intubation in all patients. Mean arterial pressure was maintained at a stable level in both groups. Mean SBT and apnoea time were 65.6 and 45.8 s in the morbidly obese group, and 70.7 and 47.7 s in the control group, respectively.

Conclusion: A combination of sevoflurane, propofol, suxamethonium and alfentanil is a suitable method for RSI which maintains cardiovascular and respiratory stability in both morbidly obese and lean patients.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2011. Vol. 28, no 11, 781-787 p.
Keyword [en]
morbidly obese patients, rapid sequence induction, sevoflurane, spontaneous breathing, volatile rapid sequence induction
National Category
Anesthesiology and Intensive Care
URN: urn:nbn:se:umu:diva-48951DOI: 10.1097/EJA.0b013e328348a9a5ISI: 000295865300006OAI: diva2:453103
Available from: 2011-11-01 Created: 2011-10-28 Last updated: 2014-04-11Bibliographically approved
In thesis
1. Assessment and management of bariatric surgery patients
Open this publication in new window or tab >>Assessment and management of bariatric surgery patients
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background: In morbidly obese individuals (MO) cardiorespiratory comorbidities and body habitus challenge the perioperative management of anesthesia. To implement safe and reproducible routines for anesthesia and fluid therapy is the cornerstone in order to minimize anesthesia-related complications and to meet individual variability in rehydration needs.

Methods: Paper I: Impact of rapid-weight-loss preparation prior to bariatric surgery was investigated. Prevalence of preoperative dehydration and cardiac function were assessed with transthoracic echocardiography (TTE). Paper II: The anesthetic technique for rapid sequence induction (RSI) in MO based on a combination of volatile and i.v. anesthetics was developed. Pre- and post-induction oxygenation, blood pressure levels and feasibility of the method was evaluated. Paper III: The preoperative ideal body weight based rehydration regime was evaluated by TTE. Paper IV: Need of rehydration during bariatric surgery was evaluated by comparing conventional monitoring to a more advanced approach (i.e. preoperative TTE and arterial pulse wave analysis).

Results: Rapid-weight-loss preparation prior to bariatric surgery may expose MO to dehydration. TTE was shown to be a robust modality for preoperative screening of the level of venous return, assessment of filling pressures and biventricular function of the heart in MO. The combination of sevoflurane, propofol, alfentanil and suxamethonium was demonstrated to be a safe method for RSI regardless of BMI. The preoperative rehydration regime implemented by colloids 6 ml/kg IBW was an adequate treatment to obtain euvolemia. In addition, preoperative rehydration seems to increase hemodynamic stability during intravenous induction of anesthesia and even intraoperatively.

Conclusion: This thesis describes a safe and comprehensive perioperative management of morbidly obese individuals scheduled for bariatric surgery. Hemodynamic and respiratory stability can be achieved by implementation of strict and proven methods of anesthesia and fluid therapy. Much focus should be placed on feasible monitoring and preoperative optimization in morbidly obese individuals for increased perioperative safety.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2014. 86 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1632
Bariatric surgery, morbid obesity, anesthesia, echocardiography, fluid therapy, preoperative, perioperative, venous return, rehydration, volatile rapid sequence induction, spontaneous breathing, sevoflurane.
National Category
Anesthesiology and Intensive Care
Research subject
urn:nbn:se:umu:diva-87546 (URN)978-91-7459-807-0 (ISBN)
Public defence
2014-05-16, Stora Aulan, Sunderby Sjukhus, 97180 Luleå, 09:00 (Swedish)
Available from: 2014-04-11 Created: 2014-04-02 Last updated: 2014-04-14Bibliographically approved

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