D. Michaloudis et al., Continuous spinal anesthesia/analgesia for perioperative management of morbidly obese patients undergoing laparotomy for gastroplastic surgery, OBES SURG, 10(3), 2000, pp. 220-229
Background: The authors determined prospectively the safety of continuous s
pinal anesthesia combined with general anesthesia and the efficacy of posto
perative pain relief with continuous spinal analgesia for morbidly obese pa
tients undergoing vertical banded gastroplasty.
Methods: 27 patients (13 men, 14 women) with a mean body mass index (BMI) o
f 50.4 +/- 7.8 and several co-morbidities were studied. All patients were a
nesthetized with the same anesthetic regimen, which included midazolam, fen
tanyl, propofol, muscle relaxants, N2O, isoflurane and intrathecal bupivaca
ine. Postoperative pain relief was provided for 5 days and all patients rec
eived the same regimen, which included intrathecal buplvacaine, fentanyl an
d intravenous tenoxicam. The intrathecal analgesic regimen was administered
continuously through a pump which had the facility of providing bolus dose
s when requested in predetermined lockout intervals. Intra-operative monito
ring included hemodynamic and respiratory parameters. Additional postoperat
ive monitoring included respiratory rate, degree of sedation, sensory level
of anesthesia, motor response and intensity of pain.
Results: Intraoperative anesthetic technique was safe and provided satisfac
tory results in the immediate postoperative period. Furthermore, the postop
erative analgesia regimen provided effective analgesia in all patients. The
mean doses of fentanyl and bupivacaine infused intrathecally for the first
24 postoperative hours were 14.1 +/- 2.0 mu g.h(-1) and 0.7 +/- 0.1 mg.h(-
1) respectively, while the requirements of analgesia decreased progressivel
y with time. The technique provided effective analgesia with low pain score
s, which was reflected by ease in mobilizing and performing physical exerci
ses with the physiotherapist. Only minor complications related to anesthesi
a and analgesia were encountered.
Conclusion: To our knowledge, this technique of anesthesia and postoperativ
e analgesia has not been described before in morbidly obese patients. This
regimen merits further controlled trials to establish its place in the peri
operative management of morbidly obese patients.