title: Total intravenous anesthesia with midazolam, remifentanil, propofol and cistracurium in morbid obesity.
abstract: BACKGROUND
  According to physical impairments of massive obesity, cardiac, respiratory and gastrointestinal physiology must be considered as much as pharmacokinetic behavior. Anesthetic management of morbidly obese patients has to be carefully planned, in order to minimize the increased risks of aspirative pneumonitis, hemodynamic instability and delay in recovery. The ideal anesthesia should provide a smooth and quick induction, allowing rapid airway control, prominent hemodynamic stability, and rapid emergence from anesthesia. To approach these ideal conditions, a Total Intravenous Anesthesia (TIVA) with midazolam, remifentanil, propofol and cisatracurium was designed and analyzed.
  
  
  METHODS
  10 consenting morbidly obese patients scheduled for elective Laparoscopic Adjustable Gastric Banding participated in the study. TIVA with midazolam, remifentanil, propofol and cisatracurium was used in all cases. Time to loss of consciousness, tracheal intubation, perianesthetic physiological parameters and complications, incidence of awareness with recall, recovery times, postoperative analgesia and costs of drugs were evaluated.
  
  
  RESULTS
  The analyzed data showed adequate time and physiological conditions for induction and tracheal intubation, stable maintenance with easy handling of deepness, low incidence of perianesthetic complications, excellent recovery performance and institutional efficiency.
  
  
  CONCLUSIONS
  TIVA with midazolam, remifentanil, propofol and cisatracurium was found to be effective, secure, predictable and economic for the anesthetic management of morbidly obese patients.
authors.affiliation: IMETCO, "Arturo Oñativia Hospital", Buenos Aires, Argentina. ghualde@intramed.net.ar
authors.forename: A O
authors.initials: AO
authors.lastname: Alvarez
authors.forename: A
authors.initials: A
authors.lastname: Cascardo
authors.forename: S
authors.initials: S
authors.lastname: Albarracin Menendez
authors.forename: J J
authors.initials: JJ
authors.lastname: Capria
authors.forename: R A
authors.initials: RA
authors.lastname: Cordero
mesh_terms: D000328:Adult; D000762:Anesthesia Recovery Period; D000771:Anesthesia, Intravenous; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000031:analogs & derivatives; D005260:Female; D015391:Gastroplasty; D006801:Humans; D008297:Male; D008874:Midazolam; D008875:Middle Aged; D009466:Neuromuscular Blocking Agents; D009767:Obesity, Morbid / Q000601:surgery; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D013997:Time Factors
chemical_list: D018686:Anesthetics, Intravenous; D009466:Neuromuscular Blocking Agents; D010880:Piperidines; D001279:Atracurium; D000077208:Remifentanil; C101584:cisatracurium; D008874:Midazolam; D015742:Propofol