title: The effects of cisatracurium on morbidly obese women.
abstract: There is conflicting evidence on the duration of action of atracurium in obese patients. Cisatracurium is one of the stereoisomers of atracurium. We investigated the neuromuscular effects of cisatracurium in morbidly obese patients. Twenty obese female patients (body mass index >40) were randomized in two groups. Group I (n = 10) received 0.2 mg/kg of cisatracurium on the basis of real body weight (RBW), whereas in Group II (n = 10) the dose was calculated on ideal body weight (IBW). In a control group of 10 normal weight female patients (body mass index 20-24), the dose of cisatracurium was based on RBW. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis, and anesthesia was induced and maintained with remifentanil and propofol. Onset time was comparable between Group I and the control group (132 s versus 135 s; P = ns). The duration 25% was longer in Group I than in the control group (74.6 min versus 59.1 min; P = 0.01) and in the control group compared with Group II (45.0 min; P = 0.016). In conclusion, the duration of action of cisatracurium was prolonged in morbidly obese patients when dosed according to RBW compared with a control group of normal weight patients. Duration was also prolonged in the control group patients compared with morbidly obese patients to whom the drug was administered on the basis of IBW.
authors.affiliation: *Departments of Anesthesia, Pain, Perioperative Medicine and Intensive Care, and †Surgery, Santa Maria degli Angeli Hospital, Pordenone, Italy; and the ‡Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University Medical School, Trieste, Italy.
authors.forename: Yigal
authors.initials: Y
authors.lastname: Leykin
authors.forename: Tommaso
authors.initials: T
authors.lastname: Pellis
authors.forename: Mariella
authors.initials: M
authors.lastname: Lucca
authors.forename: Giacomina
authors.initials: G
authors.lastname: Lomangino
authors.forename: Bernardo
authors.initials: B
authors.lastname: Marzano
authors.forename: Antonino
authors.initials: A
authors.lastname: Gullo
mesh_terms: D000328:Adult; D000768:Anesthesia, General; D018686:Anesthetics, Intravenous; D001279:Atracurium / Q000008:administration & dosage / Q000031:analogs & derivatives* / Q000493:pharmacokinetics* / Q000494:pharmacology*; D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D002138:Calibration; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D003473:Neuromuscular Nondepolarizing Agents / Q000008:administration & dosage / Q000493:pharmacokinetics* / Q000494:pharmacology*; D009767:Obesity, Morbid / Q000503:physiopathology*; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil; D009435:Synaptic Transmission / Q000187:drug effects
chemical_list: D018686:Anesthetics, Intravenous; D003473:Neuromuscular Nondepolarizing Agents; D010880:Piperidines; D001279:Atracurium; D000077208:Remifentanil; C101584:cisatracurium; D015742:Propofol