title: The use of propofol and remifentanil for the anaesthetic management of a super-obese patient.
abstract: Morbid obesity is defined as body mass index (BMI) > 35 kg.m(-2), and super-obesity as BMI > 55 kg.m(-2). We report the case of a 290-kg super-obese patient scheduled for open bariatric surgery. A propofol-remifentanil TCI (target controlled infusion) was chosen as the anaesthetic technique both for sedation during awake fibreoptic nasotracheal intubation and for maintenance of anaesthesia during surgery. Servin's weight correction formula was used for propofol. Arterial blood samples were taken at fixed time points to assess the predictive performance of the TCI system. A significant difference between measured and predicted plasma propofol concentrations was found. After performing a computer simulation, we found that predictive performance would have improved significantly if we had used an unadjusted pharmacokinetic set. However, in conclusion (despite the differences between measured and predicted plasma propofol concentrations), the use of a propofol-remifentanil TCI technique both for sedation during awake fibreoptic intubation and for Bispectral Index-guided propofol-remifentanil anaesthesia resulted in a rapid and effective induction, and operative stability and a rapid emergence, allowing rapid extubation in the operating room and an uneventful recovery.
authors.affiliation: Department of Anaesthesiology - IRCCS San Raffaele (Italy), Vita-Salute University of Milan, Milan, Italy. l.lacolla@studenti.hsr.it
authors.forename: L
authors.initials: L
authors.lastname: La Colla
authors.forename: G
authors.initials: G
authors.lastname: La Colla
authors.forename: A
authors.initials: A
authors.lastname: Albertin
authors.forename: D
authors.initials: D
authors.lastname: Poli
authors.forename: F W
authors.initials: FW
authors.lastname: Baruffaldi Preis
authors.forename: A
authors.initials: A
authors.lastname: Mangano
mesh_terms: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D050110:Bariatric Surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*; D010880:Piperidines; D015742:Propofol; D000077208:Remifentanil
chemical_list: D019162:Anesthetics, Combined; D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol