title: Volatile rapid sequence induction in morbidly obese patients.
abstract: 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.
  
  
  METHODS
  Observational study.
  
  
  METHODS
  Thirty-four patients with mean BMI 42.4 kg m undergoing bariatric surgery (morbidly obese group) and 22 patients with mean BMI 25.6 kg m 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 (SpO2) 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. SpO2 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.
  
  
  CONCLUSIONS
  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.
authors: Department of Health Science, Luleå University of Technology, Luleå, Sweden. Tomi.Poso@nll.se
authors: Tomi
authors: T
authors: Pösö
authors: Doris
authors: D
authors: Kesek
authors: Ola
authors: O
authors: Winsö
authors: Staffan
authors: S
authors: Andersson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D015760:Alfentanil / Q000008:administration & dosage; D000769:Anesthesia, Inhalation / Q000009:adverse effects; D018685:Anesthetics, Inhalation / Q000008:administration & dosage* / Q000009:adverse effects; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D050110:Bariatric Surgery; D001784:Blood Gas Analysis; D001794:Blood Pressure; D015992:Body Mass Index; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008738:Methyl Ethers / Q000008:administration & dosage* / Q000009:adverse effects; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods; D009467:Neuromuscular Depolarizing Agents / Q000008:administration & dosage; D009767:Obesity, Morbid / Q000150:complications / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D010865:Pilot Projects; D015742:Propofol / Q000008:administration & dosage; D056152:Respiratory Rate; D000077149:Sevoflurane; D013390:Succinylcholine / Q000008:administration & dosage; D013548:Sweden; D013997:Time Factors; D055815:Young Adult
chemical_list: D018685:Anesthetics, Inhalation; D018686:Anesthetics, Intravenous; D008738:Methyl Ethers; D009467:Neuromuscular Depolarizing Agents; D015760:Alfentanil; D000077149:Sevoflurane; D013390:Succinylcholine; D015742:Propofol