title: Maintenance of anesthesia in morbidly obese patients using propofol with continuous BIS-monitoring: a comparison of propofol-remifentanil and propofol-epidural anesthesia.
abstract: OBJECTIVE
  Aim of this study was to evaluate maintenance of anesthesia using propofol with continuous Bispectral Index (BIS)-monitoring in morbidly obese patients receiving propofol-remifentanil and propofol-epidural anesthesia.
  
  
  METHODS
  In the first group in ten morbidly obese patients receiving remifentanil analgesia, a propofol infusion was started at 10 mg/kg/hr and modified by aiming at BIS values between 40-60 together with predefined hemodynamic parameters. In the second group, the propofol dose resulting from the first group was prospectively evaluated in a matched cohort of six morbidly obese patients receiving propofol-epidural analgesia aiming for the same BIS and hemodynamic parameters. In both groups, propofol concentration and infusion rates, BIS and hemodynamic values were collected.
  
  
  RESULTS
  In the propofol-remifentanil group (Body Mass Index (BMI) 39-60 kg/m2), the mean propofol infusion rate that corresponded to the predefined BIS and hemodynamic parameters was 4.8 mg/kg/hr (SD 1.5). On this basis, a maintenance dose of 5 mg/kg/hr was started in the propofol-epidural group (BMI 38-58 kg/m2). In this second group, the mean propofol infusion rate that corresponded to predefined BIS and hemodynamic parameters was 5.0 mg/kg/hr (SD 0.6). Between the two groups, there was no difference in the propofol concentration-BIS relation.
  
  
  CONCLUSIONS
  Using both BIS and hemodynamic parameters as an endpoint, a maintenance dose of propofol of 4-6 mg/kg/hr is proposed for maintenance of anesthesia in morbidly obese patients undergoing bariatric surgery either in combination with remifentanil or epidural analgesia. There was no difference in propofol concentration-BIS relation in morbidly obese patients receiving propofol-remifentanil or propofol-epidural anesthesia.
authors.affiliation: Department of Anesthesiology and Intensive Care, St. Antonius Hospital, Nieuwegein. svankralingen@hotmail.com
authors.forename: S
authors.initials: S
authors.lastname: van Kralingen
authors.forename: E M W
authors.initials: EM
authors.lastname: van de Garde
authors.forename: E P A
authors.initials: EP
authors.lastname: van Dongen
authors.forename: J
authors.initials: J
authors.lastname: Diepstraten
authors.forename: V H M
authors.initials: VH
authors.lastname: Deneer
authors.forename: B
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: C A J
authors.initials: CA
authors.lastname: Knibbe
mesh_terms: D000328:Adult; D000767:Anesthesia, Epidural / Q000379:methods*; D000771:Anesthesia, Intravenous / Q000379:methods; D018686:Anesthetics, Intravenous; D050110:Bariatric Surgery; D001794:Blood Pressure / Q000187:drug effects; D015331:Cohort Studies; D004305:Dose-Response Relationship, Drug; D004569:Electroencephalography / Q000379:methods*; D005260:Female; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D009767:Obesity, Morbid / Q000601:surgery*; D010880:Piperidines; D015742:Propofol; D011446:Prospective Studies; D000077208:Remifentanil
chemical_list: D018686:Anesthetics, Intravenous; D010880:Piperidines; D000077208:Remifentanil; D015742:Propofol