| ObjectiveWith the development of the national economy, the improvement of people’s living standard, people’s nutritional status has markedly improved. But excessive eating habits and diet and obesity is increasing in china. The formation of obesity for many reasons:such as genetic factors, multifactorial inheritance, such as obesity, non-insulin-dependent diabetes mellitus; factors of social environment, many people have a" can eat is a blessing " concept, in today’s society, many types of food, by every kind of food lure, coupled with overeating, enjoy the night life, this is the main reason causing obesity; psychological factors, in order to relieve emotional troubles, the mentality of instability, many people is through the use of eat" to vent. This is because overeating and the reasons leading to obesity; factor related to movement, movement contributes to fat consumption, daily life, with the work of mechanization, transportation developed, housework decreased, making the body of calories consumed fewer opportunities, long-term daily activities more hasten is slow, lazy, and more to reduce the heat consumption, resulting in vicious spiral, on the other hand, because the body energy intake did not reduce, and the formation of obesity. Secondary to pathologic obesity causes of Cushing syndrome, pituitary disease, hypothyroidism, drug-induced etc.. Obesity not only affects the physical beauty, but also affect health, causing much inconvenience to life. Obesity is often accompanied with heart lung liver and other important organs and circulation, respiration, endocrine system changes of physiological function and presence of cardiovascular disease, hypertension, diabetes, hyperlipidemia, gout, cholelithiasis and tumor related disease, in addition to decreased reproductive capacity and psychological symptoms.Obesity refers to the degree of fatty layer too thick and significantly overweight, body fat, especially triglyceride accumulation of excess leads to a state of. Due to metabolic changes or excessive food intake and body fat accumulation leads to excessive weight caused by excessive growth and human physiology, pathology or latent. Obesity evaluation standard for the degree of obesity:=(actual weight-the standard weight/weight x±100%). Compared with normal weight patients, obese patients in adipose tissue and muscle tissue are increased, while the fat increased greater than muscle tissue. Obese patients weight gain will directly cause the blood volume increase, leading to cardiac hemorrhage volume also increased, so that the rich blood supply of organs obtained the very good perfusion. Obese patients are the main factors affecting drug distribution and structure of the body composition, plasma protein binding rate, local blood flow. So the obese patients for intravenous and inhaled anesthetics have a certain degree of influence. In obese patients during induction of general anesthesia prone to difficult mask ventilation, tracheal intubation, the entire operation process prone to hypoxemia, hypercapnia, extubation after prone tongue cause upper respiratory tract obstruction and even breathing difficulties, the other obese patients in recovery period of general anesthesia emergence agitation in incidence were also higher than those of normal weight patients. So obese patients during anesthesia risk.The improvement of medical insurance, as the patient comfortable enjoyment of medical services has laid a foundation; comfortable, safe, effective medical environment become patients in hospitals during the requirements. General anesthesia due to its no memory, little pain, has increasingly become the main choice of surgical patients during operation anesthesia. Improve the venous anesthesia involves three main categories of drugs:intravenous anesthetics, skeletal muscle relaxant, narcotic analgesics. Muscle relaxants are important adjunctive drugs during general anesthesia, muscle relaxants by selectively acting on the motor end plate of film on the N2receptor, blocking nerve impulses to the skeletal muscle transfer leading to muscle relaxation, when used for obese patients especially easy to relate to postoperative muscle relaxation, breathing recovery residual problems such as how to effectively, obese patients adjustment of dosage is important for muscle relaxation.Cisatracurium besylate (Cis) is the atracurium isomers, used for clinical operation and other operations as well as some intensive care treatment. As a general anesthetic adjuvant medication or as in the ICU sedative drugs, it can relax skeletal muscle, mechanical ventilation and endotracheal intubation is easily. Cisatracurium besylate is neuromuscular blockers. Cisatracurium besylate is non depolarizing, in effect, a quinoline benzyl ester structure of skeletal muscle relaxants. Through human clinical studies indicate, cisatracurium besylate and dose dependent histamine release unrelated to, even at doses of up to8times that of ED95is also the case. Cisatracurium besylate in motor endplates and cholinergic receptor binding, antagonistic roles of acetylcholine, and generate competitive blockade of neuromuscular transmission function. This effect can easily be anticholinergic enzyme drugs such as:neostigmine or edrophonium antagonist. Shun benzene sulfonic acid of atracurium in its activity than atracurium, cardiovascular reaction of small, in clinical dose not cause histamine release. Many related literature are reported with benzene sulfonic acid atracurium recovery index with initial dose size, prompting Shun benzene sulfonic acid atracurium muscle relaxation recovery predictability is good, and the medicine unique metabolism elimination on Hofmann. In recent years, Shun benzene sulfonic acid atracurium is widely used in clinic, but for obese patients using the drug observation reported less.The purpose of this study is to observe the obese patients application of cisatracur-ium muscle relaxing effect, for obese patients in clinical anesthesia and provide the theor-etical basis for reasonable medication. Materials and Methods60ASA Ⅰ～Ⅱ under going elective general anesthesia were divided into3groups:group I was normal body weight; group Ⅱ and group III both were obese patients. HR, SpO2, ECG, SBP, DBP and pETCO2of patients who were under endotracheal intubation with intravenous anesthesia(TIVA) were monitored. Group I and group Ⅱ received cisatracurium0.15mg/kg based on real body weight while group III received cisatracurium0.15mg/kg based on ideal body weight. Neuromuscular block at adductor pollicis was monitored by a TOF-Watch SX accelerograph. Recorded the onset time、clinical duration、recovery index and tracheal intubation conditions.The onset time(from Cis injected to T1disappeared), clinical duration(from Cis injected to T1recovered to25%), recovery index(from25%to75%recovery of Tl) and conditions of tracheal intubation were recorded respectively.Statistical methods:Spss13.0statistieal softbag used for statistieal treatment. Parametrie variables are expressed as mean or standard deviation. Analysis of varianee was used for analysis eorres Pondingly. The significance level was p<0.05.ResultsThere were no statistical significant differences in age, height, and ASA classification among three groups(P>0.05). Compared group Ⅱ and group Ⅲ with group Ⅰ, there were statistical significant differences in weight and BMI (P<0.05), but compared group II with group III there were no statistical significant differences(P>0.05).Compared with group I, the onset time of group II was shortened and group III was extended and there were statistical significant differences (P<0.05). Compared with group I, the clinical duration of group Ⅱ was extended and group III was shortened and there were statistical significant differences (P<0.05) ConclusionsWith0.15mg/kg (3ED95) cisatracurium dose in induction anesthesia can provide satisfactory conditions for tracheal intubation in obese patients.When the dose of cisatracurium given to obese patients based on their actual body weight, the onset time was shortened and clinical duration was extended.When the dose of cisatracurium given to obese patients based on their ideal body weight, the onset time was extended and clinical duration was shortened. |
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