| There is some controversy in the medical treatment of obese patients clinically in all fields of medicine.If the patient’s dose was calculated according to the real body weight(RBW),would lead to drug accumulation because of drug overdose,metabolic incomplete and so on.Among them,a large number of studies have shown that the unreasonable use of muscle relaxants in obese patients results in residual neuromuscular block(RNMB).In the past,the rational use of muscle relaxants in our department has been preliminary studied and the dose of ED95 of Rocuronium(ROC)calculated according to lean body mass(LBW)administration was 0.43mg/kg.However,there was no further study in the treatment of obese patients according to LBM during long time anesthesia at home and abroad.Part one Comparison of pharmacokinetics in recovery phase of a single application of rocuronium in obese patients at the induction stage base on real body weight or lean body mass pattern.Objective This article has touched on just comparison of pharmacodynamics following infusion rocuronium bromide injection base on real body weight and lean body mass pattern in obese patients during short-time surgeries.Methods 40 patients(20 normal weight patients BMI:18-25kg/m2(Group N)and 20 obese patients BMI:30～35 kg/m2(Group O))scheduled to undergo elective surgery(operation time<2 hours)under general anesthesia were enrolled in the study.Then the patients were divided into two groups according to different body weight and mode of administration,namely the normal weight patient group and the obese weight patient group,and then the two groups further divided into four subgroups,namely the normal weight patients according to the actual body weight administration group(NR group),normal weight patients according to the lean body mass administration group(NL group),the obese patients according to the actual body weight group(OR group)and the obese patients according to the lean body mass administration group(OL group),and the number of patients in each subgroup was 10 cases.The ROC was induced by general anesthesia to double ED95 dosage intravenous infusion according to RBW or LBW.Endotracheal intubation was performed when T1 reached maximum inhibition(ie,T1=0),allowing its natural metabolic recovery.Record the onset time,the duration of the clinical action,pharmacological action time,recovery index and tracheal intubation condition rating.Results Compared with other three groups,the duration of the clinical action,the recovery index and the pharmacological action time in group OR were prolonged in pharmacodynamics.There was no statistically significant difference(p>0.05)between group OL and group N in addition to the recovery index extension.Conclusion Obese patients according to the the lean body mass to use ROC,can be obtained with the normal body weight according to the actual weight of the administration of pharmacodynamic effects,and it also can reduce the amount of muscle relaxant medication.Part two Comparison of pharmacokinetics in recovery phase of a intermittent application of rocuronium in obese patients during long-time surgeries base on real body weight or lean body mass pattern.Objective The pharmacodynamic differences of ROC were compared between the obese patients and the obese patients.Methods 40 patients with elective craniocerebral surgery(operation time 3-5h),Groups were divided in the same way of part one.The four-subgroup patients were given an intravenous bolus of double ED95 dosage of rocuronium according to their RBW or LBM for induction dosage.When Ti recovered to 5%,a dosage of 0.5-fold ED95 was administered repeatedly for maintaining till 30 minutes before the end of the operations.The onset time for maximal depression of T1,clinical duration,recovery index and recovery time were determined with TOF-Watch SX accelerometric monitor.Results Compared with the other three groups,the onset time of group OR was shortest,and the clinical duration and recovery time was longer than others.But there was no statistical difference on recovery index among four groups.On the other hand,however,compared with normal weight groups(group NR and group NL),there were no significantly change in clinical duration and recovery time in group OL,but the onset time was shorter.Conclusion In long-term surgery,obese patients were treated with rocuronium repeated use of ED95 according to lean body weight to obtain muscle relaxation parameters similar to actual body weight administration,whereas the pharmacodynamic parameters were prolonged after actual body weight administration.The results can help us to assess muscle relaxation recovery time of obese patients,guiding the timing of muscle relaxant drug adminisrtration,reduce the incidence of muscle relaxants in obese patients with clinical guidance.Part three Comparison of pharmacokinetics in recovery phase of continuous infusion rocuronium bromide injection in obese patients during long-time surgeriesaccording to real body weight or lean body mass pattern.Objective To compare the pharmacodynamics following continuous infusion rocuronium based on real body weight and lean body mass in obese patients during long-time surgeries,providing a safegy for clinical practice in obese patients.Methods Groups were divided in the same way of part two.The four-subgroup patients were given an intravenous bolus of double ED95 dosage of rocuronium according to their real body weight(RBW)or lean body mass(LBM)for induction dosage.When T1 recovered to 3%,a continuous intravenous infusion of rocuronium with a rate of double ED95/h according to LBW and RBW was begun to maintain the muscle relaxation,and the infusion was stopped 30min before the end of the operation.The muscle relaxation of all cases were spontaneously recovered without using antagonists.Recorded the amounts of infusion time,anesthesia duration,PTC value,average dose and total dose of ROC during neuromuscular block maintenance period,and the time from PTC=2 to TOF recovered to 0.9,and the time of T1 recovered to 25%(T25),T1 recovered to 90%(T90),and T1 recovered from 25%to 75%(T25～75).Results Compared with group NR,the onset time of group O was shortened,and the onset time in obese patients according to RBW significantly shortened,and the difference between groups is statistically significant.The average value of PTC,the time of clinical action and the time of TOF recovered to 0.9,the difference among the other three groups and OR group has a were statistically difference,and there was no statistical difference between group OL and group R.Compared with group NR,the T25 to T75 time of group OR obviously increased,and the difference was statistically significant.Conclusion In a long period of surgery,obese patients were continuous infusion ROC according to the lean body weight,not only can achieve good muscle relaxation effect,but also can reduce the dose,the recovery time is shorter,reducing the occurrence of muscle relaxants,and suitable for widely used in clinical. |
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