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Michaloudis D Fraidakis O Petrou A Farmakalidou H Neonaki M Christodoulakis M Flossos A Bakos P Melissas J 《Obesity surgery》2000,10(3):220-229
Background: The authors determined prospectively the safety of continuous spinal anesthesia combined with general anesthesia
and the efficacy of postoperative pain relief with continuous spinal analgesia for morbidly obese patients undergoing vertical
banded gastroplasty. Methods: 27 patients (13 men, 14 women) with a mean body mass index (BMI) of 50.4 ± 7.8 and several co-morbidities
were studied. All patients were anesthetized with the same anesthetic regimen, which included midazolam, fentanyl, propofol,
muscle relaxants, N2O, isoflurane and intrathecal bupivacaine. Postoperative pain relief was provided for 5 days and all patients received the
same regimen, which included intrathecal bupivacaine, fentanyl and intravenous tenoxicam. The intrathecal analgesic regimen
was administered continuously through a pump which had the facility of providing bolus doses when requested in predetermined
lockout intervals. Intra-operative monitoring included hemodynamic and respiratory parameters. Additional postoperative monitoring
included respiratory rate, degree of sedation, sensory level of anesthesia, motor response and intensity of pain. Results:
Intraoperative anesthetic technique was safe and provided satisfactory results in the immediate postoperative period. Furthermore,
the postoperative analgesia regimen provided effective analgesia in all patients.The mean doses of fentanyl and bupivacaine
infused intrathecally for the first 24 postoperative hours were 14.1 ± 2.0 μg.h-1 and 0.7 ± 0.1 mg.h-1 respectively, while the requirements of anal gesia decreased progressively with time. The technique provided effective analgesia
with low pain scores, which was reflected by ease in mobilizing and performing physical exercises with the physiotherapist.
Only minor complications related to anesthesia and analgesia were encountered. Conclusion: To our knowledge, this technique
of anesthesia and postoperative analgesia has not been described before in morbidly obese patients. This regimen merits further
controlled trials to establish its place in the perioperative management of morbidly obese patients. 相似文献
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