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ANESTHETIC PHARMACOLOGY

The Effects of Cisatracurium on Morbidly Obese Women

Yigal Leykin, MD MSc^*, Tommaso Pellis, MD, Mariella Lucca, MD^*, Giacomina Lomangino, MD, Bernardo Marzano, MD, and Antonino Gullo, MD

*Departments of Anesthesia, Pain, Perioperative Medicine and Intensive Care, and Surgery, Santa Maria degli Angeli Hospital, Pordenone, Italy; and the Department of Perioperative Medicine, Intensive Care and Emergency, Trieste University Medical School, Trieste, Italy

Address correspondence and reprint requests to Yigal Leykin, Department of Anesthesia and Intensive Care, Santa Maria degli angeli Hospital, Via Montereale 24, 33170 Pordenone, Italy. Address email to yigal.leykin{at}aopn.fvg.it

There is conflicting evidence on the duration of action of atracurium in obese patients. Cisatracurium is one of the stereoisomers of atracurium. We investigated the neuromuscular effects of cisatracurium in morbidly obese patients. Twenty obese female patients (body mass index >40) were randomized in two groups. Group I (n = 10) received 0.2 mg/kg of cisatracurium on the basis of real body weight (RBW), whereas in Group II (n = 10) the dose was calculated on ideal body weight (IBW). In a control group of 10 normal weight female patients (body mass index 20–24), the dose of cisatracurium was based on RBW. Neuromuscular transmission was monitored using acceleromyography of the adductor pollicis, and anesthesia was induced and maintained with remifentanil and propofol. Onset time was comparable between Group I and the control group (132 s versus 135 s; P = ns). The duration 25% was longer in Group I than in the control group (74.6 min versus 59.1 min; P = 0.01) and in the control group compared with Group II (45.0 min; P = 0.016). In conclusion, the duration of action of cisatracurium was prolonged in morbidly obese patients when dosed according to RBW compared with a control group of normal weight patients. Duration was also prolonged in the control group patients compared with morbidly obese patients to whom the drug was administered on the basis of IBW.

IMPLICATIONS: We investigated the effects of cisatracurium, one of the stereoisomers of atracurium, on morbidly obese patients, prompted by the conflicting evidence reported for atracurium. We concluded that the duration of action of cisatracurium is prolonged when dosed according to real body weight in morbidly obese patients.

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