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Material and Methods: After institutional approval and written consent, 82 patients (pts) classified ASA l-ll with a body mass index BMI > 30kg/m2 scheduled for an OBS were randomly assigned to receive either F [n = 40] 2-3mcg/kg (IW) (ideal weight) or R [n = 42] 1 mcg/kg IW/30sec, then 0.2-0.3 mcg/kg IW/min. All pts received a standardized general anesthesia with sevoflurane MAC [1, 2] depending on the bispectral index [30-50]. A bolus dose of tramadol were given for all pts 30min before the end of surgery depending on pts weight. Heart rate (HR), systolic arterial pressure (SAP) and mean arterial pressure (MAP) were recorded before (TO) and after induction (T1), after intubation (T2), at incision (T3), during surgery (T4-T7), at wound closure (T8) and after extubation (T9). Doses of vasodilators (VD) and vasoconstrictors (VC) administered for a variation of 20% from preoperative value of SAP were registered. Time to extubation and the level of consciouness (1-4) on recovery were noted. Statistical analysis were made with “t” student tests, chi-2 and ANOVA; p < 0.05 was considered significant.
Results: Demographic data were similar between groups. Mean BMI was 44.5 ± 31 Kg/m2 and the opioids mean dose were 300 mcg of F and 1800 mcg of R. Doses of VC used were higher in R group (p = 0.18). MAP values dropped at T1, T2 (p = 0.000) and T8 with a concomitant drop of HR at T2 (p = 0.015), T7 and T8 in the R group. Increase of MAP was noted at T8 in F group (p = 0.054). Time to extubation and the level of consciousness were similar at recovery between groups.
Conclusion: R-based anesthesia did not provide hemodynamic stability or better recovery time compared to F during OBS. This leads us to use it cautiously in obese patients with cardiac disease.
