This study was designed to evaluate the use of a continuous remifentanil infusion during balanced anesthesia with sevojlurane. associated to reverse Trendlenbwg position (RTP) in obese (OP) and morbid obese pa tients (MOP) undergoing laparoscopic cholecystectomy. The study com prised 40 patients (13 males and 27females) with body mass index (BMl) qf>30-45. After preoperative preparation, anesthesia was induced with a bolus, in 120 sec, ofremifentanil Iftg/kg, followed by propofol 1.5mg/kg and cisatracurium 0.15mg/kg and was maintained by balanced anesthe sia with of 14yg/kg/h remifentanil intravenous infusion and 1.24% endtidal sevoflurane in oxygen and air. Cholecystectomy was performed us ing the "four-puncture" technique. Intraoperative monitoring included re cording heart rate (HR) and arterial pressures. During postoperative peri od, patients were maintained in semisetting position, pulmonary function tests (PFT) were performed 4 h and on days 1, 2 and 3 after operation. The degree of postoperative shoulder-tip pain (STP) was assessed by means of a visual analogue pain scale (VAS) and wound site pain by 4points verbal analogue scale. The occurrence of postoperative complica tions, duration of hospital stay and rates of morbidity and mortality were also recorded. Induction of anesthesia resulted in significant (P<0.05) de crease of arterial pressures and HR compared both to preoperative and pre-induction measures. However, CO2 insufflation and patient tilting to RTP induced significant (P<0.05) increase in arterial pressures and tachy cardia compared to estimates taken prior to insufflation and after exsufJlation |
