Anaes Cases · Volatile & inhalational agents
The obese patient for long laparoscopic surgery — agent selection
The agent-selection long case — the obese patient where a rapid emergence and reliable wake-up matter; desflurane's low solubility versus sevoflurane's stability versus TIVA; balanced against desflurane's greenhouse cost.
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ANZCAFRCAABAEDAIC
Prompt
A 48-year-old man (BMI 42) is scheduled for a three-hour laparoscopic gastric bypass. Discuss the choice of maintenance agent, weighing the pharmacokinetics of the volatiles against a total intravenous technique and the environmental cost.
Presentation
A 48-year-old man with a BMI of 42, obstructive sleep apnoea and well-controlled hypertension is scheduled for a three-hour laparoscopic gastric bypass. He is anxious but cooperative. The question is which maintenance agent to use.
References3ShowHide
- [6]Sulbaek Andersen MP, Nielsen OJ, Sherman JD. Assessing the potential climate impact of anaesthetic gases. The Lancet Planetary Health, 2023.PMID 37438003
- [3]Sonner JM, Antognini JF, Dutton RC, Flood P, et al. Inhaled anesthetics and immobility: mechanisms, mysteries, and minimum alveolar anesthetic concentration. Anesthesia & Analgesia, 2003.PMID 12933393
- [7]Bersten AD, Soni N (eds) Oh's Intensive Care Manual. 8th edition, Elsevier, 2018.