Succinylcholine in Morbidly Obese Patients: Another Interesting Advantage

A white female (age 43 years, weight 116 kg, height 166 cm, BMI 42 kg/m2 ) was scheduled for elective laparoscopic gastric banding. She had a history of arterial hypertension and diabetes mellitus. Following general anesthesia induction with fentanyl and propofol, a size 5 ProSeal™ LMA (PLMA) was gently positioned with digital technique at the first attempt [5]. A flexible fiberoptic bronchoscope introduced through the PLMA confirmed the adequate positioning of the PLMA (Fig. 1) [5]. Anesthesia was maintained with fentanyl and sevoflurane in airoxygen, while neuromuscular blockade was achieved with cisatracurium administered in a single bolus before carboperitoneum [5]. At the end of the uneventful surgical procedure, volatile anesthetic administration was discontinued and 100% oxygen was given. Suddenly, expiratory tidal volume fell to 150 ml, and the peak inspiratory pressure exceeded the oropharyngeal leak pressure of 30 cm H2O. Propofol 0.8 mg/kg i.v. was administered. Manually assisted ventilation was adopted. A flexible fiberoptic bronchoscope was introduced through the PLMA. It revealed a soft swelling of the vocal cords and of surrounding tissue and a narrowing of the laryngeal inlet without signs of gastric content reflux (Fig. 1). Due to persistent laryngospasm with difficult ventilation and air leakage, but without arterial oxygen desaturation, succinylcholine 0.1 mg/kg i.v. was administered, with good results (Fig. 1). Then, the patient was quickly awakened and the PLMA removed without respiratory complications. No other episodes of laryngospam were registered in the postanesthesia care unit. The patient was discharged to the surgical ward after 4 h and from the hospital in the following day.