Evaluation of the Efficacy of Sugammadex Based on Ideal Body Weight of Obstetric Patients with Different Groups of Body Mass Indexes

The patients included in the study will be allocated into three groups according to their BMI. The patients with BMI < 30 kg m-2 (normal BMI) will be allocated in group 1 (n=30), the patients with BMI between 30-40 kg m-2 (obese) in group 2 (n=30) and the patients with BMI > 40 kg m-2 (morbid obese) in group 3 (n=30). In the operating room, a standard monitorization including ECG, non-invasive blood pressure, pulse oxymeter, end-tidal CO2, Bi-spectral index (BIS) and train-of-four (TOF) will be performed to all patients by the anesthesiologist of the operating room. A 20 gauge intravenous line will be placed and each patient will receive 15 mL kg-1 hour-1 isotonic saline infusion. Ideal body weight (IBW) of each patient will be calculated according to the Devine formula (45.5 kg + 2.3 kg/2.4 cm over 152.4 cm) and all of the drugs will be applied based on the calculated IBW of each patient. After preoxygenation with 100% O2 for three minutes, the anesthesiologist will induce general anesthesia with intravenous 1.5-2 mg kg-1 propofol and 0.9 mg kg-1 rocuronium bromide. Endotracheal intubation will be performed when BIS score decreases below 60 and TOF score is below 10%. The anesthesiologist will maintain the anesthesia with 1-2.5% end-tidal sevofluran in a mixture of 40% O2-60% N2O by targeting a bi-spectral index (BIS) value between 40-60. Following delivery of baby by caesarian section, intravenous 4 mg ondansetron and intravenous 1 mcg kg-1 fentanyl will be applied to the mother. The fentanyl dose will be calculated according to the IBW of each patient again and 1 mcg kg-1 fentanyl will be administered. APGAR scores of newborns will be recorded at the first and fifth minute. All patients will receive intravenous 2 mg kg-1 tramadol for postoperative pain management at the end of the surgery. When train-of-four (TOF) value is 25% (moderate neuromuscular blockade), the anesthesiologist will apply intravenous 2 mg kg-1 sugammadex. TOF values will be measured at every 20 seconds intervals after sugammadex dose and if the measured TOF value is under 90% (T4/T1) at the end of 2 minutes, the patients will receive an additional dose of 2 mg kg-1 sugammadex. The time for TOF increased 90% will be recorded and then the patients will be extubated and transferred to Post anesthesia caring unit.