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1.Screening
1.2.Inclusion Criteria

American Society of Anesthesiologists (ASA) physical status I-III

III

Age

31 year

Body Surface Area

45.3 kg/m2

Scheduled to undergo sleeve gastrectomy

纳入

1.3.Exclusion Criteria

Neuromuscular disorders

Allergies to, or contraindication for muscle relaxants, neuromuscular reversing agents, nesthetics, narcotics

History of malignant hyperthermia

Pregnancy or lactation

Renal insufficiency

Chronic obstructive pulmonary disease GOLD classification 2 or higher

upper or lower airway infection

Congestive heart failure

Psychiatric illness inhibiting cooperation with study protocol or possibly obscuring results

Diaphragm with poor ultrasound visualization

2.base line
2.2.General information

Sex(male/female)

Age

31 year

Height

160 cm

Weight

116 kg

Lean body weight

51.9 kg

Ideal body weight

54.2 kg

Body Mass Index

45.3 kg/m2

Waistline

135 cm

Hypertension

mmHg

Diabetes

Dyslipidemia

2.3.Physical examination

Abdominal surgery history

Obstructive sleep apnea syndrome

2.4.follow-up 1
2.2.4.2.41、Diaphragm excursion

Diaphragm excursion

1.42 6.51 cm

2.2.4.2.42、QoR-15 score

Quality of Recovery Scores

43+18+20+20+34=135

3.In the process of the treatment
3.1.Treatment Record

fentanyl

250 ug

Rocuronium total dose

80 mg

Remifentanil dose

1500 μg

Bispectral index of the EEG

41.3

Frequency of rescue NMBA

0

Reported muscle movements

0

Entirely optimal (5) throughout pneumoperitoneum

Entirely good to optimal (4–5) throughout pneumoperitoneum

Surgical field condition score

5/5/5

Intra-abdominal pressure

14.8 mmHg

Duration of surgery

116 min

Mean arterial pressure

76.4 mmHg

Mean Heart rate

80.5 min-1

Compound sodium chloride

1000 ml

Bleeding

15 ml

Time to TOF=0.9

29 min

4.postoperation
4.1.Health Relative Quality of Life

SpO2<95% in the PACU

Duratin in the PACU

85 min

Time to out of bed

380 min

Time to gas passage

1030 min

Antiemetic

44 mg

Analgesic

200 mg

Post-Op complication

Hospital stay

120 h

Expenses of hospitalization

44352.34 yuan

4.2.follow-up 2

Shoulder pain

no

4.4.2.4.21、Diaphragm excursion

Diaphragm excursion

1.23 3.45 1.11 3.61 1.44 4.56 cm

4.4.2.4.22、QoR-15 score

Quality of Recovery Scores

15+10+20+14+28=87 25+16+20+20+37=118

4.4.2.4.23、VAS

Incision pain at rest

0/1.0/0

Incision pain at movement

1.0/1.0

Visceral pain at rest

6.0/2.0/0

Visceral pain at movement

6.0/1.0

4.4.2.4.24、Nausea and vomiting score

Postoperative nausea and vomiting grading

IV