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1.Screening
1.2.Inclusion Criteria

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

III

Age

29 year

Body Surface Area

406 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

29 year

Height

163 cm

Weight

108 kg

Lean body weight

54.6 kg

Ideal body weight

53.5 kg

Body Mass Index

40.6 kg/m2

Waistline

116 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

1.9 4.88 cm

2.2.4.2.42、QoR-15 score

Quality of Recovery Scores

50+20+20+20+40=150

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

fentanyl

400 ug

Rocuronium total dose

120 mg

Remifentanil dose

2000 μg

Bispectral index of the EEG

43.7

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

5/5/5/5

Intra-abdominal pressure

13.1 mmHg

Duration of surgery

165 min

Mean arterial pressure

91.6 mmHg

Mean Heart rate

103.3 min-1

Compound sodium chloride

1000 ml

Bleeding

20 ml

Time to TOF=0.9

85 min

4.postoperation
4.1.Health Relative Quality of Life

SpO2<95% in the PACU

Duratin in the PACU

65 min

Time to out of bed

410 min

Time to gas passage

1130 min

Antiemetic

0 mg

Analgesic

0 mg

Post-Op complication

Hospital stay

97 h

Expenses of hospitalization

40702.45 yuan

4.2.follow-up 2

Shoulder pain

no

4.4.2.4.21、Diaphragm excursion

Diaphragm excursion

1.55 2.88 1.55 3.41 1.45 3.54 cm

4.4.2.4.22、QoR-15 score

Quality of Recovery Scores

29+14+20+15+40=118 48+17+20+20+40=145

4.4.2.4.23、VAS

Incision pain at rest

0/0/0

Incision pain at movement

1.0/0

Visceral pain at rest

2.0/1.0/1.0

Visceral pain at movement

3.0/1.0

4.4.2.4.24、Nausea and vomiting score

Postoperative nausea and vomiting grading

0