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Kamal FA, Fernet LY, Da Silva NK, Briceño G, Iyoob N, Aleman Paredes K, Martinez Ramirez M, Arruarana VS. Comparing Perioperative Outcomes of Total Intravenous Anesthesia (TIVA) With Volatile Anesthesia in Patients With Obesity: A Systematic Review. Cureus 2024; 16:e54094. [PMID: 38487133 PMCID: PMC10937615 DOI: 10.7759/cureus.54094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
In this systematic review, the perioperative outcomes of total intravenous anesthesia (TIVA) and volatile anesthesia were compared in obese adults (BMI ≥ 30 kg/m²) undergoing elective surgery. The review analyzed data from 12 randomized-controlled trials involving 935 patients, sourced from PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane, Scopus, and Web of Science databases. The focus was on intraoperative vital signs, emergence time, postoperative nausea and vomiting (PONV), duration of post-anesthesia care unit (PACU) stay, and ICU admission rates. Findings showed that TIVA (using propofol) might reduce PONV, but there were no significant differences in other outcomes compared to volatile anesthesia (with desflurane as the most common agent). The review highlights the need for more research, especially comparing sevoflurane with TIVA, to establish clear clinical guidelines for anesthesia in obese patients.
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Affiliation(s)
- Faiza A Kamal
- General Practice, University of Nottingham, Nottingham, GBR
| | - Lucas Y Fernet
- General Practice, University of Nottingham, Nottingham, GBR
| | | | - Gabriela Briceño
- Obstetrics and Gynecology, Universidad de Oriente Núcleo de Anzoátegui, Barcelona, VEN
| | - Nusrath Iyoob
- Internal Medicine, Vinnytsia National Pirogov Medical University, Vinnytsya, UKR
| | - Kenneth Aleman Paredes
- Surgery, Hospital General Regional IMSS (Instituto Mexicano del Seguro Social) No. 220 "General José Vicente Villada", Toluca, MEX
| | | | - Victor S Arruarana
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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Hu ZH, Liu Z, Zheng GF, Li ZW, Liu SQ. Postoperative Recovery Outcomes for Obese Patients Undergoing General Anesthesia: A Meta-Analysis of Randomized Controlled Trials. Front Surg 2022; 9:862632. [PMID: 35965859 PMCID: PMC9366090 DOI: 10.3389/fsurg.2022.862632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Accepted: 04/25/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose This study was performed to assess the postoperative recovery outcomes in obese patients undergoing general anesthesia. Methods The eligible studies were identified from PubMed, EmBase, and the Cochrane library until December 2020. The standard mean differences (SMDs) with 95% confidence intervals (CIs) were used to calculate the role of desflurane, sevoflurane, and propofol on recovery outcomes, and the analyses using the random-effects model. Results Eleven randomized controlled trials involving 713 obese patients undergoing general anesthesia were selected for final meta-analysis. We noted desflurane was associated with a shorter time to eye-opening than sevoflurane (SMD: −0.86; 95% CI, −1.43 to −0.28; P = 0.003). The use of desflurane with shorter time to extubation as compared with propofol (SMD: −1.13; 95% CI, −1.52 to −0.73; P < 0.001) or sevoflurane (SMD: −1.19; 95% CI, −2.15 to −0.22; P = 0.016), while sevoflurane was associated with longer time to extubation as compared with propofol (SMD: 1.47; 95% CI, 1.03 to 1.91; P < 0.001). Desflurane were associated with shorter time to stating name as compared with propofol (SMD: −1.40; 95% CI, −2.32 to −0.48; P = 0.003) or sevoflurane (SMD: −2.09; 95% CI, −3.33 to −0.85; P = 0.001). In addition, desflurane was associated with a longer time for orientation to place as compared with propofol (SMD: 0.65; 95% CI, 0.22 to 1.07; P = 0.003), while desflurane with shorter time for orientation to place as compared with sevoflurane (SMD: −0.88; 95% CI, −1.46 to −0.30; P = 0.003). Conclusions The use of desflurane could provide better recovery outcomes in obese patients undergoing general anesthesia. Further large-scale trials should be comparison the long-term effectiveness of various anesthetics.
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Aftab H, Fagerland MW, Gondal G, Ghanima W, Olsen MK, Nordby T. Gastric sleeve resection as day-case surgery: what affects the discharge time? Surg Obes Relat Dis 2019; 15:2018-24. [DOI: 10.1016/j.soard.2019.09.070] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2019] [Revised: 08/06/2019] [Accepted: 09/15/2019] [Indexed: 11/16/2022]
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Wan L, Shao LJ, Liu Y, Wang HX, Xue FS, Tian M. A feasibility study of jaw thrust as an indicator assessing adequate depth of anesthesia for insertion of supraglottic airway device in morbidly obese patients. Chin Med J (Engl) 2019; 132:2185-91. [PMID: 31425359 DOI: 10.1097/CM9.0000000000000403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Jaw thrust has been proven as a useful test determining adequate depth of anesthesia for successful insertion of supraglottic airway device (SAD) in normal adults and children receiving intra-venous or inhalational anesthesia induction. This prospective observational study aimed to determine the feasibility and validity of this test when using as an indicator assessing adequate depth of anesthesia for successful insertion of SAD in spontaneously breathing morbidly obese patients receiving sevoflurane inhalational induction. Methods: Thirty morbidly obese patients with a body mass index 40 to 73 kg/m2 undergoing bariatric surgery in Beijing Friendship Hospital from October 2018 to January 2019 were included in this study. After adequate pre-oxygenation, 5% sevoflurane was inhaled and inhalational concentration of sevoflurane was increased by 1% every 2 min. After motor responses to jaw thrust disappeared, a SAD was inserted and insertion conditions were graded. The anatomic position of SAD was assessed using a fiberoptic bronchoscope. Results: The SAD was successfully inserted at the first attempt in all patients. Insertion conditions of SAD were excellent in nine patients (30%) and good in 21 patients (70%), respectively. The fiberoptic views of SAD position were adequate in 28 patients (93%). Conclusions: Jaw thrust test is a reliable indicator determining adequate anesthesia depth of sevoflurane inhalational induction for successful insertion of SAD in spontaneously breathing morbidly obese patients. Clinical trial registration: ChiCTR1800016868; http://www.chictr.org.cn/showproj.aspx?proj=28646.
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Aftab H, Fagerland MW, Gondal G, Ghanima W, Olsen MK, Nordby T. Pain and nausea after bariatric surgery with total intravenous anesthesia versus desflurane anesthesia: a double blind, randomized, controlled trial. Surg Obes Relat Dis 2019; 15:1505-1512. [DOI: 10.1016/j.soard.2019.05.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/26/2019] [Accepted: 05/07/2019] [Indexed: 10/26/2022]
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Memtsoudis SG, Cozowicz C, Nagappa M, Wong J, Joshi GP, Wong DT, Doufas AG, Yilmaz M, Stein MH, Krajewski ML, Singh M, Pichler L, Ramachandran SK, Chung F. Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea. Anesth Analg 2019; 127:967-987. [PMID: 29944522 PMCID: PMC6135479 DOI: 10.1213/ane.0000000000003434] [Citation(s) in RCA: 88] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.
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Affiliation(s)
- Stavros G Memtsoudis
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Crispiana Cozowicz
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Mahesh Nagappa
- Department of Anesthesia and Perioperative Medicine, London Health Sciences Centre and St Joseph's Health Care, Western University, London, Ontario, Canada
| | - Jean Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical School, Dallas, Texas
| | - David T Wong
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
| | - Anthony G Doufas
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University Medical Center, Palo Alto, California
| | - Meltem Yilmaz
- Department of Anesthesiology, Northwestern University, Chicago, Illinois
| | - Mark H Stein
- Department of Anesthesiology, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Megan L Krajewski
- Department of Anesthesia, Critical Care, and Pain Management, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Mandeep Singh
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada.,Toronto Sleep and Pulmonary Centre, Toronto, Canada.,Department of Anesthesia and Pain Management, Women's College Hospital, Toronto, Canada.,Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
| | - Lukas Pichler
- From the Department of Anesthesiology, Critical Care & Pain Management, Weill Cornell Medical College and Hospital for Special Surgery, New York, New York.,Department of Anesthesiology, Perioperative Medicine and Intensive Care Medicine, Paracelsus Medical University, Salzburg, Austria
| | - Satya Krishna Ramachandran
- Department of Anesthesiology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Frances Chung
- Department of Anesthesia and Pain Medicine, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, Ontario, Canada
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Johnson JM. Comment on: Pain and nausea after bariatric surgery with total intravenous anesthesia versus desflurane anesthesia: a double blind, randomized, controlled trial. Surg Obes Relat Dis 2019; 15:1512. [PMID: 31405816 DOI: 10.1016/j.soard.2019.06.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/29/2019] [Indexed: 11/23/2022]
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Hasanein R, El-sayed W, Nabil N, Elsayed G. The effect of combined remifentanil and low dose ketamine infusion in patients undergoing laparoscopic gastric bypass. Egyptian Journal of Anaesthesia 2019; 27:255-60. [DOI: 10.1016/j.egja.2011.07.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Singh PM, Borle A, McGavin J, Trikha A, Sinha A. Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Undergoing Bariatric Surgery-a Meta-Analysis of Randomized Controlled Trials. Obes Surg 2017; 27:3031-9. [PMID: 28916989 DOI: 10.1007/s11695-017-2929-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Early and clear recovery from anesthesia is the crux for preventing perioperative complications in the obese undergoing bariatric surgery. Volatile inhalation agents by virtue of high lipid solubility are expected to produce residual anesthetic effects. Prospective randomized trials comparing desflurane and sevoflurane used for anesthesia maintenance (electroencephalograph guided) during bariatric surgery published till 1st of July 2017 were searched in the medical database. Comparisons were made for surrogate markers of recovery from anesthesia that included time to eye-opening (TEo), time to tracheal-extubation (TEx), and Aldrete scores on immediately shifting to recovery (Ald-I). Five trials were included in the final analysis. Patients receiving desflurane began to respond faster by opening eyes on command (five trials) by 3.80 min (95%CI being 1.83-5.76) (random effects, P < 0.01, I2 = 78.61%), and tracheal extubation was also performed earlier (four trials) by 4.97 min (95%CI being 1.34-8.59). This meant a reduction of 37% in TEo and 33.60% in TEx over sevoflurane. Ald-I scores were higher/better with desflurane by 0.52 (95%CI being 0.19-0.84) (Fixed-effects, P < 0.01, I2 = 6.67%). Publication bias is likely for TEo (Egger's Test, X-intercept = - 8.57, P = 0.02). No airway-related complications were reported with desflurane's expedited recovery. Use of desflurane compared to sevoflurane for maintenance of anesthesia in morbidly obese patients allows attaining verbal contact faster, and tracheal extubating can be performed earlier without compromising safety. The benefits of better recovery extend into the immediate postoperative phase with patients being more awake upon shifting to the recovery.
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Elbakry A, Sultan W, Ibrahim E. A comparison between inhalational (Desflurane) and total intravenous anaesthesia (Propofol and dexmedetomidine) in improving postoperative recovery for morbidly obese patients undergoing laparoscopic sleeve gastrectomy: A double-blinded randomised controlled trial. J Clin Anesth 2018; 45:6-11. [DOI: 10.1016/j.jclinane.2017.12.001] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/23/2017] [Accepted: 12/05/2017] [Indexed: 01/01/2023]
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Honca M, Honca T. Comparison of Propofol with Desflurane for Laparoscopic Sleeve Gastrectomy in Morbidly Obese patients: A Prospective Randomized Trial. Bariatr Surg Pract Patient Care 2017. [DOI: 10.1089/bari.2016.0044] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Mehtap Honca
- Department of Anesthesiology and Reanimation, Kecioren Training and Research Hospital, Ankara, Turkey
| | - Tevfik Honca
- Department of Health, Republic of Turkey Ministry of National Defense, Ankara, Turkey
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12
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Desmet M, Vander Cruyssen P, Pottel H, Carlier S, Devriendt D, Van Rooy F, De Corte W. The influence of propofol and sevoflurane on intestinal motility during laparoscopic surgery. Acta Anaesthesiol Scand 2016; 60:335-42. [PMID: 26806956 DOI: 10.1111/aas.12675] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 11/09/2015] [Accepted: 11/11/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Volatile anaesthetics have an influence on small bowel peristalsis during laparoscopic surgery. A recent study concluded that desflurane increased intestinal motility compared to sevoflurane. Hence, a desflurane-based anaesthesia protocol may reduce surgical exposure during intestinal suturing or stapling due to small bowel hyperperistalsis. The effect of propofol on intestinal motility is not well studied. We tested the hypothesis that a propofol-remifentanil anaesthesia increases intestinal contractions in comparison with a sevoflurane-remifentanil anaesthesia. METHODS Patients scheduled for laparoscopic gastric bypass surgery were randomized in this single blind randomized controlled trial to receive remifentanil combined with sevoflurane or propofol (ISRCTN 12921661). Bispectral index monitoring was used to guide depth of anaesthesia. Visual observation of peristaltic waves was performed during 1 min at the planned site of the jejunostomy. Statistical analysis was performed using Wilcoxon two-sample test. RESULTS After obtaining written informed consent 50 patients were included. Groups were similar for demographic variables, and depth of anaesthesia during the observations. The median number of peristaltic waves was lower in the sevoflurane-remifentanil group compared to the propofol-remifentanil group (0 vs. 6, P < 0.001). CONCLUSION Propofol-remifentanil increases intestinal motility compared with sevoflurane-remifentanil during laparoscopic gastric bypass surgery. A sevoflurane-based protocol can help to avoid disturbing peristalsis.
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Affiliation(s)
- M. Desmet
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
| | - P. Vander Cruyssen
- Department Cardiovascular Sciences; KU Leuven; Leuven Belgium
- Department of Anaesthesiology; UZ Leuven; Leuven Belgium
| | - H. Pottel
- Department of Public Health and Primary Care; KU Leuven Campus Kulak; Kortrijk Belgium
| | - S. Carlier
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
| | - D. Devriendt
- Department of Abdominal Surgery; AZ Groeninge Hospital; Kortrijk Belgium
| | - F. Van Rooy
- Department of Abdominal Surgery; AZ Groeninge Hospital; Kortrijk Belgium
| | - W. De Corte
- Department of Anaesthesiology; AZ Groeninge Hospital; Kortrijk Belgium
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Abstract
Sevoflurane has been available for clinical practice for about 20 years. Nowadays, its pharmacodynamic and pharmacokinetic properties together with its absence of major adverse side effects on the different organ systems have made this drug accepted worldwide as a safe and reliable anesthetic agent for clinical practice in various settings.
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Affiliation(s)
- Stefan De Hert
- Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
| | - Anneliese Moerman
- Department of Anesthesiology, Ghent University Hospital, De Pintelaan 185, Ghent, B-9000, Belgium
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Liu FL, Cherng YG, Chen SY, Su YH, Huang SY, Lo PH, Lee YY, Tam KW. Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials. Can J Anaesth. 2015;62:907-917. [PMID: 26001751 DOI: 10.1007/s12630-015-0405-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 05/15/2015] [Indexed: 12/13/2022] Open
Abstract
PURPOSE Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. SOURCE We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). PRINCIPAL FINDINGS We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] -3.10 min; 95% confidence interval (CI): -5.13 to -1.08), to squeeze the investigator's hand (WMD -7.83 min; 95% CI: -8.81 to -6.84), to be prepared for tracheal extubation (WMD -3.88 min; 95% CI: -7.42 to -0.34), and to state their name (WMD -7.15 min; 95% CI: -11.00 to -3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. CONCLUSION Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).
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Salihoglu T, Salihoglu Z, Zengin AK, Taskin M, Colakoglu N, Babazade R. The Impacts of Super Obesity Versus Morbid Obesity on Respiratory Mechanics and Simple Hemodynamic Parameters During Bariatric Surgery. Obes Surg 2012; 23:379-83. [DOI: 10.1007/s11695-012-0783-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kira S, Koga H, Yamamoto S, Takeshima N, Hasegawa A, Miyakawa H, Noguchi T. Anesthetic management of laparoscopic adjustable gastric banding in Japanese patients with morbid obesity. J Anesth 2007; 21:424-8. [PMID: 17680200 DOI: 10.1007/s00540-007-0529-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2006] [Accepted: 03/22/2007] [Indexed: 10/23/2022]
Abstract
Laparoscopic adjustable gastric banding (LAGB) is a common type of bariatric surgery worldwide, though not so in Japan. Here we report the anesthetic management of LAGB in ten Japanese patients with morbid obesity. General anesthesia was induced with propofol, fentanyl, and vecuronium bromide and maintained with sevoflurane in oxygen and air (or nitrous oxide in some cases). In a limited number of patients, perioperative epidural analgesia was performed, with fentanyl injected intravenously for analgesia in the remaining patients. Although some special considerations were needed, in perioperative management, including thromboprophylaxis, there were no severe complications in any of the patients.
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Affiliation(s)
- Shinichiro Kira
- Department of Anesthesiology, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu, Oita 879-5593, Japan
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Abstract
PURPOSE OF REVIEW The number of obese patients undergoing anesthesia and surgery is increasing. This article aims to present recent achievements in the management of gross and morbidly obese patients in order to improve safety. RECENT FINDINGS Current investigations have demonstrated that the type of anesthesia (total intravenous anesthesia or volatile) and the anesthetics used have an important influence on the perioperative period, especially on postanesthesia recovery and respiratory failure during the postoperative period. These findings were compared with previous publications. Practical advice is also presented for performing successful intubation and mechanical ventilation in the morbidly obese patient, as well as describing drug dosage and administration. SUMMARY The progress in anesthesia techniques and modern drugs allows for safe management of obese patients, with mortality decreasing in this group of patients.
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Affiliation(s)
- Tomasz Gaszynski
- Department of Anesthesiology and Intensive Therapy, Medical University of Lodz, Poland.
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Feld JM, Hoffman WE, Stechert MM, Hoffman IW, Ananda RC. Fentanyl or dexmedetomidine combined with desflurane for bariatric surgery. J Clin Anesth 2006; 18:24-8. [PMID: 16517328 DOI: 10.1016/j.jclinane.2005.05.009] [Citation(s) in RCA: 123] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2004] [Accepted: 05/16/2005] [Indexed: 11/29/2022]
Abstract
STUDY OBJECTIVE Because fentanyl has ventilatory depressing effects, alternative methods for analgesia may be beneficial for management of bariatric surgery. We evaluated whether dexmedetomidine infusion could replace fentanyl for facilitation of open gastric bypass surgery. DESIGN Randomized, single blinded, open label. SETTING University teaching hospital. PATIENTS Twenty bariatric patients with an average body mass index of 54 to 61 kg/m2 undergoing surgery for open gastric bypass. INTERVENTIONS Patients were randomized to receive either fentanyl (0.5-microg/kg bolus, 0.5 microg.kg(-1).h(-1), n = 10) or dexmedetomidine (0.5-microg/kg bolus, 0.4 microg.kg(-1).h(-1), n = 10) for intraoperative analgesia. In both groups, end-tidal desflurane was adjusted to maintain the bispectral index at 45 to 50. MEASUREMENTS In the operating room, blood pressure and heart rate were measured at 5-minute intervals. Bispectral index and end-tidal desflurane concentration were measured every hour. During recovery in the postanesthesia care unit, patient-evaluated pain scores and morphine use by patient-controlled analgesia pump were determined. MAIN RESULTS During surgery, desflurane concentrations necessary to maintain the bispectral index at 45 to 50 were decreased, and blood pressure and heart rate were lower with in the dexmedetomidine compared with fentanyl group. In the postanesthesia care unit, pain scores and morphine use were decreased in the dexmedetomidine group. CONCLUSIONS Dexmedetomidine, when used to substitute for fentanyl during gastric bypass surgery, attenuates blood pressure and provides postoperative analgesia.
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Affiliation(s)
- James M Feld
- Department of Anesthesiology, University of Illinois at Chicago, Chicago, IL 60612, USA
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Schumann R, Jones SB, Ortiz VE, Connor K, Pulai I, Ozawa ET, Harvey AM, Carr DB. Best practice recommendations for anesthetic perioperative care and pain management in weight loss surgery. ACTA ACUST UNITED AC 2005; 13:254-66. [PMID: 15800282 DOI: 10.1038/oby.2005.35] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To develop evidence-based recommendations that optimize the safety and efficacy of perioperative anesthetic care and pain management in weight loss surgery (WLS) patients. RESEARCH METHODS AND PROCEDURES This Task Group examined the scientific literature on anesthetic perioperative care and pain management published in MEDLINE from January 1994 to March 2004. We also reviewed additional data from other sources (e.g., book chapters). The search yielded 195 abstracts, of which 35 references were reviewed in detail. Task Group consensus was used to provide recommendations when evidence in the literature was insufficient. RESULTS We developed anesthesia practice and patient safety advisory recommendations for preoperative evaluation, intraoperative management, and postoperative care and pain management of WLS patients. We also provided suggestions related to medical error reduction and systems improvements, credentialing, and future research. DISCUSSION Obesity-related comorbidities including obstructive sleep apnea place WLS patients at increased risk for complications perioperatively. Regarding perioperative safety and outcomes, conclusive evidence beyond the accepted standard of care in the reviewed literature is limited. Few reports specifically address the perioperative needs of severely obese patients. In this advisory, we synthesize current knowledge and make best practice recommendations for perioperative care and pain management in WLS patients. These recommendations require periodic review as further medical knowledge and evidence evolve.
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Affiliation(s)
- Roman Schumann
- Department of Anesthesia, Tufts-New England Medical Center, 750 Washington Street, Boston, MA 02111, USA.
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Abstract
The prevalence of obesity has increased 15% up to 20% and represents an important challenge for the anesthesiologist in drug-dosing management. The aim of this work is to provide an overview on physiological changes and pharmacokinetic implications of obesity for the anesthesiologist. Obesity increases both fat and lean masses; however, the percentage of fat tissue increases more than does the lean mass, affecting the apparent volume of distribution of anesthetic drugs according to their lipid solubility. Benzodiazepine loading doses should be adjusted on actual weight, and maintenance doses should be adjusted on ideal body weight. Thiopental sodium and propofol dosages are calculated on total body weight (TBW). The loading dose of lipophilic opioids is based on TBW, whereas maintenance dosages should be cautiously reduced because of the higher sensitivity of the obese patient to their depressant effects. Pharmacokinetic parameters of muscle relaxants are minimally affected by obesity, and their dosage is based on ideal rather than TBW. Inhalation anesthetics with very low lipid solubility, such as sevoflurane and desflurane, allow for quick modification of the anesthetic plan during surgery and rapid emergence at the end of surgery, hence representing very flexible anesthetic drugs for use in this patient population. Drug dosing is generally based on the volume of distribution for the loading dose and on the clearance for maintenance. In the obese patient, the volume of distribution is increased if the drug is distributed both in lean and fat tissues whereas the anesthetic drug clearance is usually normal or increased.
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Affiliation(s)
- Andrea Casati
- Department of Anesthesiology and Pain Therapy, University of Parma, Parma, Italy.
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Ezri T, Muzikant G, Medalion B, Szmuk P, Charuzi I, Susmallian S. Anesthesia for restrictive bariatric surgery (gastric bypass not included): laparoscopic vs open procedures. Int J Obes (Lond) 2004; 28:1157-62. [PMID: 15311219 DOI: 10.1038/sj.ijo.0802709] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UNLABELLED Publications regarding anesthetic management for weight reduction surgery are scarce. We reviewed the records of 234 patients who underwent bariatric restrictive procedures (gastric bypass not included) from May 1999 to September 2000. Variables analyzed included demographics, anesthetic data and perioperative course. Patients were allocated into two groups: laparoscopic (LPG) and open procedures (OPG), comprising 167 and 67 patients respectively. Obstructive sleep apnea was present in 4.8% in LPG vs 6.1% in OPG. Awake fiberoptic intubation was performed in 3.6% in LPG and 1.5% in OPG. The other patients were anesthetized with rapid sequence induction (classic or modified). Grade III laryngoscopy was present in 6% in LPG and 7.1% in OPG. No intraoperative complications were encountered. Postoperative PACU follow-up time was similar. In both groups, i.v. meperidine was most frequently used for postoperative analgesia (in the PACU), as compared to the other analgesics employed (P<0.03). Early postoperative complications (prolonged mechanical ventilation, unplanned ICU admission, sepsis, re-operation) occurred more frequently in OPG, but the difference between the two groups was statistically insignificant (P<0.08). The length of hospitalization was 3.8+/-1.4 days in LPG and 6.2+/-6.6 in OPG (P<0.01). Mortality was zero. Anesthesia for restrictive bariatric surgery (both open and laparoscopic approaches) was associated with few complications. SUMMARY STATEMENT We reviewed the records of 234 patients who underwent restrictive bariatric procedures (gastric bypass not included) from May 1999 to September 2000, in regard to perioperative complications. Anesthesia was associated with no intraoperative and few postoperative complications.
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Affiliation(s)
- T Ezri
- Department of Anesthesia, the Edith Wolfson Medical Center, Holon, Israel, Affiliated to Sackler School of Medicine, Tel Aviv University, Israel
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Affiliation(s)
- Ziya Salihoglu
- Istanbul University Cerrahpasa Medical School Anaesthesia Department Istanbul, Turkey
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