Retrospective assessment of the association between inhalation anesthesia and post-operative complications in morbidly obese patients undergoing bariatric surgery
Keywords:Bariatric surgery, Inhalation anesthesia, Total intravenous anesthesia (TIVA), Morbid obesity, Post-operative complications
Background/Aim: Today, obesity is a rapidly growing health problem. Healthcare professionals have been encountering both obese adult and adolescent patients in the operating room more and more frequently. Morbid obesity affects all body systems, thus necessitating greater care in anesthesia management. Studies conducted in recent years have failed to find clear evidence for the most appropriate anesthesia technique with minimal effect on post-operative complications. Therefore, this study was designed to compare the effects of inhalation anesthesia and total intravenous anesthesia (TIVA) on post-operative complications in morbidly obese patients who underwent bariatric surgery. Methods: After receiving approval from the University Ethics Committee, the files of 304 patients who underwent laparoscopic gastric bypass and sleeve gastrectomy between January 2018 and December 2021 were screened. Patients with unexpectedly difficult airways, who underwent open surgery, in whom the anesthesia technique had to be changed intra-operatively for any reason, those scheduled for intensive care as decided during surgical planning, and those with liver or kidney failure were excluded from the study. A total of 278 patients were included in the study. Patients were divided into two groups according to the method of anesthesia used: (1) TIVA (Group T) and (2) inhalation anesthesia (Group I). Results: The study was performed with 278 patients of whom 213 were women, and 65 were men. Patient demographics were similar between the two groups. Comparison of the clinical characteristics of the study groups showed that the rate of admission to the intensive care unit (P=0.032), average duration of surgery (P<0.001), and complication rate (P<0.001) were significantly higher in the TIVA group than in the inhalation anesthesia group. Conclusion: Morbidly obese patients exhibit higher rates of anesthesia- and surgery-related complications because of their comorbidities. Anesthesia management and selection of anesthetics are important in these patients. Based on the literature and results of our study, inhalation agents may be preferred for morbidly obese patients because they are associated with fewer complications in this patient population. Although our study indicates that inhalation anesthesia is a safe and appropriate choice, extensive studies with a larger number of patients are needed.
Wu Z, Li J, Wang C, Yang J, Chen X, Yang W, et al. Characterization of cardiovascular depression effect for propofol during anesthesia induction period on morbidly obese patients. Biomed Pharmacother. 2018 Oct; 106:618-23. doi: 10.1016/j.biopha.2018.06.158. Epub 2018 Jul 11. 2.P
Siampalioti A, Karavias D, Zotou A, Kalfarentzos F, Filos K. Anesthesia management for the super obese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial. Eur Rev Med Pharmacol Sci. 2015 Jul;19(13):2493-500. PMID: 26214787.MID: 29990851.
Goitein D, Raziel A, Szold A, Sakran N. Assessment of perioperative complications following primary bariatric surgery according to the Clavien-Dindo classification: comparison of sleeve gastrectomy and Roux-Y gastric bypass. Surg Endosc. 2016 Jan;30(1):273-8. doi: 10.1007/s00464-015-4205-y. Epub 2015 Apr 11. PMID: 25861906.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004 Aug;240(2):205-13. doi: 10.1097/01.sla.0000133083.54934.ae. PMID: 15273542; PMCID: PMC1360123.
Bansal T, Garg K, Katyal S, Sood D, Grewal A, Kumar A. A comparative study of desflurane versus sevoflurane in obese patients: Effect on recovery profile. J Anaesthesiol Clin Pharmacol. 2020 Oct-Dec;36(4):541-5. doi: 10.4103/joacp.JOACP_307_19. Epub 2021 Jan 18. PMID: 33840938; PMCID: PMC8022057.
Demirel I, Yildiz Altun A, Bolat E, Kilinc M, Deniz A, Aksu A, Bestas A. Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia. J Perianesth Nurs. 2021 Feb;36(1):69-74. doi: 10.1016/j.jopan.2020.07.005. Epub 2020 Oct 1. PMID: 33012596.
Bellamy MC, Margarson MP. Designing intelligent anesthesia for a changing patient demographic: a consensus statement to provide guidance for specialist and non-specialist anesthetists written by members of and endorsed by the Society for Obesity and Bariatric Anaesthesia (SOBA). Perioper Med (Lond). 2013 Jun 6;2(1):12. doi: 10.1186/2047-0525-2-12. PMID: 24472279; PMCID: PMC3964339.
Montravers P, Augustin P, Zappella N, Dufour G, Arapis K, Chosidow D, Fournier P, Ribeiro-Parienti L, Marmuse JP, Desmard M. Diagnosis and management of the postoperative surgical and medical complications of bariatric surgery. Anaesth Crit Care Pain Med. 2015 Feb;34(1):45-52. doi: 10.1016/j.accpm.2014.06.002. Epub 2015 Mar 5. PMID: 25829315.
Members of the Working Party, Nightingale CE, Margarson MP, Shearer E, Redman JW, Lucas DN, Cousins JM, et al. Association of Anaesthetists of Great Britain; Ireland Society for Obesity and Bariatric Anaesthesia. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia. 2015 Jul;70(7):859-76. doi: 10.1111/anae.13101. Epub 2015 May 7. PMID: 25950621; PMCID: PMC5029585.
Heil LB, Santos CL, Santos RS, Samary CS, Cavalcanti VC, Araújo MM, et al. The Effects of Short-Term Propofol and Dexmedetomidine on Lung Mechanics, Histology, and Biological Markers in Experimental Obesity. Anesth Analg. 2016 Apr;122(4):1015-23. doi: 10.1213/ANE.0000000000001114. PMID: 26720616.
Zoremba M, Dette F, Hunecke T, Eberhart L, Braunecker S, Wulf H. A comparison of desflurane versus propofol: the effects on early postoperative lung function in overweight patients. Anesth Analg. 2011 Jul;113(1):63-9. doi: 10.1213/ANE.0b013e3181fdf5d4. Epub 2010 Oct 21. PMID: 20966444.
Öztürk MC, Demiroluk Ö, Abitagaoglu S, Ari DE. The Effect of sevoflurane, desflurane and propofol on respiratory mechanics and integrated pulmonary index scores in laparoscopic sleeve gastrectomy. A randomized trial. Saudi Med J. 2019 Dec;40(12):1235-41. doi: 10.15537/smj.2019.12.24693. PMID: 31828275; PMCID: PMC6969621.
Dikmen Y, Eminoglu E, Salihoglu Z, Demiroluk S. Pulmonary mechanics during isoflurane, sevoflurane and desflurane anaesthesia. Anaesthesia. 2003 Aug;58(8):745-8. doi: 10.1046/j.1365-2044.2003.03285.x. PMID: 12859465.
Ebert TJ, Harkin CP, Muzi M. Cardiovascular responses to sevoflurane: a review. Anesth Analg. 1995 Dec;81(6 Suppl):S11-22. doi: 10.1097/00000539-199512001-00003. PMID: 7486143.
De Hert SG, ten Broecke PW, Mertens E, Van Sommeren EW, De Blier IG, Stockman BA, et al. Sevoflurane but not propofol preserves myocardial function in coronary surgery patients. Anesthesiology. 2002 Jul;97(1):42-9. doi: 10.1097/00000542-200207000-00007. PMID: 12131102.
De Conno E, Steurer MP, Wittlinger M, Zalunardo MP, Weder W, Schneiter D, et al. Anesthetic-induced improvement of the inflammatory response to one-lung ventilation. Anesthesiology. 2009 Jun;110(6):1316-26. doi: 10.1097/ALN.0b013e3181a10731. PMID: 19417610.
Yiğit Özay H, Demir A, Kaya Bahçecitapar M. Metabolik sendromlu koroner baypas hastalarında uygulanan iki farklı anestezi tipinin postoperatif karaciğer fonksiyonları üzerine etkisi. GKDA Derg. 2021;27(1):30-7.
Gabellini G, Graziano A, Carron M. Hepatotoxicity after desflurane anesthesia in a morbidly obese patient. J Clin Anesth. 2018 Dec; 51:55-6. doi: 10.1016/j.jclinane.2018.08.010. Epub 2018 Aug 7. PMID: 30096519.
Nor Hanipah Z, Punchai S, Augustin T, Brethauer SA, Schauer PR, Aminian A. Impact of Early Postbariatric Surgery Acute Kidney Injury on Long-Term Renal Function. Obes Surg. 2018 Nov;28(11):3580-5. doi: 10.1007/s11695-018-3398-2. PMID: 30043143.
Fernandes A, Ettinger J, Amaral F, Ramalho MJ, Alves R, Módolo NS. General anesthesia type does not influence serum levels of neutrophil gelatinase-associated lipocalin during the perioperative period in video laparoscopic bariatric surgery. Clinics (Sao Paulo). 2014 Dec;69(10):655-9. doi: 10.6061/clinics/2014(10)01. PMID: 25518015; PMCID: PMC4221328.
Varner KL, March AL. Prevention of Nausea and Vomiting After Laparoscopic Sleeve Gastrectomy: Are We Doing Enough? AANA J. 2020 Apr;88(2):142-7. PMID: 32234206.
Zengin SU, Ergun MO, Taskin HE. Factors affecting the surgeon preference for bolus opioid use to control postoperative pain after bariatric surgery. J Surg Med. 2021;5(8):803-6.
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