Effect of bispectral index monitoring on desflurane consumption and recovery time in morbidly obese patients undergoing laparoscopic sleeve gastrectomy

Abstract

Background:Morbid obesity magnifies the importance of the fat–blood solubility coefficient of the anesthetic in its relation to emergence and recovery. Using bispectral index (BIS) monitoring for the titration of the administration of inhaled anesthetics such as desflurane may permit a less consumption and more rapid recovery from desflurane anesthesia in morbidly obese patients, which enables earlier maintenance of a patent airway, better protection against aspiration, and better oxygenation.Objective:The aim of this study was to investigate the effect of BIS monitoring on postoperative extubation and recovery times, and intraoperative desflurane consumption in morbidly obese patients undergoing laparoscopic sleeve gastrectomy under general anesthesia using desflurane for maintenance.Patients and Methods:Forty morbidly obese patients were randomly enrolled in this study and divided into two groups of 20 patients each: Non-BIS group and BIS group. End-tidal desflurane concentration, mean blood pressure, and heart rate were regularly recorded. Recovery times (eye opening to verbal commands, time to extubation, and orientation to time, place, and person) and the time to achieve a modified Aldrete score of ≥ 9 were recorded by blinded study anesthesia nurse. Desflurane consumption was calculated in milliliters through gas usage option of Datex-Ohmeda S/5 anesthesia machine.Results:The mean end-tidal concentrations of desflurane were significantly decreased in the BIS group compared to the non-BIS group (P < 0.05). The mean desflurane consumption and cost were significantly lower in the BIS group (124.8 ± 5.1 ml/patient) compared to the non-BIS group (150.6 ± 6.5 ml/patient) (P < 0.05). Recovery times were significantly shorter in the BIS group versus non-BIS group (P < 0.05).Conclusion:The use of BIS monitoring was effective in reducing intraoperative desflurane requirement (cost) and in shortening early recovery times after laparoscopic sleeve gastrectomy in morbidly obese patients without compromising the hemodynamic stability, adequacy of anesthesia, or patient outcome.

Effect of entropy-guided low-flow desflurane anaesthesia on laryngeal mask airway removal time in children undergoing elective ophthalmic surgery – A prospective, randomised, comparative study

“…This observation was comparable to studies done previously in adults and children. [23417] With desflurane costing INR 35.8/mL in India, a difference of 7 mL/case amounts to saving of INR 250 per case. This when extrapolated to whole day with a minimum of 20 cases done at our centre will lead to saving of minimum INR 5000 per day.…”

Factors affecting the early post-operative prognosis in morbidly obese surgical patients after laparoscopic sleeve gastrectomy – a retrospective cohort study

“…These obese patients are often complicated with type II diabetes mellitus, hypertension, hyperlipidemia, ischemic heart disease, and obstructive sleep apnea. In addition, morbid obesity has serious problems in the management of anesthesia, such as difficulty in airway management, increased resistance with mechanical ventilation, and extraordinary pharmacokinetics for anesthetic or other drugs [ 3 – 5 ]. Furthermore, the therapeutic procedure of regional anesthesia, exemplified by epidural block, is extremely difficult in such patients.…”