Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia

Abstract

Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients undergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia. Design: This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidly obese patients (body mass index >40 kg/m 2 ). Methods: Patients were randomly divided into four groups; group P-PSI (n ¼ 30): TIVA with PSI monitoring; group P (n ¼ 30): TIVA without PSI monitoring; group D-PSI (n ¼ 30): desflurane with PSI monitoring; and group D (n ¼ 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated. Findings: No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D. Conclusions: Although TIVA and inhalational anesthesia can be safely used for obese patients, intraoperative PSI monitoring may decrease the discharge time from PACU and reduces incidence of postoperative nausea and vomiting caused by inhalation anesthetics.

Intraoperative Monitoring of the Obese Patient Undergoing Surgery: A Narrative Review

“…The majority of studies retrieved concerned the cardiovascular (n = 14) [9][10][11][12][13][14][15][16][17][18][19][20][21][22], respiratory (n = 7) [23][24][25][26][27][28][29], and neurological (n = 9) [30][31][32][33][34][35][36][37] systems. Two pertained to point-of-care testing [38,39].…”

Weight of children treated under general anaesthesia for dental rehabilitation

“…Along with that, surgical procedures in such patients are also increasing. Obese patients are at a higher risk to anesthesia related complications when compared to patients in the normal weight range (15). Obese patients are more prone to diseases such as Postoperative atelectasis and sleep apnea syndrome when compared to their normal counterpart (16).…”

Comparing Perioperative Outcomes of Total Intravenous Anesthesia (TIVA) With Volatile Anesthesia in Patients With Obesity: A Systematic Review

“…Eight studies reported on intraoperative vital signs. Four studies reported no statistically significant differences in the heart rates in a total of 336 patients [ 28 , 29 , 34 , 35 ]. One study reported that in all 100 patients studied, despite having comparable heart rates at baseline, the TIVA group recorded significantly lower heart rates from induction to discharge from PACU [ 31 ].…”

“…Of the five studies (396 patients) that reported PONV, three found no difference in the incidence of PONV (176 patients) [ 26 , 30 , 36 ], and two studies (220 patients) reported that patients who received TIVA had a lower incidence of these effects [ 31 , 35 ].…”