Fast wake-up time in obese patients: Which anesthetic is best?

Katznelson, Rita; Fisher, Joseph A.

doi:10.1007/s12630-015-0406-z

Cited by 5 publications

(5 citation statements)

References 14 publications

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“…This causes changes in the volume of distribution and lengthens drug clearance time. As a result, the duration of action of anesthetic drugs is longer and can affect emergence and discharge time of the patient (Katznelson & Fisher, 2015).…”

Section: Discussionmentioning

confidence: 99%

“…Discharge time for odontectomy patient is determined by several factors, namely pre-existing medical conditions and the location of the infection that can prolong up to 1-1.8 days (Katznelson & Fisher, 2015). The concept of fast-track surgery, which aligns with the idea of ERAS (enhanced recovery after surgery), has been mentioned in the surgical literature for the last two decades.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of Intravenous Fentanyl and Intravenous Remifentanil on Emergence Time and Discharge Time in Patients Undergoing Odontectomy: An Observational Analytical Review

Suwarman

Muftilov

Hidayat

2022

jhms

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Background: Recovery time and fast patient discharge after surgery are goals of fast-track surgery that uses the concept of ERAS (Enhanced Recovery After Surgery) to minimize pain, speed up recovery, and reduce pain and complications. Fast-track surgeries such as odontectomy require drugs with a fast onset of action and short duration hence the patient can recover from the drugs as soon as possible. The use and types of opioids have been developed for optimal fast-track surgery. One of the most widely used opioids is remifentanil. Purpose: This study aims to compare the administration of fentanyl and remifentanil to the emergence and discharge time of post-odontectomy patients with general anesthesia. Methods: Patients were divided into two groups, the fentanyl group (group F, n=21) and the remifentanil group (group R, n=21). This study used a retrospective cohort analysis of the medical records of 42 patients with elective odontectomy surgery for the period December 2020 to June 2021 at RSUP dr. Hasan Sadikin Bandung. Emergence time was assessed using the OAA/S score and discharge time was considered using the modified Aldrete score. Results: This study showed a significant difference between the emergence time in group R (168+47.98 seconds) and group F (368+58.16 seconds) with a p-value = 0.0001. There was a significant difference between the discharge time in group R (20.00+7.24 minutes) and group F (58.57+12.46 minutes) with a p-value = 0.001. Conclusion: Recovery time and discharge time for patients receiving remifentanil were faster than for patients receiving fentanyl for odontectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of Intravenous Fentanyl and Intravenous Remifentanil on Emergence Time and Discharge Time in Patients Undergoing Odontectomy: An Observational Analytical Review

Suwarman

Muftilov

Hidayat

2022

jhms

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“…To date, several studies has proposed to answer the question of which anesthetic agent is best for the obese patient[ 111 - 114 ]. Most of these investigations have evaluated primary outcomes during and after anesthesia[ 115 , 116 ]. Although efforts have been made to develop standardized guidelines or protocols for the anesthetic care of the obese patient[ 117 ], there is no known ideal anesthesia technique or drug combination.…”

Section: Immunomodulatory Effects Of Anesthetics In Obesitymentioning

confidence: 99%

Immunomodulatory effects of anesthetics in obese patients

Heil

Silva

Pelosi

2017

WJCCM

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Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells (such as monocytes, neutrophils, and specific tissue macrophages) with release of pro- or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

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“…Airway management is more challenging in obese patients 1 . Not only do they have impaired respiratory mechanics, including a decreased functional residual capacity (FRC) and vital capacity, increased airway resistance, and reduced oxygen reserve, but they also have an increased metabolic rate and oxygen consumption 2 .…”

Section: Introductionmentioning

confidence: 99%

“…Airway management is more challenging in obese patients. 1 Not only do they have impaired respiratory mechanics, including a decreased functional residual capacity (FRC) and vital capacity, increased airway resistance, and reduced oxygen reserve, but they also have an increased metabolic rate and oxygen consumption. 2 Maintaining airway patency may be difficult in obese patients due to the high collapsibility of upper airway structures and technical difficulty in applying the mask.…”

Section: Introductionmentioning

confidence: 99%

Body position and the effectiveness of mask ventilation in anaesthetised paralysed obese patients

Chang

Seol

Hwang

2021

European Journal of Anaesthesiology

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BACKGROUND Airway management is more challenging in the obese. Compared with the supine position, the sitting position can decrease the collapsibility of the upper airway and improve respiratory mechanics. OBJECTIVE The aim of this study was to evaluate the 25° semisitting position on the effectiveness of mask ventilation in anaesthetised paralysed obese patients. DESIGN A randomised, cross-over study. SETTING Medical centre managed by a university tertiary hospital. PATIENTS Thirty-eight obese adults scheduled for general anaesthesia. METHODS After anaesthesia and paralysis, two-handed mask ventilation was performed in the supine and 25° semi-sitting positions with a cross-over, in a randomised order. During mask ventilation, mechanical ventilation was delivered with a pressure-controlled mode with a peak inspiratory pressure of 15 cmH2O, a respiratory rate of 15 bpm, and no positive end-expiratory pressure. Ventilatory outcomes were based upon lean body weight. MAIN OUTCOMES Exhaled tidal volume (ml kg−1), respiratory minute volume (ml kg−1 min−1), and the occurrence of inadequate ventilation, defined as an exhaled tidal volume less than 4 ml kg−1, or absence of end-tidal CO2 recording. RESULTS Exhaled tidal volume (mean ± SD) in the 25° semi-sitting position was higher than in the supine position, 9.3 ± 2.7 vs. 7.6 ± 2.4 ml kg−1; P less than 0.001. Respiratory minute volume was improved in the 25° semisitting position compared with that in the supine position, 139.6 ± 40.7 vs. 113.4 ± 35.7 ml kg−1 min−1; P less than 0.001. CONCLUSION The 25° semisitting position improved mask ventilation compared with the supine position in anaesthetised paralysed obese patients. TRIAL REGISTRY NUMBER ClinicalTrials.gov (NCT03996161).

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Fast wake-up time in obese patients: Which anesthetic is best?

Cited by 5 publications

References 14 publications

Comparison of Intravenous Fentanyl and Intravenous Remifentanil on Emergence Time and Discharge Time in Patients Undergoing Odontectomy: An Observational Analytical Review

Comparison of Intravenous Fentanyl and Intravenous Remifentanil on Emergence Time and Discharge Time in Patients Undergoing Odontectomy: An Observational Analytical Review

Immunomodulatory effects of anesthetics in obese patients

Body position and the effectiveness of mask ventilation in anaesthetised paralysed obese patients

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