Pain and nausea after bariatric surgery with total intravenous anesthesia versus desflurane anesthesia: a double blind, randomized, controlled trial

Aftab, Hira; Fagerland, Morten Wang; Gondal, Ghous; Olsen, Magnus Kringstad; Nordby, Tom

doi:10.1016/j.soard.2019.05.010

Cited by 11 publications

(12 citation statements)

References 13 publications

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“…Another small study (n=40 patients) which randomized patients to TIVA or gas anesthesia showed no significant difference in postoperative recovery [23]. No such association was found in our main RCT [14].…”

Section: Discussionmentioning

confidence: 45%

“…This study is a sub-analysis of a single-center, double blind, randomized controlled trial (RCT) that included all patients undergoing bariatric surgery at the Østfold hospital, in the period 2016-2017 [14]. Patients included in the RCT operated with either LRYGB or SG were randomized to receive intravenous anesthesia (TIVA) with propofol, or desflurane.…”

Section: Methodsmentioning

confidence: 99%

“…This study includes a subgroup of patient operated with SG that were included in the previously reported RCT [14]. Continuous data were expressed by mean and standard deviation (SD) and compared using student's t-test and categorical data were expressed by number and proportion and compared using chi-square test or Fisher mid-P test (due to small proportions).…”

Section: Statisticsmentioning

confidence: 99%

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Gastric sleeve resection as day-case surgery: what affects the discharge time?

Aftab

Fagerland

Gondal

et al. 2019

Surgery for Obesity and Related Diseases

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Background: Sleeve gastrectomy (SG), with its short operating time, is possible to perform as same-day surgery, with the most common reason for requiring overnight hospital stay being post-operative nausea and vomiting. Objective: To demonstrate the feasibility and safety of SG as same-day surgery with regards to complication rate. Additionally, the study aimed to evaluate factors determining the duration of hospital stay, such as type of anesthesia, time of procedure, degree of postoperative nausea and pain, American Society of Anesthesiologists (ASA) score or previous abdominal surgery. Setting: Non-academic primary referral center. Method: A sub-study of a single-center, double blind, randomized controlled trial. Patients included in this study underwent SG and were randomized into one of the two types of anesthesia; Total intravenous anesthesia (TIVA) with propofol, or desflurane. Primary endpoint was the number of patients discharged the same day as surgery. Secondary endpoints were unplanned telephone calls, readmission rate and complication rate. Time of procedure was registered by the staff at the operation theatre. Visual analogue scales (VAS) score estimating patients' intensity of pain and nausea were completed at the postoperative (PO) unit, surgical ward, and 24-48 hours post-operatively. Results: Ninety-three patients were included in the study. Fifty-nine (63%) were discharged the same day as surgery (32 desflurane and 27 TIVA), 30 patients (32%) were discharged one 2 day following surgery, and four patients (4%) were discharged after more than two days (15 desflurane and 19 TIVA). The most common reasons for prolonged stay were pain, nausea and fatigue. Statistical analyses showed no association between day of discharge and the type of anesthesia, time of the procedure, degree of postoperative nausea and vomiting (PONV), pain intensity, ASA score, or previous abdominal surgery. Conclusion: Same-day surgery is feasible and safe in terms of low complication rate. The type of anesthesia, time of procedure, degree of PONV and pain, ASA score and previous abdominal surgery does not appear to affect length of hospital stay.

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Section: Discussionmentioning

confidence: 45%

Section: Methodsmentioning

confidence: 99%

Section: Statisticsmentioning

confidence: 99%

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Gastric sleeve resection as day-case surgery: what affects the discharge time?

Aftab

Fagerland

Gondal

et al. 2019

Surgery for Obesity and Related Diseases

Self Cite

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“…However, the use of longer-acting opioids could bias the postoperative recovery outcomes. Numerous studies have already compared the postoperative recovery outcomes of desflurane, sevoflurane, and propofol for obese patients (9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). We, therefore, performed a systematic review and meta-analysis to compare the effects of desflurane, sevoflurane, and propofol on recovery outcomes for obese patients.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Recovery Outcomes for Obese Patients Undergoing General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

Liu

Zheng

et al. 2022

Front. Surg.

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PurposeThis study was performed to assess the postoperative recovery outcomes in obese patients undergoing general anesthesia.MethodsThe 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.ResultsEleven 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).ConclusionsThe 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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“…In addition, this technique can facilitate rapid emergence from anesthesia without concurrent prolonged respiratory depression. 1 The low blood/gas and tissue/blood partition coefficients of desflurane permit swift alterations in the depth of anesthesia and rapid elimination, thus resulting in a rapid emergence and recovery relative to the other volatile anesthetics. 2 Current evidence has not established a significant difference in postoperative recovery durations when comparing TIVA techniques to inhalational anesthetic techniques.…”

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confidence: 99%

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

Demirel

Altun

Bolat

et al. 2021

Journal of PeriAnesthesia Nursing

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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.

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Pain and nausea after bariatric surgery with total intravenous anesthesia versus desflurane anesthesia: a double blind, randomized, controlled trial

Cited by 11 publications

References 13 publications

Gastric sleeve resection as day-case surgery: what affects the discharge time?

Gastric sleeve resection as day-case surgery: what affects the discharge time?

Postoperative Recovery Outcomes for Obese Patients Undergoing General Anesthesia: A Meta-Analysis of Randomized Controlled Trials

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

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