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

Abstract

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.

Reducing the carbon footprint of general anaesthesia: a comparison of total intravenous anaesthesia vs. a mixed anaesthetic strategy in 47,157 adult patients

“…Moreover, TIVA has been associated with a lower incidence of postoperative nausea and vomiting [36]. In patients who are obese, the use of volatile anaesthetic agents has been reported to reduce the time it takes for patients to become fully awake, but this reduction may not be considered clinically significant and remains a topic of debate [37, 38]. Lastly, a recent study conducted in our institution suggested the feasibility of very early initiation of postoperative rehabilitation in the post‐anaesthesia care unit following major thoracic surgery after general anaesthesia with TIVA [39].…”

“…Moreover, TIVA has been associated with a lower incidence of postoperative nausea and vomiting [36]. In patients who are obese, the use of volatile anaesthetic agents has been reported to reduce the time it takes for patients to become fully awake, but this reduction may not be considered clinically significant and remains a topic of debate [37,38].…”

How obesity affects the disposition of intravenous anesthetics

“…fatty tissue [17]. Figure 3b shows the 80% contextsensitive decrement time (CSDT) at a wide range of BMI.…”

“…Regarding delayed emergence after continuous infusion, propofol has been thought to sometimes have prolonged effects in obese patients because of propofol's high lipophilicity with distribution into fatty tissue [17]. Figure 3b shows the 80% context-sensitive decrement time (CSDT) at a wide range of BMI.…”

Feasibility of calculating rocuronium dosage by skeletal muscle weight in patients with obesity

“…Patients with obesity often exhibit an increased proportion of body fat and reduced blood flow through adipose tissue (1). When dosing anesthetic drugs based on actual body weight, the apparent volume of drug distribution and metabolic rate can be significantly impacted, affecting the quality and duration of awakening resulting in accumulation and prolonged duration in clinical anesthesia for patients with obesity (2)(3)(4). Suggestions have been made to administer drugs to patients with obesity based on their defatted body weight to adjust anesthetic dosage (5).…”