Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on medication adherence

LIVE: Thursday 27th June 2024, 18:00-19:30 (CEST)
Join our expert panel to discover why you need to understand the drivers of non-adherence in your patients, and how you can optimize medication adherence in your clinics to drastically improve patient outcomes.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 11/2015

01-11-2015 | How I Do It

Longer Immediate Recovery Time After Anesthesia Increases Risk of Respiratory Complications After Laparotomy for Bariatric Surgery: a Randomized Clinical Trial and a Cohort Study

Authors: Eliana C. M. Sudré, Priscila R. de Batista, Yara M. M. Castiglia

Published in: Obesity Surgery | Issue 11/2015

Login to get access

Abstract

Background

We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence.

Methods

We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs.

Results

Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06.

Conclusions

Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.
Literature
1.
Juvin P, Vadam C, Malek L, et al. Postoperative recovery after desflurane, propofol, or isoflurane anesthesia among morbidly obese patients: a prospective, randomized study. Anesth Analg. 2000;91:714–9.CrossRefPubMed
2.
Sudré ECM, Salvador MC, Bruno GE, et al. Remifentanil versus dexmedetomidine as coadjutants of standardized anesthetic technique in morbidly obese patients. Rev Bras Anestesiol. 2004;54:178–89.CrossRefPubMed
3.
Zoremba M, Dette F, Gerlach L, et al. Short-term respiratory physical therapy treatment in the PACU and influence on postoperative lung function in obese adults. Obes Surg. 2009;19:1346–54.CrossRefPubMed
4.
Zoremba M, Dette F, Hunecke T, et al. A comparison of desflurane versus propofol: the effects on early postoperative lung function in overweight patients. Anesth Analg. 2011;113:63–9.CrossRefPubMed
5.
Schumann R. Pulmonary physiology of the morbidly obese and the effects of anesthesia. Int Anesthesiol Clin. 2013;51:41–51.CrossRefPubMed
6.
Qaseem A, Snow V, Fitterman N, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144:575–80.CrossRefPubMed
7.
Thomas E, Goldman L, Mangione C, et al. Body mass index as a correlate of postoperative complications and resource utilization. Am J Med. 1997;102:277–83.CrossRefPubMed
8.
Berg H, Roed J, Viby-Mogensen J, et al. Residual neuromuscular block is a risk factor for postoperative pulmonary complications. A prospective, randomised, and blinded study of postoperative pulmonary complications after atracurium, vecuronium and pancuronium. Acta Anaesthesiol Scand. 1997;41:1095–103.CrossRefPubMed
9.
Egan T, Huizinga B, Gupta S, et al. Remifentanil pharmacokinetics in obese versus lean patients. Anesthesiology. 1998;89:562–73.CrossRefPubMed
10.
Schwartz AE, Matteo RS, Ornstein E, et al. Pharmacokinetics of sufentanil in obese patients. Anesth Analg. 1991;73:790–3.PubMed
11.
Yasuda N, Targ A, Eger EI. Solubility of I-653, sevoflurane, isoflurane, and halothane in human tissues. Anesth Analg. 1989;69:370–3.PubMed
12.
La Colla L, Albertin A, La Colla G, et al. Faster wash-out and recovery for desflurane vs sevoflurane in morbidly obese patients when no premedication is used. Br J Anaesth. 2007;99:353–8.CrossRefPubMed
13.
McKay R, Malhotra A, Cakmakkaya O, et al. Effect of increased body mass index and anaesthetic duration on recovery of protective airway reflexes after sevoflurane vs desflurane. Br J Anaesth. 2010;104:175–82.CrossRefPubMed
14.
Murphy G, Szokol J, Marymont J, et al. Residual neuromuscular blockade and critical respiratory events in the postanesthesia care unit. Anesth Analg. 2008;107:130–7.CrossRefPubMed
15.
Eikermann M, Gerwig M, Hasselmann C, et al. Impaired neuromuscular transmission after recovery of the train-of-four ratio. Acta Anaesthesiol Scand. 2007;51:226–34 A.CrossRefPubMed
16.
Butterly A, Bittner E, George E, et al. Postoperative residual curarization from intermediate-acting neuromuscular blocking agents delays recovery room discharge. Br J Anaesth. 2010;105:304–9.CrossRefPubMed
17.
Nascimento Jr P, Módolo NSP, Andrade S, et al. Incentive spirometry for prevention of postoperative pulmonary complications in upper abdominal surgery. Cochrane Database Syst Rev. 2014;2, CD006058.
18.
Rock P, Passannante A. Preoperative assessment: pulmonary. Anesthesiol Clin N Am. 2004;22:77–91.CrossRef
19.
20.
Benumof JL. Obesity, sleep apnea, the airway and anesthesia. Curr Opin Anaesthesiol. 2004;17:21–30.CrossRefPubMed
21.
Lacassie H, Habib A, Lacassie H, et al. Motor blocking minimum local anesthetic concentrations of bupivacaine, levobupivacaine, and ropivacaine in labor. Reg Anesth Pain Med. 2007;32:323–9.CrossRefPubMed
22.
Benumof JL. Obstructive sleep apnea in the adult obese patient: implications for airway management. J Clin Anesth. 2001;13:144–15.CrossRefPubMed
23.
Hedenstierna G, Rothen HU. Respiratory function during anesthesia: effects on gas exchange. Compr Physiol. 2012;2:69–96.PubMed
24.
Melo LC, Silva MA, Calles AC. Obesity and lung function: a systematic review. Einstein. 2014;12:120–5.CrossRefPubMed
25.
Eichenberger AS, Proietti S, Wicky S, et al. Morbid obesity and postoperative pulmonary atelectasis: an underestimated problem. Anesth Analg. 2002;95:1788–92.CrossRefPubMed
26.
Ireland CJ, Chapman TM, Mathew SF, Herbison GP, Zacharias M. Continuous positive airway pressure (CPAP) during the postoperative period for prevention of postoperative morbidity and mortality following major abdominal surgery. Cochrane Database Syst Rev. 2014;CD008930
27.
Hallowell PT, Stellato TA, Petrozzi MC, et al. Eliminating respiratory intensive care unit stay after gastric bypass surgery. Surgery. 2007;142:608–12. discussion 612.e1.CrossRefPubMed
28.
Sasaki N, Meyer M, Eikermann M. Postoperative respiratory muscle dysfunction: pathophysiology and preventive strategies. Anesthesiology. 2013;118:961–78.CrossRefPubMed
29.
Canet J, Mazo V. Postoperative pulmonary complications. Minerva Anestesiol. 2010;76:138–43.PubMed
Metadata
Title
Longer Immediate Recovery Time After Anesthesia Increases Risk of Respiratory Complications After Laparotomy for Bariatric Surgery: a Randomized Clinical Trial and a Cohort Study
Authors
Eliana C. M. Sudré
Priscila R. de Batista
Yara M. M. Castiglia
Publication date
01-11-2015
Publisher
Springer US
Published in
Obesity Surgery / Issue 11/2015
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1855-8

Other articles of this Issue 11/2015

Obesity Surgery 11/2015 Go to the issue

How I Do It

Laparo-Endoscopic Gastrostomy (LEG) Decompression: a Novel One-Time Method of Management of Gastric Leaks Following Sleeve Gastrectomy

Original Contributions

The Role of FTO and Vitamin D for the Weight Loss Effect of Roux-en-Y Gastric Bypass Surgery in Obese Patients

Review Article

Comparative Efficacy and Safety of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: A Meta-analysis

Letter to the Editor

Outcome Measures in Bariatric Surgery

Original Contributions

Functional Gastrointestinal Disorders in Obese Patients. The Importance of the Enrollment Source

Review Article

Robotic vs. Laparoscopic Roux-En-Y Gastric Bypass: a Systematic Review and Meta-Analysis