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

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Obesity Surgery
Published in: Obesity Surgery 10/2020

01-10-2020 | Obesity | Original Contributions

The Protective Effects of Butorphanol on Pulmonary Function of Patients with Obesity Undergoing Laparoscopic Bariatric Surgery: a Double-Blind Randomized Controlled Trial

Authors: Xiu-li Wang, Si Zeng, Xiao-xiao Li, Ye Zhao, Xing-he Wang, Tong Li, Su Liu

Published in: Obesity Surgery | Issue 10/2020

Login to get access

Abstract

Background

Obesity is a risk factor for postoperative pulmonary complications (PPCs). Recent studies have reported the pulmonary protective role of the kappa opioid receptor (KOR). Butorphanol is a narcotic with strong KOR agonist action, and the role in pulmonary protection is uncertain. Here, we hypothesized that butorphanol exerts protective effects on pulmonary function in patients with obesity undergoing laparoscopic bariatric surgery.

Methods

Patients with a body mass index ≥ 30 kg/m2 scheduled for laparoscopic bariatric surgery were randomized to receive butorphanol or normal saline. Butorphanol was administered as an initial loading dose of 10 μg/kg at 5 min before induction followed by 5 μg/(kg h) during surgery. The primary outcome was arterial-alveolar oxygen tension ratio (a/A ratio). Secondary outcomes included other pulmonary variables, biomarkers reflecting pulmonary injury, and incidence of PPCs within 7 days after surgery.

Results

Patients in the butorphanol group had a significantly higher a/A ratio at 1 h after the operation began (68 ± 7 vs. 55 ± 8, P < 0.001), end of the operation (73 ± 8 vs. 59 ± 7, P < 0.001), and 1 h after extubation (83 ± 9 vs. 70 ± 5, P < 0.001) compared with those in the control group. In addition, in the butorphanol group, dead space to tidal volume ratios were significantly lower than those in the control group at the same time points (all P < 0.001). In the control group, the levels of biomarkers reflecting pulmonary injury were significantly higher than those in the butorphanol group at 3 h, 6 h, 12 h, and 24 h postoperatively (P < 0.001). The incidence of PPCs was similar in both groups.

Conclusion

Butorphanol administration protected pulmonary function by improving oxygenation and reducing dead space ventilation in patients with obesity undergoing laparoscopic bariatric surgery. Butorphanol may therefore provide clinical benefits in patients with obesity.
Literature
1.
Abarca-Gómez L, Abdeen ZA, Hamid ZA, et al. Worldwide trends in body-mass index, underweight, overweight, and obesity from 1975 to 2016: a pooled analysis of 2416 population-based measurement studies in 128·9 million children, adolescents, and adults. Lancet. 2017;390:2627–42.
2.
Ball L, Hemmes SNT, Serpa Neto A, et al. Intraoperative ventilation settings and their associations with postoperative pulmonary complications in obese patients. Br J Anaesth. 2018;121(4):899–908.PubMed
3.
Epidemiology, practice of ventilation and outcome for patients at increased risk of postoperative pulmonary complications: LAS VEGAS - an observational study in 29 countries. Eur J Anaesthesiol. 2017;34(8):492–507.
4.
Fernandez-Bustamante A, Frendl G, Sprung J, et al. Postoperative pulmonary complications, early mortality, and hospital stay following noncardiothoracic surgery: a multicenter study by the Perioperative Research Network Investigators. JAMA Surg. 2017;152(2):157–66.PubMedPubMedCentral
5.
Shashaty MG. Physiological and management implications of obesity in critical illness. Ann Am Thorac Soc. 2014;11(8):1286–97.PubMedPubMedCentral
6.
7.
Reho JJ, Rahmouni K. Oxidative and inflammatory signals in obesity-associated vascular abnormalities. Clin Sci (Lond). 2017;131(14):1689–700.
8.
Aroor AR, Jia G, Sowers JR. Cellular mechanisms underlying obesity-induced arterial stiffness. Am J Phys Regul Integr Comp Phys. 2018;314(3):R387–8.
9.
Schinzari F, Tesauro M, Cardillo C. Endothelial and perivascular adipose tissue abnormalities in obesity-related vascular dysfunction: novel targets for treatment. J Cardiovasc Pharmacol. 2017;69(6):360–8.PubMed
10.
Gutt CN, Müller-Stich BP. Success and complication parameters for laparoscopic surgery: a benchmark for natural orifice transluminal endoscopic surgery. Endoscopy. 2009;41(01):36–41.PubMed
11.
Nishiyama T, Kohno Y. Anesthesia for bariatric surgery. Obes Surg. 2012;22(2):213–9.PubMed
12.
Rivas E, Arismendi E, Agustí A, et al. Ventilation/perfusion distribution abnormalities in morbidly obese subjects before and after bariatric surgery. Chest. 2015;147(4):1127–34.PubMed
13.
Tai KK, Jin WQ, Chan TK. Characterization of [3H]U69593 binding sites in the rat heart by receptor binding assays. J Mol Cell Cardiol. 1991;23(11):1297–302.PubMed
14.
Wittert G, Hope P. Tissue distribution of opioid receptor gene expression in the rat. Biochem Biophys Res Commun. 1996;218(3):877–81.PubMed
15.
Li J, Shi QX, Fan R, et al. Vasculoprotective effect of U50,488H in rats exposed to chronic hypoxia: role of Akt-stimulated NO production. J Appl Physiol. 2013;114(2):238–44.PubMed
16.
Li J. Role of κ-opioid receptor activation in anti-hypoxic pulmonary hypertension and its underlying mechanisms [dissertation]. China: FourthMilitary Medical University; 2017.
17.
Wu Q, Wang HY, Li J, et al. κ-opioid receptor stimulation improves endothelial function in hypoxic pulmonary hypertension. PLoS One. 2013;8:e60850.PubMedPubMedCentral
18.
Cui Y, Feng N, Gu X, et al. κ-Opioid receptor stimulation reduces palmitate-induced apoptosis via Akt/eNOS signaling pathway. Lipids Health Dis. 2019;18(1):52.PubMedPubMedCentral
19.
Jose DE, Ganapathi P, Anish Sharma NG, et al. Postoperative pain relief with epidural buprenorphine versus epidural butorphanol in laparoscopic hysterectomies: a comparative study. Anesth Essays Res. 2016;10(1):82–7.PubMedPubMedCentral
20.
Wu Y, Wan J, Zhen WZ, et al. The effect of butorphanol postconditioning on myocardial ischaemia reperfusion injury in rats. Interact Cardiovasc Thorac Surg. 2014;18(3):308–12.PubMed
21.
Huang LH, Li J, Gu JP, et al. Butorphanol attenuates myocardial ischemia reperfusion injury through inhibiting mitochondria-mediated apoptosis in mice. Eur Rev Med Pharmacol Sci. 2018;22:1819–24.PubMed
22.
Yang L, Sun DF, Wu Y, et al. Intranasal administration of butorphanol benefits old patients undergoing H-uvulopalatopharyngoplasty: a randomized trial. BMC Anesthesiol. 2015;15(1):20.PubMedPubMedCentral
23.
La Colla L, Albertin A, La Colla G, et al. Predictive performance of the ‘Minto’ remifentanil pharmacokinetic parameter set in morbidly obese patients ensuing from a new method for calculating lean body mass. Clin Pharm. 2010;49(2):131–9.
24.
The ARDS Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000;342(18):1301–8.
25.
Canet J, Gallart L, Gomar C, et al. Prediction of postoperative pulmonary complications in a population-based surgical cohort. Anesthesiology. 2010;113(6):1338–50.PubMed
26.
Mazo V, Sabaté S, Canet J, et al. Prospective external validation of a predictive score for postoperative pulmonary complications. Anesthesiology. 2014;121(12):219–31.PubMed
27.
Scholes RL, Browning L, Sztendur EM, et al. Duration of anaesthesia, type of surgery, respiratory co-morbidity, predicted VO2max and smoking predict postoperative pulmonary complications after upper abdominal surgery: an observational study. Aust J Physiother. 2009;55(3):191–8.PubMed
28.
Haines KJ, Skinner EH, Berney S, et al. Association of postoperative pulmonary complications with delayed mobilisation following major abdominal surgery: an observational cohort study. Physiotherapy. 2013;99(2):119–25.PubMed
29.
Browning L, Denehy L, Scholes RL. The quantity of early upright mobilisation performed following upper abdominal surgery is low: an observational study. Aust J Physiother. 2007;53(1):47–52.PubMed
30.
Parry S, Denehy L, Berney S, et al. Clinical application of the Melbourne risk prediction tool in a high-risk upper abdominal surgical population: an observational cohort study. Physiotherapy. 2014;100:47–53.PubMed
31.
Samnani SS, Umer MF, Mehdi SH, et al. Impact of preoperative counselling on early postoperative mobilization and its role in smooth recovery. Int Sch Res Notices. 2014;2014:250536.PubMedPubMedCentral
32.
Boden I, Browning L, Skinner EH, et al. The LIPPSMAck POP (Lung Infection Prevention Post Surgery-Major Abdominal-with PreOperative Physiotherapy) trial: study protocol for a multi-centre randomised controlled trial. Trials. 2015;16(1):1–15.
33.
Boden I, Skinner EH, Browning L, et al. Preoperative physiotherapy for the prevention of respiratory complications after upper abdominal surgery: pragmatic, double blinded, multicentre randomised controlled trial. BMJ. 2018;360:461–7.
34.
Chernik DA, Gillings D, Laine H, et al. Validity and reliability of the Observer’s Assessment of Alertness/Sedation Scale: study with intravenous midazolam. J Clin Psychopharmacol. 1990;10(4):244e51.
35.
Flier S. How to inform a morbidly obese patient on the specific risk to develop postoperative pulmonary complications using evidence-based methodology. Eur J Anaesthesiol. 2006;23(2):154–9.PubMed
36.
Writing Committee for the PROBESE Collaborative Group of the PROtective VEntilation Network (PROVEnet) for the Clinical Trial Network of the European Society of Anaesthesiology. Effect of intraoperative high positive end-expiratory pressure (PEEP) with recruitment maneuvers vs low PEEP on postoperative pulmonary complications in obese patients: a randomized clinical trial. JAMA. 2019;321(23):2292–305.
37.
Matthay MA, Bhattacharya S, Gaver D, et al. Ventilator-induced lung injury: in vivo and in vitro mechanisms. Am J Phys Lung Cell Mol Phys. 2002;283(4):L678–82.
38.
Zhang S, Zhou Y, Zhao L, et al. κ-Opioid receptor activation protects against myocardial ischemia-reperfusion injury via AMPK/Akt/eNOS signaling activation. Eur J Pharmacol. 2018;833:100–8.PubMed
39.
Zhou Y, Wang Y, Wang X, et al. The protective effects of κ-opioid receptor stimulation in hypoxic pulmonary hypertension involve inhibition of autophagy through the AMPK-MTOR pathway. Cell Physiol Biochem. 2017;44(5):1965–79.PubMed
40.
Franklin C, Fortepiani L, Nguyen T, et al. Renal responses produced by microinjection of the kappa opioid receptor agonist, U50-488H, into sites within the rat lamina terminalis. Pharmacol Res Perspect. 2015;3(2):e00117.PubMedPubMedCentral
41.
Peng P, Huang LY, Li J, et al. Distribution of kappa-opioid receptor in the pulmonary artery and its changes during hypoxia. Anat Rec (Hoboken). 2009;292(7):1062–7.
42.
Shekar K, Fraser JF. Ventilator-induced lung injury. N Engl J Med. 2014;370(4):979.PubMed
43.
Gao TT, Jiang L. Obesity exacerbates pulmonary vascular endothelial injury caused by mechanical ventilation. Int J Anesth Resu. 2018;(3):250–3. Chinese
44.
Shah RJ, Wickersham N, Lederer DJ, et al. Preoperative plasma club (Clara) cell secretory protein levels are associated with primary graft dysfunction after lung transplantation. Am J Transplant. 2014;14(2):446–52.PubMedPubMedCentral
45.
Ide S, Minami M, Ishihara K, et al. Abolished thermal and mechanical antinociception but retained visceral chemical antinociception induced by butorphanol in mu-opioid receptor knockout mice. Neuropharmacology. 2008;54(8):1182–8.PubMedPubMedCentral
46.
47.
Boom M, Niesters M, Sarton E, et al. Non-analgesic effects of opioids: opioid-induced respiratory depression. Curr Pharm Des. 2012;18(37):5994–6004.PubMed
48.
Pasternak GW. Mu opioid pharmacology: 40 years to the promised land. Adv Pharmacol. 2018;82:261–91.PubMed
49.
Commiskey S, Fan LW, Ho IK. Butorphanol: effects of a prototypical agonist-antagonist analgesic on kappa-opioid receptors. J Pharmacol Sci. 2005;98(2):109–16.PubMed
50.
Hardman JG, Aitkenhead AR. Estimating alveolar dead space from the arterial to end-tidal CO2 gradient: a modeling analysis. Anesth Analg. 2003;97(6):1846–51.PubMed
Metadata
Title
The Protective Effects of Butorphanol on Pulmonary Function of Patients with Obesity Undergoing Laparoscopic Bariatric Surgery: a Double-Blind Randomized Controlled Trial
Authors
Xiu-li Wang
Si Zeng
Xiao-xiao Li
Ye Zhao
Xing-he Wang
Tong Li
Su Liu
Publication date
01-10-2020
Publisher
Springer US
Published in
Obesity Surgery / Issue 10/2020
Print ISSN: 0960-8923
Electronic ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-020-04755-2

Other articles of this Issue 10/2020

Obesity Surgery 10/2020 Go to the issue

Correction

Correction to: Evaluation of Liver Function Tests and Risk Score Assessment to Screen Patients for Significant Liver Disease Prior to Bariatric and Metabolic Surgery

Original Contributions

Correlation between Obstructive Sleep Apnea and Non-Alcoholic Fatty Liver Disease before and after Metabolic Bariatric Surgery

Original Contributions

Preoperative Opioid Prescription Patients Do Not Suffer Distinct Outcomes After Bariatric Surgery: a Matched Analysis of Outcomes

Original Contributions

Factors Associated with the Development of Anemia During Pregnancy After Sleeve Gastrectomy

Original Contributions

Comparison of Surgical Activity and Scientific Publications in Bariatric Surgery: an Epidemiological and Bibliometric Analysis

Original Contributions

Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?—Analysis of 116 Consecutive Cases