Anesthesia management for the super obese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial

A. Siampalioti, D. Karavias, A. Zotou, F. Kalfarentzos, K. Filos

Department of Anaesthesiology and Clinical Care Medicine, and Department of Surgery, Nutrition Support and Morbid Obesity Unit; University Hospital of Patras, Rion, Greece. athinasiampalioti@gmail.com

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• Anesthesiology

OBJECTIVE: General anesthesia in obese patients is both challenging and demanding. With the rates of obesity in the general population increasing, more patients undergo bariatric surgery. The aim of this study was to compare the performance, effectiveness and recovery from anesthesia of sevoflurane and propofol in combination with remifentanil, with and without bispectral index (BIS) monitoring in super obese patients undergoing bariatric surgery.

PATIENTS AND METHODS: In this prospective, double-blind, randomized, controlled study a total of 100 super obese patients (body mass index, BMI > 50 kg/m2) undergoing bariatric surgery were randomly allocated in four groups: a sevoflurane group (n = 25), a sevoflurane with BIS monitoring group (n = 25), a propofol group (n=25) and a propofol with BIS monitoring group (n=25). Hemodynamic parameters, depth of anesthesia, recovery from anesthesia and postoperative pain were recorded.

RESULTS: The mean age of patients was 37.7 ± 9.2 years and the median BMI was 57.86 ± 9.33. There were no statistically significant differences between the four groups with respect to patient characteristics, comorbidities and duration of surgery. The intraoperatively mean arterial pressure was significantly higher in both propofol groups. No significant difference was observed between the four groups in respect to heart rate changes during anesthesia. Although the time to eye-opening and extubation was significantly shorter in both propofol groups, recovery from anesthesia, assessed with the Aldrete, Chung and White recovery scores, was significantly faster in sevoflurane groups. No significant difference was observed in postoperative pain between the four groups.

CONCLUSIONS: Although both propofol and sevoflurane provide adequate general anesthesia, sevoflurane may be preferable in super obese patients because of superior hemodynamic stability and faster recovery from anesthesia.

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