A randomised comparative study on intraoperative bispectral index monitoring vs. conventional monitoring on awakening time, extubatation time and early postoperative recovery from general anaesthesia using desflurane as inhalational anaesthetic during maintenance of anaesthesia in morbidly obese patients undergoing laparoscopic sleeve gastrectomy surgery

Abstract

Introduction: In India incidence of obesity is in increasing trend. Anaesthetising morbidly obese patients is challenge to anaesthesiologist. Due to alteration in pharmacokinetics and pharmacodynamics in obese patients, drug dosing in these patients is different from patients with normal body mass index. This has led to lot of confusion in titration of anaesthetic drugs perioperatively. Any method which helps in perioperative drug titration may help in optimal intraoperative maintenance of anaesthesia, early awakening at the end of surgery and early postoperative recovery. We hypothesize that intraoperative Bispectral index (BIS) monitoring allows optimal titration of anaesthetic drugs intraoperatively and decrease awakening time, early postoperative recovery from general anaesthesia in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery. Materials and Methods: Two groups of 40 patients each were anaesthetized with the use of BIS monitoring in BIS- GROUP and in NON-BIS GROUP patients were anaesthetized without the using BIS monitoring. The heamodynamic parameters heart rate (HR) and mean arterial pressure (MAP) were recorded before induction, after induction at 1 minute (min), 3min, and 5min, after incision at 1min, 5min, 10min, 15min, 30min, 45min, 60min, and 70min were recorded. Awakening time (time to eye opening to verbal command) recorded every minute, time to extubation at 1min, 5 min, 15 min were recorded and time to achieve Modified Aldrete score ?9 were recorded. Results: Mean awakening time, time to extubate and Modified Aldrete score ?9 were significantly shorter in the BIS group as compared to the NON-BIS group (P 0.05). Conclusion: Without compromising the hemodynamic stability BIS monitoring was effective in early awakening, associated with early postoperative recovery in morbidly obese patients undergoing laparoscopic laparoscopic sleeve gastrectomy surgery. Keywords: Morbid obesity, Bispectral index, Recovery.