Abstract
Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations. In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m(2)), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO2) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO2 in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting. The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3) CONCLUSIONS: Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study.
Highlights
The prevalence of morbid obesity is increasing worldwide, and surgical interventions may entail a considerable risk for obese patients
Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study
There were no significant differences in the demographic data, except for age, duration of the operation or anesthesia, and SpO2 on arrival between the groups
Summary
The prevalence of morbid obesity is increasing worldwide, and surgical interventions may entail a considerable risk for obese patients. In spite of widespread performance of weight reduction (bariatric) surgeries, information on the anesthetic care of morbidly obese patients is scarce. One of many problems in the anesthetic management of morbidly obese patients (body mass index [BMI], >35 kg/m2) is the maintenance of adequate oxygenation. FRC markedly decreases with possible hypoxemia and hypercapnia during the postoperative period [1,2,3]. The body weight is a primary factor determining arterial oxygen tension pneumoperitoneum and position changes (Trendelenburg and reverse Trendelenburg) do not significantly alter oxygenation despite considerable deterioration in the respiratory system mechanics [3]
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