Abstract
Background and Objectives: Early postoperative recovery after surgery is a key point for patients’ safety and comfort. Moreover, operating room turnover depends on recovery time. Our aim was to assess which method of remifentanil administration, manual (MI) or target-controlled infusion (TCI), could reduce patient time in recovery room. In this study, patients’ recovery times were registered and compared among the groups. Materials and Methods: We enrolled 31 morbidly obese patients in this prospective study. All of them had undergone bariatric surgery at the Hospital of Lithuanian University of Health Sciences Kauno Klinikos in 2020. Sevoflurane/remifentanil anaesthesia was performed for all patients. The patients were randomly assigned to the manual infusion (MI) (control group) or target-controlled infusion (TCI) group for the method of the administration of remifentanil. While the patients were waking up after the surgery, we recorded spontaneous breathing and airway reflexes recovery time, time of extubation, eye opening, recovery of orientation and beginning of the following oral command. For the TCI group, we also documented remifentanil concentrations in the blood (automatic infusion pump). Results: Patients did not differ in demographic values and duration of remifentanil infusion. We found that remifentanil consumption in the TCI group was lower, p = 0.02. Despite lower remifentanil consumption in the TCI group patients, they demonstrated longer total recovery time than the control group patiens: 14 (12–20) vs. 10 (6–16), p = 0.001. Conclusions: The study showed that, upon comparing the TCI method with MI, manual infusion produced better results in postoperative patient recovery. Additionally, higher doses of remifentanil were consumed using MI. In conclusion, the dosage recommended by highly qualified anaesthesiologists is favourable for morbidly obesity patients when compared to the TCI method.
Highlights
Morbid obesity is one of the most pressing problems of the 21st century, with the number of obese patients growing rapidly around the world and doctors of different specialisations increasingly encountering patients with morbid obesity in their clinical practice [1]
The main objective of this study was to assess which method of remifentanil administration, manual infusion (MI) or target-controlled infusion (TCI), could reduce patient time in the recovery room
We found that consumption of remifentanil in the TCI group was lower
Summary
Morbid obesity is one of the most pressing problems of the 21st century, with the number of obese patients growing rapidly around the world and doctors of different specialisations increasingly encountering patients with morbid obesity in their clinical practice [1]. In 1998, the U.S National Institutes of Health recommended bariatric surgery as a first-line treatment for morbidly obese patients, and such surgeries have increasingly been performed since [2]. Anaesthetic medicines are dispensed according to the patient’s body weight, but this rule does not apply to morbidly obese patients. Establishing a relationship between the clearance and distribution volume of drugs and the anthropometric data of the individual is a major pharmacokinetic challenge when administering anaesthetics to morbidly obese individuals [3]. Experience has shown that the circulatory and respiratory conditions and metabolism of obese patients, even those with the same BMI, can vary significantly, and additional criteria should be sought to select the appropriate dose. The main objective of this study was to assess which method of remifentanil administration, manual infusion (MI) or target-controlled infusion (TCI), could reduce patient time in the recovery room
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