Abstract
Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m−2 undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): −129 s; 95% confidence interval (CI): −211, −46], obeying commands (−160; −243, −77), tracheal extubation (−172; −266, −78), and leaving operating room (−148; −243, −54). M-Entropy guidance further reduced time to eye opening (MD: −142 s; 99.2% CI: −276, −8), tracheal extubation (−199; −379, −19), and leaving operating room (−190; −358, −23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: −0.275 (95% CI: −0.464, −0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation.
Highlights
IntroductionObesity is a growing epidemic, affecting about 650 million adults worldwide in2016 [1]
The distributions of demographics, body mass index, American Society of Anesthesiologists physical status, lifestyle factors, and coexisting diseases were generally balanced across the four groups
There was no difference in the baseline response and state entropy values, doses of intravenous anesthetics, duration of anesthesia, or amount of intravenous fluids among the four groups, either (Table 2)
Summary
Obesity is a growing epidemic, affecting about 650 million adults worldwide in2016 [1]. The global volume of surgery for obese patients is forecast to increase as a result of the growing prevalence of, and diseases related to, obesity [4]. Recovery from general anesthesia may be compromised in obese patients due to the delayed release of lipid-soluble anesthetic agents from excessive adipose tissue [5]. The latest Enhanced Recovery After Surgery (ERAS) guidelines do not recommend specific anesthetic regimens for early emergence from general anesthesia in bariatric surgery due to conflicting results in the current literature [7–16]. Some studies reported that desflurane has a consistent and rapid recovery profile in the obese population compared to sevoflurane, isoflurane and propofol [8–13]. The current evidence is insufficient to determine the optimal anesthetic agent for obese patients in terms of immediate recovery from general anesthesia
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