Interest In Bariatric Surgery Research Articles

Efficacy and Safety of Bariatric Surgery in Dutch People Living with HIV: a Retrospective Matched Cohort Analysis

PurposeObesity is rising among people with HIV (PLWH), sparking interest in bariatric surgery (BS) for this group. Yet, large-scale comparative research on BS outcomes in PLWH is lacking.MethodsWe performed a retrospective, matched cohort analysis in PLWH and HIV uninfected controls. Subjects were retrieved from the Dutch Audit for Treatment of Obesity (DATO) registry. Matching (1:7 ratio) included age (± 5-years), sex, body-mass index (BMI) of ± 3 kg/m2, surgery type, and associated health problems (AHPs) at baseline. The primary endpoint was total weight loss percentage (%TWL) ≥ 20% achieved at 1-year post-BS. Secondary endpoints were cumulative %TWL achieved at 2-years post-BS, a reported remission or improvement in AHPs post-BS, and surgical complications, both at 1-year post-BS. Comparisons were performed using conditional logistic regression.ResultsTwenty-seven PLWH and 168 controls were included. At 1-year post-BS, 89% PLWH achieved ≥ 20%TWL, compared to 94% of controls (p = 0.4). Cumulative %TWL at 2-years post-BS were 82% and 92% in PLWH and controls, respectively (p = 0.2). Improvement rates in hypertension and type 2 diabetes mellitus were 50% and 86% in PLWH, versus 87% and 87% in controls. Full remission occurred in 20% and 71% of PLHIV, versus 49% and 44% of controls, respectively. No improvement or remission was observed for dyslipidaemia in PLHIV compared to 54% improvement and 29% remission in controls. Surgical complications were 0% in PLHIV and 13% (n = 21) in controls.ConclusionEfficacy and safety outcomes of BS were similar between PLWH and controls except for the lack of improvement in dyslipidaemia in PLWH.Graphical abstract

Tackling Obesity Through Bariatric Surgery: Long-Term Outcomes and Complication Rates

Background: The prevalence of obesity and its associated health risks have led to a growing interest in bariatric surgery as a treatment option. Sleeve gastroplasty, a common bariatric procedure, has shown promise in addressing obesity-related issues. However, comprehensive studies evaluating its long-term effectiveness and safety are needed to understand its full impact on patient health, including both physical and mental aspects. Objective: This study aimed to compare the safety and effectiveness of sleeve gastroplasties by assessing patients who underwent the surgery (Patient Group, PG) against those who did not (Control Group, CG). The primary focus was on the resolution of obesity comorbidities, overall surgical morbidity, severe surgical complications, mental health outcomes, and total weight loss percentage (TWL%) over two years. Methods: The study involved 136 participants, evenly divided between the PG and CG. Propensity Score Matching (PSM) was utilized to ensure balanced comparisons. Key measures included TWL%, resolution of obesity comorbidities, severe surgical complications, total surgical morbidity, and mental health adverse events. Statistical analyses were conducted to identify significant differences between the groups at the two-year follow-up. Results: After one year, the PG exhibited a TWL% of 32.7%, whereas the CG showed 36.6%, a statistically significant difference (p = 0.002). Surgical morbidity was notably higher in the PG (28%) compared to the CG (17%), with a significant difference (p = 0.01). Severe surgical complications were similar between groups (4% in PG vs. 3% in CG, p = 0.44). Mental health adverse events were more prevalent in the PG. Both groups had comparable remission rates of obesity-related comorbidities at the one-year mark. Conclusion: The study demonstrated that sleeve gastroplasties result in effective weight reduction, as evidenced by the TWL% differences. However, the higher incidence of surgical morbidity and mental health issues in the PG underscores the need for comprehensive care, addressing both the physical and psychological aspects of bariatric surgery. Future research should focus on identifying factors influencing these outcomes to optimize the benefits of sleeve gastroplasties, considering individual patient profiles.

Scientific and Public Interest in Bariatric Surgery for Obesity: The Italian Scenario

Background: Obesity is an escalating concern in our society. Bariatric surgery appears to be the only feasible alternative for severe obesity. This study aims to conduct an integrative analysis of the Italian context concerning bariatric surgery, with a specific focus on the surgical procedures of sleeve gastrectomy, mini-gastric bypass, and gastric bypass. Methods: The analysis is based on bibliometric data extracted from the Scopus database to find Italian publications in this field from 2012 to 2022. Along with scientific interest, it is essential to assess the level of public interest in these topics. Google Trends is the most extensively utilized free tool for the analysis of online behavior. Using Google Trends data, we analyzed the amount of internet volume searches (Relative Search Volume = RSV) for the Italian terms “sleeve gastrectomy”, “mini-gastric bypass” and “gastric bypass”, both temporally (from 2012 to 2022 years) and geographically. Furthermore, to illustrate the Italian landscape, we compared Google Trends data with data from the Italian registry “Società Italiana di Chirurgia dell’Obesità e delle malattie metaboliche” (SICOB), which includes information about bariatric surgery procedures performed in the country. Results: Over the past decade, there has been a significant increase in the scientific literature on sleeve gastrectomy, mini-gastric bypass, and gastric bypass surgeries in Italy. Google Trends data has shown an increase in online public interest in these surgical procedures, from 2012 to 2022. The examination of the Google Trends information combined with the SICOB data demonstrated a remarkable association between the two data sets. Conclusions: Bariatric surgery has increased quickly in Italy in terms of scientific research and surgical interventions. The analysis of Google Trends data in conjunction with data from SICOB has revealed an interesting correlation between the two datasets therefore, Google Trends can be useful for estimating the demand for bariatric surgical procedures.

Endometrial cancer patients understanding and interest in weight loss surgery

ObjectiveObesity is a risk factor for endometrial hyperplasia (EH), endometrial intraepithelial neoplasia (EIN), and early type 1 endometrial cancer (EC) in 70%–90% of patients and is often a significant contributor to overall morbidity and mortality due to comorbidities. In 2011, bariatric surgery (BS) with lifestyle modification was identified as an intervention for reduction in overall mortality as well as risk for gynecologic cancers (Tsui et al., 2021). Our aim was to assess awareness of obesity as a risk factor and understanding of BS in an underinsured obese patient population with EC or EH. MethodThis IRB-approved survey was distributed to patients with type I EC or EH within the past 5 years and a BMI >30. Questions addressed demographics, health habits, cancer and obesity awareness, as well as benefits and concerns about undergoing BS. Information was provided about dietary requirements after BS, and then interest in BS was surveyed. Results61.2% of surveyed patients were interested in bariatric surgery for weight loss after receiving education about the procedure. Interest in bariatric surgery was correlated with higher BMI, higher ideal and comfortable weight loss in pounds and higher estimated weight loss that could be obtained with bariatric surgery. Additionally, patients who were interested in BS had better understanding of the risks of obesity with cancer overall. ConclusionObese patients with history of EC/EIN/EH are aware of hazards associated with excess weight and understand the relationship between EC/EIN/EH diagnosis and obesity, and overall are very interested in BS as a modality to improve their health.

A qualitative analysis describing attrition from bariatric surgery to identify strategies for improving retention in patients who desire treatment.

Among patients who express interest in bariatric surgery, dropout rates from bariatric surgery programs are reported as high as 60%. There is a lack of understanding how we can better support patients to obtain treatment of this serious chronic disease. Semi-structured interviews with individuals who dropped out of bariatric surgery programs from three clinical sites were conducted. Transcripts were iteratively analyzed to understand patterns clustering around codes. We mapped these codes to domains of the Theoretical Domains Framework (TDF) which will serve as the basis of future theory-based interventions. Twenty patients who self-identified as 60% female and 85% as non-Hispanic White were included. The results clustered around codes of "perceptions of bariatric surgery," "reasons for not undergoing surgery," and "factors for re-considering surgery." Major drivers of attrition were burden of pre-operative workup requirements, stigma against bariatric surgery, fear of surgery, and anticipated regret. The number and time for requirements led patients to lose their initial optimism about improving health. Perceptions regarding being seen as weak for choosing bariatric surgery, fear of surgery itself, and possible regret over surgery grew as time passed. These drivers mapped to four TDF domains: environmental context and resources, social role and identity, emotion, and beliefs about consequences, respectively. This study uses the TDF to identify areas of greatest concern for patients to be used for intervention design. This is the first step in understanding how we best support patients who express interest in bariatric surgery achieve their goals and live healthier lives.

New Options (or not) for Treatment of Idiopathic Intracranial Hypertension.

Idiopathic intracranial hypertension (IIH) is a disorder primarily affecting obese women of childbearing age and, if left untreated, can lead to irreversible vision loss. No consensus exists on the best management strategy for IIH. Weight loss is advocated and few useful medical options exist. There is an unmet need to discover new treatment options for this increasingly prevalent condition. This article reviews the recent advances and research on the treatment of IIH. Venous sinus stenting (VSS) is now performed in many experienced centers, and there is growing interest in bariatric surgery as a treatment modality. Newly approved anti-obesity drugs are showing effectiveness in weight loss, and novel targeted disease-modifying IIH therapies are being explored. Further evaluation of these novel therapeutic strategies as well as studies exploring the use of anti-obesity drugs in IIH is needed. While VSS is gaining popularity due to its efficacy and low complication rate, there is insufficient evidence to support any surgical procedure over another. Bariatric surgery is appealing for patients with non-sight-threatening IIH and needs to be further explored.

Racial Differences in the Predictors of Interest in Bariatric Surgery in the Rural, Southeastern USA.

Although African-Americans have a higher prevalence of severe obesity than Whites, they are less likely to have bariatric surgery. Demographic, healthcare, and knowledge variables contribute to this racial disparity but have not been examined separately by race. Examine the role of demographic, healthcare, and knowledge variables in African-Americans' versus Whites' interest in bariatric surgery. A random sample of 293 African-American and 259 White adults were surveyed door-to-door in the rural south. The survey assessed weight, height, demographics, access to healthcare, and knowledge of and interest in bariatric surgery. African-Americans had significantly lower knowledge of bariatric surgery than Whites but there were no racial differences in interest in the surgery. The logistic regression predicting African-Americans' interest in the surgery from demographic, healthcare, obesity, and knowledge variables revealed that obesity (OR = 4.7) and the health benefits (OR = 3.3) were the only predictors. The same regression for Whites found that knowing someone who had the surgery (OR = 3.7) was the sole predictor. Knowledge variables may be stronger than healthcare and demographic variables as predictors of interest in bariatric surgery among rural, southern, African-Americans and Whites. Whites' willingness to consider the surgery might be enhanced by favorable stories/blogs by those who had the surgery, whereas African-Americans' interest might be increased by information on the additional health benefits of the surgery. These culturally tailored messages from healthcare providers might increase utilization of and reduce racial disparities in bariatric surgery.

A152 - Google Trends as a Resource for Bariatric Education: What do Patients Want to know?

Background: Bariatric Surgery(BS) is an effective treatment for the morbidly obese patient and it is one of the most frequently performed surgical procedures in the United States(US). It is difficult to determine BS levels of interest through traditional approaches. The aim of this study is to use Google Trends(GT) as a tool to analyze the US general population interest in BS.

A388 - Is There a Learning curve in Adopting the Robotic Platform to Revisional Bariatric Surgery?

Background: Robotic technology is gaining interest in bariatric surgery with advocated benefits in revisional surgery. Whether there is of the learning curve of adopting this technology, has not been examined. Our study evaluates the introduction of this technology and impact on surgeon experience and patients outcomes.

Effectiveness and Safety of Roux-en-Y Gastric Bypass in Elderly Patients\u2014Systematic Review and Meta-analysis

IntroductionAs the population ages, there is more interest in bariatric surgery for older patients. There are controversies regarding the safety and effectiveness of surgical weight loss in this population.AimThe aim of this study was to compare the safety and efficacy of Roux-en-Y gastric bypass in patients over the age of 60 years with younger patients.MethodsThe available literature was searched for eligible studies up to February 2018. Inclusion criteria were reports on mortality, morbidity, percentage excess weight loss (%EWL), remission of diabetes, remission of hypertension, and remission of obstructive sleep apnea. Random effects meta-analyses were performed.ResultsThe initial search yielded 2000 references. The final meta-analysis involved nine studies and revealed significant differences in mortality (odds ratio 4.38, 95% confidence interval [1.25, 15.31], p = 0.02), morbidity (OR 1.88, CI [1.07, 3.30], p = 0.03), %EWL (mean difference − 5.86, 95% CI [− 9.15, − 2.56], p < 0.001), and remission of comorbidities.ConclusionHigher mortality and morbidity were found in the group of older patients. The analysis suggested lower effectiveness of Roux-en-Y gastric bypass for weight loss and improvement in comorbidity in older patients when compared with younger patients.

Using Google Trends to explore the New Zealand public's interest in bariatric surgery.

Bariatric surgery, in recent times, has gained media attention that has influenced individual, healthcare provider and wider societal attitudes towards bariatric surgery. Studies exploring public and media levels of interest in bariatric surgery have been performed overseas but studies within New Zealand (NZ) are scarce. Analysis of Google Trends data may be a useful source of information in investigating public interest levels in bariatric surgery. We aimed to analyse Google Trends information on Internet searches in NZ and to explore sequential relationships with relevant changes in policy. Key search terms for our Google Trends query were retrieved by independently reviewing news articles relating to bariatric surgery in NZ published between January 2007 and December 2017 and following a brainstorming session. Trend analyses were performed using Microsoft Excel 14.7.2. Data were captured for both NZ and worldwide search interests in Google Trends. Trend analyses showed that total search volumes for 'lap band' and 'lap band surgery' declined while 'gastric sleeve' and 'gastric sleeve surgery' increased exponentially over the 10-year period. Furthermore, search interests for key terms in NZ were comparable with those worldwide. Our findings reveal that search interests related to bariatric surgery in NZ mirror those worldwide. This includes the popularity of some bariatric procedures over others. The use of Google Trends may provide us with an additional tool to evaluate public interest levels related to bariatric surgery in NZ and could add value in examining the socio-cultural and political contexts of obesity and bariatric surgery.

Iron deficiency after bariatric surgery: what is the real problem?

The growing prevalence of obesity explains the rising interest in bariatric surgery. Compared with non-surgical treatment options, bariatric surgery results in greater and sustained improvements in weight loss, obesity associated complications, all-cause mortality and quality of life. These encouraging metabolic and weight effects come with a downside, namely the risk of nutritional deficiencies. Particularly striking is the risk to develop iron deficiency. Postoperatively, the prevalence of iron deficiency varies between 18 and 53% after Roux-en-Y gastric bypass and between 1 and 54% after sleeve gastrectomy. Therefore, preventive strategies and effective treatment options for iron deficiency are crucial to successfully manage the iron status of patients after bariatric surgery. With this review, we discuss the risks and the contributing factors of developing iron deficiency after bariatric surgery. Furthermore, we highlight the discrepancy in the diagnosis of iron deficiency, iron deficiency anaemia and anaemia and highlight the evidence supporting the current nutritional recommendations in the field of bariatric research. In conclusion, we advocate for more nutrition-related research in patient populations in order to provide strong evidence-based guidelines after bariatric surgery.

Current knowledge and perception of bariatric surgery among Greek doctors living in Thessaly.

The purpose of this study was to assess doctors' knowledge, current conceptions, and clinical practice regarding obesity and bariatric surgery. A self-administered survey was administered to 500 doctors with varying medical specialties in public and private practice. The response rate was 60%. Most participants (77.3%) were in private practice. Although almost half of the participants could define morbid obesity and obesity-related comorbidities, only 8.7% felt educated about bariatric surgery. Participants had little knowledge of various types of bariatric procedures. A minority of doctors (24.7%) knew of the existence of a bariatric center in their area. Only 21.3% of doctors had referred a patient to a bariatric center. Reasons for non-referral included lack of interest in bariatric surgery (37.3%), patient refusal (35.3%), increased operative fees (17.3%), lack of confidence in bariatric surgery (6.3%), and lack of access to a nearby bariatric center (3.7%). The majority of doctors were interested in learning more about bariatric surgery and related guidelines, but they remained reluctant to conduct patients' postoperative follow-ups. The penetration of bariatric surgery in the medical community remains limited, despite its proven effectiveness in facilitating sustained weight loss and resolving several obesity-related comorbidities. A great effort should be made to inform health-care providers about the evolution of bariatric procedures, the potential benefits they offer, and the existence of certified bariatric centers. This will allow doctors to provide optimum health care to patients who could benefit from bariatric surgery.

Publication Trends in Bariatric Surgery: a Bibliometric Study.

The interest in bariatric surgery has considerably increased in the scientific community in the last two decades. We present a bibliometric analysis of scientific publications in bariatric surgery focusing on the period 2010-2014. We used the Web of Science database as source of data. The main bibliometric indicators were applied in order to assess the increase of scientific production, the productivity of journals, authors, and countries. Bibliographic research retrieved 7860 papers for the period 2010-2014. The scientific production in bariatric surgery has an exponential distribution (r = 97.9%). A total of 76.8% (21,893/28,505) of authors signed one paper and 307 (1.1%) signed ten or more. The two most prolific journals are Obesity Surgery and SOARD, responsible for 22% of the publication. The largest contributors in absolute number of articles are the USA, the UK, and Italy, while Sweden, Norway, and Switzerland are the most prolific nations after adjustment for the number of inhabitants and prevalence of obesity. Bariatric surgery has been a field of intense research in the last 20years. We observed a growing interest of non-surgical journals and an increasing participation of new countries. Nevertheless, latest trends suggest a saturation of scientific production in this field.

Update on bariatric surgery in adolescence.

Recent evidence highlighting the prevalence of severe obesity in the pediatric population, coupled with disappointing outcomes related to medical weight loss interventions, has led to increased interest in bariatric surgery. This article focuses on recent additions to the literature regarding the current indications and outcomes of adolescent bariatric surgery, emerging guidelines on the development of surgical weight loss programs and the status of access to bariatric surgical care for adolescents in the United States. Current data have shown a steady rise in the use of bariatric surgery among adolescents and serve to highlight the prevalence of several important obesity-related comorbidities. In addition to reports showing the safety and efficacy of adolescent bariatric surgery, a number of investigators have demonstrated significant improvement in key physiological and metabolic parameters (i.e., glucose metabolism, elevated blood pressure, dyslipidemia, etc.), offering updated consensus-driven guidelines for the indications for surgical intervention, as well as the development of multidisciplinary adolescent-specific care. Despite favorable outcomes, a disparity exists between the pediatric and adult populations related to access to such care. In contrast to previous small and mostly retrospective series, contemporary studies have shown that adolescent bariatric surgery is well tolerated and effective. Despite these findings and the emergence of a national consensus regarding multidisciplinary care, skepticism among primary care providers, as well as significant challenges related to healthcare access, remain. Longitudinal studies and open dialogue within the medical community are needed.

Pediatric bariatric surgery: the clinical pathway.

Despite the rising interest in bariatric surgery (BS) for children and adolescents, algorithms that incorporate BS in weight management (WM) programs are lacking. This study presents the results of the pediatric bariatric surgery clinical pathway employed in our institution. Starting March 2008, we enrolled obese children and adolescents in a standardized multidisciplinary obesity management program. Weight loss, complications, comorbidities, and growth results of those who eventually underwent BS were compared with a matched (age, gender, and height z-score) group of patients on non-surgical WM only. Up to July 2014, a total of 659 patients received care through the pathway, of whom 291 patients underwent laparoscopic sleeve gastrectomy (LSG). Mean age and pre-LSG body mass index (BMI) were 14.4 ± 4.0 years (range; 5 to 21 years) and 48.3 ± 10.0 (range; 31.8-109.6). Mean BMI change (% excess weight loss) at 1, 2, 3, and 4 postoperative years was -16.9 ± 4.9 (56.6 ± 22.6), -17.5 ± 5.2 (69.8 ± 22.5), -18.9 ± 4.3 (75.1 ± 26.8), and -19.6 ± 6.4 (73.6 ± 24.3), respectively. Postoperatively, complications occurred in 12 patients (4.1%), with no leaks or mortality, and more than 90% of comorbidities were resolved or improved without recurrence. Additionally, LSG patients exhibited significantly higher postoperative growth velocity compared to WM patients. Applying this standardized clinical pathway with its BS component results in safe and successful weight loss for pediatric patients, with low complication rates, maximum comorbidity resolution, and minimum morbidity.

Interest in bariatric surgery among obese patients with obstructive sleep apnea

BackgroundStandard obstructive sleep apnea (OSA) therapies are poorly tolerated. Bariatric surgery is a potential alternative but the level of interest in this intervention among OSA patients is unknown. ObjectivesDetermine the proportion of OSA patients who would be interested in bariatric surgery. Setting: Sleep clinics, United States. MethodsConsecutive adult patients with untreated severe OSA and a body mass index of 35–45 kg/m2 were approached. Patients at low perioperative risk and no urgent indication for OSA treatment were invited to a separate informational visit about bariatric surgery as primary treatment for OSA. ResultsOf 767 eligible patients, 230 (30.0%) were not at low perioperative risk, 49 (6.4%) had drowsy driving, and 16 (2.1%) had no insurance coverage for bariatric surgery. Of the remaining 482 patients, over one third (35.5%) were interested in bariatric surgery. Surgical interest was 47.2% in women versus 27.6% in men (P<0.01) and 67.3% in diabetics versus 31.0% in nondiabetics (P<0.01). In multivariable adjusted models, female gender (odds ratio 1.89, 95% CI [1.10–3.25]) and diabetes (odds ratio 3.97, 95% CI [1.97–8.01]) remained highly predictive of bariatric surgery interest. ConclusionsNearly two thirds of obese patients with severe OSA are good candidates for bariatric surgery. Among candidates, over one third are interested in this treatment. Interest rates are highest among women and diabetics, indicating that metabolic improvements continue to be a major driver of surgery even in patients with severe OSA. Given patient interest, the role of bariatric surgery should be routinely discussed with obese OSA patients.

Role and cost effectiveness of bariatric surgery in T2DM

AbstractInterest in bariatric surgery has gathered pace with wider awareness of its benefits for weight loss and for important weightrelated diseases, especially type 2 diabetes mellitus (T2DM). BS enables many patients with T2DM to achieve normal blood glucose levels and discontinue medication. This has generated lively debate about the role and cost‐effectiveness of BS in treating T2DM and whether BS should be offered more widely. Paradoxically, however, these discussions seldom examine the health service perspective. This article summarises recent evidence and asks whether BS could replace conventional treatment for some people with T2DM. Copyright © 2013 John Wiley &amp; Sons, Ltd.

Vertical Gastric Plication: Is it Ready for Prime-Time?

The incidence of obesity has been increasing steadily, with approximately 10% of the world’s population meeting the criteria (1). The limited success of lifestyle and pharmaceutical interventions has resulted in an increased interest in bariatric surgery, as it is the only proven modality for achieving sustainable weight loss, and impacting survival in the clinically severe obese (BMI ≥ 40 or ≥ 35 with severe co-morbid disease) (2). In general, bariatric surgical intervention involves either a restrictive or mal-absorptive mechanism, to achieve weight loss. The two most renowned and successful procedures are; the Roux-en-Y gastric bypass and the biliopancreatic diversion with duodenal switch, and these use both routes. However, both of these procedures have potentially life threatening post-operative complications, mainly entailing leakage at anastomoses sites, thus making them less than ideal interventions. Gastric banding, sleeve gastrectomy and now recently gastric plication, are other bariatric surgeries that are essentially restrictive procedures, which are becoming more popular (3). Of the restrictive procedures, Laparoscopic Sleeve Gastrectomy (LSG) and Laparoscopic Total Gastric Vertical Plication (LTGVP) are relatively similar. Both involve decreasing the greater curvature of the stomach, and creating a gastric reservoir resembling a vertical tube (3). In general, LSG accomplishes this goal with staple lines and removal of a gastric section, while LTGVP achieves it with suture lines, without the need for a gastric section. The advantages of both procedures consist of; not introducing a foreign object into the body, preserving the stomach’s pylorus, and avoiding dumping syndrome (2). However, there are some advantages enjoyed only by plication. Since LTGVP does not involve the removal of gastric material, it has the ability to be reversible, which could make it a more ideal surgical procedure for some patients (4). Another reported benefit of LTGVP is that it decreases the risk of fistula formation at the gastroesophageal junction. It is important to recognize that these stated surgical advantages of LTGVP rely on the operator’s competency at minimally invasive techniques, in this case to perform manual laparoscopic suturing (4). This article highlights the promise that LTGVP has shown in achieving significant weight loss and reduction of comorbid conditions. Golpaie et al. have produced a well-organized study design that involved a multidisciplinary team. The drawbacks of this study were that; only * Corresponding author: Shahzeer Karmali, Center for the Advancement of Minimally Invasive Surgery, Department of Surgery, Division of General Surgery, University of Alberta, Room 405 CSC, 10240 Kingsway Ave., AB T5H 3V9, Edmonton, Canada, Tel: +1-7807356650, Fax: +1-7807356652, E-mail: shahzeer@ualberta.ca

Volatile rapid sequence induction in morbidly obese patients

The interest in bariatric surgery is growing. Morbidly obese patients have an increased risk of hypoxia and decreased blood pressure during rapid sequence induction (RSI). Alternate RSI methods that provide cardiovascular and respiratory stability are required. With this in mind, we evaluated a method for volatile RSI in morbidly obese patients. Observational study. Thirty-four patients with mean BMI 42.4 kg m undergoing bariatric surgery (morbidly obese group) and 22 patients with mean BMI 25.6 kg m as a control group were included in the study. Anaesthesia was induced with sevoflurane, propofol, suxamethonium and alfentanil, designed to avoid respiratory and haemodynamic adverse events and to minimise depressing effect on the brain respiratory centre under ongoing RSI. Peripheral oxygen saturation (SpO2) and mean arterial blood pressure were registered before and after endotracheal intubation. In addition, two time periods were measured during RSI: spontaneous breathing time (SBT) and apnoea time. We found no significant differences between the groups. No periods of desaturation were detected. SpO2 was 100% before and after endotracheal intubation in all patients. Mean arterial pressure was maintained at a stable level in both groups. Mean SBT and apnoea time were 65.6 and 45.8 s in the morbidly obese group, and 70.7 and 47.7 s in the control group, respectively. A combination of sevoflurane, propofol, suxamethonium and alfentanil is a suitable method for RSI which maintains cardiovascular and respiratory stability in both morbidly obese and lean patients.