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Kamal FA, Fernet LY, Da Silva NK, Briceño G, Iyoob N, Aleman Paredes K, Martinez Ramirez M, Arruarana VS. Comparing Perioperative Outcomes of Total Intravenous Anesthesia (TIVA) With Volatile Anesthesia in Patients With Obesity: A Systematic Review. Cureus 2024; 16:e54094. [PMID: 38487133 PMCID: PMC10937615 DOI: 10.7759/cureus.54094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
In this systematic review, the perioperative outcomes of total intravenous anesthesia (TIVA) and volatile anesthesia were compared in obese adults (BMI ≥ 30 kg/m²) undergoing elective surgery. The review analyzed data from 12 randomized-controlled trials involving 935 patients, sourced from PubMed/MEDLINE (Medical Literature Analysis and Retrieval System Online), Cochrane, Scopus, and Web of Science databases. The focus was on intraoperative vital signs, emergence time, postoperative nausea and vomiting (PONV), duration of post-anesthesia care unit (PACU) stay, and ICU admission rates. Findings showed that TIVA (using propofol) might reduce PONV, but there were no significant differences in other outcomes compared to volatile anesthesia (with desflurane as the most common agent). The review highlights the need for more research, especially comparing sevoflurane with TIVA, to establish clear clinical guidelines for anesthesia in obese patients.
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Affiliation(s)
- Faiza A Kamal
- General Practice, University of Nottingham, Nottingham, GBR
| | - Lucas Y Fernet
- General Practice, University of Nottingham, Nottingham, GBR
| | | | - Gabriela Briceño
- Obstetrics and Gynecology, Universidad de Oriente Núcleo de Anzoátegui, Barcelona, VEN
| | - Nusrath Iyoob
- Internal Medicine, Vinnytsia National Pirogov Medical University, Vinnytsya, UKR
| | - Kenneth Aleman Paredes
- Surgery, Hospital General Regional IMSS (Instituto Mexicano del Seguro Social) No. 220 "General José Vicente Villada", Toluca, MEX
| | | | - Victor S Arruarana
- Internal Medicine, Brookdale University Hospital Medical Center, New York City, USA
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Goertz L, Stavrinou P, Hamisch C, Perrech M, Czybulka DM, Mehdiani K, Timmer M, Goldbrunner R, Krischek B. Impact of Obesity on Complication Rates, Clinical Outcomes, and Quality of Life after Minimally Invasive Transforaminal Lumbar Interbody Fusion. J Neurol Surg A Cent Eur Neurosurg 2020; 82:147-153. [PMID: 33352610 DOI: 10.1055/s-0040-1718758] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Percutaneous pedicle screw fixation in obese patients remains a surgical challenge. We aimed to compare patient-reported outcomes and complication rates between obese and nonobese patients who were treated by minimally invasive transforaminal lumbar interbody fusion (MIS-TLIF). METHODS The authors retrospectively reviewed patients who underwent MIS-TLIF at a single institution between 2011 and 2014. Patients were classified as obese (body mass index [BMI] ≥30 kg/m2) or nonobese (BMI < 30 kg/m2), according to their BMI. Outcomes assessed were complications, numerical rating scale (NRS) scores for back and leg pain, Oswestry Disability Index (ODI), and 36-Item Short-Form Survey (SF-36) scores. RESULTS The final study group consisted of 71 patients, 24 obese (33.8%, 34.8 ± 3.8 kg/m2) and 47 nonobese (66.2%, 25.4 ± 2.9 kg/m2). Instrumentation failures (13.6 vs. 17.0%), dural tears (17.2 vs. 4.0%), and revision rates (16.7 vs. 19.1%) were similar between both groups (p > 0.05). Perioperative improvements in back pain (4.3 vs. 5.4, p = 0.07), leg pain (3.8 vs. 4.2, p = 0.6), and ODI (13.3 vs. 22.5, p = 0.5) were comparable among the groups and persisted at long-term follow-up. Obese patients had worse postoperative physical component SF-36 scores than nonobese patients (36.4 vs. 42.7, p = 0.03), while the mental component scores were not statistically different (p = 0.09). CONCLUSION Obese patients can achieve similar improvement of the pain intensity and functional status even at long-term follow-up. In patients with appropriate surgical indications, obesity should not be considered a contraindication for MIS-TLIF surgery.
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Affiliation(s)
- Lukas Goertz
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Pantelis Stavrinou
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Christina Hamisch
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Moritz Perrech
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Dierk-Marko Czybulka
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Kaveh Mehdiani
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Marco Timmer
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Roland Goldbrunner
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
| | - Boris Krischek
- Center for Neurosurgery, University Hospital Cologne, Cologne, Nordrhein-Westfalen, Germany
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Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Undergoing Bariatric Surgery-a Meta-Analysis of Randomized Controlled Trials. Obes Surg 2018; 27:3031-3039. [PMID: 28916989 DOI: 10.1007/s11695-017-2929-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Early and clear recovery from anesthesia is the crux for preventing perioperative complications in the obese undergoing bariatric surgery. Volatile inhalation agents by virtue of high lipid solubility are expected to produce residual anesthetic effects. Prospective randomized trials comparing desflurane and sevoflurane used for anesthesia maintenance (electroencephalograph guided) during bariatric surgery published till 1st of July 2017 were searched in the medical database. Comparisons were made for surrogate markers of recovery from anesthesia that included time to eye-opening (TEo), time to tracheal-extubation (TEx), and Aldrete scores on immediately shifting to recovery (Ald-I). Five trials were included in the final analysis. Patients receiving desflurane began to respond faster by opening eyes on command (five trials) by 3.80 min (95%CI being 1.83-5.76) (random effects, P < 0.01, I2 = 78.61%), and tracheal extubation was also performed earlier (four trials) by 4.97 min (95%CI being 1.34-8.59). This meant a reduction of 37% in TEo and 33.60% in TEx over sevoflurane. Ald-I scores were higher/better with desflurane by 0.52 (95%CI being 0.19-0.84) (Fixed-effects, P < 0.01, I2 = 6.67%). Publication bias is likely for TEo (Egger's Test, X-intercept = - 8.57, P = 0.02). No airway-related complications were reported with desflurane's expedited recovery. Use of desflurane compared to sevoflurane for maintenance of anesthesia in morbidly obese patients allows attaining verbal contact faster, and tracheal extubating can be performed earlier without compromising safety. The benefits of better recovery extend into the immediate postoperative phase with patients being more awake upon shifting to the recovery.
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Boodaie BD, Bui AH, Feldman DL, Brodman M, Shamamian P, Kaleya R, Rosenblatt M, Somerville D, Kischak P, Leitman IM. A perioperative care map improves outcomes in patients with morbid obesity undergoing major surgery. Surgery 2017; 163:450-456. [PMID: 29195738 DOI: 10.1016/j.surg.2017.09.047] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Revised: 09/05/2017] [Accepted: 09/27/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND The surgical management of patients with morbid obesity (body mass index ≥ 40) is notable for a relatively high risk of complications. To address this problem, a perioperative care map was developed using precautions and best practices commonly employed in bariatric surgery. It requires additional medical assessments, sleep apnea surveillance, more stringent guidelines for anesthetic management, and readily available bariatric operating room equipment, among other items. This care map was implemented in 2013 at 4 major urban teaching hospitals for use in patients undergoing all types of nonambulatory surgery with a body mass index greater than 40 kg/m2. The impact on patient outcomes was evaluated. METHODS The American College of Surgeons National Surgical Quality Improvement Program database was used to compare 30-day outcomes of morbidly obese patients before the year 2013 and after the years 2015 care-map implementation. In addition, trends in 30-day outcomes for morbidly obese patients were compared with those for non-obese patients. RESULTS Morbidly obese patients, between 2013 and 2015, saw an adjusted decrease in the rate of unplanned return to the operating room (OR = 0.49; P = .039), unplanned readmission (OR = 0.57; P = .006), total duration of stay (-0.87 days; P = .009), and postoperative duration of stay (-0.69 days; P = .007). Of these, total duration of stay (-0.86 days; P = .015), and postoperative duration of stay (-0.69 days; P = .012) improved significantly more for morbidly obese patients than for nonmorbidly obese patients. CONCLUSION Outcomes in morbidly obese patients improved from 2013 to 2015. Implementation of a perioperative care map may have contributed to these improvements. The care map should be further investigated and considered for more widespread use.
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Affiliation(s)
| | - Anthony H Bui
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - David L Feldman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY; Hospitals Insurance Company, New York, NY
| | - Michael Brodman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Peter Shamamian
- Montefiore Medical Center Albert Einstein College of Medicine, Surgery, Bronx, NY
| | - Ronald Kaleya
- Maimonides Medical Center, Department of Surgery, Brooklyn, NY
| | - Meg Rosenblatt
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
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Mecoli M, Kandil A, Campion M, Samuels P. Pediatric Obesity: Anesthetic Implications and Perioperative Considerations for Weight Loss Surgery. CURRENT ANESTHESIOLOGY REPORTS 2017. [DOI: 10.1007/s40140-017-0211-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Solsky I, Edelstein A, Brodman M, Kaleya R, Rosenblatt M, Santana C, Feldman DL, Kischak P, Somerville D, Mudiraj S, Leitman IM, Shamamian P. Perioperative care map improves compliance with best practices for the morbidly obese. Surgery 2016; 160:1682-1688. [PMID: 27622571 DOI: 10.1016/j.surg.2016.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Revised: 07/19/2016] [Accepted: 07/23/2016] [Indexed: 01/21/2023]
Abstract
BACKGROUND Morbid obesity can complicate perioperative management. Best practice guidelines have been published but are typically followed only in bariatric patients. Little is known regarding physician awareness of and compliance with these clinical recommendations for nonbariatric operations. Our study evaluated if an educational intervention could improve physician recognition of and compliance with established best practices for all morbidly obese operatively treated patients. METHODS A care map outlining best practices for morbidly obese patients was distributed to all surgeons and anesthesiologists at 4 teaching hospitals in 2013. Pre- and postintervention surveys were sent to participants in 2012 and in 2015 to evaluate changes in clinical practice. A chart audit performed postintervention determined physician compliance with distributed guidelines. RESULTS In the study, 567 physicians completed the survey in 2012 and 375 physicians completed the survey in 2015. Postintervention, statistically significant improvements were seen in the percentage of surgeons and anesthesiologists combined who reported changing their management of morbidly obese, operatively treated patients to comply with best practices preoperatively (89% vs 59%), intraoperatively (71% vs 54%), postoperatively (80% vs 57%), and overall (88% vs 72%). Results were similar when surgeons and anesthesiologists were analyzed separately. A chart audit of 170 cases from the 4 hospitals found that 167 (98%) cases were compliant with best practices. CONCLUSION After care map distribution, the percentage of physicians who reported changing their management to match best practices significantly improved. These findings highlight the beneficial impact this educational intervention can have on physician behavior. Continued investigation is needed to evaluate the influence of this intervention on clinical outcomes.
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Affiliation(s)
- Ian Solsky
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY
| | - Alex Edelstein
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Michael Brodman
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Ronald Kaleya
- Department of Surgery, Maimonides Medical Center, Brooklyn, NY
| | - Meg Rosenblatt
- Icahn School of Medicine at Mount Sinai, Surgery, New York, NY
| | - Calie Santana
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY
| | | | | | | | | | | | - Peter Shamamian
- Montefiore Medical Center/Albert Einstein College of Medicine, Surgery, Bronx, NY.
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Optimal Drug Dosing in the Obese--Still Many Years Ahead. Obes Surg 2015. [PMID: 26224374 DOI: 10.1007/s11695-015-1826-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Friesen JHP. Lean Body Weight Is Not a Weight Scalar for Estimating Drug Doses in Morbid Obesity. Obes Surg 2015; 25:1496-7. [DOI: 10.1007/s11695-015-1758-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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