Abstract
Background
general anesthesia and mechanical ventilation impair pulmonary function, even in normal individuals, and results in decreased oxygenation in the post anesthesia period. They also cause a reduction in functional residual capacity of up to 50% of the pre anesthesia value. It has been shown that pulmonary atelectasis is a common finding in anesthetized individuals because it occurs in 85% to 90% of healthy adults.
Aim of the Work: Study of the effect of anesthesia and analgesia on control of breathing after bariatric surgery.
Patients and Methods
study design: Systemic Review and Meta-analysis study. Published studies and abstracts concerning prevention and management of complications associated with patient positioning during surgeries were identified through a comprehensive search of electronic databases that will include PubMed (www.ncbi.nlm.nih.gov./entrez/query.fcgi), ScienceDirect (www.sciencedirect.com), Scirus (www.scirus.com/srsapp), ISI Web of Knowledge (http://www.isiwebofknowledge.com), Google Scholar (http://scholar.google. com) and CENTRAL (Cochrane Central Register of Controlled Trials (http://www. mrw.interscience.wiley.com/cochrane/cochrane_clcentral_articles_fs.htm), using a combination of the following key words: “Anesthesia”, “analgesia”, “respiratory outcome” and “morbid obese”.
Results
our initial search yielded 98 citations. Based on the screening criteria for titles and abstracts, 47 citations were excluded. After reviewing the full text of the remaining 52 reports, only 17 eligible RCTs fit our inclusion criteria and were selected for the study. All studies were published in English during 2000 to 2017, and the sample sizes ranged from 28 to 90 patients. Among these studies 50 obese patients were elevated and reported distinct outcome measurements. In all trials, the recruited patients were American Society of Anesthesiologists (ASA) status I–III who underwent general anesthesia with endotracheal intubation. In addition, in all trials the patients underwent elective bariatric operations. The mean BMI of the patients ranged from 37.7 to 54.0 kg/m2.
Conclusion
our meta-analysis indicated that recovery was significantly faster in the desflurane groups than in the sevoflurane, isoflurane, and propofol groups in obese adult patients who underwent bariatric surgery. Although no clinically relevant difference was observed in the PACU discharge time, or postoperative pain scores, patients who were given desflurane exhibited higher oxygen saturation on entry to or during stays in the PACU. Thus, in morbidly obese patients, we suggest that desflurane should be considered as the inhaled anesthetic because of its more rapid and consistent recovery profile.
Correction to: How Does Fat Mass Change in the First Year After Bariatric Surgery? A Systemic Review and Meta-Analysis