Volatile anesthesia in bariatric surgery

Background: Obesity causes anesthesiologists a broad variety of perioperative theoretical and practical problems. The aim of this study was to compare two protocols of anesthesia employing Isoflurane and Sevoflurane and evaluate the cardiorespiratory parameters, postoperative recovery and analgesia. Methods: 90 patients underwent biliopancreatic diversion. 60 patients (group A) received Isoflurane and 30 patients (group B) were anesthetized with Sevoflurane. Intraoperative monitoring consisted of EKG, invasive arterial pressure, SpO2, EtCO2, Etanest, Spirometry, urinary output and TOF. Cardiorespiratory parameters and end tidal expiratory concentrations of volatile agents were collected during specific phases of surgery: 1) before induction of anesthesia, 2) after intubation, 3) after skin incision, 4) after positioning of costal retractors, 5) in the reverse Trendelenburg position, 6) end of surgery. During the postoperative period the Aldrete test was carried out to evaluate the recovery from anesthesia. VAS was administered for 6 hours after the end of surgery to set the quality of analgesia. Results: No statistically significant differences in cardiorespiratory parameters were found between the two groups. Extubation time was significantly less in the Sevoflurane Group than in the Isoflurane (15 ± 7 min vs 24 ± 5 min, p< 0.05). The Sevoflurane Group showed an Aldrete score significantly higher than the Isoflurane (8.8 ± 0.3 vs 8.1 ± 0.4, p < 0.05). VAS values did not show statistical differences. Conclusion: The introduction of Sevoflurane, a volatile agent with rapid pharmacokinetic properties, seems to offer an interesting application in these patients.