Anestesia en cirugía bariátrica / Anaesthesia for bariatric surgery

Julio 2, 2016. No. 2375 Anestesia para el súper obeso. ¿Es sevorano superior al propofol como único agente anestésico? Estudio doble ciego controlado Anesthesia management for the super obese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial. Siampalioti A1, Karavias D, Zotou A, Kalfarentzos F, Filos K. Eur Rev Med Pharmacol Sci. 2015 Jul;19(13):2493-500. Abstract OBJECTIVE: General anesthesia in obese patients is both challenging and demanding. With the rates of obesity in the general population increasing, more patients undergo bariatric surgery. The aim of this study was to compare the performance, effectiveness and recovery fromanesthesia of sevoflurane and propofol in combination with remifentanil, with and without bispectral index (BIS) monitoring in super obese patients undergoing bariatric surgery. PATIENTS AND METHODS: In this prospective, double-blind, randomized, controlled study a total of 100 super obese patients (body mass index, BMI > 50 kg/m2) undergoing bariatric surgery were randomly allocated in four groups: a sevoflurane group (n = 25), a sevoflurane with BIS monitoring group (n = 25), a propofol group (n=25) and a propofol with BIS monitoring group (n=25). Hemodynamic parameters, depth ofanesthesia, recovery from anesthesia and postoperative pain were recorded. RESULTS: The mean age of patients was 37.7 ± 9.2 years and the median BMI was 57.86 ± 9.33. There were no statistically significant differences between the four groups with respect to patient characteristics, comorbidities and duration of surgery. The intraoperatively mean arterial pressure was significantly higher in both propofol groups. No significant difference was observed between the four groups in respect to heart rate changes during anesthesia. Although the time to eye-opening and extubation was significantly shorter in both propofol groups, recovery from anesthesia, assessed with the Aldrete, Chung and White recovery scores, was significantly faster in sevoflurane groups. No significant difference was observed in postoperative pain between the four groups. CONCLUSIONS: Although both propofol and sevoflurane provide adequate general anesthesia, sevoflurane may be preferable in super obese patients because of superior hemodynamic stability and faster recovery from anesthesia. PDF Anestesia para pacientes de cirugía bariátrica. Experiencia de dos años en un hospital Suizo Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland. Lindauer B1, Steurer MP2, Müller MK3, Dullenkopf A1. BMC Anesthesiol. 2014 Dec 18;14:125. doi: 10.1186/1471-2253-14-125. eCollection 2014. Abstract BACKGROUND: In the field of anesthesia for bariatric surgery, a wide variety of recommendations exist, but a general consensus on the perioperative management of such patients is missing. We outline the perioperative experiences that we gained in the first two years after introducing a bariatric program. METHODS: The perioperative approach was established together with all relevant disciplines. Pertinent topics for the anesthesiologists were; successful airway management, indications for more invasive monitoring, and the planning of the postoperative period and deposition. This retrospective analysis was approved by the local ethics committee. Data are mean [SD]. RESULTS: 182 bariatric surgical procedures were performed (147 gastric bypass procedures (GBP; 146 (99.3%) performed laparascopically). GBP patients were 43 [10] years old, 78% female, BMI 45 [7] kg/m(2), 73% ASA physical status of 2. 42 patients (28.6%) presented with obstructive sleep apnea syndrome. 117 GBP (79.6%) patients were intubated conventionally by direct laryngoscopy (one converted to fiber-optic intubation, one aspiration of gastric contents). 32 patients (21.8%) required an arterial line, 10 patients (6.8%) a central venous line. Induction lasted 25 [16] min, the procedure itself 138 [42] min. No blood products were required. Two patients (1.4%) presented with hypothermia (<35 °C) at the end of their case. The emergence period lasted 17 [9] min. Postoperatively, 32 patients (21.8%) were transferred to the ICU (one ventilated). The other patients spent 4.1 [0.7] h in the post anesthesia care unit. 15 patients (10.2%) required take backs for surgical revision (two laparotomies). CONCLUSIONS: The physiology and anatomy of bariatric patients demand a tailored approach from both the anesthesiologist and the perioperative team. The interaction of a multi-disciplinary team is key to achieving good outcomes and a low rate of complications. KEYWORDS: Anesthesia; Bariatric surgery; Complications; Obesity PDF Comité Europeo de Enseñanza en Anestesiología Curso de Actualización en Anestesiología Anestesia por Especialidades y Simposio Anestesia y Cirugía Plástica Seguras Agosto 5-7, 2016. Tijuana BC, México Información Dr. Sergio Granados Tinajero granadosts@gmail.com  16th World Congress of Anaesthesiologists 28 August - 2 September 2016  Hong Kong Convention and Exhibition Centre World Federation of Societies of Anaesthesiologists http://wca2016.com/  Anestesiología y Medicina del Dolor 52 664 6848905 vwhizar@anestesia-dolor.org anestesia-dolor.org