Intraoperative awareness during laparoscopic sleeve gastrectomy

Year 2021, Volume: 7 Issue: 4, 380 - 385, 04.07.2021

Ozan Şen , Fatih Can Karaca , Seniyye Zengin , Ahmet Türkçapar

https://doi.org/10.18621/eurj.811379

Cited By: 2

Abstract

Objectives: The aim of this study is to determine the incidence of intraoperative awereness (IA) in our patients who underwent laparoscopic sleeve gastrectomy (LSG) and the factors affecting the formation of this complication.

Methods: Four hundred ten patients who underwent LSG between March 2018 and September 2020 were included in the study. By April 2019, we started using the Bispectral index (BIS) monitoring, which measures the depth of anesthesia in all of our LSG cases (n = 167). Patients with and without BIS monitorization were divided into two groups and compared.

Results: In our series, IA was seen in 3 patients (2 males) in two different hospitals (0.7%; n = 410). They were all in the non BIS group (n = 243). The median duration of anesthesia was 120 minutes (ranging 90-180) in the non-BIS, and 113 minutes (ranging, 90-140) in the BIS group (p < 0.001). Hypotension developed in 63 patients in non-BIS and 12 patients in BIS group at the beginning of the operation (< 90/60 mm Hg). The total remifentanil infusion dose administered during the anesthesia period in the BIS group was 1310 ± 351 mcg, and 1330 ± 270 mcg in the non BIS group (p = 0.002). The effect of BIS monitorization between groups on IA, did not show statistical significance (p = 0.27).

Conclusions: Anesthesia techniques that work well for patients with normal weight may not be safe and appropriate for obese patients. Especially in patients with intraoperative hypotension, it is necessary to be more careful about dose adjustment of anesthetic drugs.

Keywords

Bariatric surgery, sleeve gastrectomy, general anesthesia, complication, intraoperative awareness

References

• 1. English WJ, DeMaria EJ, Brethauer SA, Mattar SG, Rosenthal RJ, Morton JM. American Society for Metabolic and Bariatric Surgery estimation of metabolic and bariatric procedures performed in the United States in 2016. Surg Obes Relat Dis 2018;14:259-63.
• 2. Green B, Duffull SB. What is the best size descriptor to use for pharmacokinetic studies in the obese? Br J Clin Pharmacol 2004;58:119-33.
• 3. Morgan DJ, Bray KM. Lean body mass as a predictor of drug dosage. Implications for drug therapy. Clin Pharmacokinet 1994;26:292-307.
• 4. Ingrande J, Brodsky JB, Lemmens HJ. Lean body weight scalar for the anesthetic induction dose of propofol in morbidly obese subjects. Anesth Analg 2011;113:57-62.
• 5. Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth 2010;105(Suppl 1):i16-23.
• 6. Nightingale CE, Margarson MP, Shearer E, Redman JW, Lucas DN, Cousins JM, et al. Peri-operative management of the obese surgical patient 2015: Association of Anaesthetists of Great Britain and Ireland Society for Obesity and Bariatric Anaesthesia. Anaesthesia 2015;70:859-76.
• 7. Moerman N, Bonke B, Oosting J. Awareness and recall during general anesthesia. Anesthesiology 1993;79:454-64.
• 8. Osterman JE, Van der Kolk A. Awareness during anesthesia and posttraumatic stress disorder. Gen Hosp Psychiatry 1998;50:274-8.
• 9. Domino KB, Posner KL, Caplan RA, Cheney FW. Awareness during anesthesia: a closed claims analysis. Anesthesiology 1999;90:1053-61.
• 10. Sebel P, Bowdle T, Ghoneim M, Rampil I, Padilla R, Gan T, et al. The incidence of awareness during anesthesia: a multicenter United States study. Anesth Analg 2004;99:833-9.
• 11. Paech MJ, Scott KL, Clavisi O, Chua S, McDonnell N, The ANZA Trials Group. A prospective study of awareness and recall associated with general anaesthesia for Caesarean section. Int J Obstet Anesth 2008;17:298-303.
• 12. Ranta S, Jussila J, Hynynen M. Recall of awareness during cardiac anaesthesia: influence of feedback information to the anaesthesiologist. Acta Anaesthesiol Scand 1996;40:554-60.
• 13. Ghoneim MM, Block RI, Haffarnan M, Mathews MJ. Awareness during anesthesia: risk factors, causes and sequelae: a review of reported cases in the literature. Anesth Analg 2009;108:527-35.
• 14. Pandit JJ, Andrade J, Bogod DG, Hitchman JM, Jonker WR, Lucas N, et al.; Royal College of Anaesthetists; Association of Anaesthetists of Great Britain and Ireland. The 5th National Audit Project (NAP5) on accidental awareness during general anaesthesia: protocol, methods and analysis of data. Anaesthesia 2014;69:1078-88.
• 15. Subramani Y, Riad W, Chung F, Wong J. Optimal propofol induction dose in morbidly obese patients: A randomized controlled trial comparing the bispectral index and lean body weight scalar. Can J Anesth 2017;64:471-9.
• 16. Cao Y-H, Chi P, Zhao Y-X, Dong X-C. Effect of bispectral index-guided anesthesia on consumption of anesthetic and eraly postoperative cognitive dysfunction after liver transplantation. Medicine 2017:96:e7966.
• 17. Punjasawadwong Y, Boonjeungmonkol N, Phongchiewboon A. Bispectral index for improving anaesthetic delivery and postoperative recovery. Cochrane Database Syst Rev 2007;4:CD003843- CD003843
• 18. Myles PS, Leslie K, McNeil J, Forbes A, Chan MT. Bispectral index monitoring to prevent awareness during anaesthesia: the B-Aware randomised controlled trial. Lancet 2004;363:1757-63