Comparison of Different Anesthetic Regimens in Patients Undergoing Laparoscopic Adjustable Gastric Banding Operations: A Prospective Randomized Trial

Eglė Kontrimavičiūtė^{1, 2}, Jūratė Šipylaitė^{1, 2}, Diana Aksionova^{1, 3}, Giedrė Cincilevičiūtė⁴, Gintautas Brimas^{1, 3}

¹Faculty of Medicine, Vilnius University, ²Clinic of Anesthesiology and Reanimatology, Vilnius University Hospital Santariškių Klinikos, ³Clinic of Gastroenterology, Nefrourology and Surgery, Vilnius University Hospital Santariškių Klinikos, ⁴Department of Pulmonology and Immunology, Medical Academy, Lithuanian University of Health Sciences, Lithuania

Key words: morbid obesity; laparoscopic adjustable gastric banding operation; respiratory function; remifentanil-induced hyperalgesia; reverse Trendelenburg position.

Summary. Background and Objective. Obesity is a multisystem disorder, particularly involving the respiratory and cardiovascular systems; therefore, a multidisciplinary approach is required. In spite of widespread performance of weight reduction (bariatric) surgeries, information regarding the anesthetic care of morbidly obese patients is scarce. The aim of this study was to compare the impact of fentanyl and remifentanil on the time of recovery, breathing parameters, and postoperative pain in morbidly obese patients undergoing laparoscopic adjustable gastric banding operations.

Material and Methods. In this prospective randomized study, 66 morbidly obese patients (BMI>35 kg/m²), aged between 24 and 70 years, scheduled for a laparoscopic adjustable gastric banding operation were divided into 2 groups based on the opioid used for anesthesia: group 1 whose who received remifentanil; and group 2, fentanyl). The following parameters were recorded: peripheral blood oxygenation (SpO₂) while breathing room air at baseline and 5 minutes after preoxygenation (100%); end-tidal carbon dioxide pressure at designated time points during the procedure; time to extubation; SpO₂ in the postanesthesia care unit; and pain intensity (using the visual analogue scale); and the presence of nausea and vomiting.

Results. The time to extubation was shorter in the remifentanil group, but there was no significant difference in the time to discharge from the postanesthesia care unit. The recovery of respiratory parameters to the baseline values was better and faster in the remifentanil group. The intensity of postoperative pain was similar in both groups (VAS, <3)

Conclusions. Remifentanil showed good analgesic properties during laparoscopic gastric banding surgery. Postanesthesia recovery and return of respiratory parameters to the baseline values was faster when remifentanil was used. Postoperative pain and the rate of opioid-induced side effects after analgesia with remifentanil were similar as after anesthesia with a longer acting opioid, fentanyl. Despite the problem widely discussed in literature about remifentanil-induced hyperalgesia, no cases of analgesic overconsumption were registered in our study.

Correspondence to E. Kontrimavičiūtė, Clinic of Anesthesiology and Reanimatology, Vilnius University Hospital Santariškių Klinikos, Santariškių 2, 08661 Vilnius, Lithuania. E-mail: egle.kontrimaviciute@santa.lt

Received 3 November 2011, accepted 30 October 2012