Anesthesia management for the super obese: is sevoflurane superior to propofol as a sole anesthetic agent? A double-blind randomized controlled trial.

OBJECTIVE : General anesthesia in obese patients is both challenging and demand - ing.With the rates of obesity in the general popu - lation increasing, more patients undergo bariatric surgery.The aim of this study was to compare the performance, effectiveness and recovery from anesthesia of sevoflurane and propofol in combi - nation with remifentanil, with and without bispec - tral index (BIS) monitoring in super obese pa - tients undergoing bariatric surgery. PATIENTS AND METHODS: In this prospec - tive, double-blind, randomized, controlled study a total of 100 super obese patients (body mass index, BMI > 50 kg/m 2 ) 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 of anesthesia, recovery from anesthesia and post - operative 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 differ - ences between the four groups with respect to patient characteristics, comorbidities and dura - tion of surgery. The intraoperatively mean arteri - al 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 sig - nificantly shorter in both propofol groups, recov - ery from anesthesia, assessed with the Aldrete, Chung and White recovery scores, was signifi - cantly faster in sevoflurane groups. No signifi - cant 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 pa - tients because of superior hemodynamic stability and faster recovery from anesthesia. Eur opean Rev iewfor Med icaland Pharmacological Sciences