Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study

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dc.contributor.authorSudré, Eliana C. M.
dc.contributor.authorde Batista, Priscila R.
dc.contributor.authorCastiglia, Yara M. M. [UNESP]
dc.contributor.institutionVVH Medical Center
dc.contributor.institutionUniversidade Federal do Espírito Santo (UFES)
dc.contributor.institutionUniversidade Estadual Paulista (Unesp)
dc.date.accessioned2015-12-07T15:31:24Z
dc.date.available2015-12-07T15:31:24Z
dc.date.issued2015
dc.description.abstractWe compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.en
dc.description.affiliationDepartment of Anesthesiology, VVH Medical Center, Vila Velha, ES, Brazil
dc.description.affiliationDepartment of Physiotherapy, VVH Medical Center, Universidade Federal do Espírito Santo, Vitória, ES, Brazil
dc.description.affiliationDepartment of Anesthesiology, UNESP—Universidade Estadual Paulista, Botucatu, SP, Brazil
dc.description.affiliationUnespDepartment of Anesthesiology, UNESP-Universidade Estadual Paulista, Botucatu, SP, Brazil.
dc.format.extent2205-2212
dc.identifierhttp://dx.doi.org/10.1007/s11695-015-1855-8
dc.identifier.citationObesity Surgery, v. 25, n. 11, p. 2205-2212, 2015.
dc.identifier.doi10.1007/s11695-015-1855-8
dc.identifier.issn1708-0428
dc.identifier.pubmed26374138
dc.identifier.urihttp://hdl.handle.net/11449/131077
dc.language.isoeng
dc.publisherSpringer
dc.relation.ispartofObesity Surgery
dc.rights.accessRightsAcesso restrito
dc.sourcePubMed
dc.subjectAnesthesiaen
dc.subjectBariatric surgeryen
dc.subjectObesityen
dc.subjectPostoperative complicationsen
dc.titleLonger immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort studyen
dc.typeArtigo
dcterms.rightsHolderSpringer
unesp.campusUniversidade Estadual Paulista (Unesp), Faculdade de Medicina, Botucatupt

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