Comparison Of Intravenous Anesthesia With Propofol And Inhalation Anesthesia With Sevoflurane On The Quality Of Anesthesia For Bariatric Surgery

BackgroundBariatric surgery is an important treatment for obese patients and is gradually developed into ambulatory surgery.But the risks of anesthesia are still significant and how to ensure the safety of perioperative anesthesia and improve the quality of anesthesia remains enormous challenge.Propofol intravenous anesthesia and sevoflurane volatile anesthesia are two commonly general anesthesia modalities and used widely in clinic.Studies have shown that it is still remained controversity about the effect of the two anesthesia modalities on postoperative nausea and vomiting,pain,pulmonary complications and quality of patient recovery in different surgeries.The management of anesthesia for bariatric surgery is also controversial and inconclusive.ObjectiveTo compare the effects of propofol intravenous anesthesia and sevoflurane inhalation anesthesia on the quality of postoperative recovery(Qo R-40 scale),anesthesia awakening time and quality,nausea and vomiting,pain,recovery of gastrointestinal motility(time to first ambulation,time to first flatus,time to first defecation,time tolerability of semiliquid food),length of postoperative hospital stay,perioperative hypoxemia,intraoperative circulation and respiratory dynamics in order to provide optimal protocols and strategies for perioperative anesthesia management in bariatric surgery.MethodsThis study was a single-center prospective randomized controlled clinical trial.With the approval of the Ethics Committee of Xijing Hospital of Air Force Military Medical University,102 obese patients who underwent laparoscopic sleeve gastrectomy from June2022 to February 2023 at Xijing Hospital were selected and randomly divided into the propofol intravenous anesthesia group(Group P)and sevoflurane inhalation anesthesia group(Group S).After routine induction in both groups,Anesthesia was maintained with propofol target-controlled infusion in Group P,and sevoflurane inhalation in Group S,respectively.Heart rate,Blood pressure,Pulse oximetry and Respiratory mechanics were recorded intraoperatively using Mindray monitors,and Pulse oximetry was monitored continuously for 2 hours after surgery using a Masimo portable oximeter.The dose of medication administered during surgery and the setting of respiratory parameters were calculated using adjusted body weight.The Primary outcome was Quality of Recovery Scale(Qo R-40)score on postoperative day 1(POD 1),then comparing with preoperative day 0(POD 0)and postoperative day 2(POD 2).Secondary outcomes:(I)Wake-up time and Aldrete score;Wake-up time refers to the time from drug withdrawal to extubation;(II)incidence of postoperative vomiting and pain,visual analogue score(VAS)of nausea and vomiting and pain: the observation time points were 1h postoperatively(T1),2h postoperatively(T2),6h postoperatively(T3),1d postoperatively(T4)and 2d postoperatively(T5);(III)Length of postoperative hospital stay,Time to first ambulation,Time to first flatus,Time to first defecation,Time tolerability of semiliquid food;(IV)The incidence of perioperative hypoxemia: arterial blood was taken after admission to the operating room(T0),half an hour after pneumoperitoneum(T1),immediately after the end of pneumoperitoneum(T2)and one hour after extubation(T3)for blood gas analysis to calculate the oxygenation index and the incidence of hypoxaemia.An oxygenation index of<300 was defined as hypoxemia.(V)Intraoperative respiratory parameters: TV,PEEP,Pplat,Compl.Results1.Comparison of indicators related to quality of anaesthesia(Ⅰ)Qo R-40: Qo R-40 scale scores were lower than POD0(Group P 183.67±11.96/Group S 187.19±8.80)in both the propofol and sevoflurane anaesthesia groups on postoperative POD1(Group P 165.62±14.55/Group S169.13±16.57)and POD2(Group P175.04±13.89/Group S 179.52±11.97,P<0.05),and increased on POD2 compared to POD1(P < 0.05),with no statistical difference in Qo R-40 scale scores at each timepoints between two groups.(Ⅱ)Wake-up time: the wake-up time was significantly shorter in the sevoflurane anesthesia group compared to the propofol anesthesia group(Group P21.13±6.36min/Group S 15.25±8.49,P<0.05),but there was no statistical difference in the Aldrete score between the two groups(Group P 10(9-10)/Group S 9(9-10),P>0.05).(Ⅲ)Nausea,vomiting and pain: VAS scores for nausea and vomiting and pain were not statistically different between the two groups at different times postoperatively(P>0.05),but a relatively high incidence of vomiting occurred in both group with no statistically difference between the two groups(Group P 74.4%/Group S 74.5%,P>0.05).(Ⅳ)Length of postoperative hospital stay,Time to first ambulation,Time to first flatus,Time to first defecation,Time tolerability of semiliquid food: There was no statistical difference between the two groups in terms of time to first ambulation(Group P15.2±3.44/Group S 16.13±7.75),time to first flatus(Group P 29.39±17.6/Group S30.07±15.82),time to first defecation(Group P 51.99±15.56/Group S 51.42±19.05)and time tolerability of semiliquid food(Group P 51.03±15.28/Group S 54.69±13.71,P>0.05).Length of hospital stay was not statistically significantly different between the two groups(Group P 63.38±2.69/Group S 64.79±5.03,P>0.05).2.Comparison of perioperative hypoxemiaIn the propofol and sevoflurane anesthesia groups,the oxygenation index were lower than the preoperative baseline levels immediately after pneumoperitoneum,immediately after the end of pneumoperitoneum and 1h after extubation(P < 0.05),and the oxygenation index were higher immediately after the end of pneumoperitoneum and 1h after extubation(P < 0.05).There was no statistical difference in the oxygenation index between the groups(P > 0.05).A high incidence of mild hypoxemia ocurred both in intraoperation and postoperation,but there was no statistical difference between the two groups [intraoperation:Group P 73.3%/Group S 77.4%,P>0.05;postoperation: Group P 66.7%/Group S 71.7%,P>0.05].Time-weighted pulse oximetry was lower in postoperation than in intraoperation in both groups(P < 0.05),but with no statistically significant difference between the two groups intraoperatively(Group P 97.78±1.63/Group S 97.58±1.34,P>0.5)and postoperatively(Group P 96.15±2.31/Group S 95.89±2.11,P>0.05).3.Comparison of respiratory mechanics-related indicatorsThere were not statistically different in the intraoperative TV(Group P534.37±55.89/Group S 549.45±68.04),PEEP(Group P 6.51±1.89/Group S 6.75±2.07),Pplat(Group P 23.29±3.82/Group S 24.20±3.14),Compl(Group P 31.35±8.18/Group S31.65±7.49)between the propofol anesthesia group and the sevoflurane inhalation anesthesia group..ConclusionIn bariatric surgery,propofol intravenous anesthesia took longer wake-up time than sevoflurane inhalation anesthesia,and high scores in Qo-R40 and Aldrete.while Low scores in PONV and pain were obtained in both groups with no statistical difference between the groups,although accompanying a high incidence of postoperative vomiting and perioperative mild hypoxemia,suggesting that both anesthetic drugs can be safely used in bariatric surgery and that satisfactory quality of anesthesia can be obtained,which provides a guarantee for rapid recovery from bariatric surgery.