FAST-TRACK ANAESTHESIA DURING THE ABDOMINAL SURGERY IN PATIENTS WITH OBESITY
Keywords:
obesity, fast-track anesthesia, anesthesia technologyAbstract
For implementation of the fast-track surgery concept during abdominal surgery in patients with obesity may be used neuraxial blockade in combination with an inhaled anesthetic. Objective. To evaluate the effect of combined inhaled-epidural anesthesia on the velocity of the post-operative recovery and the occurrence of complications in obese patients undergoing surgery on the abdominal cavity and the abdominal wall. Materials and methods. Depending on the technology of anesthesia 56 patients with a BMI of (37±6) kg/m2, undergoing elective abdominal surgery ((176±35) min duration) were divided into 2 groups: combined inhaled-epidural anesthesia (CIEA) group (n=28) and total intravenous anesthesia (TIVA) group, n=28. Main outcome measures: time of extubation, adequacy of analgesia, ileus recovery time, complications, duration of the hospital stay. Statistical analysis was performed using Student’s t-test, χ2 test and Fisher exact test. Results. The extubation time was (18±10) min in CIEA-group and (37±14) min in TIVA-group (p<0.05). The intensity of pain was less than 4 points in 100% of CIEA-patients and in 14 (50%) of TIVA-patients (p<0.05). The recovery of ileus happened on the 1st day at 10 patients (36%) of CIEA-group and 0 patient of TIVA-group (p<0.05), on the 2nd day — at 15 patients (54%) of CIEA-group and 11 patients (39%) of TIVA-group (p>0.05), on the 3rd day — at 3 patients (10%) of CIEA-group and 12 patients (43%) of TIVA-group (p>0.05). Duration of hospital stay wasn’t significantly different between groups ((7.9±2.2) days (CIEA) and (8.4±3.1) days (TIVA), p>0.05). Only respiratory complications were more frequent in TIVA-group than in CIEA-group: 12 vs 3 respectively, ARR=0.135, 95% CI=-0.11 to +0.282, p<0.05. Conclusions. Combined inhalation-epidural anesthesia as the technology of fast-track anesthesia for major abdominal surgery in patients with obesity contributes to early extubation of patients, provides adequate post-operative analgesia and reduces the number of pulmonary complications.
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