Postoperative recovery after anesthesia in morbidly obese patients

a systematic review and meta-analysis of randomized controlled trials

研究成果: 雜誌貢獻文章

16 引文 (Scopus)

摘要

Purpose: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. Source: We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). Principal findings: We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] −3.10 min; 95% confidence interval (CI): −5.13 to −1.08), to squeeze the investigator’s hand (WMD −7.83 min; 95% CI: −8.81 to −6.84), to be prepared for tracheal extubation (WMD −3.88 min; 95% CI: −7.42 to −0.34), and to state their name (WMD −7.15 min; 95% CI: −11.00 to −3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. Conclusion: Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).
原文英語
頁(從 - 到)907-917
頁數11
期刊Canadian Journal of Anesthesia
62
發行號8
DOIs
出版狀態已發佈 - 八月 23 2015

指紋

Meta-Analysis
Anesthesia
Randomized Controlled Trials
Postoperative Nausea and Vomiting
Airway Extubation
Confidence Intervals
General Anesthesia
Isoflurane
Propofol
Names
Hand
Incidence
Airway Obstruction
Postoperative Pain
PubMed
Analgesics
Research Personnel
Parturition
Databases
desflurane

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

引用此文

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title = "Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials",
abstract = "Purpose: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. Source: We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). Principal findings: We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] −3.10 min; 95{\%} confidence interval (CI): −5.13 to −1.08), to squeeze the investigator’s hand (WMD −7.83 min; 95{\%} CI: −8.81 to −6.84), to be prepared for tracheal extubation (WMD −3.88 min; 95{\%} CI: −7.42 to −0.34), and to state their name (WMD −7.15 min; 95{\%} CI: −11.00 to −3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. Conclusion: Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).",
author = "Liu, {Feng Lin} and Yih-Giun Cherng and Chen, {Shin Yan} and Yen-Hao Su and Huang, {Shih Yu} and Lo, {Po Han} and Lee, {Yen Ying} and Ka-Wai Tam",
year = "2015",
month = "8",
day = "23",
doi = "10.1007/s12630-015-0405-0",
language = "English",
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pages = "907--917",
journal = "Canadian Journal of Anaesthesia",
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T1 - Postoperative recovery after anesthesia in morbidly obese patients

T2 - a systematic review and meta-analysis of randomized controlled trials

AU - Liu, Feng Lin

AU - Cherng, Yih-Giun

AU - Chen, Shin Yan

AU - Su, Yen-Hao

AU - Huang, Shih Yu

AU - Lo, Po Han

AU - Lee, Yen Ying

AU - Tam, Ka-Wai

PY - 2015/8/23

Y1 - 2015/8/23

N2 - Purpose: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. Source: We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). Principal findings: We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] −3.10 min; 95% confidence interval (CI): −5.13 to −1.08), to squeeze the investigator’s hand (WMD −7.83 min; 95% CI: −8.81 to −6.84), to be prepared for tracheal extubation (WMD −3.88 min; 95% CI: −7.42 to −0.34), and to state their name (WMD −7.15 min; 95% CI: −11.00 to −3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. Conclusion: Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).

AB - Purpose: Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia. Source: We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV). Principal findings: We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] −3.10 min; 95% confidence interval (CI): −5.13 to −1.08), to squeeze the investigator’s hand (WMD −7.83 min; 95% CI: −8.81 to −6.84), to be prepared for tracheal extubation (WMD −3.88 min; 95% CI: −7.42 to −0.34), and to state their name (WMD −7.15 min; 95% CI: −11.00 to −3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement. Conclusion: Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).

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