Comparing the use of myorelaxant agent quantity in laparoscopic sleeve gastrectomy operations with tiva, low-flow and high-flow inhalation anaesthesia

Introduction-Objective: Morbid obesity is the second most frequent cause of preventable death after smoking in the world. In the present time, surgical therapy is used effectively in morbid obesity. Drug metabolism displays variability, due to variable lean body weight (LBW), clearance and volume of distrubution in obese patients. We aimed to compare the effects of different general anesthesia management such as low-flow, high flow inhalation and total intravenous ansthesia (TIVA) on myorelaxant agents pharmacokinetics in cases of obesity patients undergoing sleeve gastrectomy. Material and Methods: The study includes 60 patients that elective Laparoscopic Sleeve Gastrectomy (LSG) was planned, with the age of between 18-65 years, ASA II-III and body mass index (BMI) between 35-55. The patients were separated into groups by sealed tender. Standard anesthesia induction was performed in all patients. After routine preoperative procedures and limitation of oral feeding for sufficient time, drug adjustments were made by considering the corrected weight (LBW) in all patients. Propofol 2 mg/kg was used in inhalation aneshesia groups and Propofol 1 mg/kg, was used in TIVA grup; Fentanyl 1 mcg/kg, Rocuronium 0.6 mg/kg were used in all groups for induction of anesthesia. Orotracheal entubation was performed in the patients with TOF count lower than %25 and mechanic ventilation used with the parameters of 6 ml/kg tidal volume, 12/dk frequency and PEEP 8 cmH2O. Sevofluran consantration in inhalation anesthesia groups and rate of propofol infusion in TIVA group (Group T, n: 20) were altered for to fixed the BIS levels between 40-60 during maintenance of anesthesia. In low-flow group (Group D, n: 20), fresh gas flow (FGF) was reduced to 1L/min after the use of 4 L/min for 15 min. In high-flow group (Group Y, n:20) FGF remained at the level of 4L/min until the end of the operation. Propofol 6-10 mg/kg/h iv infusion was administered to TIVA group. Remifentanyl 15 mcg/kg/h used in all three groups. Remifentanil infusion dose was rearranged according to blood pressure. Hemodynamical parameters of patients and depletion amount of myorelaxant and anaesthetic agents were recorded during the operation. Results: In this study, we confirmed that less amount of rocuronium was used in the low-flow and high-flow inhalation groups beside the TIVA group. There was not significant difference between low-flow and high-flow groups. Use of Remifentanyl was also higher in TIVA group.Conclusions: In the present time, low-flow anesthesia practice is used more, especially due to positive contribution on cost. Low flow anesthesia in our study reduced the amount of myorelaxant needed during operation.