Randomized comparison of isoflurane and sevoflurane for laparoscopic gastric
banding in morbidly obese patients.
Author(s): Torri G, Casati A, Albertin A, Comotti L, Bignami E, Scarioni M, Paganelli M.
Affiliation(s): Department of Anesthesiology and Department of General Surgery, Vita-Salute
University of Milan, IRCCS H San Raffaele, Via Olgettina, Milan, Italy.
Publication date & source: 2001, J Clin Anesth. , 13(8):565-70
STUDY OBJECTIVE: To compare the efficacy and recovery profile of sevoflurane and
isoflurane as the main anesthetics for morbidly obese patients.
DESIGN: Randomized, blinded study.
SETTING: Inpatients.
PATIENTS: 30 ASA physical status II and III obese patients [body mass index (BMI)
> 35 kg/m(2)] undergoing laparoscopic gastric banding for morbid obesity.
INTERVENTIONS: After standard intravenous induction of general anesthesia and
tracheal intubation, anesthesia was maintained with either sevoflurane or
isoflurane as the main anesthetics. The end-tidal concentrations of the volatile
drugs were adjusted to maintain systolic arterial blood pressure within +/-20%
from baseline values. When the surgeon started the skin suture, the end-tidal
concentration of the inhalational drug was reduced to 0.5 minimum alveolar
concentration in both groups. At the last skin suture, the inhalational drug was
discontinued and the vaporizator was removed to allow blinded evaluation of the
emergence times.
MEASUREMENTS AND MAIN RESULTS: No differences in anesthetic exposure, hemodynamic
parameters, incidence of untoward events, or postoperative pain relief were
reported between the two groups. Extubation, emergence, and response times were
shorter after sevoflurane [6 min (3-15 min), 8 min (5-18 min), and 12 (6-25 min)]
than isoflurane [10 min (6-26 min), 14 min (6-21 min), and 21 min (14-41 min)] (p
= 0.001, p = 0.03, and p = 0.0005, respectively). The median time for
postanesthesia care unit discharge was 15 minutes (25th-75th percentiles: 10-18
min) after sevoflurane and 27 minutes (25th-75th percentiles: 20-30 min) after
isoflurane (p = 0.0005).
CONCLUSIONS: Sevoflurane provides a safe and effective intraoperative control of
cardiovascular homeostasis in morbidly obese patients undergoing laparoscopic
gastric banding, with the advantage of a faster recovery and earlier discharge
from the postanesthesia care unit than isoflurane.
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