Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial
Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients....
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-12-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/11/1/162 |
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| author | Yu-Ming Wu Yen-Hao Su Shih-Yu Huang Po-Han Lo Jui-Tai Chen Hung-Chi Chang Yun-Ling Yang Yih-Giun Cherng Hsiang-Ling Wu Ying-Hsuan Tai |
| author_facet | Yu-Ming Wu Yen-Hao Su Shih-Yu Huang Po-Han Lo Jui-Tai Chen Hung-Chi Chang Yun-Ling Yang Yih-Giun Cherng Hsiang-Ling Wu Ying-Hsuan Tai |
| author_sort | Yu-Ming Wu |
| collection | DOAJ |
| description | Obesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m<sup>−2</sup> undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): −129 s; 95% confidence interval (CI): −211, −46], obeying commands (−160; −243, −77), tracheal extubation (−172; −266, −78), and leaving operating room (−148; −243, −54). M-Entropy guidance further reduced time to eye opening (MD: −142 s; 99.2% CI: −276, −8), tracheal extubation (−199; −379, −19), and leaving operating room (−190; −358, −23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: −0.275 (95% CI: −0.464, −0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation. |
| first_indexed | 2024-03-10T03:35:55Z |
| format | Article |
| id | doaj.art-a4802115ec0d40e3975f6a7598b0a69c |
| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-10T03:35:55Z |
| publishDate | 2021-12-01 |
| publisher | MDPI AG |
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| series | Journal of Clinical Medicine |
| spelling | doaj.art-a4802115ec0d40e3975f6a7598b0a69c2023-11-23T11:44:35ZengMDPI AGJournal of Clinical Medicine2077-03832021-12-0111116210.3390/jcm11010162Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled TrialYu-Ming Wu0Yen-Hao Su1Shih-Yu Huang2Po-Han Lo3Jui-Tai Chen4Hung-Chi Chang5Yun-Ling Yang6Yih-Giun Cherng7Hsiang-Ling Wu8Ying-Hsuan Tai9Department of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDivision of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanDepartment of Anesthesiology, Taipei Veterans General Hospital, Taipei 11217, TaiwanDepartment of Anesthesiology, Shuang Ho Hospital, Taipei Medical University, New Taipei City 23561, TaiwanObesity increases the risk of prolonged emergence from general anesthesia due to the delayed release of anesthetic agents from body fat. This trial aimed to evaluate the effects of sevoflurane and desflurane along with anesthetic depth monitoring on emergence time from anesthesia in obese patients. Adults with a body mass index ≥ 30 kg·m<sup>−2</sup> undergoing laparoscopic sleeve gastrectomy at a medical center were randomized into four groups: sevoflurane or desflurane anesthesia with or without M-Entropy guidance on anesthetic depth in a ratio of 1:1:1:1. In the M-Entropy guidance groups, the dosage of sevoflurane and desflurane was adjusted to achieve response and state entropy values between 40 and 60 during surgery. In the non-M-Entropy guidance groups, the dosage of anesthetics was titrated according to clinical signs. Primary outcome was time to spontaneous eye opening. A total of 80 participants were randomized. Compared to sevoflurane, desflurane anesthesia significantly reduced the time to spontaneous eye opening [mean difference (MD): −129 s; 95% confidence interval (CI): −211, −46], obeying commands (−160; −243, −77), tracheal extubation (−172; −266, −78), and leaving operating room (−148; −243, −54). M-Entropy guidance further reduced time to eye opening (MD: −142 s; 99.2% CI: −276, −8), tracheal extubation (−199; −379, −19), and leaving operating room (−190; −358, −23) in the desflurane but not the sevoflurane group. M-Entropy guidance significantly reduced the risk of agitation during emergence, i.e., risk difference: −0.275 (95% CI: −0.464, −0.086); and number needed to treat: 4. Compared to sevoflurane, using desflurane to maintain general anesthesia accelerated the return of consciousness in obese patients. M-Entropy guidance further hastened awakening in patients using desflurane and prevented emergence agitation.https://www.mdpi.com/2077-0383/11/1/162bariatric surgerydepth of anesthesiaelectroencephalographic monitoringemergence agitationmorbid obesity |
| spellingShingle | Yu-Ming Wu Yen-Hao Su Shih-Yu Huang Po-Han Lo Jui-Tai Chen Hung-Chi Chang Yun-Ling Yang Yih-Giun Cherng Hsiang-Ling Wu Ying-Hsuan Tai Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial Journal of Clinical Medicine bariatric surgery depth of anesthesia electroencephalographic monitoring emergence agitation morbid obesity |
| title | Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial |
| title_full | Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial |
| title_fullStr | Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial |
| title_full_unstemmed | Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial |
| title_short | Recovery Profiles of Sevoflurane and Desflurane with or without M-Entropy Guidance in Obese Patients: A Randomized Controlled Trial |
| title_sort | recovery profiles of sevoflurane and desflurane with or without m entropy guidance in obese patients a randomized controlled trial |
| topic | bariatric surgery depth of anesthesia electroencephalographic monitoring emergence agitation morbid obesity |
| url | https://www.mdpi.com/2077-0383/11/1/162 |
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