Bispectral Index (BIS) monitoring in morbidly obese patients undergoing gastric bypass surgery: experience in 23 patients.
BACKGROUND
Early and uneventful postoperative recovery of morbidly obese patients remains a challenge for anesthesiologists. BIS monitoring is useful in providing fast recovery.


METHODS
We describe the anesthetic management of 23 morbidly obese patients who underwent elective open Roux-en-Y gastric bypass (RYGBP) for morbid obesity. Thoracic epidural analgesia combined with light general anesthesia with propofol and nitrous oxide adjusted to keep the bispectral index (BIS) around 60 was performed. Intraoperative hemodynamic stability, early and intermediate recovery and patient satisfaction were assessed.


RESULTS
The cardiovascular variables were fairly stable during surgery. Times to spontaneous respiration, response to orders, tube removal and orientation were 4 +/- 3, 6 +/- 2, 8 +/-3, and 13 +/- 7 respectively. Times until the patients were able to sit unassisted, stand unassisted and walk freely without assistance were 319 +/- 25, 803 +/- 78, 1070 +/- 75 respectively (values expressed as min, mean +/- se).


CONCLUSIONS
Propofol-nitrous oxide anesthesia adjusted to keep BIS around 60, combined with thoracic epidural analgesia, seems to be effective in providing predictable and uneventful recovery to patients submitted to elective RYGBP.
Pandazi
Ageliki
A
2nd Department of Anesthesiology, University of Athens School of Medicine, Attikon Hospital, Athens, Greece. pa0240@ee.teiath.gr
Bourlioti
Anastasia
A
Kostopanagiotou
Georgia
G
D000713:Anastomosis, Roux-en-Y / Q000009:adverse effects / Q000379:methods; D000762:Anesthesia Recovery Period; D000767:Anesthesia, Epidural / Q000009:adverse effects / Q000379:methods*; D000768:Anesthesia, General / Q000009:adverse effects / Q000379:methods*; D018686:Anesthetics, Intravenous / Q000008:administration & dosage; D015992:Body Mass Index; D015331:Cohort Studies; D017558:Elective Surgical Procedures / Q000379:methods; D004869:Equipment Safety; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D009767:Obesity, Morbid / Q000175:diagnosis / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome
D018686:Anesthetics, Intravenous