title: Intragastric balloon positioning and removal: sedation or general anesthesia?
abstract: BACKGROUND
  Different anesthesiological techniques are currently used for intragastric balloon positioning and removal. The aim of this study is to compare different anesthesiological approaches for balloon positioning and removal in a large multicentric patient population.
  
  
  METHODS
  Retrospective multicenter study was conducted. From May 2000 to April 2008, 3,824 patients underwent BIB(®) placement [1,022 male/2,802 female; mean age 39.5 ± 14.7 years, range 12-71 years; mean body mass index (BMI) 44.8 ± 9.7 kg/m(2), range 28.0-79.1 kg/m(2); excess weight (EW) 59.1 ± 29.8 kg, range 16-210 kg; %EW 89.3 ± 31.7, range 21.4-262]. Patients were allocated to three groups according to anesthesiological technique used: conscious sedation (group A), deep sedation (group B), and general anesthesia (group C). Intragastric balloon was placed after diagnostic endoscopy and removed after 6 months. Both positioning and removal were done under different protocols. Conscious sedation was obtained with topical lidocaine spray, adding diazepam (0.05-0.1 mg/kg iv) or midazolam (0.03-0.05 mg/kg iv). Deep sedation was obtained with propofol alone or adding other drugs such as midazolam, meperidine/fentanyl or meperidine/fentanyl + midazolam. General anesthesia was obtained with midazolam premedication (0.01-0.02 mg/kg iv) followed by induction with propofol (1-1.5 mg/kg iv) + Norcuron (80 mcg/kg iv) + fentanyl (0.5-1 mcg/kg iv), and maintenance with propofol (50-150 μg/kg/min) or sevorane. Oxygen saturation, hemodynamic stability, major anesthesiological complications and related mortality, patient satisfaction, time to return to autonomous walking, duration of procedure, and hospital stay were considered.
  
  
  RESULTS
  Sedation-related mortality was absent. A significant number of patients with bronchoinhalation during balloon removal was observed with general anesthesia (P < 0.001).
  
  
  CONCLUSIONS
  BIB positioning and removal should be performed under conscious sedation for patient safety and comfort, and technical success.
authors.affiliation: GILB (Italian Study Group for LapBand & BIB), Via Maresca 54, 80058 Torre Annunziata, NA, Italy.
authors.forename: Teresa
authors.initials: T
authors.lastname: Messina
authors.forename: Alfredo
authors.initials: A
authors.lastname: Genco
authors.forename: Roberto
authors.initials: R
authors.lastname: Favaro
authors.forename: Roberta
authors.initials: R
authors.lastname: Maselli
authors.forename: Fiore
authors.initials: F
authors.lastname: Torchia
authors.forename: Francesco
authors.initials: F
authors.lastname: Guidi
authors.forename: Roberto
authors.initials: R
authors.lastname: Razza
authors.forename: Nadia
authors.initials: N
authors.lastname: Aloi
authors.forename: Marco
authors.initials: M
authors.lastname: Piattelli
authors.forename: Michele
authors.initials: M
authors.lastname: Lorenzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000768:Anesthesia, General / Q000379:methods*; D018681:Anesthetics, General; D050110:Bariatric Surgery / Q000295:instrumentation / Q000379:methods*; D002648:Child; D016292:Procedural Sedation / Q000379:methods*; D020878:Device Removal / Q000379:methods; D015905:Gastric Balloon; D006801:Humans; D006993:Hypnotics and Sedatives; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D018681:Anesthetics, General; D006993:Hypnotics and Sedatives