Factors associated with prolonged anesthesia recovery following laparoscopic bariatric surgery: a retrospective analysis.
BACKGROUND
Phase I postanesthesia recovery is often prolonged after laparoscopic bariatric surgery. We hypothesized that postoperative respiratory depression is a major contributor to this delayed recovery.


METHODS
Medical records of all patients who had a laparoscopic bariatric surgical operation from January 1, 2009, to December 31, 2012, were reviewed for clinical, anesthetic, and postanesthesia variables. Recoveries were defined as discharge from the recovery room in ≤90 min and in >90 min (prolonged postanesthesia recovery). We compared characteristics of patients without prolonged recovery to those with prolonged recovery.


RESULTS
Of 781 bariatric patients, 304 (38.9 %) had prolonged recovery. These patients had more respiratory depression (29 vs 6 patients), more postoperative nausea and vomiting (106 vs 92 patients), more treatments of hypertension in the recovery room (49 vs 33 patients), and more opioid treatment (median intravenous morphine equivalents [interquartile range], 10.0 [3.0-15.0] vs 5.0 [0.0-10.5]) (P < 0.001 for all). On multivariable analysis, preoperative history of hypertension (P = 0.03), fewer prophylactic antiemetics received (P = 0.02), and longer surgical duration (P = 0.03) were associated with prolonged postanesthesia recovery.


CONCLUSIONS
Inadequate antiemetic prophylaxis and the treatment of postoperative hypertension were associated with prolonged postanesthesia recovery. Surprisingly, diagnosis of obstructive sleep apnea was not associated with prolonged recovery, which may be attributable to use of continuous positive airway pressure devices following emergence from anesthesia. Prolonged recovery in patients treated for hypertension may be related to institutional guidelines that require additional monitoring time after these medications are administered.
Department of Anesthesiology, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA, weingarten.toby@mayo.edu.
Toby N
TN
Weingarten
Natasha M
NM
Hawkins
W Brian
WB
Beam
Heather A
HA
Brandt
Diana J
DJ
Koepp
Todd A
TA
Kellogg
Juraj
J
Sprung
D000328:Adult; D000701:Analgesics, Opioid / Q000627:therapeutic use; D000758:Anesthesia / Q000009:adverse effects*; D000932:Antiemetics / Q000627:therapeutic use; D050110:Bariatric Surgery / Q000009:adverse effects*; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000209:etiology*; D020250:Postoperative Nausea and Vomiting / Q000188:drug therapy / Q000209:etiology*; D020127:Recovery of Function; D012131:Respiratory Insufficiency / Q000209:etiology*; D012189:Retrospective Studies; D013997:Time Factors
D000701:Analgesics, Opioid; D000932:Antiemetics