title: Comparison of recovery criteria in morbidly obese patients undergoing laparoscopic gastric sleeve resection following use of sevoflurane and isoflurane.
abstract: BACKGROUND
  The favorable kinetic properties of sevoflurane could be advantageous in obese patients undergoing bariatric surgery, improving recovery from general anesthesia (GA).
  
  
  OBJECTIVE
  To compare the recovery criteria following anesthesia with sevoflurane and isoflurane in morbidly obese patients undergoing laparoscopic gastric sleeve resection.
  
  
  METHODS
  This was a prospective randomized controlled study conducted in 50 patients undergoing laparoscopic sleeve gastrectomy.
  
  
  METHODS
  Following awake fiberoptic intubation, GA was induced and maintained with sevoflurane in Group A and isoflurane in Group B. 2% sevoflurane and 1.2% isoflurane were used and concentration varied to maintain a mean arterial pressure (MAP) of >75 mm of Hg, maximum concentration being 3% for sevoflurane and 2% for isoflurane. Inhalational agent was terminated at time of skin suturing and patients were extubated when completely awake. Recovery criteria followed were eye opening on call, voluntary head raising on command for 5 s and orientation assessed by answering name and location.
  
  
  METHODS
  Student's t-test was used to test statistical significance of difference in mean values between the groups, analysis of covariance was used to test diastolic blood pressure (DBP) changes and Chi-square test to assess association between categorical variables.
  
  
  RESULTS
  There was no significant variability in heart rate, systolic blood pressure, DBP and MAP between 2 groups up to 210 min. Group A patients had significantly faster eye opening compared to Group B (4.4 ± 1.6 vs. 9.2 ± 2.18 min), were significantly faster in obeying commands (6.08 ± 1.6 vs. 10.08 ± 2.02 min), had a significantly shorter extubation time (7.08 ± 1.6 vs. 11.16 ± 2.18 min) and significantly faster orientation in time as compared to Group B (9.24 ± 1.7 vs. 12.32 ± 2.42 min).
  
  
  CONCLUSIONS
  Sevoflurane has a better recovery profile based on eye opening, obeying commands, time for extubation and orientation, than isoflurane in morbidly obese patients undergoing laparoscopic sleeve gastrectomy.
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Sunil
authors.initials: S
authors.lastname: Rajan
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Harindran
authors.initials: H
authors.lastname: Narendran
authors.affiliation: Department of Anaesthesiology and Critical Care, Amrita Institute of Medical Sciences and Research Centre, Kochi, Kerala, India.
authors.forename: Susamma
authors.initials: S
authors.lastname: Andrews
keywords: Isoflurane; laparoscopic sleeve gastrectomy; obese; recovery; sevoflurane