title: Postoperative recovery after anesthesia in morbidly obese patients: a systematic review and meta-analysis of randomized controlled trials.
abstract: OBJECTIVE
  Obese patients present a challenge to safe general anesthesia because of impaired cardiopulmonary physiology and increased risks of aspiration and acute upper airway obstruction. Since studies are lacking regarding the postoperative effects on recovery from general anesthesia in morbidly obese patients, we conducted a systematic review and meta-analysis of recovery outcomes in morbidly obese patients who had undergone general anesthesia.
  
  
  METHODS
  We systematically searched the PubMed, EMBASE™, Cochrane, and Scopus™ databases for randomized controlled trials that evaluated the outcome of anesthesia with desflurane, sevoflurane, isoflurane, or propofol in morbidly obese patients. Using a random effects model, we conducted meta-analyses to assess recovery times (eye opening, hand squeezing, tracheal extubation, and stating name or birth date), time to discharge from the postanesthesia care unit (PACU), and the incidence and severity of postoperative nausea and vomiting (PONV).
  
  
  RESULTS
  We reviewed results for 11 trials and found that patients given desflurane took less time: to respond to commands to open their eyes (weighted mean difference [WMD] -3.10 min; 95% confidence interval (CI): -5.13 to -1.08), to squeeze the investigator's hand (WMD -7.83 min; 95% CI: -8.81 to -6.84), to be prepared for tracheal extubation (WMD -3.88 min; 95% CI: -7.42 to -0.34), and to state their name (WMD -7.15 min; 95% CI: -11.00 to -3.30). We did not find significant differences in PACU discharge times, PONV, or the PACU analgesic requirement.
  
  
  CONCLUSIONS
  Postoperative recovery was significantly faster after desflurane than after sevoflurane, isoflurane, or propofol anesthesia in obese patients. No clinically relevant differences were observed regarding PACU discharge time, incidence of PONV, or postoperative pain scores. The systematic review was registered with PROSPERO (CRD42014009480).
authors.affiliation: Department of Anesthesiology, Taipei Medical University - Shuang Ho Hospital, New Taipei City, Taiwan.
authors.forename: Feng-Lin
authors.initials: FL
authors.lastname: Liu
authors.forename: Yih-Giun
authors.initials: YG
authors.lastname: Cherng
authors.forename: Shin-Yan
authors.initials: SY
authors.lastname: Chen
authors.forename: Yen-Hao
authors.initials: YH
authors.lastname: Su
authors.forename: Shih-Yu
authors.initials: SY
authors.lastname: Huang
authors.forename: Po-Han
authors.initials: PH
authors.lastname: Lo
authors.forename: Yen-Ying
authors.initials: YY
authors.lastname: Lee
authors.forename: Ka-Wai
authors.initials: KW
authors.lastname: Tam
mesh_terms: D000762:Anesthesia Recovery Period; D000768:Anesthesia, General; D018685:Anesthetics, Inhalation; D006801:Humans; D009767:Obesity, Morbid / Q000150:complications*; D020250:Postoperative Nausea and Vomiting / Q000453:epidemiology; D016032:Randomized Controlled Trials as Topic
chemical_list: D018685:Anesthetics, Inhalation