Prospects of minimally invasive methods of anesthesia for laparoscopic bariatric interventions in patients with morbid obesity, according to the principle of accelerated rehabilitation

Abstract

This clinical article presents clinical examples of the successful implementation of the program for accelerated management of the postoperative period in patients with morbid obesity after laparoscopic stomach longitudinal resection , using combined anesthesia based on intravenous administration of propofol, inhalation low flow anesthesia with sevoflurane, and peri operative multimodal analgesia.The objective. Was optimization of methods of general anesthesia of bariatric surgical interventions in patients with morbid obesity.Patients and methods. 26 patients with a BMI of 36-45 took part in the study, who underwent laparoscopic stomach longitudinal resection with the use of combined low flow anesthesia with sevoflurane and multimodal analgesia. All patients underwent the concept of minimally invasive intraoperative anesthetic monitoring and an accelerated postoperative rehabilitation program.Results. The dynamics of the values of central hemodynamics showed a high hemodynamic stability at all stages of the operation, with a tendency towards normalization of initially elevated blood pressure. The indices of the adequacy of oxygenation and ventilation (SpO2 and EtCO2) corresponded to normal values and did not differ from the level of stress norm. In all patients, recovery of spontaneous breathing occurred on average 8 minutes after the end of the operation. Extubation was performed on the operating table in 8±2 minutes (p=0,05), therefore, prolonged artificial ventilation was not required. At that, the level of postoperative pain on the operating table by VAS was minimal – 0–2 points. In the early postoperative period, the pain level according to the VAS in patients was on average 3±2 points (p=0.05). Accordingly, there was no need for narcotic analgesics. All patients were activated within the first 24 hours after the operation. Patients were discharged on 2,9±0,25 days after the operation (p=0,05).Conclusion. Inhalation low flow anesthesia based on sevoflurane with the use of multimodal analgesia during laparoscopic stomach longitudinal resection in patients with morbid obesity does not require prolonged ventilation and is a worthy alternative to combined epidural anesthesia. Rejection of invasive monitoring allows early activation of patients and a shortened stay in the hospital.