EFFECTS OF USING PROPOFOL OR SEVOFLURANE FOR MAINTENANCE OF ANESTHESIA ON POSTOPERATIVE METABOLIC STATE IN BARIATRIC SURGERY

Cerrahi yöntem ve anestezinin obez hastaların postoperatif metabolik durumu üzerine değişen derecelerde etkisi mevcuttur.Bu çalışma ile intravenöz propofol infüzyonu ya da inhaler sevofluranla anestezi idamesinin obez hastalardaki metabolik sonuçlarınıaraştırdık.Yöntem: Ters trendelenburg pozisyonunda laparoskopik sleeve gastrektomi yöntemiyle yapılan 140 hastanın verileri çalışmaya dahiledildi. Birinci gruba idamede total intravenöz anestezi alanlar, ikinci gruba sevofluranla inhalasyon anestezisi alanlar dahil edildi.Her iki grupta da idamedeki ek ajan remifentanil idi. Her iki gruptaki hastaların demografik verileri, preoperatif ve postoperatif laboratuarincelemeleri, cerrahi süreleri, intraoperatif sıvı yönetimleri kaydedildi.Bulgular: Hastaların demografik verileri, cerrahi süreleri açısından gruplar arası farklılık tespit edilmedi. Propofol alan grupta daha çokmayi ihtiyacı olduğu tespit edildi. Her iki grupta da postoperatif AST, ALT değerleri preoperatif ölçümlerden yüksekti (p

BAR‹ATR‹K CERRAH‹DE PROPOFOL VEYA SEVOFLURAN ‹LE YAPILAN ANESTEZ‹ ‹DAMES‹N‹N POSTOPERAT‹F METABOL‹K DURUM ÜZER‹NE ETK‹LER‹

Surgical method and anesthesia have variable effects on postoperative metabolic state of the obese patients. In the currentstudy, we investigated metabolic consequences of maintenance of anesthesia with intravenous propofol infusion or inhaled sevoflurane inobese patients.Method: Data of 140 patients who underwent laparoscopic sleeve gastrectomy in reverse trendelenburg position were reviewed forthe study. The first group consisted of patients receiving total intravenous anesthesia for maintenance and the second group includedpatients receiving inhalation anesthesia with sevoflurane. Remifentanil was the additional agent used for maintenance in both groups.Demographic data, pre and postoperative laboratory values, duration of operation and intraoperative fluid management were recordedfor two study groups.Results: Patients in Group propofol received higher intraoperative fluid replacement. Postoperative AST and ALT values were greaterthan preoperative values in both groups (p=0.0001). Postoperative PaCO2values were greater than preoperative values but remainedwithin physiological limits in both groups (p=0.0001). Compared to preoperative values, propofol group had greater postoperative CKand LDH and lower pH and HCO3values (p=0.0001). Postoperative ALT elevation was more severe in sevoflurane group versus propofolgroup but reductions in pH and HCO3were more significant in propofol group.Conclusion: Anesthesia has clear postoperative metabolic consequences in bariatric surgery. It should be kept in mind that propofolinfusion induces overt metabolic acidosis and sevoflurane can result in elevated liver enzymes and although these increases remain inphysiological limits, care should be taken when choosing drugs for patients who can not compensate such adverse effects

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