Aims: According to the World Health Organization, obesity is an abnormal or excessive fat accumulation in adipose tissue that impairs health. In recent years, due to the increase in the number of patients referred for surgery with diagnoses of obesity surgery or other clinical conditions, the perioperative evaluation and anesthesia management of these patients have become crucial. Obesity is associated with increased anesthesia risk due to its effects on metabolic, cardiovascular, and pulmonary functions. This study compares the effects of propofol dosing based on lean body weight (LBW) and total body weight (TBW) on hemodynamics and intraoperative awareness in patients undergoing laparoscopic sleeve gastrectomy.
Methods: This study is a prospective observational and randomized clinical trial. It included 54 patients aged 18-60 who underwent elective laparoscopic sleeve gastrectomy under general anesthesia at Ankara Keçiören Training and Research Hospital. The patients were ASA I-III, with surgeries lasting less than 2 hours, and propofol was used for induction. Patients were randomized into Group LBW and Group TBW based on the calculation of the propofol dose according to their lean body weight and total body weight, respectively. Clinical, demographic, perioperative, and hemodynamic data were recorded for all patients. Additionally, all patients were assessed using the Appendix 1 questionnaire.
Results: The dose of propofol administered was higher in Group TBW than in Group LBW (p<0.001). When propofol was administered based on TBW, systolic blood pressure was significantly lower at the 1st and 2nd minutes of induction (p<0.05). There was no significant difference in systolic blood pressure recorded during the intraoperative period and post-extubation between the two groups. Diastolic blood pressure, mean arterial pressure, and heart rate were significantly lower in Group TBW post-extubation (p=0.003). Intraoperative BIS values were significantly lower in Group TBW at the 1st, 2nd, and 3rd minutes post-induction and post-extubation. No intraoperative awareness (IOA) was detected in either group according to the Appendix 1 questionnaire.
Conclusion: In obese patients undergoing sleeve gastrectomy, propofol doses calculated based on LBW during induction were associated with less hemodynamic instability compared to doses calculated based on TBW.