eISSN: 2299-0054
ISSN: 1895-4588
Videosurgery and Other Miniinvasive Techniques
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vol. 14
Bariatric surgery
Randomized controlled trial

Comparison of effects of low-flow and normal-flow anesthesia on cerebral oxygenation and bispectral index in morbidly obese patients undergoing laparoscopic sleeve gastrectomy: a prospective, randomized clinical trial

Sedat Akbas, Ahmet Selim Ozkan

Videosurgery Miniinv 2019; 14 (1): 19–26
Online publish date: 2018/07/24
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The effects of low-flow anesthesia on cerebral oxygenation in high-risk, morbidly obese patients are not well known.

In this prospective randomized study, we compared the effects of low-flow (0.75 l/min) and normal-flow (1.5 l/min) anesthesia on regional cerebral oxygen saturation (rSO2) and the bispectral index (BIS) in morbidly obese patients undergoing laparoscopic bariatric surgery.

Material and methods
Fifty-two morbidly obese patients undergoing laparoscopic bariatric surgery (sleeve gastrectomy) were enrolled in this study. Patients were randomly allocated to two study groups: low-flow and normal-flow anesthesia groups. Heart rate, mean arterial pressure, peripheral oxygen saturation, end-tidal carbon dioxide, BIS, left and right rSO2, and duration of anesthesia and surgery were recorded.

The groups were similar with respect to age, gender, height, weight, body mass index, American Society of Anesthesiology physical status, heart rate, duration of anesthesia, and procedure. Mean arterial pressure and end-tidal carbon dioxide, both before and after insufflation of carbon dioxide and after the reverse Trendelenburg position, were significantly higher in the low-flow group. BIS values and left and right rSO2 during the preoperative and intraoperative periods were similar. Although the difference in right rSO2 between the two groups after awakening from anesthesia was statistically significant, the results of both groups remained within the normal range and were not clinically meaningful.

Low-flow anesthesia is safe regarding hemodynamic and respiratory characteristics, depth of anesthesia, and regional cerebral oxygen saturation in morbidly obese patients undergoing laparoscopic bariatric surgery.


morbid obesity, bispectral index, bariatric/metabolic surgery, anesthesia management, low flow anesthesia, regional cerebral oximetry

Turkey Endocrinology and Metabolism Society of Obesity Diagnosis and Treatment Guide. Obesity, Dyslipidemia, Hypertension Working Group 2014; 1: 11-5.
Arterburn DE, Courcoulas AP. Bariatric surgery for obesity and metabolic conditions in adults. BMJ 2014; 349: g3961.
Kostecka M, Bojanowska M. Problems in bariatric patient care – challenges for dieticians. Videosurgery Miniinv 2017; 12: 207-15.
Gerges FJ, Kanazi GE, Jabbour-Khoury SI. Anesthesia for laparoscopy: a  review. J Clin Anesth 2006; 18: 67-78.
Settakis G, Páll D, Molnár C, et al. Cerebrovascular reactivity in hypertensive and healthy adolescents: TCD with vasodilatory challenge. J Neuroimaging 2003; 13: 106-12.
Fülesdi B, Limburg M, Bereczki D, et al. Cerebrovascular reactivity and reserve capacity in type II diabetes mellitus. J Diabetes Complications 1999; 13: 191-9.
Végh T. Cerebral oximetry in general anaesthesia. Turk J Anaesthesiol Reanim 2016; 44: 247-9.
Jöbsis FF. Noninvasive, infrared monitoring of cerebral and myocardial oxygen sufficiency and circulatory parameters. Science 1977; 198: 1264-7.
Kupisiak J, Goch R, Polenceusz W, et al. Bispectral index and cerebral oximetry in low-flow and high-flow rate anaesthesia during laparoscopic cholecystectomy – a  randomized controlled trial. Videosurgery Miniinv 2011; 6: 226-30.
Baum J. Low Flow Anaesthesia: The Theory and Practice of Low Flow, Minimal Flow and Closed System Anaesthesia. 2nd ed. Butterworth-Heinemann; Oxford, Boston 2001.
Hönemann C, Hagemann O, Doll D. Inhalational anaesthesia with low fresh gas flow. Indian J Anaesth 2013; 57: 345-50.
Aldrete JA, Cubillos P, Sherrill D. Humidity and temperature changes during low flow and closed system anaesthesia. Acta Anaesthesiol Scand 1981; 25: 312-4.
Suttner S, Boldt J. Low-flow anaesthesia. Does it have potential pharmacoeconomic consequences? Pharmacoeconomics 2000; 17: 585-90.
Schulz KF, Altman DG, Moher D. CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials. Int J Surg 2011; 9: 672-77.
Aldrete JA, Kroulik D. A  postanesthetic recovery score. Anesth Analg 1970; 49: 924-34.
Frank AHR, Groene P, von Ehrlich-Treuenstätt V, et al. Evaluation of pain relief sufficiency using the Cumulative Analgesic Consumption Score (CACS) and its modification (MACS). Videosurgery Miniinv 2017; 12: 448-54.
Kemerci PU, Demir A, Aydınlı B, et al. 10 cm H2O PEEP application in laparoscopic surgery and cerebral oxygenation: a  comparative study with INVOS and FORESIGHT. Surg Endosc 2016; 30: 971-8.
Fassoulaki A, Kaliontzi H, Petropoulos G, Tsaroucha A. The effect of desflurane and sevoflurane on cerebral oximetry under steady-state conditions. Anesth Analg 2006; 102: 1830-5.
Razlevice I, Rugyte DC, Strumylaite L, Macas A. Assessment of risk factors for cerebral oxygen desaturation during neonatal and infant general anesthesia: an observational, prospective study. BMC Anesthesiol 2016; 16: 107.
Casati A, Fanelli G, Pietropaoli P, et al. Monitoring cerebral oxygen saturation in elderly patients undergoing general abdominal surgery: a  prospective cohort study. Eur J Anaesthesiol 2007; 24: 59-65.
Pelosi P, Croci M, Ravagnan I, et al. The effects of body mass on lung volumes, respiratory mechanics, and gas exchange during general anesthesia. Anesth Analg 1998; 87: 654-60.
Jędrzejewski E, Liszka M, Maciejewski M, et al. Age is not associated with increased surgical complications in patients after laparoscopic sleeve gastrectomy. Videosurgery Miniinv 2018; 13: 82-7.
Sprung J, Whalley DG, Falcone T, et al. The impact of morbid obesity, pneumoperitoneum, and posture on respiratory system mechanics and oxygenation during laparoscopy. Anesth Analg 2002; 94: 1345-50.
Cooke SJ, Paterson-Brown S. Association between laparoscopic abdominal surgery and postoperative symptoms of raised intracranial pressure. Surg Endosc 2001; 15: 723-5.
de Waal EE, de Vries JW, Kruitwagen CL, Kalkman CJ. The effects of low-pressure carbon dioxide pneumoperitoneum on cerebral oxygenation and cerebral blood volume in children. Anesth Analg 2002; 94: 500-5.
Gipson CL, Johnson GA, Fisher R, et al. Changes in cerebral oximetry during peritoneal insufflation for laparoscopic procedures. J Minim Access Surg 2006; 2: 67-72.
Jo YY, Kim JY, Lee MG, et al. Changes in cerebral oxygen saturation and early postoperative cognitive function after laparoscopic gastrectomy: a  comparison with conventional open surgery. Korean J Anesthesiol 2016; 69: 44-50.
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