Factors associated with anaesthetic complications in bariatric surgery at the Delafontaine Saint-Dénis Hospital

Research Article


Abstract views: 108 / PDF downloads: 31

Authors

  • Wilfrid Mbombo

DOI:

https://doi.org/10.58372/2835-6276.1124

Keywords:

bariatric surgery, anaesthetic complications, Delafontaine Hospital

Abstract

Background and objective. Anaesthesia during bariatric surgery is a high-risk procedure.  This study investigated factors associated with anaesthetic complications in patients undergoing this type of surgery at Delafontaine hospital.

Methods. This cross-sectional study was conducted at the Delafontaine Hospital from 01/01/2021 to 01/06/2022 in patients who underwent anaesthesia for bariatric surgery for all indications. Sociodemographic, clinical, anaesthetic and evolutionary data were collected and analysed with SPSS 25.0 using Student's t test, Pearson's Chi-square test or Fischer's exact test and logistic regression for p<0.05.

Results. One hundred and thirty-five patients were enrolled. Females predominated (sex ratio M/F: 0.35). The mean age was 39.41 (range: 20 to 57 years). The median BMI was 43.25kg/m². All patients underwent surgery under general anaesthesia with tracheal intubation. Complications were present in 44% of patients: arterial hypotension (28.8%), difficult orotracheal intubation (28.1%), desaturation (22.9%), postoperative nausea and vomiting (16.2%), bronchospasm (7.4%), arterial hypertension (6.6%) and anaphylactic shock (3.3%). No deaths were recorded. Older age, the presence of comorbidities and Mallampati, Cormack and ASA scores ≥ 3 were associated with the occurrence of complications.

Conclusion. The incidence of peri-anaesthetic complications in bariatric surgery is high in this series. Advanced age (> 40 years), the presence of comorbidities and Mallampati, Cormack and ASA scores ≥ 3 were associated with the occurrence of complications.

References

Mahmoud A., Carel W le R., Neil GD.: Morbidity and mortality associated with obesity:Review Ann Transl Med. 2017; 5(7):161. DOI: 10.21037/atm.2017.03.107

Hugo C., Adrienne C., Elizabeth B., Mary A., Mary C., Sara K. National Institute for Health and Care Excellence. Obesity prevention. NICE guidelines CG43. 2006. Available: http://guidance.nice.org.uk/CG43.

Goubaux B., Bruder N., Raucoules-Aimé M. Prise en charge péri-opératoire du patient obèse : EMC-Anesthésie-Réanimation Vol.1, 2004 .p102-123. https://doi.org/10.1016/j.emcar.2003.04.001.

Elizabeth B., Mary A., Hugo C., Adrienne C.: National Institute for Health and Care Excellence. Obesity: identification, assessment and management. NICE guidelines CG189. 2014. ISBN-13: 978-1-4731-5285-4.http://www.nice.org.uk/guidance/cg189.

Douglas IJ., Bhaskaran K., BatterhamRL.,Smeeth L.: Bariatric Surgery in the United Kingdom: A Cohort Study of Weight Loss and Clinical Outcomes in Routine Clinical Care. 2015. PLoS Med 12(12): e1001925. doi:10.1371/journal.

Badaoui R., Popov I., Dhahri A., Regimbeau J.M., Verhaeghe P.& Dupont H. Traps for the anesthetist in bariatric surgery that the surgeon must know.Obésité(2012)7:178-183. DOI10.1007/s11690-012-0338-5.

Audrey De J., Amélie R., François-Régis S., OlfaYengui, Daniel V., Gérald Chanques et al. How can I manage anaesthesia in obese patients?Anaesthesia Critical Care & Pain MedicineVol 39, Issue 2; 2020:p229-238.

Lienhart A. Auroy Y. ,Péquignot F. ,Benhamou D. ,Warszawski J. ,Bovet M. et al.: Preliminary results from the SFAR-INSERM inquiry on anaesthesia related deaths in France : mortality rates have fallen ten-fold over the past two decades; anesth; Bulletin de L'académieNationale de Médecine, 2004,188(8):142937; https://doi.org/10.1016/s0001-4079(19)33666-0.

Talab H., Zabani I., Abdelrahman H., Bukhari W., Mamoun I., Ashour M., Sadeq B. et al,:Intraoperative ventilatory strategies for prevention of pulmonary atelectasis in obese patients undergoing laparoscopic bariatric surgery;Anesthésie et analgésie 2009. 109(5):p 1511-1516, DOI : 10.1213/ANE.0b013e3181ba7945.

Vieito M., Hernández Iniesta J., Santiveri X., García CH., Maestre P., Villalonga A et al.: Morbidity and mortality related to anesthesia and surgery in 60 patients treated with bariatric surgery ; Anestesiol Reanim,2002;49(7):365-72.

Toby N.,Natasha M. ,Brian Beam W., Heather A.,Diana J. ,Todd A. Kellogg et al. : Facteurs associés à une recuperation prolongée sous anesthésie après une chirurgie bariatrique laparoscopique .vol 25 , 2004 , p1024–1030.

Lubbe J.: Metabolic surgery in South Africa: an initial academic hospital experience, S Afr J Surg. 2019;57(2):20-26.

Anna Dayer-J., Pierre F ,Pierre A. & Michel S. : Complications After Laparoscopic Roux-en-Y Gastric Bypass in 1573 Consecutive Patient ; 2016, 26(1):12-20.

Suter M., Giusti V. , Héraief E.,Zysset F. , Calmes JM.: Laparoscopic Roux-en-Y gastric bypass: initial 2-year experience ; 2003 ;17 (4) :603-9.

Monique T. Young ,Michael J. Phelan,Ninh T. Nguyen : A Decade Analysis of Trends and Outcomes of Male vs Female Patients Who Underwent Bariatric Surgery, Journal of the American College of SurgeonsVol.222, Issue 3, 2016 , p226-231; https://doi.org/10.1016/j.jamcollsurg.2015.11.033.

OMS: https://www.carenity.com/infos-maladie/chirurgie-bariatrique/chiffres-cles-sur-la-chirurgie-bariatrique-543, HAS 2018.

Czernichow S., Paita M.,Nocca D, Msika S, Basdevant A., Millat B, Fagot-Campagna A. : Current challenges in providing bariatric surgery in France: A nationwide study. 2016, 95(49):e5314.

Bastien L.; Marc P Steurer ,Markus K Müller &AlexandreDullenkopf : Anesthetic management of patients undergoing bariatric surgery: two year experience in a single institution in Switzerland, Anesthésiol BMC.2014 ; 18:14:125. DOI: 10.1186/1471-2253-14-125.

Aly E., Alexandre B., Sarah-Eve L., Sebastian D., Olivier C., Amin A.: Medium to long-term outcomes of bariatric surgery in older adults with super obesity; SurgObesRelat Di.2018;14(4):470-476.DOI: 10.1016/j.soard.2017.11.008.

Alexander H., Apoorva K C., Jaime Abraham P., Regina C., Scott A M., Kayla D., Mujjahid A., Amitabh C.: Reduced risk of de novo Barrett esophagus after bariatric surgery: a national database study, 2023:S1550-7289, DOI:hhps://doi.org/10.1ps016/j.soard.2023.08.009.

Neligan PJ., Malhotra G., Fraser M., Williams N., Greenblatt E., Cereda M., et al.: Non invasive ventilation immediately after extubation improves lung function in morbidly obese patients with obstructive sleep apnea undergoing laparoscopic bariatric surgery; 2010;111(2):519. DOI: 10.1213/ANE.0b013e3181ef5e86.

Mohamed M Hashim et al. : L'intubation trachéale difficile chez les patients en chirurgie bariatrique, mythe ou réalité ? BJA : British Journal of Anesthesia , volume 115, 2015, https://doi.org/10.1093/bja/el_13316.

Ligia de Albuquerque M., Pedro Leme S., Paolo P., Patricia R. : Stratégies de ventilation mécanique invasive contrôlée chez les patients obèses opérés. Rev Respir Med. 2017;11(6): 443-452. DOI:10.1080/17476348.2017.1322510.

Tiffany S L., Pamela E Fox ,Alwin S. ; AbouM.,Michel X Gonzales,Taylor JP. ; Babatunde O.: The influence of morbid obesity on difficult intubation and difficult mask ventilation; JAnesth. 2019;33(1):96-102.DOI: 10.1007/s00540-018-2592-7.

Ziemann-Gimmel P. , Goldfarb A., Koppman J., Marema R.: Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis, F. J. Anesth.2014 ; 112(5) :906-11. DOI: 10.1093/bja/aet551.

Navarro Martínez MJ., PindadoMartínez ML., Paz Martín D., Caro Cascante M., Mariscal Flores M., Ruiz de Adana JC., : Perioperative anesthetic management of 300 morbidly obese patients undergoing laparoscopic bariatric surgery and a brief review of relevant pathophysiology. Rev EspAnestesiolReanim. 2011;58(4):211-7.

Luis I Cortínez , Natalia De la Fuente, Douglas J Eleveld, Ana Oliveros, Fernando Crovari, Pablo Sepulveda, Mauricio Ibacache, Sandra Solari: Performance of propofoltarget-controlled infusion models in the obese: pharmacokinetic and pharmacodynamicanalysis; AnesthAnalg. 2014;119(2):302-310.doi: 10.1213/ANE.0000000000000317.

Bergland A., Gislason H., Raeder J.: Fast-track surgery for bariatric laparoscopic gastric bypass with focus on anaesthesia and peri-operative care. Experience with 500 cases. Anaesthesiol Scand. 2008;52(10):1394-9.doi:10.1111/j.1399-6576.2008.01782.

Kirby IJ, Howard EC. Propofol in a morbidly obese patient. Anaesthesia 1987; 42: 1125-1126.

Earl M Strum, Janos Szenohradszki, Wayne A Kaufman, Gary J Anthone, Ingrid L Manz, Philip D Lumb: Emergence and recovery characteristics of desflurane versus sevoflurane in morbidly obese adult surgical patients: a prospective, randomized study, 2004 Dec.99(6):1848-1853.

PreetMohinder S., Anuradha B., Jason McGavin, Anjan T., Ashish Sinha: Comparison of the Recovery Profile between Desflurane and Sevoflurane in Patients Undergoing Bariatric Surgery-a Meta-Analysis of Randomized Controlled Trials; 2017 27(11):3031-3039, DOI: 10.1007/s11695-017-2929-6.

Manuel C V. ,NeeraSah, Amy L Phelps, O'Donnell J, Ryan C Romeo: Desflurane versus sevoflurane for laparoscopic gastroplasty in morbidly obese patients; J Clin Anesth.2007 ; 19(1):3-8. doi: 10.1016/j.jclinane.2006.04.003.

Maria S., Francesco A., Ahmed A W., Antonio S., Alessandra Cutolo : Sugammadex and ideal body weight in bariatric surgery ; Anesthésiol Res Pract.2013 :2013 :389782.DOI: 10.1155/2013/389782.

Rachel-Meyer N., Berger C., Wittmann C., Solomon C., Abels E A M., Rietbergen H., Reuter D A.: Recovery from prolonged deep rocuronium-induced neuromuscular blockade: A randomized comparison of sugammadex reversal with spontaneous recovery.Anesthésiste 2015;64(7):506-12. DOI : 10.1007/s00101-015-0048-0.

Ki Tae Jung, Jae Wook Kim, Tong Kyu Kim, Tae Hun An: A comparison of the clinical duration and recovery characteristics of cisatracurium after priming using rocuronium or cisatracurium: preliminary study 2014 Jan; 66(1): 18-22.

Assouline, B., et al., Benefit and harm of adding ketamine to an opioid in a patient-controlled analgesia device for the control of postoperative pain: systematic review and meta-analyses of randomized controlled trials with trial sequential analyses. Pain, 2016;157(12):2854-64.

Kranke, P., et al., Continuous intravenous perioperative lidocaïne infusion for postoperative pain and recovery. Cochrane DatabaseSystRev, 2015(7):CD009642.

Martinez, V.B., H., Ketamine for pain management in France, an observational survey. AnaesthesiaCritical Care & Pain Medicine, 2015;34(6):357-61.

Heinrich S.,Horbach T. , Salleck D., Birkholz T., Un Irouschek , J Schmidt ;Prise en charge anesthésique périopératoire chez 167 patients subissant une chirurgie bariatrique ; 2011;136(6):604-11.

Shireen Ahmad , Alexander Nagle, Robert J McCarthy, Paul C Fitzgerald, John T Sullivan, Jay Prystowsky: Postoperative hypoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery,AnesthAnalg 2008;107(1):138-43.: 10.1213/ane.0b013e318174df8b.

Liu J. H., Zingmond D., Etzioni D. A., O'Connell J. B., Maggard, M. A., Livingston et al. Characterizing the performance and outcomes of obesity surgery in California. The American Surgeon, 2003;69(10), 823-828.

Downloads

Published

2024-01-03

How to Cite

Wilfrid Mbombo. (2024). Factors associated with anaesthetic complications in bariatric surgery at the Delafontaine Saint-Dénis Hospital: Research Article. American Journal of Medical and Clinical Research & Reviews, 2(12), 1–14. https://doi.org/10.58372/2835-6276.1124

Issue

Section

Articles