Inhalation anesthesia and total intravenous anesthesia (TIVA) regimens in patients with obesity: an updated systematic review and meta-analysis of randomized controlled trials.

Sabrina Soledad Domene, Daniela Fulginiti, Antonia Thompson, Vanessa P Salolin Vargas, Laura C Rodriguez, Meraris D Tolentino Colón, Mariela D Fermin Madera, Juan N Layton, María I Peña Encarnación, Victor S Arruarana, Camila Sanchez Cruz, Ernesto Calderon-Martínez
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引用次数: 0

Abstract

Background: Obesity is a global epidemic, projected to affect 4 billion people by 2035. Anesthesia regimens, including volatile anesthetics and total intravenous anesthesia (TIVA), impact postoperative outcomes, particularly in obese patients who face increased risks of complications. Volatile anesthetics are often associated with higher rates of postoperative nausea and vomiting (PONV), while TIVA may improve recovery but can increase costs and present additional challenges. This systematic review and meta-analysis evaluate the effects of these anesthesia methods on perioperative outcomes, including hemodynamic stability, recovery, and PONV, in this high-risk population.

Methods: Adhering to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and registered in PROSPERO (CRD42024547776) studies were identified through PubMed, Web of Science, Scopus, China National Knowledge Infrastructure, CINDAHL, Cochrane, EMBASE, and Google Scholar. Two reviewers independently extracted data and assessed the risk of bias. A meta-analysis using a random-effects model was conducted.

Results: Thirteen studies with 1072 participants were included. Inhalational anesthesia significantly increases PONV (RR, 2.09; 95% CI, 1.21-3.60; p = 0.01; I2 = 34%) and intraoperative heart rate (MD, 3.49; 95% CI, 0.01-6.97; p < 0.01; I2 = 67.6%) compared to TIVA. Other outcomes, including mean arterial pressure, duration of intensive care unit stay, recovery time, opioid use, and pain, showed no significant differences between TIVA and inhalational anesthesia in the present analysis.

Conclusion: TIVA appears to improve perioperative outcomes in obese patients by reducing PONV and intraoperative heart rate, highlighting its potential advantages in clinical practice. Further research is needed to address variability and establish evidence-based guidelines for anesthesia management in this high-risk population.

Systematic review registration number in prospero: CRD42024547776.

肥胖患者的吸入麻醉和全静脉麻醉(TIVA)方案:随机对照试验的最新系统综述和荟萃分析。
背景:肥胖是一种全球性流行病,预计到2035年将影响40亿人。麻醉方案,包括挥发性麻醉剂和全静脉麻醉(TIVA),影响术后结果,特别是肥胖患者,其并发症风险增加。挥发性麻醉剂通常与较高的术后恶心和呕吐(PONV)率相关,而TIVA可以改善恢复,但可能增加成本并带来额外的挑战。本系统综述和荟萃分析评估了这些麻醉方法对高危人群围手术期结局的影响,包括血流动力学稳定性、恢复和PONV。方法:通过PubMed、Web of Science、Scopus、中国国家知识基础设施、CINDAHL、Cochrane、EMBASE和谷歌Scholar等网站对在PROSPERO (CRD42024547776)注册并遵循系统评价和meta分析首选报告项目指南的研究进行筛选。两名审稿人独立提取数据并评估偏倚风险。采用随机效应模型进行meta分析。结果:纳入13项研究,1072名受试者。吸入麻醉显著增加PONV (RR, 2.09;95% ci, 1.21-3.60;p = 0.01;I2 = 34%)和术中心率(MD, 3.49;95% ci, 0.01-6.97;p 2 = 67.6%)。其他结果,包括平均动脉压、重症监护病房住院时间、恢复时间、阿片类药物使用和疼痛,在本分析中显示TIVA和吸入麻醉之间没有显着差异。结论:TIVA通过降低PONV和术中心率改善肥胖患者围手术期预后,凸显其在临床实践中的潜在优势。需要进一步的研究来解决这一高危人群的变异性,并建立以证据为基础的麻醉管理指南。系统评价注册号:CRD42024547776。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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