Randomized Comparison of Isoflurane and Sevoflurane for Laparoscopic Gastric Banding in Morbidly Obese Patients

Study Objective: To compare the efficacy and recovery profile of sevoflurane and isoflurane as the main anesthetics for morbidly obese patients.

Design: Randomized, blinded study.

Setting: Inpatients.

Patients: 30 ASA physical status II and III obese patients [body mass index (BMI) > 35 kg/m²] undergoing laparoscopic gastric banding for morbid obesity.

Interventions: After standard intravenous induction of general anesthesia and tracheal intubation, anesthesia was maintained with either sevoflurane or isoflurane as the main anesthetics. The end-tidal concentrations of the volatile drugs were adjusted to maintain systolic arterial blood pressure within ±20% from baseline values. When the surgeon started the skin suture, the end-tidal concentration of the inhalational drug was reduced to 0.5 minimum alveolar concentration in both groups. At the last skin suture, the inhalational drug was discontinued and the vaporizator was removed to allow blinded evaluation of the emergence times.

Measurements and Main Results: No differences in anesthetic exposure, hemodynamic parameters, incidence of untoward events, or postoperative pain relief were reported between the two groups. Extubation, emergence, and response times were shorter after sevoflurane [6 min (3–15 min), 8 min (5–18 min), and 12 (6–25 min)] than isoflurane [10 min (6–26 min), 14 min (6–21 min), and 21 min (14–41 min)] (p = 0.001, p = 0.03, and p = 0.0005, respectively). The median time for postanesthesia care unit discharge was 15 minutes (25th—75th percentiles: 10–18 min) after sevoflurane and 27 minutes (25th—75th percentiles: 20–30 min) after isoflurane (p = 0.0005).

Conclusions: Sevoflurane provides a safe and effective intraoperative control of cardiovascular homeostasis in morbidly obese patients undergoing laparoscopic gastric banding, with the advantage of a faster recovery and earlier discharge from the postanesthesia care unit than isoflurane.