Objectives
To evaluate obesity effect on anesthetic and surgical outcome of patients of varying BMI assigned for open abdominal surgery.
Patients and methods
Sixty patients were categorized according to WHO classification of obesity into three classes: class I ( = 30), class II ( = 18) and class III ( = 12). All patients underwent open laparotomy under combined anesthesia using continuous remifentanil infusion and balanced sevoflurane anesthesia. Hemodynamic variables, duration of surgery, intraoperative bleeding, frequency of blood transfusion, recovery times and intraoperative anesthetic or surgical problems were recorded. The occurrence of postoperative complications, admission to ICU, duration till 1st ambulation, 1st oral intake, hospital stay period and rates of morbidity and mortality were recorded.
Results
Induction of anesthesia significantly decreased arterial pressures and heart rate compared both to preoperative and pre-induction measures. After extubation all parameters returned to preoperative levels. Mean operative time was significantly longer and mean intraoperative blood loss was significantly more in patients of class III compared to those of class I and II. All recovery times showed BMI dependence as all were significantly prolonged in class II and III patients compared to class I patients with significantly shorter awakening and extubation times in class II patients than class III patients. Mean time till 1st walk was significantly longer in class III patients than class I and II patients, but time till 1st oral intake was non-significantly different. Sixteen patients developed PO complications. Mean PO hospital stay was significantly longer in class III patients compared to class I and II patients with significantly shorter duration in class II patients than those of class III.
Conclusion
Obesity caused deleterious anesthetic and surgical effects with prolonged operative and recovery times and more need for blood transfusion, ICU admission and prolonged hospital stay duration. The used anesthetic regimen allowed controlled hypotension without compromising patients’ general condition.