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The effect of intraoperative esmolol infusion compared to remifentanil on opiaterequirement after laparoscopic gastric bypass surgery: a randomised pilot study
Örebro University, School of Medical Sciences. Dept. of Paediatric Anaesthesia and Intensive Care, Sahlgrenska University Hospital, Gothenburg, Sweden.ORCID iD: 0000-0002-3066-9544
School of Medical Sciences, Örebro University, Örebro, Sweden. (Clinical Epidemiology and Biostatistics)
Örebro University, School of Medical Sciences.
Dept. of Anaesthesia and Intensive Care, School of Medical Sciences, Örebro University, Örebro, Sweden; Dept. of Anaesthesia and Intensive Care Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
(English)Manuscript (preprint) (Other academic)
National Category
Surgery
Identifiers
URN: urn:nbn:se:oru:diva-62089OAI: oai:DiVA.org:oru-62089DiVA, id: diva2:1154277
Available from: 2017-11-02 Created: 2017-11-02 Last updated: 2018-09-18Bibliographically approved
In thesis
1. Perioperative complications in obese patients: A thesis on risk reducing strategies
Open this publication in new window or tab >>Perioperative complications in obese patients: A thesis on risk reducing strategies
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Aspiration of gastric content and delayed or failed intubation are the leading causes of anesthesia-related mortality and morbidity. In the recovery period, airway obstruction with subsequent hypoxia is a relatively common cause of morbidity, and is highly associated to the amount of opioids administered, especially in obese patients.

The overall aim of this thesis was to study these risk factors for airway complications and postoperative hypoxia in obese patients, and to evaluate possible strategies for their prevention.

In Study I, intubation times and incidence of failed intubation in obese patients were compared between direct laryngoscopy and videolaryngoscopy with the Stortz® C-MAC™. In Studies II and III, the effect of esmolol vs. remifentanil on the esophageal junction, and the possible analgesic properties of low-dose esmolol vs. placebo were evaluated using high-resolution manometry and the cold pressor test, respectively. Finally, in Study IV, the possible opioid-sparing effect of esmolol after laparoscopic gastric bypass surgery was evaluated.

The use of videlaryngoscopy did not shorten intubation times, however appeared to reduce the incidence of failed intubation. Our results also show that esmolol has a favorable profile, compared to remifentanil, with regard to the protection against passive regurgitation and aspiration of gastric content. No analgesic effect of low-dose esmolol was however demonstrated. The intraoperative administration of esmolol instead of remifentanil also did not reduce the requirement of morphine for treatment of post-operative pain.

The use of Stortz® C-MAC™ may be recommended for intubation of obese patients. Further studies are however required to clarify the possible role of esmolol in anesthesia.

Place, publisher, year, edition, pages
Örebro: Örebro University, 2017. p. 74
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 167
Keywords
Intubation time, videolaryngoscopy, obesity, esophagogastric junction, remifentanil, esmolol, high-resolution manometry, pulmonary aspiration, postoperative pain, postoperative opioid-sparing
National Category
Surgery
Identifiers
urn:nbn:se:oru:diva-59411 (URN)978-91-7529-215-1 (ISBN)
Public defence
2017-11-24, Örebro universitet Campus USÖ, hörsal C2, Södra Grev Rosengatan 32, Örebro, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-08-29 Created: 2017-08-29 Last updated: 2017-11-06Bibliographically approved

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Ander, FredrikAhlstrand, Rebecca

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CiteExportLink to record
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