• Anesthesia
• Desflurane
• Obesity
• Postoperative anesthesia care unit
• Postoperative period
• Propofol

• PACU
• PSI monitoring
• TIVA
• inhalation anesthesia
• morbid obesity

General anesthesia with intravenous or inhalation anesthetics reduces respiratory functions. We investigated the effects of propofol, desflurane, and sevoflurane on postoperative respiratory function tests.

This single-center randomized controlled study was performed in a university hospital from October 2015 to February 2017. Ninety patients scheduled for endoscopic endonasal transsphenoidal pituitary surgery were randomly categorized into either of these three groups: propofol (n = 30, the Group TIVA), desflurane (n = 30, the Group D) or sevoflurane (n = 30, the Group S). We analyzed the patients before, after, and 24 h following surgery, to identify the following parameters: forced expiratory volume in 1 second (FEV₁) %, forced vital capacity (FVC) %, FEV₁/FVC, and arterial blood gases (ABG). Furthermore, we also recorded the intraoperative dynamic lung compliance and airway resistance values.

We did not find any significant differences in FEV₁ values (primary outcome) among the groups (P = 0.336). There was a remarkable reduction in the FEV₁ and FVC values in all groups postoperatively relative to the baseline (P < 0.001). The FVC, FEV₁/FVC, ABG analysis, compliance, and airway resistance were similar among the groups. Intraoperative dynamic compliance values were lower at the 1st and 2nd hours than those immediately after intubation (P < 0.001).

We demonstrated that propofol, desflurane, and sevoflurane reduced FEV₁ and FVC values postoperatively, without any significant differences among the drugs.

• Airway resistance
• Desflurane
• Lung compliance
• Propofol
• Respiratory function tests
• Sevoflurane

• Anaesthesia
• anaesthetic techniques
• general
• inhalation
• intravenous
• monitoring
• spirometry

The purpose of the Society of Anesthesia and Sleep Medicine Guideline on Intraoperative Management of Adult Patients With Obstructive Sleep Apnea (OSA) is to present recommendations based on current scientific evidence. This guideline seeks to address questions regarding the intraoperative care of patients with OSA, including airway management, anesthetic drug and agent effects, and choice of anesthesia type. Given the paucity of high-quality studies with regard to study design and execution in this perioperative field, recommendations were to a large part developed by subject-matter experts through consensus processes, taking into account the current scientific knowledge base and quality of evidence. This guideline may not be suitable for all clinical settings and patients and is not intended to define standards of care or absolute requirements for patient care; thus, assessment of appropriateness should be made on an individualized basis. Adherence to this guideline cannot guarantee successful outcomes, but recommendations should rather aid health care professionals and institutions to formulate plans and develop protocols for the improvement of the perioperative care of patients with OSA, considering patient-related factors, interventions, and resource availability. Given the groundwork of a comprehensive systematic literature review, these recommendations reflect the current state of knowledge and its interpretation by a group of experts at the time of publication. While periodic reevaluations of literature are needed, novel scientific evidence between updates should be taken into account. Deviations in practice from the guideline may be justifiable and should not be interpreted as a basis for claims of negligence.

Obesity is associated with a chronic systemic inflammatory process. Volatile or intravenous anesthetic agents may modulate immune function, and may do so differentially in obesity. However, no study has evaluated whether these potential immunomodulatory effects differ according to type of anesthesia in obese patients undergoing laparoscopic bariatric surgery.

The OBESITA trial is a prospective, nonblinded, single-center, randomized, controlled clinical pilot trial. The trial will include 48 patients with a body mass index ≥ 35 kg/m², scheduled for laparoscopic bariatric surgery using sleeve or a Roux-en-Y gastric bypass technique, who will be allocated 1:1 to undergo general inhalational anesthesia with sevoflurane or total intravenous anesthesia (TIVA) with propofol. The primary endpoint is the difference in plasma interleukin (IL)-6 levels when comparing the two anesthetic agents. Blood samples will be collected prior to anesthesia induction (baseline), immediately after anesthetic induction, and before endotracheal extubation. Levels of other proinflammatory and anti-inflammatory cytokines, neutrophil chemotaxis, macrophage differentiation, phagocytosis, and occurrence of intraoperative and postoperative complications will also be evaluated.

To our knowledge, this is the first randomized clinical trial designed to compare the effects of two different anesthetics on immunomodulation in obese patients undergoing laparoscopic bariatric surgery. Our hypothesis is that anesthesia with sevoflurane will result in a weaker proinflammatory response compared to anesthesia with propofol, with lower circulating levels of IL-6 and other proinflammatory mediators, and increased macrophage differentiation into the M2 phenotype in adipose tissue.

Registro Brasileiro de Ensaios Clínicos, RBR-77kfj5. Registered on 25 July 2018.

The online version of this article (10.1186/s13063-019-3399-z) contains supplementary material, which is available to authorized users.

• Clinical trial
• Cytokines
• Inflammation
• Interleukin 6
• Lung injury
• Obesity
• Propofol
• Sevoflurane

Anesthesia and surgery have an impact on inflammatory responses, which influences perioperative homeostasis. Inhalational and intravenous anesthesia can alter immune-system homeostasis through multiple processes that include activation of immune cells (such as monocytes, neutrophils, and specific tissue macrophages) with release of pro- or anti-inflammatory interleukins, upregulation of cell adhesion molecules, and overproduction of oxidative radicals. The response depends on the timing of anesthesia, anesthetic agents used, and mechanisms involved in the development of inflammation or immunosuppression. Obese patients are at increased risk for chronic diseases and may have the metabolic syndrome, which features insulin resistance and chronic low-grade inflammation. Evidence has shown that obesity has adverse impacts on surgical outcome, and that immune cells play an important role in this process. Understanding the effects of anesthetics on immune-system cells in obese patients is important to support proper selection of anesthetic agents, which may affect postoperative outcomes. This review article aims to integrate current knowledge regarding the effects of commonly used anesthetic agents on the lungs and immune response with the underlying immunology of obesity. Additionally, it identifies knowledge gaps for future research to guide optimal selection of anesthetic agents for obese patients from an immunomodulatory standpoint.

• Anesthesia
• Immune system
• Perioperative care
• Obesity
• Inflammation

• Aged
• Anesthesia, Inhalation/adverse effects
• Anesthesia, Intravenous/adverse effects
• Anesthetics, Inhalation/adverse effects
• Anesthetics, Intravenous
• Humans
• Intraocular Pressure/drug effects
• Laparoscopy/methods
• Male
• Middle Aged
• Pain Measurement
• Pain, Postoperative/diagnosis
• Pain, Postoperative/epidemiology
• Postoperative Nausea and Vomiting/epidemiology
• Postoperative Nausea and Vomiting/prevention & control
• Propofol
• Prostatectomy/methods
• Randomized Controlled Trials as Topic
• Robotic Surgical Procedures/methods

• Ehlers-Danlos syndrome
• Hypermobility type
• Joint hypermobility and dislocation

• Adolescents
• Anesthetic depth
• Bariatric
• Bispectral index
• Morbidly obese
• Pediatric
• Propofol
• Total intravenous anesthesia

• U01 DK072493 NIDDK NIH HHS

• Anesthetics
• desflurane
• inhalational
• low-flow anesthesia