Background

The anesthetic management of patients with class III obesity presents unique challenges due to the increased prevalence of comorbidities. There is no clear consensus in the scientific community regarding the superior choice of general anesthesia technique used in patients with class III obesity. This systematic review compared the outcomes of using total intravenous anesthesia (TIVA) and volatile anesthesia in patients with a BMI >= 40 kg/m² undergoing elective surgery.

Methods

Studies from PubMed/MEDLINE, Cochrane, Scopus and other databases were systematically reviewed. The outcomes of interest included intra-operative vital signs, emergence from anesthesia, incidence of post-operative nausea and vomiting (PONV), length of stay in the Post-Anesthesia Care Unit (PACU), rates and reasons for admission to the Intensive Care Unit.

Results

Three articles met the inclusion criteria, encompassing 320 individuals. All three studies were prospective double-blind RCTs. Propofol was the TIVA agent in all studies, while desflurane or sevoflurane were used for volatile anesthesia. TIVA was associated with significantly lower heart rates compared to volatile anesthesia in one study. Intraoperative mean arterial pressure varied across studies. Time to emerge from anesthesia, PACU length of stay, and postoperative analgesia requirements were shorter with TIVA. Incidence of PONV was also consistently lower with TIVA.

Conclusions

In patients with class III obesity, TIVA shows promise in enhancing postoperative recovery, as evidenced by lower rates of PONV, shorter PACU stays, and reduced postoperative analgesia requirements. While further research is needed to validate these findings, this systematic review fills an important gap in current literature.