Longer immediate recovery time after anesthesia increases risk of respiratory complications after laparotomy for bariatric surgery: a randomized clinical trial and a cohort study

We compared the effects of two anesthesia protocols in both immediate recovery time (IRT) and postoperative respiratory complications (PRCs) after laparotomy for bariatric surgery, and we determined the association between the longer IRT and the increase of PRC incidence. We conducted the study in two stages: (i) in a randomized controlled trial (RCT), patients received either intervention (sevoflurane-remifentanil-rocuronium-ropivacaine) or control protocol (isoflurane-sufentanil-atracurium-levobupivacaine). All patients received general anesthesia plus continuous epidural anesthesia and analgesia. Treatment was masked for all, except the provider anesthesiologist. We defined IRT as time since anesthetics discontinuation until tracheal extubation. Primary outcomes were IRT and PRCs incidence within 15 days after surgery. We also analyzed post-anesthesia care unit (PACU) and hospital length of stays; (ii) after the end of the RCT, we used the available data in an extension cohort study to investigate IRT > 20 min as exposure factor for PRCs. Control protocol (n = 152) resulted in longer IRT (30.4 ± 7.9 vs 18.2 ± 9.6 min; p < 0.0001), higher incidence of PRCs (6.58 vs 2.5 %; p = 0.048), and longer PACU and hospital stays than intervention protocol (n = 200); PRC relative risk (RR) = 2.6. Patients with IRT > 20 min (n = 190) presented higher incidence of PRCs (7.37 vs 0.62 %; p < 0.0001); RR = 12.06. Intervention protocol, with short-acting anesthetics, was more beneficial and safe compared to control protocol, with long-acting drugs, regarding the reduction of IRT, PRCs, and PACU and hospital stays for laparotomy in bariatric patients. We identified a 4.5-fold increase in the relative risk of PRCs when morbid obese patients are exposed to an IRT > 20 min.

Respiratory responses of the tropical millipede Plusioporus setiger (Broelemann, 1902) (Spirostreptida: Spirostreptidae) to normoxic and hypoxic conditions

1. 1. Oxygen consumption and its relationship to declining oxygen tension was examined in the tropical spirotreptid millipede, Plusioporus setiger. 2. 2. At 25°C and normoxia, the allometric equations relating the weight-specific oxygen consumption rates and body weight were V ̇O2 = 2.1266 × W-53 for males, and V ̇O2 = 2.0915 × W-64 for females, but no significant difference was detected from the b-values. 3. 3. Plusioporus setiger regulated respiration down to 35.40 mmHg O2 when suddenly exposed to a lowered oxygen tension, or 17.70 mmHg O2, when examined in a stepwise declining oxygen tension. 4. 4. O2 dependence indices ( K1 K2) were relatively low, also expressing regulation, but no relation to size (weight) was recorded. 5. 5. After exposure to hypoxia, P. setiger showed a typical pattern of under repayment, on the return to normoxia. © 1987.