Postoperative Recovery and Outcomes after Anesthesia in Patients with Morbid Obesity: A Systematic Review

Abstract

Objectives: To evaluate the postoperative recovery and outcomes in patients with morbid obesity undergoing anesthesia.

Methods: A thorough search across four databases identified 720 relevant publications. After removing duplicates using Rayyan QCRI and screening for relevance, the search yielded 358 publications, of which 90 full-text articles were reviewed, and 5 met the eligibility criteria for evidence synthesis.

Results: We included 5 studies with a total of 477 patients with morbid obesity and less than half of them were females 219 (45.9%). The results indicate that in morbidly obese patients, total intravenous anesthesia (TIVA) with propofol and dexmedetomidine (DEX) was more effective than inhalation anesthesia, leading to reduced analgesic use, fewer postoperative nausea and vomiting episodes, and shorter recovery times. Propofol alone, however, was associated with cardiovascular depression in morbidly obese individuals. DEX outperformed fentanyl by reducing extubation time, opioid consumption, and early postoperative pain scores. Furthermore, sevoflurane was superior to propofol in minimizing complications and optimizing recovery time and hospital stay, while Penthrox demonstrated safety and high satisfaction rates during colonoscopy.

Conclusion: The evidence indicates that DEX, particularly in combination with TIVA, offers superior postoperative outcomes for morbidly obese patients compared to other anesthetic options, such as inhalation anesthesia or fentanyl. Sevoflurane also demonstrated benefits in reducing complications and enhancing recovery metrics. These findings emphasize the importance of selecting tailored anesthetic regimens to improve surgical outcomes in this patient population. Further research is warranted to confirm these results in diverse clinical settings and to explore the long-term impact of these anesthetic strategies.