Effects of using propofol or sevoflurane for maintenance of anesthesia on postoperative metabolic state in bariatric surgery

Objective: surgical method and anesthesia have variable effects on postoperative metabolic state of the obese patients. in the current study,we investigated metabolic consequences of maintenance of anesthesia with intravenous propofol infusion or inhaled sevoflurane in obese patients. method: data of 140 patients who underwent laparoscopic sleeve gastrectomy in reverse trendelenburg position were reviewed for the study. the first group consisted of patients receiving total intravenous anesthesia for maintenance and the second group included patients receiving inhalation anesthesia with sevoflurane. remifentanil was the additional agent used for maintenance in both groups. demographic data,pre and postoperative laboratory values,duration of operation and intraoperative fluid management were recorded for two study groups. results: patients in group propofol received higher intraoperative fluid replacement. postoperative ast and alt values were greater than preoperative values in both groups (p=0.0001). postoperative pac02 values were greater than preoperative values but remained within physiological limits in both groups (p=0.0001). compared to preoperative values,propofol group had greater postoperative ck and ldh and lower ph and hc03 values (p=0.0001). postoperative alt elevation was more severe in sevoflurane group versus propofol group but reductions in ph and hc03 were more significant in propofol group. conclusion: anesthesia has clear postoperative metabolic consequences in bariatric surgery. it should be kept in mind that propofol infusion induces overt metabolic acidosis and sevoflurane can result in elevated liver enzymes and although these increases remain in physiological limits,care should be taken when choosing drugs for patients who can not compensate such adverse effects.