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Intragastric balloon positioning and removal: sedation or general anesthesia?

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Abstract

Background

Different anesthesiological techniques are currently used for intragastric balloon positioning and removal. The aim of this study is to compare different anesthesiological approaches for balloon positioning and removal in a large multicentric patient population.

Methods

Retrospective multicenter study was conducted. From May 2000 to April 2008, 3,824 patients underwent BIB® placement [1,022 male/2,802 female; mean age 39.5 ± 14.7 years, range 12–71 years; mean body mass index (BMI) 44.8 ± 9.7 kg/m2, range 28.0–79.1 kg/m2; excess weight (EW) 59.1 ± 29.8 kg, range 16–210 kg; %EW 89.3 ± 31.7, range 21.4–262]. Patients were allocated to three groups according to anesthesiological technique used: conscious sedation (group A), deep sedation (group B), and general anesthesia (group C). Intragastric balloon was placed after diagnostic endoscopy and removed after 6 months. Both positioning and removal were done under different protocols. Conscious sedation was obtained with topical lidocaine spray, adding diazepam (0.05–0.1 mg/kg iv) or midazolam (0.03–0.05 mg/kg iv). Deep sedation was obtained with propofol alone or adding other drugs such as midazolam, meperidine/fentanyl or meperidine/fentanyl + midazolam. General anesthesia was obtained with midazolam premedication (0.01–0.02 mg/kg iv) followed by induction with propofol (1–1.5 mg/kg iv) + Norcuron (80 mcg/kg iv) + fentanyl (0.5–1 mcg/kg iv), and maintenance with propofol (50–150 μg/kg/min) or sevorane. Oxygen saturation, hemodynamic stability, major anesthesiological complications and related mortality, patient satisfaction, time to return to autonomous walking, duration of procedure, and hospital stay were considered.

Results

Sedation-related mortality was absent. A significant number of patients with bronchoinhalation during balloon removal was observed with general anesthesia (P < 0.001).

Conclusions

BIB positioning and removal should be performed under conscious sedation for patient safety and comfort, and technical success.

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Disclosures

Teresa Messina, Alfredo Genco, Roberto Favaro, Roberta Maselli, Fiore Torchia, Francesco Guidi, Roberto Razza, Nadia Aloi, Marco Piattelli, and Michele Lorenzo have no conflicts of interest or financial ties to disclose.

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Authors and Affiliations

  1. GILB (Italian Study Group for LapBand & BIB), Via Maresca 54, 80058, Torre Annunziata, NA, Italy

    Teresa Messina, Alfredo Genco, Roberto Favaro, Roberta Maselli, Fiore Torchia, Francesco Guidi, Roberto Razza, Nadia Aloi, Marco Piattelli & Michele Lorenzo

Authors
  1. Teresa Messina
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  2. Alfredo Genco
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  3. Roberto Favaro
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  4. Roberta Maselli
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  5. Fiore Torchia
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  6. Francesco Guidi
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  7. Roberto Razza
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  8. Nadia Aloi
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  9. Marco Piattelli
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  10. Michele Lorenzo
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Correspondence to Michele Lorenzo.

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Messina, T., Genco, A., Favaro, R. et al. Intragastric balloon positioning and removal: sedation or general anesthesia?. Surg Endosc 25, 3811–3814 (2011). https://doi.org/10.1007/s00464-011-1794-y

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  • DOI: https://doi.org/10.1007/s00464-011-1794-y

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