P0833 - Total Intravenous Anesthesia vs Inhalation Anesthesia for Transoral Outlet Reduction

Elissa Lin, MD, Kush Fansiwala, MD, Philip Kozan, MD, Erik Dutson, MD, Yijun Chen, MD, Anna Balioukova, NP, Sue Na Park, NP, Danny Issa, MD, Michael Wolfe, MD, Alireza Sedarat, MD, Adarsh Thaker, MD
UCLA, Los Angeles, CA

Introduction: Anesthesia management for endoscopic bariatric therapies, such as transoral outlet reduction (TORe) for patients with weight gain after prior gastric bypass surgery, typically consists of endotracheal intubation using either total intravenous anesthesia (TIVA) (i.e. propofol sedation) or inhalation anesthetics (GAS). TIVA is associated with faster recovery times and fewer side effects than GAS for many procedures, but providers may opt against TIVA for patients with obesity due to concerns about dosing or volume of distribution. It is also unknown whether the advantages of TIVA apply to patients with obesity specifically undergoing a relatively short bariatric procedure such as TORe. We therefore aimed to compare sedation related adverse events (SRAEs) and recovery in patients who received TIVA or GAS for TORe.

Methods: This was a retrospective study of consecutive patients who underwent TORe at a tertiary care center between July 2020 and October 2022 for obesity or weight regain after gastric bypass surgery. Intraprocedural and postprocedural SRAEs, defined as hypoxia (O2 saturation < 85% of any duration), hypotension (systolic blood pressure < 90 mmHg requiring vasopressors), cardiac arrhythmias, or premature termination of endoscopy were measured. Post-procedure nausea/vomiting, analgesic use, and recovery time were also assessed.

Results: Of 107 total TORe procedures, TIVA was used in 47 cases verses GAS in 60 cases. There were no significant differences in demographics, BMI, or ASA score (Table 1) between groups. SRAEs occurred in 19% of TIVA procedures and 23% of GAS procedures (Figure 1). After controlling for age, gender, and BMI in regression analysis, there was no significant difference in SRAEs between the two groups (OR 0.65; CI 0.25-1.70). Patients who received TIVA had significantly shorter recovery times (185 min vs 225 min; p=0.04). There was no significant difference in anesthesia duration, post-op nausea/vomiting, or unplanned admission rates. There were no premature procedure terminations, cardiac arrests, or deaths.

Discussion: TIVA and GAS appear to have similar safety and recovery profiles for patients undergoing TORe, while the use of TIVA was associated with faster recovery of nearly 40 minutes. Either form of sedation may be appropriate for TORe when combined with careful patient selection, good communication, and planning between the endoscopist and anesthesiology team.




Disclosures:


Elissa Lin, MD, Kush Fansiwala, MD, Philip Kozan, MD, Erik Dutson, MD, Yijun Chen, MD, Anna Balioukova, NP, Sue Na Park, NP, Danny Issa, MD, Michael Wolfe, MD, Alireza Sedarat, MD, Adarsh Thaker, MD. P0833 - Total Intravenous Anesthesia vs Inhalation Anesthesia for Transoral Outlet Reduction, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.