The effect of remifentanil and sufentanil in TCI mode on airway pressures during laparascopic gastric banding procedures in patients with adiposity based chronic disease

Introduction: Wooden chest syndrome or opioid induced thorax wall rigidity, presents a serious challenge during anesthesia in patients with adiposity-based chronic disease. This study aims to investigate the impact of remifentanil TCI and sufentanil TCI on airway pressures during laparoscopic gastric banding in obese patients. Methods: During the first analysis of the original data De Baerdemaeker L. et al 1 , a statistical significant difference in mean peak airway pressure between remifentanil TCI and sufentanil TCI was observed. This study was a post-hoc analysis with detailed analysis of airway pressures at defined timepoints. Thirty-six patients were randomly allocated to receive remifentanil TCI (Minto Model) or sufentanil TCI (Gepts model) during laparoscopic gastric banding surgery. 18 patients were allocated to each group. Two patients in each group were excluded due to missing data. All patients received propofol, rocuronium 0.9 mg.kg-1 ideal body weight during induction, anesthesia was maintained using BIS guided desflurane. Airway pressures were measured before (T1), during (T2), and after pneumoperitoneum (T3). Independent samples t-test was used for statistical nalysis between groups and paired t-test for within group analysis. Results: No statistically significant difference in peak - and plateau ventilation pressures was observed between the remifentanil and sufentanil groups throughout the surgical procedure. Both opioids exhibited similar effects on airway pressures before (T1), during (T2) and after pneumoperitoneum (T3). Discussion and Conclusion: There is no significant advantage in selecting remifentanil over sufentanil in terms of ventilation pressures during laparoscopic gastric banding. The concurrent administration of opioids with muscle relaxants may mitigate the risk of opioid-induced rigidity, aligning with previous findings. Further research is warranted to elucidate optimal strategies for airway management in obese patients undergoing laparoscopic procedures.