Effect of malnutrition on total intravenous anaesthesia in patients undergoing elective gastrointestinal surgery

Aim: The effects of malnutrition on anesthesia induction, hemodynamics, recovery criteria, propofol consumption and complications were evaluated in patients undergoing elective gastrointestinal surgery. Material and method: Fifty adult patients (ASA I-III) were divided as well-nourished (n=24) and malnourished (n=26) after preanesthetic evaluation. For anesthesia induction, all patients recieved remifentanil (1 μgr kg^-1), 1 % propofol (until loss of consciousness and release of the object from the hand) and cisatracurium (0.1 mg kg^-1). Patients were intubated 3 minutes afterwards. For maintenance, remifentanil 0.15 μg kg^-1 min ^-1, propofol 75 μg kg^-1 min^-1 and cisatracurium 0.08 mg kg^-1 h^-1 were administered. Propofol dosage was adjusted according to hemodynamic changes. Age, weight loss in last 6 months, body weight, serum albumin level, intubation conditions, mean arterial pressure, heart rate, recovery criteria (spontaneous breathing, eye opening and extubation times), amount of propofol used and complications were recorded. Results: Mean age and weight loss were higher in malnourished patients when compared to well-nourished patients while body weight and albumin levels were lower (p<0.05). Mean arterial pressure at 20 and 30 minutes during the operation were higher in well-nourished patients (p<0.05). Heart rate was lower in well-nourished patients at 1 and 5 minutes during intubation and at 10 minutes during operation (p<0.05). The incidence of hypotension was higher in malnourished patients during anesthesia induction (p<0.05). Time to recovery of spontaneous breathing was shorter in well nourished patients (p<0.05), while eye opening and extubation times were similar. Conclusion: We propose that malnutrition might cause negative effects on blood pressure during anaesthesia induction. However, it does not alter intubation conditions, propofol consumption and recovery criteria.