Research Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia Ismail Demirel, MD * , Aysun Yildiz Altun, MD, Esef Bolat, MD, Mikail Kilinc, MD, Ahmet Deniz, MD, Ahmet Aksu, MD, Azize Bestas, MD Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig, Turkey Keywords: morbid obesity inhalation anesthesia TIVA PSI monitoring PACU abstract Purpose: Obese patients have a significantly higher risk of adverse effects associated with general anesthesia. The purpose of this study was to evaluate the effects of Patient State Index (PSI) monitoring on recovery from anesthesia and the incidence of any postoperative complications among patients un- dergoing bariatric surgery with total intravenous anesthesia (TIVA) and inhalational anesthesia. Design: This prospective, double-blind, and randomized controlled trial was conducted between February 2017 and August 2017 and included 120 morbidlyobese patients (body mass index >40 kg/m 2 ). Methods: Patients were randomly divided into four groups; group P-PSI (n ¼ 30): TIVA with PSI moni- toring; group P (n ¼ 30): TIVA without PSI monitoring; group D-PSI (n ¼ 30): desflurane with PSI monitoring; and group D (n ¼ 30): desflurane without PSI monitoring. The discharge time from the postanesthesia care unit (PACU), postoperative complications, and hemodynamic parameters were recorded and evaluated. Findings: No significant differences were found in demographic data, duration of anesthesia, admittance to PACU, discharge from PACU, modified Aldrete scores, and perioperative mean blood pressure and heart rate. Nausea and vomiting scores were significantly lower in group P-PSI, group P, and group D-PSI compared with group D. Conclusions: Although TIVA and inhalational anesthesia can be safely used for obese patients, intra- operative PSI monitoring may decrease the discharge time from PACU and reduces incidence of post- operative nausea and vomiting caused by inhalation anesthetics. © 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved. A balanced general anesthetic is achieved through the use of hypnotic agents and analgesics while maintaining hemodynamic stability. A balanced general anesthetic can be achieved through the use of a combination of intravenous anesthetic medications, inha- lational agents, and analgesics. The medications and inhalational agents used by anesthesia providers are chosen based on the patient's current physical status, medical comorbidities, and sur- gical procedure. A total intravenous anesthesia (TIVA) can consist of a combination of remifentanil and propofol. This medication combination can produce safe and effective anesthesia and anal- gesia throughout the intraoperative period, starting from induction and lasting throughout the surgical procedure. In addition, this technique can facilitate rapid emergence from anesthesia without concurrent prolonged respiratory depression. 1 The low blood/gas and tissue/blood partition coefficients of desflurane permit swift alterations in the depth of anesthesia and rapid elimination, thus resulting in a rapid emergence and recovery relative to the other volatile anesthetics. 2 Current evidence has not established a sig- nificant difference in postoperative recovery durations when comparing TIVA techniques to inhalational anesthetic techniques. 3,4 Conflict of interest: All authors declare that they have no conflict of interest. Compliance with ethical standards: The study was approved by the local ethics board prior to conduction of the study. Informed consent: Informed consent was obtained from all individual participants included in the study. Financial disclosure: The authors declared that this study has received no financial support. * Address correspondence to Ismail Demirel, Medicine Faculty, Anesthesiology and Reanimation Department, Firat University, Elazig 23119, Turkey. E-mail address: ismaildemirel23@gmail.com (I. Demirel). Contents lists available at ScienceDirect Journal of PeriAnesthesia Nursing journal homepage: www.jopan.org https://doi.org/10.1016/j.jopan.2020.07.005 1089-9472/© 2020 American Society of PeriAnesthesia Nurses. Published by Elsevier, Inc. All rights reserved. Journal of PeriAnesthesia Nursing xxx (xxxx) xxx Please cite this article as: Demirel I et al., Effect of Patient State Index Monitoring on the Recovery Characteristics in Morbidly Obese Patients: Comparison of Inhalation Anesthesia and Total Intravenous Anesthesia, Journal of PeriAnesthesia Nursing, https://doi.org/10.1016/ j.jopan.2020.07.005