Swap Anesthetic Versus Continuous Desflurane in Adults Undergoing Bariatric Surgery

This randomized, parallel-group, non-inferiority clinical trial aims to evaluate whether an anesthetic swap strategy consisting of sevoflurane followed by desflurane 30 minutes before the end of surgery is non-inferior to continuous desflurane anesthesia with respect to extubation time in adults undergoing elective laparoscopic bariatric surgery. Secondary outcomes include time to achieve a Patient State Index (PSi) greater than 80, time to achieve an Aldrete score of at least 8, incidence of postoperative nausea and vomiting, post-anesthesia care unit length of stay, and desflurane-related costs.

Inclusion Criteria: * Age 18 years or older. * Scheduled for elective laparoscopic gastric bypass surgery. * Body mass index between 30 and 50 kg/m². * American Society of Anesthesiologists physical status II or III. * Able and willing to provide written informed consent. Exclusion Criteria: * Surgical procedure lasting less than 2 hours. * Body mass index greater than 50 kg/m². * Significant cardiac disease. * Moderate or severe obstructive respiratory disease, including uncontrolled asthma or chronic obstructive pulmonary disease. * Pregnancy or breastfeeding. * Known allergy or contraindication to medications used during the intraoperative period. * Personal or family history of malignant hyperthermia. * Active illicit drug use or substance dependence. * Advanced chronic kidney disease, defined as an estimated glomerular filtration rate below 60 mL/min. * Myasthenia gravis or another neuromuscular junction disorder. * Severe cognitive or psychiatric disorder. * Refusal to participate or withdrawal of informed consent at any time.