Opiod Sparing Anesthesia in Mini-Gastric Bypass Using Dexmedetomidine, Ketamine and Remifentanil, Propofol Total Intravenous Anesthesia (TIVA)

Presenter: R. Rutledge (Centers for Laparocopic Obesity Surgery, Henderson, United States of America)

Background Anesthetic management of morbidly obese patients is problematic with particular concerns re: difficult airway, respiratory depression/failure and post operative nausea and vomiting (PONV). Opiod sparing techniques may allow improved management of these difficult patients.

Methods Mini-Gastric Bypass MGB patients were treated with either TIVA (remifentanil & propofol) with (TKD) or without (TNO) opiod sparing doses of supplemental ketamine (50-100 mg) and dexmedetomidine (100 μg IV over 10 minutes.) We compared post-anesthetic recovery analogue pain score (APS) and narcotic use (# of doses), post operative nausea and vomiting (PONV) and overall patient satisfaction.

Result Over a two year period 720 patients underwent MGB, 343 TKD patients and 377 TNO patients. The mean age 39 + 8, 85% female, mean BMI 45 + 7, mean operative time 39 + 5 min. No patient required reintubation for respiratory depression. In comparing the two groups the TKD patients had: significantly lower mean APS, fewer doses of rescue narcotics, a higher mean respiratory rate in recovery room, less PONV and higher levels of patient satisfaction.

Conclusion Morbidly obese patients present a serious anesthetic challenge to the surgeon and anesthesiologist. The short operative time of the Mini-Gastric Bypass (39 min) allows the use of opiod sparing techniques that decrease respiratory depression and PONV caused by narcotics. This decreases the need for narcotics, improves pain score, decrease PONV and improves overall patient satisfaction.


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