a-00103

Dr. Robert RUTLEDGETitle of Paper: OPIOID SPARING ANESTHESIA IN MINI-

GASTRIC BYPASS USING DEXMEDETOMIDINE, KETAMINE AND TOTAL INTRAVENOUS ANESTHESIA (TIVA)

Nationality: United States of AmericaPosition: Director

Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery

Tel: +1-702 714 0011E-mail: drr@clos.net

OPIOID SPARING ANESTHESIA IN MINI-GASTRIC BYPASS USING

DEXMEDETOMIDINE, KETAMINE AND TOTAL INTRAVENOUS

ANESTHESIA (TIVA)

Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America

Introduction

• Anesthetic management of morbidly obese, Difficult/Dangerous/Deadly, Difficult airway, Respiratory Insufficiency/Depression/Failure, Post Operative Nausea and Vomiting (PONV).

• "Opioid Sparing" Techniques may Decrease Resp Depression Decrease PONV

Introduction• OPIOIDS Drugs: Critical in Pain

Management. BUT: • Increased in-hospital morbidity and

costs, • Respiratory depression • Postoperative nausea and vomiting

[PONV]• Sedation, Sleep disturbance, Urinary

retention,

Introduction

• Opioid sparing Anesthesia/Analgesia is an Intervention designed to:

• Provide Pain Relief• Decrease the need/use of Narcotics to • Protect patients from the risks of

Narcotics, • (PONV, Respiratory Depression etc.)

Opioid Sparing Drugs

• Dexmedetomidine (Precedex),

• Ketamine,

• NSIADS (Intravenous Paracetamol)

Methods:

• Anesthesia Techniques: • Mini-Gastric Bypass MGB patients were

treated with• TIVA (remifentanil & propofol) without Opioid

Sparing (T-No) vs • TIVA (remifentanil & propofol) with• "Opioid Sparing" • Ketamine (50-150mg) • Dexmedetomidine (100 μg IV over 10

minutes.) (T-KD)

Results

• Comparison: Post-anesthetic recovery analogue pain score (APS) Narcotic use (# of doses),

• Post operative nausea and vomiting (PONV) and Overall patient satisfaction Recovery Room Nurse Assessment

Results

• Over a two year period 720 patients underwent MGB, 343 T-KD patients and 377 T-No patients.

• The mean age 39, 85% female, mean BMI 45 +/- 8, mean operative time 39 min.

• No patient required reintubation for respiratory depression.

Results

• Fewer T-KD patients required rescue narcotics. (9% vs 87%)

• Higher mean respiratory rate in recovery room. (15.3 + 2 vs 8.1 + 5)

• Less PONV in T-KD patients (3% vs 23%)

• Higher patient satisfaction. (4.7/5 vs 4.1/5)

Conclusions:

• Morbidly obese patients present a serious challenge.

• The short operative time of the Mini-Gastric Bypass (39 min) allows the use of opioid sparing techniques that decrease respiratory depression and PONV caused by narcotics.

Conclusions

• "Opioid Sparing" • decreases the need for narcotics, • improves pain score, • decrease PONV and • improves overall patient satisfaction.