Title: Anaesthetic Management of Bariatric Surgery by Using Combination of Low Dose Dexmedetomidine and Propofol; an Alternative to Conventional Opioids and Inhalational Anaesthetics
Authors: Dr Neha Sharma, Dr Sanjay Kalani, Dr Vijeta Khandelwal, Dr Jeetendra Sharma
DOI: https://dx.doi.org/10.18535/jmscr/v4i10.99
Obesity is increasing like an epidemic; number of bariatric surgeries is also increasing proportionately. Obese patients are very prone to develop respiratory depression and hemodynamic instability due to anatomical and physiological factors. These problems are magnified by use of opioids and most of the inhalational agents which are used very frequently in bariatric surgery. We are presenting a case report with use of alternative method –combination of low dose dexmedetomidine and propofol. This study highlights their many benefits over other established techniques of anaesthesia like reduced other anaesthetic requirement during surgery, good hemodynamic stability, better recovery profile, less analgesic use, no need of ventilator support and less physiotherapy requirement in postoperative period along with better affordability and availability. Key words-Bariatric, Dexmedetomidine, Opioids, Propofol. 1. Rawal N, Sjostrand U, Christofferson E, Dahlstrom B, Arvill A, Rydman H. Comparison of intramuscular and epidural morphine for postoperative analgesia in the grossly obese. Influence of postoperative ambulation and pulmonary function .Anesth Analg 1984;63:583-92. 2. Arain SR, Ruehlow RM, Uhrich TD, Ebert TJ. The efficacy of dexmedetomidine versus morphine for postoperative analgesia after major inpatient surgery. Anesth Analg 2004; 98:153-8. 3. Dutta S, Karol MD, Cohen T, Jones RM, Mant T. Effect of dexmedetomidine on propofol requirements in healthy subjects. J Pharm Sci 2001; 90:172-81. 4. Thornton C, Lucas MA, Newton DE, Dore CJ, Jones RM. Effects of dexmedetomi-dineon isoflurane requirements in healthy volunteers. 2: Auditory and somatosensory evoked responses. Br J Anaesth 1999; 83:381-6. 5. Dholakia C, Beverstein G, Garren M, Nemergut C, Boncyk J, Gould JC. The impact of perioperative dexmedetomidine infusion on postoperative narcotic use and duration of stay after surgery. J Gastrointest Surg 2007;11:1556-9. 6. Gupta P, Tobias JD, Goyal S, Miller MD, de Moor MM, Noviski N, et al. Preliminary experience with a combination of dexmedetomidine and propofol infuse-ons for diagnostic cardiac catheterization in children. J Pediatr Pharmacol Ther 2009;14:106–12. 7. Campbell C, Weinger MB, Quinn M. Alterations in diaphragm EMG activity during opiate-induced respiratory depress-sion. Respir Physiol 1995;100:107-17. 8. Maze M, Scarfini C, Cavaliere F. New agents for sedation in the intensive care unit. Crit Care Clin 2001;17:881-97. 9. Beule AG, Wilhelmi F, Kuhnel TS, Hansen E, Lackner KJ, Hosemann W. Propofol versus sevoflurane: bleeding in endoscopic surgery. Otolaryngol Head Neck Surg 2007;136:45–50. 10. Pascoe PJ, Ilkiw JE, Frischmeyer KJ. The effect of the duration of propofol administration on recovery from anesth-esia. Vet Anaesth Analg 2006;33:2–7. 11. Cravens GT, Packer DL, Johnson ME. Incidence of propofol infusion syndrome during noninvasive radiofrequency ablation for atrial flutter or fibrillation. Anesthesiology 2007;106:1134–38. 12. Talke P, Richardson CA, Scheinin M, Fisher DM. Postoperative pharmacokinet-ics and sympatholytic effects of dexmede-tomidine. Anesth Analg 1997;85:1136–42. 13. Javahert S ,Abraham WT, Brown C, Nishi ama H, Giesting R, Wagoner LE. Prevalence of obstructive sleep apnea and periodic limb movement in 45 subjects with heart transplantation. Euro Heart J 2004;25:260-6. 14. Escalamado R.M., Glen MG, Mcculloch TM, Cummings CW. Peri-operative complications and risk factors in the surgical treatment of obstructive sleep apnea. Laryngoscope 1989;99:1125-9. 15. White PF. Comparative evaluation of intravenous agents for rapid sequence induction-thiopentol, ketamine and mida-zolam. Anaesthesiology 1982;57:279-84.Abstract
References