R Rutledge, MD. Center for Laparoscopic Obesity s
The goals of anesthesia of obese patients include relaxation during surgery with no weakness post op; no drug induced bleeding and excellent anesthesia and analgesia without respiratory depression or nausea and vomiting post op. The present study documents a new anesthetic technique that aggressively utilizes exclusion of inhalational anesthetics and minimization of narcotic administration via foundation of Total Intravenous Anesthesia (TIVA) and concomitant use of Opioid Analgesia and Anesthesia (OAA).
Materials and Methods
Anesthesia has been modified in a continuous improvement process to manage patients undergoing the Mini-Gastric Bypass. The MGB is relatively unique because of several features: abdominal, laparoscopic, very short operating time (20 to 60 minutes), minimal bleeding, and very short hospital stay (less than 24 hours.) This unique surgery requires a tailored approach to anesthesia and post operative management.
Over a period of 15 years the anesthetic management has been modified from a gas and narcotic based traditional technique to one much more akin to out patient or conscious sedation techniques. Premeds the day and night morning of surgery include the use of a gabapentin and melatonin. A drip of Propofol and Remifentanil is used and patients are treated preoperatively with a graded low dose of Ketamine and a loading dose of Dexmedetomidine. Narcotic use was decreased and need for antiemetic was also minimized. Mean respiratory rate in the recovery room increased with the lesser use of narcotics and antiemetic (mean 8 to mean of 12 respirations / minute). Patient satisfaction was high and need for ICU admission for respiratory support was present in 2 patients who recovered quickly. Hospital stay was less than 24 hours in 93% of patients.
Newer anesthetic techniques can match newer mini surgical procedures. Elimination of inhalational agents, rare use of paralysis, TIVA and opioid sparing techniques can lead to safe management rapid recovery of independent respiratory status and rapid discharge.
Session Number: Poster – Poster Presentations
Program Number: P534