Apc a-00103-opioid sparing

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Apc a-00103-opioid sparing

  1. 1. a-00103 Dr. Robert RUTLEDGE Title of Paper: OPIOID SPARING ANESTHESIA IN MINI-GASTRIC BYPASS USING DEXMEDETOMIDINE, KETAMINE AND TOTAL INTRAVENOUS ANESTHESIA (TIVA) Nationality: United States of America Position: Director Department: Surgery Organization: Center For Laparoscopic Obesity Surgery Tel: +1-702 714 0011 E-mail: drr@clos.net
  2. 2. OPIOID SPARING ANESTHESIA IN MINI-GASTRIC BYPASS USINGDEXMEDETOMIDINE, KETAMINE AND TOTAL INTRAVENOUS ANESTHESIA (TIVA) Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
  3. 3. 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
  4. 4. 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,
  5. 5. 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.)
  6. 6. Opioid Sparing Drugs• Dexmedetomidine (Precedex),• Ketamine,• NSIADS (Intravenous Paracetamol)
  7. 7. 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)
  8. 8. 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
  9. 9. 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.
  10. 10. 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)
  11. 11. 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.
  12. 12. Conclusions• "Opioid Sparing"• decreases the need for narcotics,• improves pain score,• decrease PONV and• improves overall patient satisfaction.

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