apc a-00103-opioid sparing
TRANSCRIPT
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: [email protected]
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.