Laparotomy in a patient under opioid-free anaesthesia
DOI:
https://doi.org/10.23938/ASSN.0294Keywords:
Opioids. Adjuvants to local anaesthetics. General anaesthetic. Anaesthetic and analgesic. Bariatric surgery.Abstract
Obese patients subjected to bariatric surgery have a high probability of presenting complications that worsen with the use of opioids and can be reduced thanks to anaesthetic techniques like opioid-free anaesthetics (OFA). The risk of having to convert the laparoscopic surgical technique into open surgery is one of the criticisms aimed at this anaesthetic modality, facing the possibility of there not being a correct sympathetic or nociceptive control.
We present the case of a patient scheduled for laparoscopic bariatric surgery who, while maintaining OFA, was converted to open surgery (exploratory laparoscopy), with correct control achieved of both haemodynamics and perioperative pain.Downloads
References
HOFER RE, SPRUNG J, SARR MG, WEDEL DJ. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anesth 2005; 52: 176-180.
LOPEZ PP, STEFAN B, SCHULMAN CI, BYERS PM. Prevalence of sleep apnea in morbidly obese patients who presented for weight loss surgery evaluation: more evidence for routine screening for obstructive sleep apnea before weight loss surgery. Am Surg 2008; 74:834-838.
KOPPERT W, WEIGAND M, NEUMANN F, SITTL R, SCHUELTLER J, SCHMELTZ M et al. Perioperative intravenous lidocaine has preventive effects on postoperative pain and morphine consumption after major abdominal surgery. Anesth Analg 2004; 98: 1050-1055.
AHMAD S, NAGLE A, MCCARTHY RJ, FITZGERALD PC, SULLIVAN JT, PRYSTOWSKY J. Postoperative hipoxemia in morbidly obese patients with and without obstructive sleep apnea undergoing laparoscopic bariatric surgery. Anesth Analg 2008; 107: 138-143.
APFEL CC, HEIDRICH FM, JUKAR-RAO S, JALOTA L, HORNUSS C, WHELAN RP. Evidence-based analysis of risk factors for postoperative nausea and vomiting. Br J Anesth 2012; 109: 742-753.
ZIEMANN-GIMMEL P, GOLDFARB AA, KOPPMAN J, MAREMA RT. Opioid-free total intravenous anaesthesia reduces postoperative nausea and vomiting in bariatric surgery beyond triple prophylaxis. Br J Anesth 2014; 112: 906-911.
THORELL A, MACCORMICK AD, AWAD S, REYNOLDS N, ROULIN D, DEMARTINES N et al. Guidelines for perioperative care in bariatric surgery: Enhanced recovery after surgery (ERAS) society recommendations. World J Surg 2016; 40: 2065-2083.
HUTTER MM, SCHIRMER BD, JONES DB, CLIFFORD Y, COHEN ME, MERKOW RP et al. First report from the American College of Surgeons – Bariatric Surgery Center Network: Laparoscopic sleeve gastrectomy has morbidity and effectiveness positioned between the band and the bypass. Ann Surg 2011; 254: 410-422.
MUTTER TC, CHATEAU D, MOFFATT M, RAMSEY C, ROOS LL, KRYGER M. A matched cohort study of post-operative outcomes in obstructive sleep apnea. Anesthesiology 2014; 121: 707-718.
ALSINA E, MATUTE E, RUIZ-HUERTA AD, GILSANZ F. The effects of sevoflurane or remifentanil on the stress response to surgical stimulus. Curr Pharm Des 2014; 20: 5449-5468.
MULIER J. Perioperative opioids aggravate obstructive breathing in sleep apnea syndrome: Mechanisms and alternative anesthesia strategies. Curr Opin Anaesthesiol 2016; 29: 129-133.
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