Abstract
Purpose
To describe the anesthetic management of a patient with extreme obesity undergoing bariatric surgery whose intraoperative narcotic management was entirely substituted with dexmedetomidine.
Clinical features
We describe a 433-kg morbidly obese patient with obstructive sleep apnea and pulmonary hypertension who underwent Roux-en-Y gastric bypass. Because of the concern that the use of narcotics might cause postoperative respiratory depression, we substituted their intraoperative use with a continuous infusion of dexmedetomidine (0.7µg·kg-1·hr-1). The anesthesia course was uneventful, and the intraoperative use of dexmedetomidine was associated with low anesthetic requirements (0.5 minimum alveolar concentration). After completion of the operation and after tracheal extubation, the dexmedetomidine infusion was continued uninterrupted throughout the end of the first postoperative day. The analgesic effects of dexmedetomidine extended narcotic-sparing effects into the postoperative period; the patient had lower narcotic requirements during the first postoperative day [48 mg of morphine by patient-controlled analgesia (PCA)] while still receiving dexmedetomidine, compared to the second postoperative day (morphine 148 mg by PCA) with similar pain scores.
Conclusion
Dexmedetomidine may be a useful anesthetic adjunct for patients who are susceptible to narcotic-induced respiratory depression. In this morbidly obese patient the narcotic-sparing effects of dexmedetomidine were evident both intraoperatively and postoperatively.
Résumé
Objectif
Décrire la démarche anesthésique utilisée chez un patient atteint d’obésité morbide devant subir un pontage gastrique. Les narcotiques peropératoires ont été entièrement remplacés par la dexmédétomidine.
Éléments cliniques
Le patient pesait 433 kg, présentait une apnée du sommeil obstructive et de l’hypertension pulmonaire. Il devait subir un pontage gastrique de Roux-en-Y. Inquiets de causer une dépression respiratoire postopératoire en utilisant des narcotiques, nous avons substitué leur usage peropératoire par une perfusion continue de dexmédétomidine (0,7 µg·kg-1·hr-1). L’anesthésie s’est bien déroulée et l’usage peropératoire de dexmédétomidine a été associé à de faibles demandes d’anesthésiques (concentration alvéolaire minimale de 0,5). Après l’opération et l’extubation endotrachéale, la perfusion continue de dexmédétomidine a été poursuivie jusqu’à la fin du premier jour postopératoire. La dexmédétomidine a permis d’économiser aussi les narcotiques après l’opération; le patient a demandé moins de narcotiques pendant le premier jour postopératoire [48 mg de morphine en analgésie autocontrôlée (AAC)] tout en recevant la dexmédétomidine, comparativement au deuxième jour (148 mg de morphine en AAC). Les scores de douleur étaient comparables.
Conclusion
La dexmédétomidine peut être un ajout anesthésique utile chez les patients susceptibles de dépression respiratoire induite par les narcotiques. Les effets d’économie de narcotiques de la dexmédétomidine ont été évidents ici pendant et après l’opération.
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Support for this report is provided from the Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota, USA.
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Hofer, R.E., Sprung, J., Sarr, M.G. et al. Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics. Can J Anaesth 52, 176–180 (2005). https://doi.org/10.1007/BF03027725
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DOI: https://doi.org/10.1007/BF03027725