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. OPIOID SPARING ANESTHESIA IN
MINI-GASTRIC BYPASS USING
DEXMEDETOMIDINE, KETAMINE
AND TOTAL INTRAVENOUS
ANESTHESIA (TIVA)
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

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. 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. 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. Opioid Sparing Drugs
• Dexmedetomidine (Precedex),
• Ketamine,
• NSIADS (Intravenous Paracetamol)

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. 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. 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. 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. 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. Conclusions
• "Opioid Sparing"
• decreases the need for narcotics,
• improves pain score,
• decrease PONV and
• improves overall patient satisfaction.