Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics

Roger E. Hofer, Juraj Sprung, Michael G. Sarr, Denise J. Wedel

Research output: Contribution to journalArticle

114 Scopus citations

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 (0.7 μg·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.

Original languageEnglish (US)
Pages (from-to)176-180
Number of pages5
JournalCanadian Journal of Anesthesia
Volume52
Issue number2
DOIs
StatePublished - Feb 2005

ASJC Scopus subject areas

  • Anesthesiology and Pain Medicine

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