الفهرس 
PHYSIOLOGY AND PHARMACOLOGYOnly 14 pages are availabe for public view
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Abstract
Laparoscopic approach has been a popular alternative to the traditional open abdominal surgery as it combines the benefits of less post-operative pain, less postoperative ileus, less affection of postoperative respiratory functions with shorter postoperative hospital stay and rapid return to normal life. However, laparoscopic surgeries are associated with ventilatory, hemodynamic and neuroendocrinal changes which result from the combined effects of hypercapnia resulted from CO2 absorption, pneumoperitoneum, and patient position.
The aim of our study was to evaluate the efficacy and safety of giving general anesthesia without the use of opioids in laparoscopic bariatric surgery.
This randomized controlled clinical study was conducted on 50 adult patients of both sexes, ASA I and II, scheduled for elective laparoscopic bariatric surgeries under general anesthesia in Ain Shams University Hospitals.
The Patients were randomly divided into two equal groups. The Non-opioid group received intravenous analgesic dose of ketamine 0.25 mg /kg IBW, dexmedetomidine 0.5 - 1 ug/ kg IBW, lidocaine 1.5 mg /kg IBW and magnesium 40 mg /kg IBW. The calculated doses of ketamine, dexmedetomidine, magnesium and lidocaine were prepared in 20 ml normal saline syringe given slowly over 10 minutes. The opioid group received fentanyl 2-4 mcg/Kg. The calculated fentanyl dose for each patient was prepared in a total volume of 20 ml normal saline.
General anesthesia was induced by propofol and rocuronium and maintained with sevoflurane (titrated to maintain BIS in the range 40-60), Muscle relaxation was maintained giving boluses of rocuronium (10-20 mg) and adjusted to ensure complete disappearance of the first twitch Of TOF stimulation. Ventilator settings were set to keep ETCO2 between 35 and 40 mmHg.
Infusion of the maintenance drugs stopped five minutes before the anticipated end of surgery, and isoflurane was stopped also at the end of the surgery and the residual neuromuscular blockade was antagonized with sugammadex 2 mg/kg.
Hemodynamic measurements perioperative, postoperative pain, the incidence of adverse events in the postoperative period (hypoxemia, PONV, postoperative opioid consumption) were recorded.
At the end of surgery, extubation was done when there were recovery from muscle relaxation as indicated by a full train of four and the patient was able to follow commands.
In PACU patients were observed for level of consciousness, SpO2, MAP, HR, pain by VAS score and any postoperative complications (e.g. hypotension, bradycardia, nausea, vomiting, somnolence).
Analgesics in the form of: 1 gram of paracetamol every 6 hours and fentanyl for PCA with concentration 10 mcg/ml, with a dose of 1 ml and lock out interval of 6 minutes with infusion rate 5 ml/hour were given.
There were no statistically significance differance between both groups as regard heart rate, mean blood pressure, EtCO2, peak inspiratory pressure. But postoperative oxygen saturation was higher and pain score was lower in the non - opioid group.
Our study showed that combining non opioid drugs will produce adequate analgesia and hence anesthesia compared to total balanced anesthesia using opioids during laparoscopic bariatric surgeries. Non-opioid treated patients postoperatively were less sedated, with less respiratory depression, and had less pain scores