Update on Anesthesia for Bariatric Surgery (Opioid Free Anesthesia as a Model

Abstract

SUMMARY O besity is a chronic relapsing neurochemical disease that is more prevalent all over the world leading to much co morbidity. Obesity becomes a global health problem in the present time. Obesity is an increasing of adipose tissue mass which affect on all body systems functions. Obesity is a central player in pathophysiology of diabetes mellitus, insulin resistance and atherosclerosis. It is also influences organ dysfunction. Due to health complication of obesity there is a need to treat obesity. The treatment of obesity is consists of combination of diet regimens, exercises and medical drugs to have a healthy body weight of obese patients many patients will be improved on this type of treatment. When medical treatment failed surgical procedure will be an obligatory solution. Bariatric surgical procedures cause weight loss by restricting the amount of food the stomach can hold causing malabsorption of nutrients only or combination with gastric restriction. The most common bariatric surgery procedures are gastric bypass, sleeve gastrectomy, adjustable gastric band and biliopancreatic diversion with duodenal switch. The goals of anesthesia of obese patients include relaxation during surgery with no weakness post operatively and excellent anesthesia and analgesia with no respiratory depression or nausea and vomiting. To overcome the pathological changes of obesity during anesthesia the anesthetic drug must be calculated on Lean body weight, prepare for any susceptibility of difficult airway management and taking a concern about post operative complication. Recently there is a trend to do an anesthesia for bariatric surgery without using opioids which lead to avoid postoperative complications respiratory depression, obstructive sleep apnea, deep venous thrombosis, hyperalgesia, immunosuppression and achieve enhanced rapid recovery after surgery. By using a multi model analgesic techniques as neural block, Non steroidal anti-inflammatory drugs, Ketamine, Magnesium sulphate and others.