Bataller Bassols Adriana, Quintero Moreno Dayana, Colina Vargas Yerlin-Andrés, Santaliestra Fierro Jesús, Rivero Novoa Eloymar, Ballesta Carlos, Ramirez-Paesano Carlos
Centro Médico Teknon, Grupo Quironsalud, Barcelona, Spain.
Resident in Anesthesiology, Universidad Pontificia Bolivariana, Medellín, Colombia.
J Med Case Rep. 2025 Aug 15;19(1):404. doi: 10.1186/s13256-025-05484-9.
Bariatric surgery has been established as an effective intervention for weight reduction and the improvement of comorbidities. In this context, the use of opioid-free anesthesia with multimodal analgesia is gaining importance because of its ability to minimize respiratory complications and other opioid-related adverse effects in these patients. In the reviewed literature we found no reports of the use of opioid-free anesthesia/analgesia with total intravenous anesthesia based on propofol/lidocaine/ketamine/dexmedetomidine in bariatric surgery for patients with morbid obesity with a body mass index greater than 60 kg/m.
The anesthetic management of a 50-year-old white-Hispanic female patient was documented. The patient suffered from morbid obesity with weight 260 kg, height 1.62 m, and a body mass index of 99 kg/m. She was American Society of Anesthesiologists III with obesity hypoventilation syndrome, and chronic heart failure.The patient was scheduled for laparoscopic gastric bypass. Opioid-free anesthesia/analgesia was performed via total intravenous anesthesia based on propofol and standard multimodal analgesia. Low-dose infusions of lidocaine, ketamine, and dexmedetomidine were continued for 48 hours. The patient had a good level of satisfaction during the postoperative period, without the need for postoperative rescue opioids. There was effective pain control (VAS < 3) and an absence of postoperative nausea and vomiting. No respiratory, cardiovascular, or gastric complications were observed during the hospital stay, and she was discharged on the eleventh postoperative day, indicating a high level of satisfaction without complications or adverse effects.
This case shows that opioid-free anesthesia/analgesia can be feasible and safe. The mandatory use of anesthetic depth monitoring together with the validation of target-control infusion models for propofol in obese patients are both recommended to facilitate the more frequent use of total intravenous anesthesia-target-control infusion in this population.
减重手术已被确立为一种有效的减重及改善合并症的干预措施。在此背景下，使用无阿片类麻醉联合多模式镇痛正变得越来越重要，因为它能够将这些患者的呼吸并发症及其他与阿片类相关的不良反应降至最低。在我们查阅的文献中，未发现有关在体重指数大于60kg/m²的病态肥胖患者的减重手术中使用基于丙泊酚/利多卡因/氯胺酮/右美托咪定的全静脉麻醉进行无阿片类麻醉/镇痛的报道。
记录了一名50岁白种西班牙裔女性患者的麻醉管理情况。该患者患有病态肥胖，体重260kg，身高1.62m，体重指数为99kg/m²。她是美国麻醉医师协会Ⅲ级，患有肥胖低通气综合征和慢性心力衰竭。该患者计划接受腹腔镜胃旁路手术。通过基于丙泊酚的全静脉麻醉和标准多模式镇痛进行无阿片类麻醉/镇痛。低剂量输注利多卡因、氯胺酮和右美托咪定持续48小时。患者术后满意度良好，无需术后补救性使用阿片类药物。疼痛得到有效控制（视觉模拟评分法＜3），且未出现术后恶心和呕吐。住院期间未观察到呼吸、心血管或胃部并发症，患者于术后第11天出院，表明满意度高，无并发症或不良反应。
该病例表明无阿片类麻醉/镇痛是可行且安全的。建议在肥胖患者中强制使用麻醉深度监测并验证丙泊酚的靶控输注模型，以促进该人群更频繁地使用全静脉麻醉-靶控输注。
