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Background <p>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&#xa0;kg/m<sup>2</sup>.</p> Case presentation <p>The anesthetic management of a 50-year-old white-Hispanic female patient was documented. The patient suffered from morbid obesity with weight 260&#xa0;kg, height 1.62&#xa0;m, and a body mass index of 99&#xa0;kg/m<sup>2</sup>. 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&#xa0;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 &lt; 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.</p> Conclusions <p>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.</p>

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Total intravenous-opioid-free anesthesia/analgesia (OFAA) for a morbid obese patient with a body mass index of 99 kg/m2 undergoing gastric bypass: a case report

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  • 发表日期：

    2025年8月15日

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  • Adriana Bataller Bassols,
  • Dayana Quintero Moreno,
  • Yerlin-Andrés Colina Vargas,
  • Jesús Santaliestra Fierro,
  • Eloymar Rivero Novoa,
  • Carlos Ballesta,
  • Carlos Ramirez-Paesano

摘要

Background

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/m2.

Case presentation

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/m2. 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.

Conclusions

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.