title: Anesthesia for a patient with morbid obesity using dexmedetomidine without narcotics.
abstract: OBJECTIVE
  To describe the anesthetic management of a patient with extreme obesity undergoing bariatric surgery whose intraoperative narcotic management was entirely substituted with dexmedetomidine.
  
  
  METHODS
  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 microg.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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Anesthesiology, Mayo Clinic College of Medicine, 200 First Street S.W., Rochester, MN 55905, USA.
authors.forename: Roger E
authors.initials: RE
authors.lastname: Hofer
authors.forename: Juraj
authors.initials: J
authors.lastname: Sprung
authors.forename: Michael G
authors.initials: MG
authors.lastname: Sarr
authors.forename: Denise J
authors.initials: DJ
authors.lastname: Wedel
mesh_terms: D000328:Adult; D016058:Analgesia, Patient-Controlled; D000713:Anastomosis, Roux-en-Y; D000758:Anesthesia; D020927:Dexmedetomidine; D015390:Gastric Bypass; D018475:Head-Down Tilt; D006801:Humans; D006993:Hypnotics and Sedatives; D008209:Lymphedema / Q000150:complications; D008297:Male; D016343:Monitoring, Intraoperative; D009294:Narcotics; D009767:Obesity, Morbid / Q000150:complications*; D010149:Postoperative Pain / Q000188:drug therapy; D012121:Respiration, Artificial; D020181:Sleep Apnea, Obstructive / Q000150:complications
chemical_list: D006993:Hypnotics and Sedatives; D009294:Narcotics; D020927:Dexmedetomidine