Case Analysis : Lam And Mui

1742 WordsMar 19, 20177 Pages
Lam and Mui (2016), applied a multimodal analgesia model in their bariatric patients, which included premedication with pantoprazole 40mg the night before and 2g PO paracetamol and 150mg or 300mg of PO pregabalin (depending on BMI) two hours before surgery. Once in the operating room, 1-2mg of midazolam was administered, then a dexmedetomidine infusion was started at 0.2mcg/kg/hr based on the patient’s lean body weight (LBW). Induction included the use of 100mcg of fentanyl, propofol, and either suxamethonium or rocuronium. After intubation was achieved, a loading dose of ketamine of 0.3mg/kg/hr of LBW was administered, along with, parecoxib 40mg, tramadol 100mg, dexamethasone 8mg, and tropisetron 5mg. A rocuronium drip was titrated to…show more content…
431). Ahmad et al. study included 40 morbidly obese patients who underwent laparoscopic bariatric surgery. Their anesthetic included desflurane and a remifentanil and morphine administration, which resulted in common hypoxic episodes in the first 24 hours. Of the 40 participants, 14 had more than five hypoxic episodes per hour (Lam and Mui, 2016). Hofer et al. (2005) presented a case study of a 42 year old male who is morbidly obese (433kg) presenting for bariatric surgery. His comorbidities included obstructive sleep apnea, pulmonary hypertension, lower extremity lymphedema, and gastroesophageal reflux. Arterial blood gas was obtained and the results were as follows: pH 7.39, PaO2 69 mmHg, SaO2 91%, bicarbonate 30mEq, and PaCO2 51 mmHg and a pulmonary function test that indicated severe restrictive pattern. The patient’s intra-operative pain was strictly treated with dexmedetomidine. Post-operatively the patient was transferred to the ICU and remained intubated overnight due to not meeting extubation criteria, which he did meet two hours later, but the decision was made to leave the patient intubated overnight. Once extubated, the patient’s opioid requirements were less; indicating that opioid-free anesthesia is an effective alternative pain relief while avoiding opioid-induced respiratory depression. Bakhamees’ et al. (2007) study showed the same results as that of Hofer’s et al. study, but in a
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