Multimodal opioid-sparing total intravenous anesthesia in bariatric surgery – initial experience
Authors:
M. Hrobský 1,2; T. Henlín 1; J. Blažek 2; P. Šrámková 2; M. Fried 2
Authors‘ workplace:
Anesthesia s. r. o, Anesteziologie a resuscitace, Praha
1; Centrum pro léčbu obezity a metabolických poruch, OB klinika a. s., Praha
2
Published in:
Gastroent Hepatol 2025; 79(6): 465-468
Category:
doi:
https://doi.org/10.48095/ccgh2025465
Overview
Obesity represents a significant challenge for anesthesia management due to different drug pharmacodynamics and an increased risk of perioperative complications. Multimodal opioid-sparing total intravenous anesthesia is one of the options for positively influencing these complications. Since opioid-sparing methods are still considered by most anesthesiologists to be the only alternative techniques, we present our initial experiences and a comparison with inhalation anesthesia in laparoscopy as inspiration for others.
Keywords:
obesity – opioid-sparing anesthesia – multimodal techniques – TIVA – anesthesia depth monitoring
Sources
1. Navrátilová M. Bariatrická onemocnění z pohledu internisty. Brno: ČSARIM. 2024 [online]. Dostupné z: https: //www.akutne.cz/res/publication/000594/attach-001-52-2024-09-27-06-32 - 15.pdf.
2. Kloock S, Ziegler CG, Dischinger U. Obesity and its comorbidities, current treatment options and future perspectives: challenging bariatric surgery? Pharmacol Ther 2023; 251 : 108549. doi: 10.1016/j.pharmthera.2023.108549.
3. Runkle JR, Kocz R. Anesthetic considerations in bariatric surgery. StatPearls: Treasure Island 2024.
4. Nair A, Mistry T, Elghadban H et al. Analgesic efficacy of remifentanil versus other opioids: pharmacokinetic and pharmacodynamic considerations in obese patients. Cureus 2025; 17 (6): e86691. doi: 10.7759/cureus.86691.
5. Tochie JN, Bengono RS, Metogo JM et al. The efficacy and safety of an adapted opioid-free anesthesia in bariatric surgery: a randomized controlled trial. BMC Anesthesiology 2022; 22 (1): 325. doi: 10.1186/s12871-022-01856-6.
6. Ziemann-Gimmel P, Goldfarb AA, Koppman J et al. Opioid-free total IV anesthesia reduces PONV after bariatric surgery: prospective RCT. Br J Anaesth 2014; 112 (5): 906–911. doi: 10.1093/bja/aet551.
7. De Cassai A, Tulgar S, Carron M et al. Regional anesthesia in bariatric surgery. Curr Opin Anesthesiol 2025; 38 (5): 527–533. doi: 10.1097/ACO. 0000000000001506.
8. White PF. The changing role of non-opioid analgesic techniques in postoperative pain. Anesth Analg 2005; 101 (5 Suppl): S5–S22. doi: 10.1213/01.ANE.0000177099.28914.A7.
9. Vujović KS, Vučković S, Stojanović R et al. Interactions Between Ketamine and Magnesium for the Treatment of Pain: Current State of the Art. CNS Neurol Disord Drug Targets 2021; 20 (5): 392–400. doi: 10.2174/1871527320666210121144216.
10. Sun Y, Li T, Wang N et al. Perioperative systemic lidocaine for postoperative analgesia and recovery after abdominal surgery: meta-analysis of RCTs. Dis Colon Rectum 2012; 55 (11): 1183–1194. doi: 10.1097/DCR.0b013e318259 bcd8.
11. Purdon PL, Sampson A, Pavone KJ et al. Clinical electroencephalography for anesthesiologists: part I: background and basic signatures. Anesthesiology 2015; 123 (4): 937–960. doi: 10.1097/ALN.0000000000000841.
12. Beloeil H. Opioid-free anesthesia. Best Pract Res Clin Anaesthesiol 2019; 33 (3): 353–360. doi: 10.1016/j.bpa.2019.09.002.
13. Hung KC, Chiu CC, Hsu HW et al. Impact of Opioid-Free Anesthesia on Analgesia and Recovery Following Bariatric Surgery: a Meta-Analysis of RCS. Obes Surg 2022; 32 (9): 3113–3124. doi: 10.1007/s11695-022-06213-7.
14. Beloeil H, Garot M, Lebuffe G et al. POFA Study Group. Balanced Opioid-free Anesthesia with Dexmedetomidine versus Balanced Anesthesia with Remifentanil for Major or Intermediate Noncardiac Surgery. Anesthesiology 2021; 134 (4): 541–551. doi: 10.1097/ALN.0000000000003725.
Labels
Paediatric gastroenterology Gastroenterology and hepatology SurgeryArticle was published in
Gastroenterology and Hepatology
2025 Issue 6
Most read in this issue
- Acute and chronic pancreatitis at the Centre National Hospitalier Universitaire de Cotonou from 2011 to 2022 : epidemiological, diagnostic, therapeutic, and prognostic aspects
- Swallowing disorder as the first symptom of desminopathy
- Hereditary pancreatitis as a cause of complications in the treatment of severe hematological malignancy
- Treatment strategies for pediatric gallstone disease: a systematic review