Previous article Table of Contents  Next article

LETTERS TO EDITOR
Year : 2023  |  Volume : 17  |  Issue : 2  |  Page : 286

Opioid-free anesthesia for the obese: An evolving script…


1 Department of Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India
2 Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi, India

Correspondence Address:
Rohan Magoon
Department of Cardiac Anaesthesia, Atal Bihari Vajpayee Institute of Medical Sciences (ABVIMS) and Dr. Ram Manohar Lohia Hospital, Baba Kharak Singh Marg, New Delhi - 110001
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_568_22

Rights and Permissions
Date of Submission06-Aug-2022
Date of Acceptance07-Aug-2022
Date of Web Publication10-Mar-2023
 


How to cite this article:
Nayak SS, Magoon R. Opioid-free anesthesia for the obese: An evolving script…. Saudi J Anaesth 2023;17:286

How to cite this URL:
Nayak SS, Magoon R. Opioid-free anesthesia for the obese: An evolving script…. Saudi J Anaesth [serial online] 2023 [cited 2023 Mar 27];17:286. Available from: https://www.saudija.org/text.asp?2023/17/2/286/371443



Dear Editor,

The most recent issue of the Saudi Journal of Anaesthesia provides extremely useful insights into the intricacies of bariatric anesthesia.[1] However, the ever-evolving nature of our specialty calls for a constant acknowledgement of newer emerging concepts. The aforementioned is exemplified by the present-day concept of an opioid-free anesthesia (OFA), the latter gaining impetus by virtue of an increasing embracement of the non-opioid analgesics and innovative regional techniques.[2] Withstanding the same, elaboration on the scope of OFA for the obese would be an appropriate extension of the discussion on bariatric anesthesia, resonating well with the Journal's readership.

While opioid stewardship in itself remains an ardently researched topic,[2] the obese in particular can be overly susceptible to opioid-related adverse events. As per the American Society of Anesthesiologists (ASA) closed claims database, as much as 48% of the adverse respiratory events consequent to opioids transpired in obese individuals.[3] The risk becomes all the more pronounced in those with obstructive sleep apnea given an enhanced propensity to upper airway obstruction. The altered pharmacokinetics of opioids in the obese further compound the matter.[3]

The proponents of OFA additionally cite that limiting the intraoperative opioids is expected to assume an enhanced relevance in the context of tolerance and hyperalgesia, the latter potentially culminating as increased postoperative opioid requirements. From a specific research standpoint in the obese population, a very recent meta-analysis by Hung et al. on the impact of OFA on analgesia and recovery following bariatric surgery deserves attention.[4] Subsequent to a pooled analysis of eight randomized, controlled trials (RCTs), OFA was found to be associated with lower 24-h pain scores and risk postoperative nausea vomiting (PONV) in absence of a significant beneficial role in minimizing the 24-h postoperative opioid consumption. Nonetheless, owing to an inconsistent quality of evidence for outcomes other than PONV, the authors propound the need for future well-designed RCTs featuring OFA in the obese.[4] Moreover, the obese being a characteristically predilected cohort, safety of an OFA regime is undeniably pivotal especially reflecting upon the premature termination of projects such as the Postoperative and Opioid-free Anesthesia (POFA) trial following cases of severe bradycardia with non-opioid analgesics like dexmedetomidine.[5]

To conclude, OFA presents a new horizon to the anesthesiologists involved in the perioperative care of the obese. However, the script of OFA for the obese would only evolve in the times to come backed by an enriching evidence and experience in the affiliated domain and efficiently consolidating our eternal pursuit of an augmented perioperative patient safety.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Eldawlatly AA. Special issue on “Bariatric anesthesia”. Saudi J Anaesth 2022;16:275.  Back to cited text no. 1
  [Full text]  
2.
Magoon R, Choudhury A. Opioid free anesthesia: Is it too early to bid adieu? Can J Anaesth 2019;66:1268-9.  Back to cited text no. 2
    
3.
Ingrande J, Lemmens HJ. Dose adjustment of anaesthetics in the morbidly obese. Br J Anaesth 2010;105(Suppl 1):i16-23.  Back to cited text no. 3
    
4.
Hung KC, Chiu CC, Hsu CW, Lin CM, Liao SW, Teng IC, et al. Impact of opioid-free anesthesia on analgesia and recovery following bariatric surgery: A meta-analysis of randomized controlled studies. Obes Surg 2022. doi: 10.1007/s11695-022-06213-7.  Back to cited text no. 4
    
5.
Beloeil H, Garot M, Lebuffe G, Gerbaud A, Bila J, Cuvillon P, et al. SFAR research network. balanced opioid-free anesthesia with dexmedetomidine versus balanced anesthesia with remifentanil for major or intermediate noncardiac surgery. Anesthesiology 2021;134:541-51.  Back to cited text no. 5
    




 

Top
 
Previous article    Next article
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  IN THIS Article
   References

 Article Access Statistics
    Viewed178    
    Printed2    
    Emailed0    
    PDF Downloaded26    
    Comments [Add]    

Recommend this journal