The effect of combined remifentanil and low dose ketamine infusion in patients undergoing laparoscopic gastric bypass

Hasanein, Riham; El-Sayed, Wael; Nabil, Nashwa; Elsayed, Ghada

doi:10.1016/j.egja.2011.07.009

The effect of combined remifentanil and low dose ketamine infusion in patients undergoing laparoscopic gastric bypass

Authors

10.1016/j.egja.2011.07.009

Abstract

Background
The choice of anesthesia in morbidly obese patients remains controversial. We evaluated the effect of continuous low dose ketamine infusion combined with remifentanil and propofol in patients undergoing laparoscopic gastric bypass, on hemodynamic stability, postoperative analgesic requirement and recovery profile.
Methods
60 patients aged 25–50 years, allocated into 2 groups. Group I: received continuous infusion of (propofol 6–10 mg/kg/h + remifentanil 0.2 μg/kg/min + saline). Group II: received continuous infusion of (propofol 6–10 mg/kg/h + remifentanil 0.2 μg/kg/min+ ketamine 1μg/kg/min). All patients recieved intravenous morphine by patient controlled analgesia (PCA) postoperatively.
Results
During anesthesia, mean arterial blood pressure and heart rate were decreased in group I compared with group II. The amount of propofol required to maintain the target BIS was lower in group II compared with group I . The amount of intraoperative boluses of remifentanil required to maintain hemodynamics was lower in group II compared with group I. The amount of PCA morphine at 2 h in the PACU and the first post operative day were lower in group II compared with group I. Pain scores at 1 h and 2 h postoperatively were lower in group II compared to group I. value <0.05 was considered significant.
Conclusion
During laparoscopic gastric bypass in morbidly obese patients the co-administration of low dose ketamine and remifentanil by continuous infusion provide more hemodynamic stability, satisfactory recovery profile and adequate postoperative pain relieve.

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