OBEZ

Opioidler premedikasyonda, intraoperatif dönemde indüksiyon ve idamede ve postoperatif dönemde etkin analjeziuygulamalarında kendine yer bulan, ancak respiratuvar depresyon, bulantı kusma gibi yan etkileri de bulunan özellikli ilaçlardır.Obezite ise opioidlerinin yan etki profillerinin belirginleştiği bir yandaş hastalık olup, opioidlerin bu popülasyondaki fizyolojik vepatofizyolojik profilleri, klinisyenlerin anaestezi yönetimi sırasında opioidlerden kısmen veya tamamen uzaklaşmasına nedenolmaktadır. Opioidsiz anestezi uygulamasında kullanılan ilaçlar bunlarla sınırlı olmamakla beraber, sıklıkla ?-2 adrenerjik reseptöragonistleri, ketamin, lidokain, gabapentinoidler, magnezyum ve kombinasyonlarını içermektedir. Opioidsiz anestezi uygulamasıiçin anaestezistlerin opioidlerin yerine geçecek ilaçların obez hasta grubundaki farmakokinetik ve farmakodinamik özellikleriniiyi bilmeleri ve anestezi derinliğini monitorize etmeleri gerekmektedir. Minimal invazif cerrahi teknikleri, deneyimli cerrahi veanestezi ekipleri tekniğin başarısına katkı sağlayacaktır. Bu bağlamda, opoidsiz anestezi dikkatle seçilmiş hasta ve cerrahilerdetercih edilmelidir.

A NEW GOAL IN OPIOID MANAGEMENT IN OBESE PATIENTS

Opioids have unique features that facilitate premedication, smooth induction, ease the maintenance of anaesthesia and improvepostoperative pain relief. However, they also have side effects such as respiratory depression, nausea and vomiting. Obesity is oneof the most frequent disorders that require attentive opioids management. The physiological and pathophysiological consequencesof opioids in obese population lead clinicians avoid or limit these drugs during anaesthetic management. The drugs used for anopioid-free anaesthesia plan include, but are not limited to, ?-2 adrenergic receptor agonists, ketamine, lidocaine, gabapentinoidsand magnesium, separately or in combinations. For opioid-free anaesthesia, clinicians should have thorough knowledge ofpharmacokinetic and pharmacodynamic properties of substitute drugs used instead of opioids. Anaesthesia depth should bemonitored. Minimally invasive surgery, experienced surgery and anaesthesia team help ensuring the success of this technique.Opioid-free anaesthesia is a new horizon for anaesthetists who try to perfect their practice in overweight patients. In this regard,opioid-free anaesthesia for obese population should be reserved for cautiously-selected patients and interventions.

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