Bariatric surgery: the role of dexmedetomidine

Bariatric surgery has become a popular treatment for morbid obesity. The type of surgery could be either a gastric resection with Roux-en-Y construction or an adjustable gastric banding. Although still performed as an open procedure, bariatric surgery is now usually performed laparoscopically. The pathophysiology of morbid obesity puts the patient at risk for major respiratory and cardiovascular adverse events. To ameliorate these risks, the α₂-adrenoreceptor agonist dexmedetomidine was introduced for the anesthetic and postoperative management of these patients. In one center, over 2000 bariatric procedures have now been performed safely using the perioperative administration of dexmedetomidine. Dexmedetomidine has little effect on ventilation is cardioprotective and neuroprotective and allows for a hemodynamically very stable course, while reducing the need for opioids and inhalational agents. This results in less respiratory depression and airway compromise, less nausea and vomiting, better intestinal function, and potentially, a day surgery (less than 24 hour admission) procedure.