الفهرس 
REVIEW OF LITERATUREOnly 14 pages are availabe for public view
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Abstract
Opioids have historically been a first-line therapy for surgical pain control. They were considered optimum and the mainstay of balanced anesthesia but recently, concerns about their side effects have been raised. Side effects of opioids could lead to significant morbidity and even mortality due to their effect on conscious level, respiratory drive, nausea, vomiting, and constipation. Additionally, there is evidence that opioids could affect the outcome of surgery by increasing the risk of infection or increasing the risk of metastasis in patients suffering from cancer owing to their immunosuppressive effect.
These effects are more obvious in the obese population owing to the fact that they show a higher incidence of cardiac and pulmonary diseases as well as OSA prevalence.
The concept of opioid free anesthesia (OFA) was introduced to provide a safer alternative that would provide benefits as well as enhance recovery after surgery.
An effective OFA strategy consists of a combination of pharmacological agents and non-pharmacological techniques that target different pathways of the pain mechanism.
The key concept in designing a multimodal strategy for pain control is targeting multiple different neurotransmitters and neural relays in the ascending and descending pathways of the nociceptive system simultaneously by anti-nociceptive agents that can act to disrupt information processing
The current study compares the use of a mixture of dexmedetomidine and ketamine infusion with traditional fentanyl infusion intra-operative on many variables, both intra-operative and post-operative in bariatric surgeries. Hemodynamic events (bradycardia, hypotension and hypertension), time to extubation, time to reach an Aldrete score of 9, post-operative hypoxemia, vomiting, pain scores, and nalbuphine consumption were recorded and compared with the traditional balanced anesthesia (TBA)
OFA has a better profile than TBA with regard to post-operative pain score and opioid consumption post-operative, but they have a relative increase in time to extubation and time to reach an Aldrete score of 9.