الفهرس 
Definition & Prevalence of obesityOnly 14 pages are availabe for public view
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Abstract
Obesity is a major worldwide problem in public health, reaching epidemic proportions in western countries. Bariatric surgery has been shown to be more effective in the management of morbid obesity, compared to medical treatments in terms of weight loss and amelioration of comorbidities.( 125) With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic gastric bypass has also been found to be of value in surgical control of obesity. Laparoscopic techniques offer major benefits to the patient such as minimized incision size and trauma with reduced postoperative discomfort, shortened recovery rates and a lower incidence of postoperative wound infections. These factors all contribute to shorter in-patient stay and reduced perioperative morbidity.(127) The goal in anesthetic management of obese patients is to have proper anesthesia when needed, but a rapid emergence and resumption of adequate respiration and physiology very shortly after the end of the procedure. Anything done to minimize the need of postoperative opioids and minimize the risk of postoperative nausea and vomiting is very valuable. Therefore, this patient population could benefit from a drug that can produce analgesic effects without significant or long-lasting effects on respiratory function.(139) Dexmetomidine is a sedative α2 agonist drug introduced to the market after approved by the F.D.A in 1999. It has some desirable effects like decreasing the heart rate, moderate hypotension, rapid onset of action and rapid elimination. It is now well known that it has a good analgesic properties. Recently precedex has been approved by the F.D.A to be used for morbidly obese patients.(140) The aim of this study was to compare the efficacy of dexmedetomidine versus fentanyl infusion during general anesthesia using total intravenous anesthesia with propofol in laparoscopic bariatric surgeries as regard to recovery profile, postoperative analgesia up to 12 hours and hemodynamic profile. This study was carried out in Tanta University Hospitals in General Surgery Department from July 2016 to July 2017 on sixty-four patients between 20-40 years old scheduled for elective laparoscopic bariatric surgeries. Patients were allocated randomly into group I (Dexmedetomidine group) and group II (Fentanyl group). In Dexmedetomidine group the patient received loading dose of Dexmedetomidine (0.5 ug/kg) intravenously over 10 minutes followed by continuous infusion at a rate of (0.5 ug/ kg/ h) after intubation and was stopped 10 minutes before the end of surgery. In Fentanyl group, Fentanyl (1 ug/kg) was given intravenously over 10 minutes before induction of anesthesia as loading dose followed by continuous infusion at a rate of (1ug/kg/hr) after intubation and was stopped 10 minutes before the end of surgery. In both groups, Propofol infusion at rate 10 mg /kg/ hr for the first 10 min, 8 mg/kg/hr for the next 10 min and then at 5–6 mg/kg/hr for the duration of the procedure. Which was further reduced to 2 mg/ kg/ hr at skin closure. The results of this study: 1- There was no statistically significant difference between both groups as regard to demographic data which included (Age, sex, BMI and duration of surgery). 2- As regard to hemodynamics, the use of dexmedetomidine in total intravenous anesthesia in comparison to the use of fentanyl significantly decreased the HR and the MAP. 3- As regard anesthetic requirements, dexmedetomidine decreased the additional required dose of propofol to adjust MAP and BIS significantly. 4- Also according to the recovery profile which is the primary outcome, it was improved as dexmedetomidine significantly decreased the time to spontaneous eye opening, the time to tracheal extubation and the time to follow commands as compared to fentanyl. 5- There was no statistically significant difference as regard to (bispectral index (BIS), urine output and postoperative oxygen saturation). 6- As regards to the postoperative analgesia, dexmedetomidine prolong the duration of first analgesic request and decreased postoperative analgesic consumption. 7- According to adverse events, the use of dexmedetomidine significantly increased the incidence of bradycardia and hypotension as compared to fentanyl but fentanyl increased the incidence of postoperative nausea and vomiting.