Preinductive use of clonidine and ketamine improves recovery and reduces postoperative pain after bariatric surgery

Wherefore ketamine?

“…Several other publications concerning perioperative use have appeared in the review period. Earlier results have been reaffirmed [65]; a single ketamine dose at induction has again been shown not to reduce postoperative morphine requirements [66], although preinduction administration of ketamine with clonidine seemed beneficial [67].…”

Perioperative management of the severely obese patient: a selective pathophysiological review

“…There are a number of options for adjunctive therapy to reduce analgesic requirements, with positive studies using preoperative central a-2 receptor agonists (e.g., clonidine and dexmedetomidine), pregabalin and gabapentin, and combined clonidine and S-ketamine. [125][126][127][128] If opioid-based patient-controlled analgesia is to be used, background infusions should be avoided, and the lockout period should be adjusted to minimize sedation and respiratory depression.…”

Controversies in Perioperative Anesthetic Management of the Morbidly Obese: I Am a Surgeon, Why Should I Care?

“…High analgesic efficacy NSAIDs like ketorolac are known to provide optimal analgesia (especially post laparoscopic procedures) without significant adverse respiratory effects [20,21,80]. Multiple recent reports have shown that the use of analgesic adjuvants, for example, alpha-2 blockers like clonidine [81] and dexmedetomidine [82], low dose ketamine as an infusion, magnesium [83], pregabalin, etc., in the postoperative period adds to clinically effective analgesia avoiding the need for opioids. Use of patient-controlled intravenous/ epidural analgesia must be encouraged in these patients for expedited pain-free recovery [84].…”