Effect of Intraoperative Anesthetic Management on Postoperative Nausea and Vomiting in Bariatric Surgery

Study Overview
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Brief Summary
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Morbidly obese patients are at high risk for Postoperative Nausea and Vomiting (PONV) after surgery and general anesthesia. The results of our observational study indicate that 42.7% of patients require medication to treat PONV in the first 24 hours after bariatric surgery despite our aggressive perioperative approach with triple prophylaxis. Common risk factors for PONV are the use of intraoperative narcotics and anesthetic gases. Preliminary results of multimodal postoperative analgesia in the first 24 hours lead to a reduction of narcotic consumption, desaturations and use of antiemetic medication. Our study hypothesis is that different types of anesthetics reduce PONV further. Patient would be randomly assigned to receive either our current intraoperative management or a narcotic free, total intravenous general anesthetic (TIVA). The investigators hope to improve patients' satisfaction by reducing PONV in the postoperative period.

Detailed Description
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See above

Official Title
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Effect of Intraoperative Anesthetic Management on Postoperative Nausea and Vomiting (PONV) in Bariatric Surgery

Conditions
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Postoperative Nausea and Vomiting

Intervention / Treatment
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* Drug: TIVA NoNarc


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: All patients scheduled for bariatric surgery at Flagler Hospital will be included after written and informed consent. Exclusion Criteria: Patients will be excluded from the study if they don't consent to participate in the study. Patients allergic to any of the study medication will be excluded. Patients with second or third degree heart block will be excluded.

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Prevention
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| No Intervention: Balanced Anesthesia<br>Patients will receive balanced general anesthesia including volatile anesthetics and narcotics. This reflects our current clinical practice. | |
| Active Comparator: NoNarc TIVA<br>Patients will receive narcotic free total intravenous anesthesia with Propofol, dexmedetomidine and ketamine | Drug: TIVA NoNarc<br>* patients in both groups receive antiemetic prophylaxis patients in the TIVA NoNarc group will receive propofol, dexmedetomidine, ketamine, ketorolac and acetaminophen intraoperatively postop management in both groups is similar in both groups<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| PONV During the First 24 Hours After Bariatric Surgery | Postoperative Nausea and Vomiting | 24 hours | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Number of Patients Requiring Antiemetic Rescue Medication (AERM) |  | 24hours | 
| PONV Between Different Surgical Procedures (Percentage of Participants) |  | 24 hours | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Bariatric Surgery, TIVA, PONV, non-opioid, OSA