Conditions: Postoperative Nausea and Vomiting
Keywords: Bariatric Surgery TIVA PONV non-opioid OSA
Allocation: RANDOMIZED | Intervention model: PARALLEL
Enrollment: 124
Healthy volunteers: no

Brief summary:
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:
See above

Arms:
arm 1: Patients will receive balanced general anesthesia including volatile anesthetics and narcotics. This reflects our current clinical practice. arm 2: Patients will receive narcotic free total intravenous anesthesia with Propofol, dexmedetomidine and ketamine

Interventions: intervention 1: TIVA NoNarc
Intervention descriptions: intervention 1: * 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

Protocol document: